1. University of Missouri Health Care Service Excellence University of Missouri Health Care September 1, 2005 From Good to Great

2. University of Missouri Health Care The charge for University of Missouri Health Care is to move from a good organization to a great one. We HAVE a sense of urgency to do this.

3. University of Missouri Health Care Our employees, our physicians and our patients ARE our health system’s top priority.

4. University of Missouri Health Care UMHC Culture This commitment requires people to change.

5. University of Missouri Health Care ‘Hardwiring Excellence’ by Quint Studer Model for organizational excellence Guide for best practices, not a mold

6. University of Missouri Health Care Becoming a World-Class Organization Requires: Committing to excellence Measuring the important things Building a culture around excellence Creating and developing leaders Focusing on employee satisfaction Building individual accountability Aligning behaviors with goals and values Communicating at all levels Recognizing and rewarding success

7. University of Missouri Health Care Our Commitment to Excellence The journey to excellence begins with a firm and measurable commitment from EVERYONE. We no longer want to be good. Our goal is to be Grrrreat!

8. University of Missouri Health Care Our Commitment to Excellence There is no ‘THEY’

9. University of Missouri Health Care Our Mission As part of a land-grant university, University of Missouri Health Care’s core mission is to provide education, research and service to the residents of Missouri with an emphasis on the needs of rural Missouri. Our Vision To offer programs of unsurpassed excellence that will be integrated into a highly efficient, fiscally sound, professionally outstanding, service oriented health system that is unified in a common purpose to be one of the premier comprehensive academic health systems in the nation. University of Missouri Health Care

10. Our Values Quality. We believe in quality – quality in the patient care we deliver and the people we hire. Efficiency. Our goal is to provide the highest quality care at the lowest possible price. Caring Attitude. We care about the people who come here, whether they are patients or visitors. We treat them with courtesy and respect. Participation. We encourage and depend on our staff to help us guide this organization. Their guidance is accomplished by participating in elected and appointed committees and task forces.

11. University of Missouri Health Care Community  Growth  Finance  Quality  People  Service We identified six Columns of Excellence to provide the foundation for setting goals and direction for service and organizational excellence at University of Missouri Health Care

12. University of Missouri Health Care System Approach to Columns ServiceQualityPeopleGrowth Patient Satisfaction Key Clinical Indicator Review Medication Errors Reduction of Patient Falls Turnover Turnover – First 90 Days Employee Satisfaction & Retention Employee Evaluation Completion Wins Operating Margin (MTD/YTD) Cash Collection New Patient Volume Growth Surgical Growth No Shows Financial Examples

13. University of Missouri Health Care Facility Approach to Columns ServiceQualityPeopleGrowth Financial Examples Patient Satisfaction Reward & Recognize leaders of areas scoring well Standard of the Month Celebration Patient letters Key Clinical Indictors – results for the org Reward & Recognize leaders Reward & Recognize staff Turnover Staff forums Upcoming hospital celebrations Operating Margin Cash Collections AR days Market Share Specific Service line growth No Shows Community Events

14. University of Missouri Health Care Department Approach to Columns ServiceQualityPeopleGrowth Financial Examples Dept Patient Satisfaction Patient comments What we have improved Where we need to focus Ideas from staff Dept Quality Indicators R&R improved areas Key action steps for staff to take next 30 days New tools & equipment Introduce new employees New Tools & Equipment Dept Turnover Upcoming training activities Reward & Recognition Dept Productivity Dept supply costs Key actions for staff to take next 30 days Hospital/Dept financial performance YTD Dept admissions Community Events Hospital growth YTD

15. University of Missouri Health Care Building a Culture Around Excellence Core Team Formed –January 2005 Service Teams Formed –April 2005 –Approximately 100 employees involved to date Quarterly Leadership Retreats

16. University of Missouri Health Care Standards Team Ben Atwell Shanna Baldridge Karen BrozDr Robert Bynum Dave GeigerMarty Hausman Michel HayesCraig Hosey Pam MulhollandKaren Scott Kay Steward Team Members:

17. University of Missouri Health Care Purpose : To create the foundation of our culture of Service Excellence Goals: We asked ourselves : What kind of behaviors do we need to become a culture of excellence for patients, staff, and physicians? The answer: The Standards of Performance What We Do

