1. Creating a Culture of Quality and Safety James M. Anderson President and CEO, 1996-2009 Making Excellence a Way of Life

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3. Cincinnati Children’s (Fiscal 2013) Registered beds598 Operating revenue$1.9 billion Employees13,852; 97 nationalities Research grants$158 million Locations16 Patients from 50 states; 53 countries Department of Pediatrics for the University of Cincinnati College of Medicine 3

4. Tressel Fragile System –15 years of intense work improving quality and safety –34% decrease in hospital-wide mortality –43% decrease in ICU mortality Transparency –With families –With employees –With other institutions –With the outside world We need to be able to talk about these things 5

5. Requirements to Create a Culture of Quality and Safety Vision: Take time to develop it thoughtfully Plans: Focus on what needs to be done, not on trailing results, like financial results Consistent message: Consistent behavior, even when there is increased risk Management process that delivers sustainable outcomes 6

6. Our Vision: To be the leader in improving child health If we can deliver outstanding results in some areas, why not all? What results are we delivering? How are we measuring them? 7

7. Creating a Culture 8

8. Business Units: Participants 1.Physician, nursing and business leaders Shared objectives Single budget 2.Access to senior leadership team 3.Predictable, recurring meetings 9

9. Business Units: Template Reports Financial Activity over time expressed in numbers Holistic view as a framework for change Non-financial How will we be safer, more accessible, patient-centered, innovative? Focused attention on transformation 10

10. Other Tools Real time data Strategic planning Transparency High-reliability systems Learning from other high-risk industries 11

11. Final Thoughts Each part of the organization must perform well for the whole organization to perform to potential Organizational structure reflects priorities Mechanisms must be hard-wired, predictable and must foster agility Institutionalize boundaryless thinking, risk taking, transparency, small tests of change Institution needs a shared, compelling vision and high aspirations 12