Leadership

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Thursday, October 11, 2012

Gaylord Opryland Resort and Convention Center

Nashville, TN

Keynote

Quint Studer Thursday, October 11, 2012

Observations No victim thinking Control our own destiny People need you You not only save lives but you save healthcare

Communication Tip

WHY

WHAT HOW

Field of Dreams

Tips Validating the Message Feedback/Communication Power of Role Modeling

“Vision without execution is hallucination.” Thomas Edison

Result Triangle Strategy

Results Structure

Execution

Execution Triangle

Accountability

Consistency

Reliability

Myths Patients: They have unrealistic expectations Staff: Leaders job is to get everyone on board Physicians: It is impossible to get physicians aligned Leadership: Engagement of people and patient experience are soft skills Data: Low “n” – means the data isn’t useful Scoring: The best way to improve a score is to focus on it Easy: Seems common sense so it is simple

Reimbursement changes, technology changes, procedures change, medications change, events and people change, the most important skill is to create a culture that has the agility and ability and to adapt to the changes.

Human Responsibility When you know you have a solution to a problem that is causing pain for someone – you have a human responsibility to act, and to do so with all urgency. ~ Quint Studer

Beth Keane

Studer Group Partners Outperform the Nation across HCAHPS Composites Studer Group Difference over NonPartners in National Percentile Ranking

Overall Rating

25

Studer Group Difference over Non-Partners in National Percentile Ranking Source: The graph above shows a comparison of the average percentile rank for Studer Group Partners that have received EBL coaching since Oct 2008 and non-partners for each composite; updated 7.24.12 using 4Q10-3Q11 CMS data.

Studer Group Partners Outperform the Nation across HCAHPS Composites Average Change in Top Box Results in One Year Studer Group Partners vs. Non Partner

Patients who gave a rating of 9 or 10 (high)

0.9

Non-Partner Change 4Q09-3Q10 to 4Q10-3Q11 SG Partners Change 4Q09-3Q10 to 4Q10-3Q11 Source: The graph compares the change In one year in “top box” results achieved by Studer Group partners vs. non-partners. Change is from 4Q09-3Q10 to 4Q10-3Q11. The “top-box” is the most positive response to HCAHPS survey questions.

1.7

Studer Group Partners Perform Better Than the Nation in Core Measures 100% 96.90%

98% 96% 94%

98.34% 95.70%

98.29% 96.42%

94.90%

97.29%

96.98%

95.82%

95.83%

93.20%

92.50%

94.55%

92% 90% 88%

87.70%

86% 84% 82% 80%

Heart Failure

Healthcare-Associated Infections

Pneumonia

Heart failure pts Pneumonia pts Pneumonia pts Surgery pts who given discharge whose initial ER given the most were given an instructions blood culture was appropriate antibiotic at the performed prior initial rt time to the admin of antibiotics(s) the first Hosp dose of Antibiotics

SG Partners Data that CMS footnoted, “number of cases is too small to be sure how well a hospital is performing” has been removed from this analysis

Surgery pts who Surgery pts Heart surgery pts were given the rt whose whose blood kind of antibiotic preventative sugar is kept to help prevent antibiotics were under good infection stopped at the rt control in the time days rt after surgery

SG Non-Partners

Studer Group Partners Perform Better Than the Nation in Core Measures 100% 98% 96% 94% 92% 90% 88% 86% 84% 82% 80%

96.90%

96.30% 93.70%

95.10%

96.00%

94.30%

93.60%

Surgical Care Improvement

Heart Attack No data: # of cases too small

No data: # of cases too small

Surgery pts who were Surgery pts whose Pts who got treatment Heart attack pts given taking heart drugs called doctors ordered at the rt time to help fibrinolytic medication beta blockers before treatments to prevent prevent blood clots after w'in 30 minutes of coming to the hospital, blood clots after certain certain types of surgery arrival who were kept on the types of surgeries beta blockers during the period just before and after their surgery

SG Partners Data that CMS footnoted, “number of cases is too small to be sure how well a hospital is performing” has been removed from this analysis

93.20%

Heart attack pts given PCI win 90 minuts of arrival

SG Non-Partners

Patients’ Perception of Care = Quality Vascular Catheter-Association Infection

Patients’ Perception of Care = Quality Manifestations of Poor Glycemic Control

Patients’ Perception of Care = Quality Pressure Ulcer Stages III and IV

Healthcare Flywheel®

Bottom Line Results

Prescriptive To Do’s

(Transparency and Accountability)

