1. Our Outside Consultant Experience Presented to the CHA Respiratory Therapy Directors Forum November 15, 2013 Leo Langga, MBA, RRT-NPS Dan Villareal, MBA, RRT

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6. Objectives Introduction – Laying the foundation with the executive leadership and finance teams for productivity standards and goals How to prepare information for the consultant The meeting Following up is critical – Data review, validation, benchmarking Initial & Final Recommendations Lessons Learned Today Questions 6

7. Introduction – Laying the foundation for productivity standards and goals Build relationships and understanding of the Respiratory Care operation at the beginning with COO, DSS, CNO, Patient Care Director – Labor Hours/UOS vs Labor Hours/Patient day Understand where all the labor and revenue flows to – Clinical Lab, Pharmacy, Sleep Lab, Transport Team, ECMO Understand sources for variances Use the PACT data to provide operational understanding and perspective to COO, DSS, CNO, Patient Care Director 7

8. Determining What Data to Present – Assessing the consultant’s background Our consultant had a RT (Radiation Therapy) background, however, had overseen a Respiratory Care operation – How do I help the consultant understand my operation? Provide high level perspective Operational documents for review – Scope of service – Staffing regulations- » California Children’s Services » Title 22 – Staffing worksheets – Key Service Trends – Labor goals for the year and financial performance data 8

9. Respiratory Care Division Overview Prepared for Consulting Group TABLE OF CONTENTS: 9 Topic: Scope of ServiceSection I Operational Performance Data Service Volume Trend Mechanical Ventilation Trend Productive FTEs/Budgeted FTEs Section II Regulatory Requirements in California California Children’s Services Regional NICU Provider Standards Title 22: Acute Respiratory Care Service Section III Staffing Tools Staffing Worksheet for Day Shift Staffing Worksheet for Night Shift Section IV

10. Engaging the Consultant Presenting the data – Formal Presentation Packet Discussions/Questions Describing the department operations – Fact gathering Limited time to describe/analyze department operations 10

11. The waiting…follow-up is CRITICAL… Timing is critical – Before Executive Leadership Team Presentation – Or, After Executive Leadership Team Presentation Data review – What was the process in which the data was collected? Validation – Is it accurate? Benchmarking – What are they basing their recommendations on? – Is there data to support recommendations? 11

12. Initial Consultant Recommendations Labor – FTE reduction of 6.1-8.5 FTE Opportunity ($555K-$777K) Operational 12 MeasuresRatingLeading PracticeFindings Benchmarks-External: Productivity RedProductivity metrics (WHPUOS) are in the top quartile when compared to peer departments Below 50 th percentile Benchmarks-Internal: Overtime Use RedOvertime hours are between 2% and 4% of total worked hours Overtime averages 29.2% (includes 12 hour shift overtime; Uses OT rather than PT or PD. Management: Productivity Tools YellowProductivity tools are utilized, both proactively and reactively, by management Use of 4 hour staffing tool Monthly review of Budget vs. Actual UOS and Productive Management: Staffing to Volumes YellowStaff scheduled relative to shift and day of week demand with periodic, real-time evaluations and adjustments Uses 4-hour staffing tool to review workload and flexes staff accordingly Aligned by Service Line to participate in multidisciplinary care model Operations Cross Training RedNurse cross-trained to perform basic O2 admin, mdi/nebulizer treatments on nights Department functions as an RT staffing model based on CCS Regional NICU Provider Standards: Provides significant support for the Sleep Lab Operations: Process Improvement YellowStaff participate in periodic structured reviews of key processes, seeking to improve efficiency/quality Regular staff meetings are held as a forum for workflow feedback on concerns or recommendation to improve patient care

13. Rebuttal to Recommendations Timely response is essential Involving your Chief Patient Care Officer & Patient Care Director Backing from Decision Support 13

14. Final Outcome COO & DSS Key to Final Decision – Ideally, decisions and recommendations are based on good data – Education of COO/DSS to Respiratory Care operations is critical, particularly with limited information 14

15. Lessons Learned The initial objective of the consultation was to review patient flow, throughput processes….be wary – Assume that everything is open for review Be prepared and have key operational data ready Validate the information consultants are reviewing because their understanding of basic processes may not be completely accurate 15

16. Today, how are we working with our outside consultants… LEAN Projects – Non- labor initiatives – Patient Flow/throughput – Documentation – MAPS CLAIRVIA – Productivity tools, scheduling, staffing 16

17. Questions 17