18. University of Missouri Health Care Current Staff All signing is cascaded down through executive Leadership, then their direct reports, etc… All staff are to have signed by September 30, 2005 New staff HR – on line Standards prior to application access Departmental signing as well and departmental orientation (added to orientation checklist) The Commitment

19. University of Missouri Health Care Education: A traveling carnival : UH, CRH, EFCC, QD Positive Learning Environment Fun and Interactive Different Booths to Represent each Standard Prizes, candy, etc. for winners Standard of the Month Our Projects

20. University of Missouri Health Care Patient Satisfaction Team Barb Barrett Deb Calder Jan Degraffenreid Paula Flandermeyer Shawn McGrew Ellen McKenzie Nakia Moore Katherine Payne Team Members: Laura Phillips Bonnie Potter Linda Robb Dan Smith Susan Straatmann Patty Wells Darian Younger

21. University of Missouri Health Care Purpose Ensure highest level of service is consistently provided Develop new ideas to continually improve the service and to share best practices among departments to help others learn Goals Look for ways to “wow” patients and families Solicit input on ways to improve care Develop & implement “key words at key times” Implement communication boards in patient rooms Implement nurse leader rounding Implement discharge phone calls What We Do

22. University of Missouri Health Care Our Projects Cascade Learning Packets –Interest, Concern, Apologize, Respond, and Educate Quick Wins for specific areas

23. University of Missouri Health Care Physician Satisfaction Team Team Members: Pete Ackerman, MDMarty McCormick Karen Calhoun, MDDavid Mountjoy Steve Calloway, RPhSue Scott, RN Kevin Dellsperger, MDTom Selva, MD Jessica HardyBeth Van Hove Nancy Jones, RNJennifer Wallace, RN Melissa Lyons, M3Andrew Wheeler, M3 Dennis McGowanMary Williamson, RN

24. University of Missouri Health Care Purpose: Responsible for “wowing” physicians and improving the level of service to them and their patients Goals: Implement action steps with outcomes that will be seen by medical staff as a “win” Modify key processes within the institutions that will allow for ease in patient care delivery What We Do

25. University of Missouri Health Care Quick Wins: House Phone Conversions Replacing Tone Pagers with Text Capabilities On Call Schedules – On Line, One Reference Point Hospital Marketing for Physician Providers Facility Improvements – Hit Squad concept Nurse Call Line Our Projects

26. University of Missouri Health Care Hypothesis: Addressing Patient Care Made Easier will improve physician, staff and patient satisfaction levels Action Steps: Identified discharge planning process as area for re- design PSTF team joins forces with nursing administration to reach key goals for discharge planning revisions Blitz Session to address key goals scheduled for September 30, 2005 Priority Focus: “Patient Care Made Easier”

27. University of Missouri Health Care Employer of Choice Team Team Members: Anissa LeaseburgMindy Cherrington Lezlie DahlkeLinda Davis Gayla MaierRamonna McKinzie Theresa Nation Brenda Quinlan Carey SmithRandy Wade Angela Waller David Wiss

28. University of Missouri Health Care Purpose Implement programs and opportunities to help employees feel they are doing meaningful, purposeful and worthwhile work Goals To make UMHC the “destination employer”, not a stepping stone What We Do

29. University of Missouri Health Care Our projects will focus on system wide policies, procedures and programs that can be implemented to make UMHC an Employer of Choice. Future recommendations: Encouraging opportunities for employees to be involved in decision making about issues that affect them, such as hiring decisions and work space and facility decisions Ensuring that UMHC has a market competitive compensation program that encourages and rewards superior performance and shares gains with rank and file employees Enhancing an already strong benefits program Sustaining a culture that holds everyone in the organization, at all levels, accountable for their performance Our Projects

30. University of Missouri Health Care Measurement Team Team Members: Kim BassAmy Camp Karen CoxRachel Haverstick Christine HeathBruce Horwitz Will KiehlManuel Navarro Michele SchutteDavid Sohl Barb White

31. University of Missouri Health Care Purpose: To correctly measure, interpret, and communicate progress toward the organization’s objectives Goals: To develop and distribute performance data in a clear and useful format to all departments and administration Work with leadership to promote understanding and utilization of data Assist other teams by providing information for planning, decision-making and reward/recognition What We Do

32. University of Missouri Health Care Current and future projects/actions: Design patient satisfaction reports for each unit, department and facility Create a presentation to provide an overview and explain the data to departments Review/evaluate current survey tools Develop methodology for distribution and review of survey comments Our Projects

