1. { Looking for Quality in Your Candidates Marion C. Martin, RN, MSN, MBA COO, The Center for Quality Roper St. Francis Healthcare

2. Healthcare Value 2 Patient Experience

3. Present State A hospital is only as good as the care it provides, and no hospital renders quality care to a patient without the leadership of a quality physician With the economy steadily improving,physicians who have come out off retirement or switching jobs are starting to make moves. Some 44, 250 full time doctors could be lost in the next 4 years equaling about 91 million fewer patient encounters each year.

4. Millions of new patients are expected to grab health insurance from insurance exchanges and flood the healthcare system starting in 2014 further worsening the physician shortage. To stay competitive, hospitals should avoid behaviors that might dissuade doctors from landing elsewhere : drawn out hiring processes or unwieldy contract negotiations Present State

5. asdfasdf Primary Care Value-Based Market Forces 5

6. Healthcare is being reformed by the market place Healthcare is being reformed by the market place Medicare & Medicaid paying less Medicare & Medicaid paying less Self Pay increasing Self Pay increasing Commercial insurance and employers no longer willing to accept cost shift Commercial insurance and employers no longer willing to accept cost shift Realities 6

7. More payors will be reimbursing us at Medicare rates More payors will be reimbursing us at Medicare rates Need to take >15% of cost out to break even on Medicare Need to take >15% of cost out to break even on Medicare Technology and Quality initiatives driving cost up, not down Technology and Quality initiatives driving cost up, not down 7 Realities

8. Healthcare: Facing the Perfect Storm? CONSISTENT THEMES NATIONALLY, REGIONALLY, AND LOCALLY 8 Rising Costs Inflation Excess Capacity Information Technology Advanced Medical Technology Shifting Demographics  Aging Population (shifting from private plans to Medicare)  Health Reform Coverage Changes Increasing Demand for Quality/Cost Performance  By Patients, Payers, Government  Migration of care to lowest cost setting Limited Access to Capital  Credit Barriers  Changing Debt Terms  Bond Rating Pressures  Bankrupt Bond Insurers (e.g., AMBAC) Declining Revenues  Federal & State budget crisis  Reimbursement Cuts  Decline in Elective Procedures  “Great Recession”  Investment Losses  Decreased philanthropy New Payer Strategies / Payment Reform  P4P, Bundling, Shared Savings (ACO)  “No Pay” for Underperformance  Never Events, Readmissions, etc.  Overutilization

9. Converging Strategies 9 Reengineering Workflows to Improve Outcomes QualityFinance Improved Clinical Outcomes Improved Financial Controls Improved Financial Controls

10. Individuals, families, businesses, municipalities can’t afford health care Health care costs continue to escalate Costs shifting to individual employees & their families Access, Quality, Safety & overall Population Health is mediocre Clinicians & staff stress is high (and worsening) due to inefficiencies Lack of Physicians (especially PCP’s) for aging & obese population Current Situation is Unsustainable 10

11. System of CARE Alignment Is the Imperative 11 Retail Pharmacy Wellness and Fitness Center Diagnostic/ Imaging Center Urgent Care Center Hospital Home Care Home Acuity Acute Care Post-Acute Care Physician Clinics Ambulatory Procedure Center OP Rehab IP Rehab SNF IP = inpatient; OP = outpatient; SNF = skilled nursing facility. Preventive Care Community-Based Care

12. Developed for Toyota by Mr. Ohno after WWII involved: reengineering the culture eliminating waste for their processes improved quality Lean Management

13. Hold a work session to look at your recruiting processes Map the current process: include every step and everyone involved in the process All involved become part of the process Steps in your process

14. Pool the staff’s collective knowledge: this prevents a build up of inbound work Utilize the tools of Lean: mapping, cause and effect diagrams, value stream mapping, cycle times and error proofing Steps to success

15. { The Model :

16. Improvements You Can Make Using Lean Techniques Proactive versus reactive recruiting Elimination of duplicate work my medical staff office and hospital Enhancement of candidate screening process Reduction in the amount of time from physician presentation to the department decision makers Reduction in the time between confirmation and the start of the credentialing process Change responsibilities among staff to promote better process flow

17. What is the state of your hospital/ system right now in terms of cost, quality, customer satisfaction, market share? What are your strengths, weaknesses, opportunities and threats? Where do you want the health care system to be in the future?

18. Collaboration Quality services: Data collection Data Collection: FPPE OPPE Quality Metrics Publicity Reported Data

19. The “Quality” talk with Candidates Rounding Safety huddles Patient and Family engagement Leadership opportunities Lean training

20. Making those Behavioral choices Make interview process stand out Do everything better than your competition Develop a core group of interviewers: Who would that be in your organization? Train your core group to become expert interviewers and evaluators: Do you include a patient or family member in the process?

21. Behavioral Interviewing skills Start with : Tell me about a time……

22. Sample questions Tell me about a time you were running late and needed to spend extra time with a patient due to their diagnosis. A nurse makes a critical comment about you in front of others, tell me how you would handle that. Tell me what patient and family engagement means to you Tell me how you worked with those that provided you with data Tell me about a time you led change to provide better patient outcomes

23. Under what circumstances do you feel it is okay to terminate a relationship with a patient ? How do you know if a patient understands what you are telling them? If you could customize your schedule, what would it look like? Tell me how you work with Case Management to ensure a safe transition for your patient ? Tell us about a time you had a conflict with a co-worker. How did you handle the situation?