1. Saving Lives through Performance Excellence Rulon F. Stacey, PhD, FACHE President/CEO, Poudre Valley Health System

2. Poudre Valley Health System Private, integrated health system locally owned, not-for-profit Full spectrum of healthcare services –2 tertiary hospitals, outpatient campus, numerous satellite clinics –Regional medical hub for cardiac & trauma services, orthopedics, oncology, neonatal intensive care & bariatric surgery

3. Poudre Valley Health System Service area: Northern Colorado, Wyoming & Nebraska 5,300 employees, 600 physicians & 1,000 volunteers $1.4 billion in annual revenue

4. 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

5. Leadership: Find an improvement model The Work Horse Philosophy Performance Excellence Journey

6. Our Vision To provide world-class health care Wendy Oncology patient

7. Definition of World-Class Striving for results in the 90 th percentile or top 10% of available national comparative databases Craig Trauma patient

8. Set Direction Communicate Direction Our Beliefs

9. 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

10. Plan & Align

11. Core Competencies

12. 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

13. 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

14. Partnering: Next Generation Poudre Valley Medical Group (PVMG) –27 Clinics, 180 clinicians, 600 support staff –Physician Changing Model 2008: nearly 100% independent practice 2011: 25% in PVMG, 75% independent University of Colorado Hospital –Share overall management structure –Pool revenue and expenses

15. Execute the Plan & Drive Performance

16. Execute the Plan & Drive Performance Balanced Scorecard Process

17. Develop People

18. 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

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

20. Execute the Plan & Drive Performance Personal Goal Cards

21. Learn, Share & Innovate

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

23. 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

24. Gabriel, NICU “Graduate” Results

25. Healthcare Outcomes Risk-Adjusted Mortality Rate

26. Customer-Focused Outcomes Top Box Scores for Patient Satisfaction 9 years of consistent improvement

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

28. Financial & Market Outcomes Patient Discharges 40% population growth in Competitor’s home county from 2000 to 2010 15% increase in Competitor discharges from 2000 to 2010 59% increase in PVHS discharges from 2000 to 2010 19% population growth in Larimer County from 2000 to 2010

29. Workforce-Focused Outcomes Staff Voluntary Turnover

30. Workforce-Focused Outcomes Staff: 93rd percentile for employee satisfaction (MSA) Volunteers: 99% satisfaction on internal survey Physicians: 96 th percentile for physician loyalty (Gallup) Top 100 Best Places to Work, 2008, 2009, 2010 Modern Healthcare

31. Workforce-Focused Outcomes Physician Engagement Scorecard

32. Remaining Competitive Hospital Charges

33. Community Benefit Charity Care Family Medicine Center Community Case Management Patient Navigators Poudre Valley Nurse Line Mental Health & Substance Abuse Partnership Lifestyle Challenge Healthy Kids Club Well City Initiative Poudre Valley Prenatal Aspen Club Safe Kids Coalition Teen Motor Vehicle Safety Coalition

34. 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…

35. Challenging Times Continue U.S. Healthcare Patient Protection & Affordable Care Act Future Trends –Integration: Coordinate care, patient is the customer –Value: Deliver quality outcomes and high levels of service at a reasonable cost –Transparency: Learn, grow and respond

36. Top 10% for Inpatient Mortality, Patient Satisfaction, Employee Satisfaction & Physician Engagement (PVHS) 2008, 2009, 2010 Top 100 Best Places to Work, Modern Healthcare (PVHS) 2008, 2009, 2010 Magnet designation PVH since 2000, MCR 2010 NDNQI Outstanding Nursing Quality Award for last 3 years World-Class Results

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

38. Additional Information: PVHS Center for Performance Excellence Priscilla Nuwash: pjn@pvhs.org Sonja Wulff: sbw2@pvhs.org www.pvhs.org