Purpose, worthwhile work and making a difference

SelfMotivation

WHY

®

Execution Framework Evidence-Based LeadershipSM Foundation STUDER GROUP®: Objective Evaluation System

Leader Development

Aligned Goals Implement an organizationwide staff/leadership evaluation system to hardwire objective accountability Principle 1, 2, & 7

Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results Principle 4&8

Must Haves®

Performance Management

Aligned Behavior Agreed upon tactics and behaviors to achieve goals

Re-recruit high and middle/solid performers

Principle 3, 5, 6, & 9

Move low performers up or out Principle 4

Standardization Accelerators

Aligned Process Processes that are consistent and standardized Process Improvement PDCA Lean Six Sigma Baldrige Framework Principle 1&2

Software

Rev 4.8.11

High Performing Organizations What were the most influential factors in their success? Executive and Senior Leadership Commitment Leadership Evaluation / Accountability Leadership Development Communication / Employee Sessions Knowing this was the “Right” Thing To Do (Why) High Performing Organization Study 2004 Measures

Only through standardized implementation of leadership best practices will healthcare systems maximize the human potential within their organization and most importantly achieve their desired mission.

Hardwiring Excellence Creates

Hardwired Mission Creates

Hardwired Positive Margins

Challenges

Quality

Access

Cost

U.S. Health Related Money Woes

Source: Pamela Villarreal, National Center for Policy Analysis, “Social Security and Medicare Projections: 2009,” October 11, 2009, No. 662, page 2.

The healthcare expense United States increase is taking up Health Care Expense more of the growth domestic product Total expenditure on health, % of gross domestic product

CANADA GERMANY ISRAEL MEXICO

Total health expenditure per capita, US$ PPP

Total expenditure on Healthcare CAGR, % Change, CAGR, Total health expenditure health, % of gross Costs 200020002000-2008 2000-2008 per capita, US$ PPP 2008 % change 2008 domestic product 18.18% 2.11% Healthcare 61.93% 6.21% % Change,1.94% CAGR,0.24% Costs CAGR, 40.01% 4.30% 2000-2008 4.00%2000-2008 0.49% 2000-2008 22.96% 2000-2008 2.62% % change 67.72%

Gross domestic product (GDP), current PPPs, billion US dollars Gross domestic product GDP 2000CAGR, (GDP), 2008 % current PPPs, 2000-2008 change billion US dollars 48.40%

GDP 200042.13% 2008 % 57.03% change

5.06%

CAGR, 4.49%

2000-2008 5.80%

64.46%

6.42%

NETHERLANDS 23.75% 2.70% 73.63% 7.14% 51.16% 5.30% UNITED 19.40% 44.43% 4.70% SPAIN 25.00%2.24% 2.83% 60.28% 88.69% 6.07% 8.26% 75.03% 7.25% STATES SWEDEN 14.63% 1.72% 51.79% 5.36% 46.61% 4.90% SWITZERLAND

4.90%

0.60%

43.65%

4.63%

52.28%

5.40%

UNITED KINGDOM

24.29%

2.75%

70.33%

6.88%

48.96%

5.11%

UNITED STATES

19.40%

2.24%

60.28%

6.07%

44.43%

4.70%

Source: OECD, Source OECD database, accessed November 12, 2010

“People wish to be settled; but only as far as they are unsettled, is there any hope for them.” Ralph Waldo Emerson

Phases of Competency and Change Even with positive change, there is resistance . . .

Operating Margin Outlook The average hospital has a 2.2% operating margin. Looking at reimbursement cuts, 2.2% will be a 16.8% deficit.

2.2% 2021 2011

-16.8%

The Normal Toolkit Squeeze vendors Stop Travel Eliminate Overtime Slow Down Capital Expenditures Reduction in Force Not filling opened positions Supply Chain Management Revenue Cycle Managed Care Negotiations

An Additional Approach: Accomplish more with less pain Capture Withheld Reimbursement

Increase Market Share

Eliminate Never Events Become more efficient and effective (work process improvement)

Physician Access to Quality of Care or Performance Data % RECEIVING DATA ON THE FOLLOWING ASPECTS OF PATIENT CARE 100 80

 1 physician in 3 receives any data about performance.  1 physician in 5 receives data pertinent to clinical outcomes.  1 physician in 4 receives patient survey data.

