1. Oklahoma Health Care Authority February, 2005 MANAGEMENT INTELLIGENCE FOR HEALTH CARE

2. My InnerView Today

3. Customers in 37 states

4. 15 state LTC association endorsements

5. Alliance for Quality Nursing Home Care » MyInnerView selected as provider of family satisfaction surveys for member multifacility companies with 2100 locations.

6. Evidence-based management calls for a paradigm shift in the approach to quality improvement: An appreciation of data, the ability to turn data into information and knowledge, and to use that information and knowledge to improve quality. Evidence-based Management Philosophy

8. Outcomes: 2006 1. Continued improvement in compliance with state/federal regulations 2. Promotion of financial integrity and fraud prevention 3. Progress in prevention of confirmed abuse and neglect 4. High rates on consumer satisfaction surveys 5. Improvement in retention and turnover 1. Continued improvement in compliance with state/federal regulations 2. Promotion of financial integrity and fraud prevention 3. Progress in prevention of confirmed abuse and neglect 4. High rates on consumer satisfaction surveys 5. Improvement in retention and turnover

9. The Georgia Experience Making Quality First Work

10. My InnerView’s evidence- based path to quality and risk management Turn plan into action: improve process Turn knowledge into plan: apply new wisdom to process Turn information into knowledge: study current process Collect data: ensure validity, organize Turn data into information: benchmark, study variation Evaluate outcomes: measure variation © My InnerView Inc.™

11. Quality of Data-GA

12. Family response by council © 1/1/05, My InnerView Inc.™ +2% +1% -4% +3% +6% +5% +2% +4% 20032004

13. Employee response by council © 1/1/05, My InnerView Inc.™ +16% +14% +8% +18% +21% +20% +17% +16% +19% 20032004

14. © 1/1/05, My InnerView Inc.™ Quality Profile participation rate 20032004

15. © 1/1/05, My InnerView Inc.™ Data submission 20032004 Submitted dataSubmitted on time (by 10th of month)

16. Oscar vs. My InnerView data © 1/1/05, My InnerView Inc.™

17. 2004 Special Focus: Leadership Skills

18. Number of Attendees at AARP Sponsored Training Sessions 8 58 129 77 32 44

19. Many Attendees Statewide

20. The Voice of Employees 2003 vs. 2004

21. p =.02 SUPERVISION Overall “Supervision” scale

22. p =.13 CARE/CONCERN OF SUPERVISOR How your supervisor cares about you as a person

23. p =.13 COMMUNICATION BY SUPERVISOR How supervisor regularly gives work-related information

24. p =.000 APPRECIATION OF SUPERVISOR How supervisor regularly shows appreciation for job well done

25. p =.000 FAIRNESS OF EVALUATIONS How fair your performance evaluations are

26. How the facility helps you deal with job stress or burnout 39.6 43.8 p =.000

27. p =.008 RESPECTFULNESS OF STAFF How the staff treats the resident with respect

28. Facility Case Study

29. GOOD 20032004 TOTAL 20032004 EXCELLENT Family surveys Overall satisfaction 33%38%43%60%76%98% Recommendation of facility 39%48%41%45%80%93% Quality of care from nurses 33%30%56%64%89%94% Quality of care from CNAs 33%34%48%55%81%89% 20032004 IMPROVEMENTDECREASE

30. GOOD 20032004 TOTAL 20032004 EXCELLENT Employee surveys Overall satisfaction 6%17%39%44%45%61% Recommendation of facility as place to work 18%26%32%39%50%65% Recommendation of facility as place to receive care 15%31%42%43%57%74% 20032004 IMPROVEMENTDECREASE

31. © 1/1/05, My InnerView Inc.™ RNs/LVNs/LPNs without absenteeism 20032004 State AverageFacility

32. © 1/1/05, My InnerView Inc.™ CNAs/NAs without absenteeism 20032004 State AverageFacility

33. © 1/1/05, My InnerView Inc.™ Residents without pressure ulcers 20032004 State AverageFacility

34. Key points » Data are absolutely critical to benchmark performance statewide or within individual facilities. » Without data you have no “beef”. » Data are absolutely critical to benchmark performance statewide or within individual facilities. » Without data you have no “beef”.

35. Statewide Clinical GA Metrics: July 2003 to Dec 2004

36. Residents without falls PERCENT 2003 2004

37. Residents without falls by geographic region PERCENT 2003 2004 A B C Rural Suburban Urban

38. Residents without anti-psychotic medications PERCENT 2003 2004

39. Residents without anti- psychotic medications by size of organization. PERCENT 2003 2004 A B C D E Independent 2–10 fac. 11–25 fac. 26–50 fac. 50+ fac.

