1. 1 Building A Healthy Work Environment

2. 2 Who Is HCA? Nation’s leading provider of healthcare services 182 locally managed hospitals 94 outpatient surgery centers Imaging centers Physician clinics and offices 22 states, England & Switzerland Revenues exceeding $24.5 Billion (2005) Assets of more than $22 billion (2005) 190,000 employees

3. 3 What are we trying to achieve? Increased Quality & Service Reduced claims risk  Patient Satisfaction Expanded volumes Higher revenue  Physician Satisfaction HEALTHCARE PROVIDER OF CHOICE Stronger retention Greater productivity Better place to work  Employee Engagement EMPLOYER OF CHOICE

4. 4 So How Do We Get There Establish High Performance Criteria –Balanced focus Patient/Physician Satisfaction (Top Quartile) Productivity/Retention Financial Indicators (EBDITA, Operating Expense/Adjust Admit) Employee Engagement Rankings –Consistent or Improving over multiple years Identify High Performing Facilities Within The System Research differentiating practices and behaviors

5. 5 Much Lower Turnover Turnover at HPFs decreased 3.9% while increasing 1.4% at low performers

6. 6 Lower levels of risk Higher Patient Safety Source: HCI – Issues in Review – 2004 & 2005. Risk level determined by and representative of actual claims for incidents that occurred over a three year period from January 1, 2002 and December 31, 2004

7. 7 Financial Performance $15m more in average EBDITA per facility

8. 8 Higher Engagement Ratio

9. 9 What We Learned External Consultants Internal OE Team The basic leadership and workplace behaviors and practices we’ve said for years matter... really do impact a hospital’s success.

10. 10 Healthy Work Environment Doing well in these five areas is key to transforming good places to work into GREAT places to work

11. 11 Leadership Effectiveness Senior Leadership Vision/Direction Distinct leadership styles practiced Leaders available and approachable Clear vision communicated and shared Supervisor/Management Coach Work/Life Balance Skills/Career Development LESSONS Philosophy that drives decision making and communication Prototype for selection/cultural fit Balance Scorecard Accountability Effective visibility

12. 12 Voice/Communication Two-way communication Willingness to share good and bad news Employee Advisory Groups exist HR is perceived to be employee advocate LESSONS Employee Advisory Groups Communication Toolkits No Employment At Will

13. 13 Staffing and Workload Quality drives staffing decisions Resources/Technology support caregivers Selection based on behavioral fit Solid focus on learning and development LESSONS Role clarity Management Development Staffing Models

14. 14 Compensation Practices Market competitive pay practices Flexibility is rewarded Understanding of total compensation Fair and equitable rewards LESSONS Articulated Philosophy to include market position/communication strategy Leveling Recognition Programs Variable pay practice guidelines

15. 15 Recognition/Service Culture Recognition and appreciation occurs formally and informally at all levels Regular and frequent activities to promote community  Strong standards put patients first, and include family, physicians and colleagues  Physicians take ownership for facility outcomes and accountability for behaviors LESSONS Diversity Management Medical Staff Leadership Consultation/Support Community Involvement Programs Longevity/Retention Programs

16. 16 High Performance The #sPeople Culture sustainable outcomes balanced focus