1. Saving Lives through Performance Excellence Priscilla Nuwash, MBA, CLM President, Center for Performance Excellence Poudre Valley Health System

2. Private, locally owned, not-for-profit Full spectrum of healthcare services –2 tertiary hospitals, outpatient campus, numerous satellite clinics –Regional medical hub for cardiac, trauma, orthopedic & oncology services, neonatal intensive care & bariatric surgery

3. Vision: To Provide World-Class Healthcare Definition of World-Class: Striving for results in the 90 th percentile or top 10% of available national comparative databases Poudre Valley Health System

4. Service area: Northern Colorado, Wyoming & Nebraska 5,200 employees, 600 primarily independent physicians & 800 volunteers $1.3 billion in annual revenue

5. Where Our Journey Started (1997) Community hospital serving Fort Collins, Colorado 1,500 employees, 300 independent physicians & 575 volunteers 24% annual employee turnover 5 CEOs in 4 years $250 million in annual revenue Changing healthcare market Demand for physician integration

6. Leadership: Find an improvement model Decision: Baldrige National Quality Program Where Our Journey Started (1997)

7. Systems perspective –Manage your whole organization, as well as components, to achieve success Feedback –Notes major strengths –Highlights impact of opportunities for improvement –Measures progress –Guides improvements Why Baldrige?

8. 2000Submitted first application, with each Category written by separate team Baldrige happened outside of “normal” work Category teams met just to write Application 2001Took a year off “to work on improvements” 2002Applied again, expecting “success” 2003Repeat the process The Early Years

9. Use Baldrige for a business framework A Turning Point (2004)

10. Set Direction Communicate Direction Our Beliefs

11. Communicate Direction New Employee Orientation Forums for Employees & Volunteers –Quarterly updates on performance & action plans that support each Strategic Objective Name Badges Meeting Templates Learn & Lead Program Vision/Mission/Values Team Leadership Meetings Medical Executive Committees

12. Plan & Align

13. Core Competencies

14. Partnering: An Innovative Strategy Identify strategic opportunities –How can we provide a lifetime of care? Align economic incentives & build relationships –Outpatient services, home health, sub- acute care, third-party administrator, strategic vendor relationships –Win-win for PVHS, other healthcare providers, patients & community Improve clinical quality

15. The Ultimate Partnership PVHS & Regional West Medical Center Rural dilemma –Insufficient volumes to ensure quality –Choice: Revenue or optimal outcomes? New alternative –PVHS + Regional West Medical Center = Medical Center of the Rockies –Improved outcomes & revenues for all

16. Interdisciplinary teams: engage the workforce Benchmarking: top 10% Consideration of new ideas: Business Decision Support Process Reward innovation & high performance, support strategy: R&R Program, Optional Performance Plan Build innovation into improvement methodology: PDCA using LEAN Guide best practice inquiry with stakeholder involvement & using the voice of the customer: Building MCR Driving Innovation

17. Execute the Plan & Drive Performance

18. Execute the Plan & Drive Performance Balanced Scorecard Process

19. Develop People

20. Performance Review Process Reward & Recognition, including Peer-to-Peer Coupons Optional Performance Plan Learn & Lead, Building Blocks of Leadership Learn & Grow Grand Rounds, Tuesday Afternoon Conferences Mentoring Program Tuition Reimbursement Professional Associations, Conferences

21. Performance Review Process –Best Practice: Integration of Values, Behavior Standards, Core Competencies, Key Customer Requirements & Personal Goal Cards Develop People

22. Execute the Plan & Drive Performance Personal Goal Cards

23. Learn, Share & Innovate

24. Performance Excellence Teams –Baldrige-driven improvements PDCA Model for Process Improvement Process Design –Best practices: Stakeholder involvement & Voice of the Customer Learn, Share & Innovate

25. An Example: Medical Center of the Rockies 20 interdisciplinary teams with staff, physicians, partners, vendors & community members Community focus groups –Wayfinding, spirituality, furniture, menus, naming National site visits with physicians, staff & vendors Mock-ups for OR, trauma suite, patient room & elevator Day-in-a-Life Scenarios

26. Healthcare Outcomes Risk-Adjusted Mortality Rate

27. Customer-Focused Outcomes Top Box Scores for Patient Satisfaction 8 years of consistent improvement

28. Customer-Focused Outcomes HCAHPS* *Hospital Consumer Assessment of Healthcare Providers & Systems

29. 50% increase in PVHS discharges from 2000 to 2008 18% increase in Competitor discharges from 2000 to 2008 39% population growth in Competitor’s home county from 2000 to 2008 11% population growth in Larimer County from 2000 to 2008 Financial & Market Outcomes Patient Discharges: 50% increase since 1 st Baldrige application

30. Workforce-Focused Outcomes Staff Voluntary Turnover

31. Workforce-Focused Outcomes Physician Engagement Scorecard

32. Health Care Advisory Board 10/18/2010 “Moodys: Downgrades outpace upgrades for first time in 2010” In a "material shift" from previous quarters, Moody's Investors Service issued more downgrades of not-for-profit hospitals and health systems than upgrades in the third quarter, illustrating the industry's ongoing financial pressures.

33. Sept 2009: Moody’s and Standard & Poors upgrades PVHS bond ratings, citing strong financial performance. “We expect performance in fiscal year 2010 to be strong as well,” Moody’s stated. May 1, 2010: PVHS receives bond upgrade from Standard & Poor's. S&P's report recognized: –continued excellent financial results and robust cash flow –improvements a combined effort by staff, physicians and volunteers to drive quality, minimize expenses and reduce capital expenditures Sustainability

34. Ensuring Financial Stability Financial Flexibility Index Total Margin Return on Investment Replacement Viability Equity Financings Days Cash on Hand Cash Flow to Total Debt Average Age of Plant

35. Increased hospital discharges almost 50% with only 11% population growth Doubled the workforce Added 2 nd hospital, outpatient campus & numerous offsite clinics Expanded service area from Fort Collins community to 50,000 square miles in Colorado, Wyoming, Nebraska Challenging Times…

36. Top 10% for inpatient mortality, patient satisfaction, employee satisfaction & physician engagement Thomson Reuters Top 100 Hospital for 5 consecutive years Top 100 Best Places to Work, Modern Healthcare 2008, 2009, 2010 Magnet designation since 2000 NDNQI Outstanding Nursing Quality Award for last 3 years World-Class Results

37. Lessons Learned: The Journey Consider it productive time Make it how you do your business De-emphasize the award It’s hard work Start now

38. What’s Next? Continue with teams Continue with self-assessment Assist others in their performance excellence journey

39. Our Vision To provide world-class health care Molly 4th generation treated at PVH

40. Additional Information: PVHS Center for Performance Excellence pjn@pvhs.org 970-237-7132 www.pvhs.org