1. A Funny Thing Happened… Brian Paradis

2. A Funny Thing Happened…Emergency Department Enterprise

3. “As is” State… Not fixable Agency high (40-50% Some Campus’) 6.3% (20,000 people) - Left w/o seeing Doctor Patient Satisfaction – 20 th %tile Costs Climbing - 20-30% Front door effectively closed (walk-in & ambulance)

4. Approach Design Drivers Patient Driven Core process based “Fundamentals” (3D’s) Frontline Engagement Physician – Partnered/Led Team Work (Enterprise wide) Fact based (Data Key) RELENTLESS

5. ED Performance Red Slide

6. ED Performance

7. Performance Outcomes As is NowStats Door to Doctor 120 min 50 min EMS Offload Time 70 min 8 min Cost per Visit $142$132 Perceptions of Safety 41%51% Agency40%5%

8. ED Patient Satisfaction 80 th percentile

9. Our team is telling us something…Are we listening?

10. Engagement Trend

11. 2008 Gallup Engagement ActualGoal 4.104.07 However.....

12. Gallup Engagement Clinical & Non-Clinical Comparison (2007) Mean%tileE / D Clinical3.9051%3.7 : 1 Non-Clinical4.1066%5.5 : 1

13. Safety Culture Survey Results ‘Overall perceptions of Safety’ (Positive Responses) Nursing52% Physician50% (or 35 th percentile)

14. Critical Survey Questions (% Positive Responses) NursesPhysiciansAvg. Management Support 5864 Non-punitive response 422642 Teamwork Across Units 5056 Hand-offs and transitions 41 48

15. Physician Satisfaction Survey Willingness to Recommend this Hospital? 44 th % Overall Satisfaction with this Hospital? 35 th % (Percentile)

16. Critical Survey Questions (%tile) Actual Efficiency of Hospital (Transfers, Turnarounds, etc) 18 th Promptly/Accurately respond to Physician Orders 24 th Ease of Scheduling/Performing IP Surgery 21 st Ability to manage admission process 23 rd (Percentile)

17. Our patients agree…Do we care?

18. HCAHPS Patient Experience Survey (Definitely Yes) Recommend this hospital to family & friends Definitely Yes%tile 58% 23 rd

19. Critical Survey Questions (Always) Actual 1. Got bathroom help as soon as wanted 49% 2. Pain was well controlled 56% 3. Staff described side effect of Meds 32% 4. Nurses listened carefully to you 55% 5. Discharge information communicated and written 75% 6. Room clean and quiet 50%

20. Is it getting warm in here?...Or is it just me?

21. What is the Point? Our mission demands much better that our reality There is no place to hide (facts are the facts) This is fixable, there is much hope Patient Safety/Quality and Patient Experience are ALMOST the same thing Process, Process, Process... Fundamentals, Fundamentals, Fundamentals

22. Approach Design Drivers Patient Driven Core process based “Fundamentals” (3D’s) Frontline Engagement Physician – Partnered/Led Team Work (Enterprise wide) Fact based (Data Key) RELENTLESS

23. ED Performance Red Slide

24. ED Performance

25. ED Patient Satisfaction 80 th percentile