60 40 20

20

18

25

33

0

Process of Care Clinical Outcome Data Data

Patient Survey Data

Any Data

Source: Physicians’Views on Quality of Care: Findings from the Commonwealth Fund National Survey of Physicians and Quality of Care; Anne-Marie J. Audet, Michelle M. Doty, Jamil Shamasdin, & Stephen C. Schoenbaum; May 2005

Value-Based Purchasing Roadmap CMS quality-based payment initiatives will put more than 11% of payment at risk

2010

2011

2012

2013

2014

2015

2016

2017

REPORTING HOSPITAL QUALITY DATA FOR ANNUAL PAYMENT UPDATE

2018 2% of APU

2%

VALUE-BASED PURCHASING 1%

1.25%

1.5%

1.75%

2%

READMISSIONS 1%

2%

3%

1%

3% 3%

3%

HOSPITAL-ACQUIRED CONDITIONS

1%

MEANINGFUL USE

5%

2%

3%

4%

5%

VBP Dollars at Risk Avg. Total VBP dollars at risk

HCAHPS Patient Experience (30%) at risk

Large Hospitals

622-683 $ 1,200,000

$360,000

Medium Hospitals

288-361

$748,000

$224,400

Small Hospitals

186-200

$312,000

$93,600

Bed Size of Examples Used

Never Events Financial Impact Condition

$ / Stay

Stage III & IV Pressure Ulcers

$43,180

Falls & Trauma

$33,894

Deep Vein Thrombosis/Pulmonary Embolism

$50,937

Vascular Catheter-Associated Infection

$103,027

Certain Manifestations of Poor Control of Blood Sugar Levels

Range: $35k-45,989

Catheter-Associated Urinary Tract Infections

$44,043

Foreign Object Retained After Surgery

$63,631

Surgical Site Infections Following Certain Elective Procedures

Range: $63k-180,142

Infection after Coronary Artery Bypass Graft

$299,237

Air Embolism

$71,636

Blood Incompatibility

$50,455

Source: CMS Fact Sheet, “CMS PROPOSES ADDITIONS TO LIST OF HOSPITAL-ACQUIRED CONDITIONS FOR FISCAL YEAR 2009”

Research Straight A Leadership Assessment

Survey data collected 2009-2012, Database of 17,104 leader responses, >300 hospital systems, located in 44 different states, ranging in bed size from 11 beds to 1,100 beds.

Executive Summary: Straight A Leadership What organization does well: Leader perception of organizational strengths are not always supported by the data. Alignment: The more aligned the senior team is, the more positive HCAHPS and process of care outcomes. Objective Evaluation System: High ratings on leadership evaluation systems positively affect HCAHPS and process of care outcomes. Leadership Development: High ratings on leader training positively affect HCAHPS outcomes.

Executive Summary: Straight A Leadership Patient/Physician Perception: High ratings on patient/family point of view and ease of practicing medicine for physicians both positively affect HCAHPS outcomes. Consistency of Leadership: High ratings on consistency of leadership positively affect HCAHPS outcomes. Standardization of Best Practices: High ratings on standardization of best practices positively affect HCAHPS outcomes. Performance Management: Fewer low performers positively affect HCAHPS and process care outcomes.

What the Organization Does Well Please list the top three (3) things your organization does well and should continue to do? Quality of Care Patient Safety Focus on Mission/Vision/Values Financial Performance/Fiscal Responsibility (net revenue, EBDITA, etc) Patient Satisfaction/Perception of Care Community Outreach Leadership (engagement, visibility, and support) Goal Setting and Strategic Planning Technology Education, Training, and Skill Development Employee Compensation and Benefits Communication (transparent and open) Measurement Employee Engagement and Satisfaction Accountability Physician Engagement and Satisfaction Dealing with Low Performers

44%

30%

3% 0%

25% 24% 23% 21% 18% 18% 16% 14% Top 3 Things Does Well: 13%  Quality of Care 12%  Patient Safety 11% 11%  Focus on Mission, 9% Vision and Values 8% 10%

20%

30% Percent

40%

50%

Opportunities for Improvement Please list the top three (3) opportunities for improvement at your organization

Dealing with Low Performers Accountability Communication (transparent & open) Employee Engagement and Satisfaction Patient Satisfaction/Perception of Care Physician Engagement and Satisfaction Employee Compensation and Benefits Education, Training, and Skill Development Leadership (engagement, visibility, and support) Technology Community Outreach Goal Setting and Strategic Planning Financial Performance/Fiscal Responsibility (net revenue,… Quality of Care Measurement Patient Safety Focus on Mission/Vision/Values