33. University of Missouri Health Care Sample Reports

34. University of Missouri Health Care 66.1Admitting73.9OMER 66.6Pharmacy76.1PM&R Clinic 71.7Data Processing, TSS/ITS 76.4 Endoscopy 75.4Ortho Rehab84.7CPG Brookfield 79.5Human Resources 88.4 Guest House Mean CRH Employees Mean UHC Employees Five Best - Employee Satisfaction Five Best - Patient Satisfaction ERMeanCRHMeanUHCMeanUHC PedsMeanClinicsMeanOutpatientMean BestCRH ER85.8Well Baby88.3CICU87.9PSSC86.9ORAL SURG EF94.8Chemo91.8 2ndUHC ER80.53OB86.9Stepdown85.1PICU86.2HALLSVILLE CL93.4Radthrp91.6 3rd NICU86.6Oppu82.6Peds81.5CANCER SCR EF92.4CardRhb91.0 4th 5Central85.9SICU81.1Adol80.9FERTILITY CL91.6Lab90.2 5th 4North84.7Emo79.8 LOZ CL91.0Echocard89.4 More Sample Reports

35. University of Missouri Health Care Service Recovery Team Team Members: Anita BeallSusan Lee Kim BrucksVelma Moore Lorna CarverCarol Nierling Karen HarrisDan Smith Candace HawkesTracie Wideman Mickie KummerAmanda Wood

36. University of Missouri Health Care To provide staff with information to enhance their customer service skills To provide staff with the tools necessary to “recover” when a customer’s expectations have not been met What We Do

37. University of Missouri Health Care Develop a brochure for staff that provides key words/scripting to promote good customer service skills Develop an educational video with case scenarios depicting excellent customer service delivery Provide each department with a “tool kit” that will provide immediate access to resources for service recovery Develop a log for each department to document service recovery occurrences and to determine trends for process improvement Our Projects

38. University of Missouri Health Care The educational brochure attached will give staff information to enhance their customer service skills and includes the “I CARE” document This brochure will also list specific measures to take when service recovery is needed It will also be used during new staff orientation to promote appropriate customer service skills with new staff and will reinforce our Standards of Performance Our Projects

39. University of Missouri Health Care Communications Team Team Members: Cindy Alverson FreeseClay Anderson, M.D. Jennifer CoffmanRosemary Frank Janice GartmanPaula Heaviland Mary JenkinsJulie McKay Scott SteverSusan Straatmann Tina TaylorCarol Wilhite

40. University of Missouri Health Care Purpose: To encourage and facilitate open, truthful and timely communication using a wide variety of communication sources Goals: To ensure all University of Missouri Health Care employees have easy and convenient access to both system-wide and department-specific information To help other Service Excellence teams communicate their initiatives, projects and progress with the entire University of Missouri Health Care staff and, when appropriate, the community at large What We Do

41. University of Missouri Health Care Six principles should guide all communication Be truthful Be transparent Be kind Be an active listener Be respectful Be timely Team Principles

42. University of Missouri Health Care Communication Boards: Step one: Place one public communication board in each of the seven major facilities, including: –University Hospital –University Physicians Medical Building –Columbia Regional Hospital –Ellis Fischel Cancer Center –Quarterdeck –School of Medicine –Missouri Rehabilitation Center Step two: Place one department-specific communication board in every department within University of Missouri Health Care Our Projects

43. University of Missouri Health Care Public Communication Boards will contain: System-wide and facility-specific Communication that falls under one of the six columns of Service Excellence Department Communication Boards will contain: Department-specific information that falls under one of the six columns of Service Excellence Our Projects

44. University of Missouri Health Care Training for Managers: Cascade learning on how to hold staff meetings Communication Support: Help other teams construct communication plans for disseminating information about their programs, plans, progress and people Future Projects

45. University of Missouri Health Care Reward & Recognition Team Team Members: Kevin AndersonBarb Brucks Karen Calhoun, MDCarol Clark Justin DelapDeborah Harvey Louise HarveyRon Hausheer Sarah KnoerrCheryl Kyle Jane NelsonKym Pieper Catherine PriceWayne Richards Deneal SullivanCeresa Ward