40. Residents without acquired catheters PERCENT 2003 2004

41. Residents without acquired catheters by ownership type PERCENT 2003 2004 A B C Government owned (state, county or city) Not-for-profit (with religious affiliation) Not-for-profit (without religious affiliation) D E For-profit (privately owned) For-profit (publicly traded)

42. Residents without acquired physical restraints PERCENT 2003 2004

43. Residents without acquired physical restraints by ownership type PERCENT 2003 2004 A B C Government owned (state, county or city) Not-for-profit (with religious affiliation) Not-for-profit (without religious affiliation) D E For-profit (privately owned) For-profit (publicly traded)

44. Residents without unplanned weight loss/gain PERCENT 2003 2004

45. Residents without unplanned weight loss/gain by size of organization PERCENT 2003 2004 A B C D E Independent 2–10 fac. 11–25 fac. 26–50 fac. 50+ fac.

46. Residents without unplanned weight loss/gain by geographic region PERCENT 2003 2004 A B C Rural Suburban Urban

47. Residents without acquired pressure ulcers PERCENT 2003 2004

48. Residents without acquired pressure ulcers by size of organization PERCENT 2003 2004 A B C D E Independent 2–10 fac. 11–25 fac. 26–50 fac. 50+ fac.

49. Employee Commitment: Statewide 2003 and 2004

50. % CNAs/NAs without turnover PERCENT 2003 2004

51. % CNAs/NAs without turnover by geographic region PERCENT 2003 2004 A B C Rural Suburban Urban

52. % RNs/LVNs/LPNs without turnover PERCENT 2003 2004

53. % RNs/LVNs/LPNs without turnover by geographic region PERCENT 2003 2004 A B C Rural Suburban Urban

54. CNAs/NAs: Stability PERCENT 2003 2004

55. CNAs/NAs: Stability by Geographic Region PERCENT 2003 2004 A B C Rural Suburban Urban

56. RNs/LVNs/LPNs: Stability PERCENT 2003 2004

57. RNs/LVNs/LPNs: Stability by Geographic Region PERCENT 2003 2004 A B C Rural Suburban Urban

58. RNs/LVNs/LPNs: Stability by Size of Organization PERCENT 2003 2004 A B C D E Independent 2–10 fac. 11–25 fac. 26–50 fac. 50+ fac.

59. The Voice of Families 2003 vs. 2004

60. 20032004 © 1/1/05, My InnerView Inc.™ Recommendation to others Overall satisfaction 85% 84% 85% 84%

61. p =.005 CHOICES/PRFERENCES How resident’s choices and preferences are met

62. p =.07 RESIDENT-TO-RESIDENT FRIENDSHIPS How … offered opportunities for friendships with other residents

63. p =.03 MEANINGFULNESS OF ACTIVITIES How the resident is offered meaningful activities

64. p =.001 RELIGIOUS/SPIRITUAL OPPORTUNITIES How resident’s religious and spiritual needs are met

65. Organizational Systems Model Family Satisfaction Employee Satisfaction Organizational Factors: Size Ownership Chain Affiliation Geographic Location

66. Correlations between Employee Satisfaction and Family Satisfaction Sub-scales Employee Satisfaction Sub-scales Pearson Correlation Coefficient Sample Size (N) Training.415**305 Supervision.921**314 Management.904**314 Work Environment.988**314 Global Satisfaction.530**305

67. Scatter Plot of Family Satisfaction and Work Environment

68. Facilities with higher family satisfaction have better work environments < 54%54% to 58%58% to 64%> 64% Mean = 68.0 EMPLOYEE ENVIRONMENT SCORE (%) FAMILY SATISFACTION

69. Facilities with higher family satisfaction have better supervision < 54%54% to 58%58% to 64%> 64% Mean = 72.2 EMPLOYEE SUPERVISION SCORE (%) FAMILY SATISFACTION

70. Predictors of Family Satisfaction Independent Variable Standardized Beta Significance Facility Size-.16.003 Ownership Type.09.098 Chain Type.19.001 Geographic Region.09.074 Employee Satisfaction Score.42.000 R 2 =.327 (F=27.8; p <.000)

71. Creating a Culture of Quality

72. Quality Improvement Model Feedback Loop (Performance Measurement System) Leadership Core Systems Information Human Resource Clinical Operations Environmental Design Performance Outcomes Quality of Life Quality of Care Quality of Workplace Staff Turnover Customer Satisfaction Regulatory Compliance

73. Evidence-based Management Evidence-based Management Leadership Excellence Culture Change Three-legged Platform for Excellence

74. Key Opportunities » Leadership development for culture change » Enhancing quality of life and quality of the workplace through culture change » Adopting the philosophy of evidence-based management » Leadership development for culture change » Enhancing quality of life and quality of the workplace through culture change » Adopting the philosophy of evidence-based management

75. Key opportunities, cont’d. » Policy assessment and development. » Resource allocation. » Pay for performance. » Incentivize best practices. » Reduce liability costs. » Data customization. » Benchmarking in Oklahoma and outside. » Policy assessment and development. » Resource allocation. » Pay for performance. » Incentivize best practices. » Reduce liability costs. » Data customization. » Benchmarking in Oklahoma and outside.

76. Questions? MANAGEMENT INTELLIGENCE FOR HEALTHCARE