0%

36% 31% 28% 27% 25% 23% 21% 20% 19% 19% 10% 10% 8% 7% 5% 5% 4% 10%

Top 3 Opportunities:  Dealing with Low Performance  Accountability  Communication 20% Percent

30%

40%

Barriers and Challenges Please list the top three (3) barriers/challenges you face that keep you from achieving your results in your area of responsibility at your organization Too Many Priorities Resource Limitations (staffing,equipment,space, etc.) Financial Constraints and Industry Pressures Inconsistency/Lack of Standardization and Hardwiring Employee engagement/buy-in System/Silo Thinking Communication Low Performers Time Management Physician Engagement and Satisfaction Education, Training, and Skill Development Gaps Employee Turnover Leadership (engagement, visibility, and support) Leadership Development and Skill Patient Satisfaction/Perception of Care Quality of Care Patient Safety

48% 45% 30% 25% 24% 21% 18% 17% 14% Top 3 Barriers: 13%  Too Many Priorities 11%  Resource Limitations 10% 9%  Financial Constraints

and Industry Pressures

6% 5% 1% 0% 0%

10%

20%

30% Percent

40%

50%

External Environment If your organization continues to act/perform exactly as it does today (with the same processes, same cost structure, same efficiencies, same patient care volume, same productivity, same techniques) your results over the next five years will be: (1=Much Worse, 2=Worse, 3=Same, 4=Better, 5=Much Better)

37% of the leaders who took the survey feel if the organization stays the same, the results will be the same, better or much better.

It is crucial for all healthcare organizations to correctly frame the external environment and communicate it in a manner whereby stakeholders have the same sense of urgency and understand the needed actions to take for the organization to achieve desired results.

Organizations who gave high ratings on their leadership evaluation systems had better HCAHPS outcomes.

Objective Evaluation: HCAHPS Lowest vs. Highest Responses

How well does your leadership evaluation system help build leadership accountability today? (1=Very Poor, 2=Poor, 3=Fair, 4=Good, 5=Excellent)

Average Percentile Rank

HCAHPS Average Percentile Rank by Response to Question. Lowest Quartile Responses vs. Highest Quartile Responses 70% 65%

64%

64%

62%

66%

63%

60% 55%

52%

48%

50% 45%

41%

40%

65% 59%

45%

39%

59%

45%

55% 44%

36%

35%

45%

50%

35%

30%

Quiet at Night

Doctor Comm

Nurse Comm

Pain Responsive- Rating of Room Explained DischargeRecommend Mgmt ness 9 or 10 Cleanliness Meds Info

Lowest Quartile Responses

Highest Quartile Responses

Example Hospital Inpatient Monthly Percentile Score Year 1 – Year 5 100%

95%

Goal = 90%

90% 80% 70% 60% 50% 40% 30%

Leader Evaluation Tool Implemented

20% 10%

Year 1

Year 2

Year 3

Year 4

Year 5

Aug

Jun

Apr

Feb

Dec

Oct

Aug

Jun

Apr

Feb

Dec

Oct

Aug

Jun

Apr

Feb

Dec

Oct

Aug

Jun

Apr

Feb

Dec

Oct

Aug

Jun

Apr

Feb

0%

Example Hospital Inpatient Monthly Percentile Score Year 5 – Year 7 100% 90%

99%

Goal = 90%

80% 70% 60% 50% 40%

Leader Evaluation Tool Implemented

30% 20% 10%

Year 5

Year 6

Year 7

May

Mar

Jan

Nov

Sep

Jul

May

Mar

Jan

Nov

Sep

Jul

May

Mar

Jan

0%

Leader Development: HCAHPS Lowest vs. Highest Responses

Organizations where leaders felt their leader training well prepared them for success had higher average HCAHPS outcomes.

How well does your current leader training prepare you to lead for success in the organization today? (1=Very Poor, 2=Poor, 3=Fair, 4=Good, 5=Excellent)

HCAHPS Average Percentile Rank by Response to Question. Lowest Quartile Responses vs. Highest Quartile Responses Average Percentile Rank

80% 70%

68%

66%

70%

71%

67%

64%

60% 50%

48%

42%

37%

40%

43%

61% 46%

46%

68% 56% 45%

32%

46%

52%

28%

30% 20%

Quiet at Night

Doctor Comm

Nurse Comm

Pain Mgmt

Responsiveness

Lowest Quartile Responses

Rating of 9 or 10

Room Cleanliness

Explained Meds

Highest Quartile Responses

Discharge Recommend Info

Leadership Foundational Skills - Mentoring SKILL SET DESCRIPTION

Running effective meetings Managing financial resources Answering tough questions so as to not create a “we/they” culture (compensation w’ salaries) Selection of talent Development of talent Critical thinking De-selection Understanding the external environment Manage up the positive, the solution and the decision Improving processes Communication Total