46. University of Missouri Health Care Goal: Impact staff, physician and patient satisfaction by: Reinforcing desired behaviors by rewarding & recognizing employees Building a culture of ownership and responsibility with regards to reward and recognition Actions: Work with leaders to identify recognition opportunities Evaluate and improve existing programs Implement new programs for areas where there are gaps Assist with other celebrations as needed “Compensation is a right; Recognition is a gift.” - Rosaveth Moss Kanter - Our Purpose

47. University of Missouri Health Care Proposed Basic Structure ProgramHowWhen Legendsextraordinary efforts or contributions above and beyond the scope of ones job requirements or for sustained outstanding achievement for consistent efforts within one's professional discipline - Annual - No numerical limit - Balance of all functions Heroesefforts or contributions above and beyond the scope of ones job requirements or for sustained outstanding achievement for consistent efforts within one's professional discipline - 4 Heroes of the month - 8 other individuals or teams recognized - Balance of all functions Delivering the Difference - Upon event - Approved by managers or designee Leadership Thank You Notes any positive action that is aligned with the core values or six columns of excellence As needed Peer Thank YousAnytime (All the time) Verbal Thank YousAnytime (All the time)

48. University of Missouri Health Care Department Based Proposal Budgeting for department based recognition Spontaneous recognition for “crunch time” effort Other department based activities

49. University of Missouri Health Care Making This Work Consistently give verbal Thank You’s and write Thank You Notes Nominate staff, peers, and leaders for Heroes/Legends Tell great stories at meetings and events Harvest the celebrations – collect stories from your direct reports and expect them to collect from their staff “Never underestimate the difference you can make!” - Quint Studer - Support Requested

50. University of Missouri Health Care Leadership Development Team Team Members: Kevin AndersonKim Bass Lynne HedrickSusan Heimsoth Linda LightfootJuni Muhota LuAnn TandyCeresa Ward and… Your Participation is Requested

51. University of Missouri Health Care Goal: For our organization to go from good to great, we must have great leaders who Learn Grow in their knowledge and role Share information, time and recognition Model the way Lead the charge Leadership Development

52. University of Missouri Health Care Actions: Work with Executive Team to establish Leadership Retreat outcomes Coordinate Leadership Retreat delivery and implementation Communication – Pre and Post Leadership Retreat Ensure that leadership retreats are creative and fun Assist with development of Cascade Learning Leadership Development

53. University of Missouri Health Care Purpose: Communication and Training Goal: Consistent basic message with ability to meet departmental needs Delivery: 1.Leaders first learn/hear the message 2.Receive a cascade learning packet 3.Present and discuss the message with department 4.Report completion to Associate Director Cascade Learning

54. University of Missouri Health Care Cascade Learning Employee Thank You Notes Rounding for Outcomes Discharge Phone Calls Key Words / Key Actions Alignment of Organizational Goals Selection and Retention of Staff Must Haves

55. University of Missouri Health Care Satisfied employees do a better job. To increase employee satisfaction, we use a process called “rounding for outcomes” involving senior leadership and department managers. Information will be used to improve the environment. Rounding

56. University of Missouri Health Care When managers make rounds with purpose, they ask: Tell me what is working well today? Are there any individuals I should be recognizing? Are there any physicians I should be recognizing? Is there anything we can do better? Do you have the tools and equipment to do your job? Rounding

57. University of Missouri Health Care A sense of ownership in the organization, builds individual accountability. Ways to create a sense of ownership and accountability include: Allowing employees to participate in peer interviews Asking their feedback in 30- and 90-day new employee meetings Requiring them to sign a Standards of Performance Agreement Encouraging employees to share their ideas for best practices Renters vs. Owners

58. University of Missouri Health Care Communication is key to our success. We will employ the following measures to achieve improvement: Managing up – positioning people well Employee forums – quarterly, led by senior leaders Communication boards – department-level, key information on progress toward the organization’s goals Storytelling – sharing stories about everyday acts of heroism that take place in our facilities We want to duplicate positive behavior. Communication

59. University of Missouri Health Care The Magic Bus “First, you have to get the right people on the bus, the wrong people off the bus, and the right people in the right seats – and then you figure out where to drive it.” - Jim Collins - Author of “Good to Great”

60. University of Missouri Health Care Our actions speak much more clearly than our words… “We are not in the health care business – we are in the life enhancement business.” - Timothy Jarm - President /CEO Jewish Hospital Summary

61. University of Missouri Health Care “A journey of a thousand miles begins with a single step.” - Confucius - Our Future