Senior Mgmt

Dept Director

Manager / Supervisor

75

73

65

79.55

76.92

65

84.5

76.28

65

81.82 93.18 59.5 82.27

77.56 82.05 59.62 75.23

60 75 55 70

72.73

76.28

65

77.27

75.28

68

72.73 75 85.58

78.21 73 82.22

64 65 70.70

Organizations whose leaders gave high ratings to the ability to implement and standardize best practices had higher average HCAHPS outcomes.

Standardization of Best Practices: HCAHPS Lowest vs. Highest Response

Rate the skill set at your organization in implementing and standardizing best practices throughout the organization today. (1=Worst to 10=Best in Class)

HCAHPS Average Percentile Rank by Response to Question. Lowest Quartile Responses vs. Highest Quartile Responses Average Percentile Rank

70% 60%

66% 56%

50%

64% 43%

62%

36%

40%

63% 42%

63%

61%

42% 32%

60% 40%

65% 54% 43%

53%

39% 27%

30% 20% 10% 0% Quiet at Night

Doctor Comm

Nurse Comm

Pain Mgmt

Responsiveness

Lowest Quartile Responses

Rating of 9 or 10

Room Cleanliness

Explained Meds

Highest Quartile Responses

Discharge Info

Recommend

Organizations whose leaders rated consistency of leadership highly had higher average HCAHPS outcomes.

Leadership Consistency: HCAHPS Lowest vs. Highest Response

Rate your perception of the consistency in the leadership throughout the organization today. (1=Worst to 10=Best in Class)

HCAHPS Average Percentile Rank by Response to Question. Lowest Quartile Responses vs. Highest Quartile Responses Average Percentile Rank

70% 60% 50%

57% 51%

63% 55%

44%

40%

40%

60%

33%

57%

61%

40%

58% 38%

62% 42%

60% 38%

27%

30%

55%

25%

20% 10% 0% Quiet at Night

Doctor Comm

Nurse Comm

Pain Mgmt

Responsiveness

Lowest Quartile Responses

Rating of 9 or 10

Room Cleanliness

Explained Meds

Highest Quartile Responses

Discharge Info

Recommend

Nurse Manager Patient Rounding Impact Patients who ‘strongly agree’ that a nurse manager visited them daily have higher Rate Hospital and Nurse Communication scores.

80

HCAHPS Results

73

Survey Question: “A nurse manager or leader visited me about my care daily.” Data Source: Kaiser Permanente Program wide All IP combined average results (Jan 2010 – Aug 2011) National 75th percentile for Rate Hospital is 73% and for Nurse Communication is 80% (CMS 2010Q1-Q4)

Nurse Knowledge Exchange (NKE) Full Bundle Impact The Full Bundle of NKE Behaviors has the greatest impact.

HCAHPS Results

80 73

Data Source: Kaiser Permanente Program wide All IP combined average results (Jan 2010 – Aug 2011) National 75th percentile for Rate Hospital is 73% and for Nurse Communication is 80% (CMS 2010Q1-Q4) Survey Questions:

Organizations reporting the fewest low performers have higher average HCAHPS outcomes across all composites.

Performance Management: HCAHPS - Highest vs. Lowest % of Low Performers

How many of the employees that you directly supervise are not meeting performance expectations?

Average Percentile Rank

HCAHPS Average Percentile Rank by Response to Question. High % of Low Performers vs. Low % of Low Performers 70% 60%

55%55%

50%

51%55%

60% 45%

63% 48%

54%56%

53% 39%

40%

61%

58% 44%

48%

55% 42%

48% 29%

30% 20% 10% 0%

Quiet at Night

Doctor Comm

Nurse Comm

Pain Mgmt

Responsiveness

Most Low Performers

Rating of 9 or 10

Room Cleanliness

Explained Meds

Discharge Info Recommend

Least Low Performers

* According to the results, when the % of low performers is below 5% you should see improved results. When the % of low performers increases to 9.5%, you can expect to see poor HCAHPS results.

Values On a scale of 1-10 …

• Where would you rank in how value driven you are as an organization?

Performance On a scale of 1-10 …

• Where would you rank in dealing with performance issues?

Good performers deserve a great place to work

Beth Keane

A Calling

Thank You for Answering