1. Our Journey Lisa Michaelis Heartland Regional Medical Center Administrator

2. Why we do what we do Our Journey to Quality - Baldrige Voice Of Customers (VOC) Connection to Purpose Customer Engagement Workforce Engagement Overview

3. Heartland Health, St. Joseph, Mo. Heartland is a fully integrated health-care delivery system, located in the heart of America and comprised of four entities: Heartland Regional Medical Center Heartland Clinic Heartland Foundation Community Health Improvement Solutions

4. Heartland Health, St. Joseph, Mo. To make Heartland Health and our service area the best and safest place in America to receive health care and live a healthy and productive life. Heartland Health’s vision

6. Why We Do what we do

7. Obesity 65 percent overweight or obese School district reports an alarming increase in obesity Direct connection between poverty and obesity

8. Nine percent of people in St. Joseph live with diabetes In the under $15,000 bracket, rate soars to nearly 21 percent Diabetes

9. Smoking 1 out of 4 people in St. Joseph smoke … Under $15,000 income bracket, the smoking rate doubles!

10. Our community needs more than a hospital

11. Included in Strategic Planning Process Community health needs assessment Listen to the voice of the customer Social Responsibility because we care

12. Our Solution – Heartland’s Health Pyramid

13. The Foundation of our Health Pyramid

14. 89 percent of students say they can make a difference EmPower Plant The emPower Plant program provides a hands–on experience for students on the brink of adulthood

15. The Health Express Innovative Solutions Youth Health Partnership Increase childhood immunizations and well–child exams Reduce teen pregnancy Improve oral health care

16. The Middle of our Health Pyramid

17. Innovative Programs Pound Plunge — 12–week, team approach, weight loss challenge National model for community health improvement events

18. Innovative Partnerships and Solutions Community Health Improvement Solutions’ Wellness Connections program creates health and wellness plans for individual businesses

19. The Tip of our Health Pyramid

20. Quality Care Innovation — putting the needs of the patient first

21. Why Baldrige

22. The First Few Steps Recognition Change course

23. Early Approach CEO support Few key leaders spearheaded efforts Small group assisted

24. Early Changes Organizational Structure Measurement Quality focus Growth Leadership Changes

25. Engaging Others Excellence in Missouri Foundation Balanced scorecards Processes Customers Leadership Performance Improvement Across entire organization

26. Later Lessons Learned Needed to enhance knowledge of the criteria Trained eight employees as examiners Deep understanding of customers Success with performance improvement

27. More Changes Shifted to more of a team approach Category leads and teams formed Focus on integration and learning

28. Voice of our Customers

29. Health Pyramid Hospital and Clinic Inpatients Outpatients ER Clinics Community Health Improvement Solutions Members Community Heartland Foundation Community Region

30. Leadership System

31. Strategic Planning Process

32. Customer Relationship Model (CRM) (2) (5) (1) (4) (3)

33. If it’s important to them, it’s important to us. Customer Groups CRM #1

34. Key Customer Requirements Satisfaction Priorities/ Examples Customer Segment Listening and Input Methods Patients Inpatient Satisfiers/Priorities Comfort Pain Personal needs Compassion Response to concerns/complaints Address emotional needs Includes you in decisions Addresses Pain Patient Surveys – D, M Discharge Calls – D Key Words – D Rounding - D Key: Frequency: A–Annual, B-Biennial, D-Daily, M-Monthly, P-Periodic, AN–As Needed Voice of the Customer Requirements CRM #2

35. Listening to their concerns Analysis and Decision Making CMR #3 Collect, review and assess voice of the customer data and inputs Performance improvement

36. Continuous Multiple Methods (Figure 6.1-1) Problem, Analysis, Solution, Transition, Evaluation (PASTE) — continuous improvement PASTEplus — with Black Belt support PASTEplus for Design — design or redesign with Black Belt Support Analysis Performance Improvement CRM #3

37. 90-Day action plans, Balanced Scorecard (BSC) and goals Requirements shared with the caregivers, medical staff, board Deployment Strategy and Plans CRM #4

38. Opportunities for improvement Cycles of improvement Evaluation and Improvement CRM #5

39. Connection to Purpose – Customer Engagement

40. Patient Member Community Region

41. Listening Rounding Satisfaction surveys Community perception survey Focus groups Voice of the Customer

42. Leader action plan Rounding with patients, members and caregivers Service recovery Thank you notes Coaching and teaching Patient/Member Engagement Keywords Discharge calls Behavioral standards Individual care plan Leader goals

43. Community Engagement Health improvement programs Community forums–summits Community Alliance Corporate citizenship Youth health Senior health Employee health

44. Regional Engagement Heartland Foundation regional development Regional electronic medical record Specialty clinics

45. Customer Satisfaction Results PG = Press Ganey

46. Inpatient Satisfaction Results PG = Press Ganey Key Drivers

47. Willingness to Recommend

48. Regional Referrals

49. Net Revenue

50. Connection to Purpose - Workforce Engagement

52. Our Caregivers Everyone is a caregiver at Heartland Employees Volunteers Physicians

53. Heartland’s Workforce Our Aspiration … Creating an engaging workplace culture for our patients to receive care, for our caregivers to work, for our physicians to practice and for our community members to volunteer.

54. ENGAGEMENT OF:  Leadership  Caregivers  Physicians  Volunteers INTEGRATION OF:  HRMC  HC  CHIS  HF ROLE CAPABILITIES  Skills  Competencies  Education  Certifications  Licensures  Essential Requirements  Physical capacity BEHAVIOR STANDARDS Respect Counts HEART  H ear  E xcellence  A ppearance  R esponsibility  T eamwork Heartland’s People Plan: Workforce Alignment

55. Heartland’s People Plan Employer of Choice, a strategic goal Aligned to organizational needs relative to: Capacity Capability The safety and security of our workforce is essential to our workforce plans HEART behaviors set common standard for caregivers, physicians, volunteers and leaders

56. Behaviors: “HOW You Do It” HEART behaviors lay a foundation for our culture: H – Hear: Voice of the Customer E – Excellence: Life long learning A – Appearance: Creating a positive impression R – Responsibility: Adhering to standards T – Teamwork: Collaborating with others

57. Hire the “right” people: a servant’s heart combined with the skills and competencies to achieve our strategic priorities. Engagement begins day one. Expectations and enculturation vital Workforce Strategies Alignment

58. Development and Learning Aligned to Strategic Planning Process Leadership effectiveness a clear differentiator New expectations for formal education completion Specific focus on our high performers Workforce Strategies Alignment

59. Investment in Leadership: Leadership Development Institutes: –Highly inclusive –Partnership with Advisory Board Company –Themes and seating arrangements encourage relationship building –Accountability; Teamwork; Developing Staff; Critical Conversations; Influence; Conflict Management; Leading Change Fellowship of the Advisory Board Company: –Mini-MBA –National Track for High Potential Front-Line Leaders –Local Cohort with Administrators/Physician Leaders Physician Leadership Academy –Topics aligned to the rest of our Leadership Curriculum –Introduced by CEO Dr. Laney –Employed and independent physicians invited –Leverages physician’s voice in strategic conversations

60. AFR – A BIG Breakthrough for Us: Critical Conversations and AFR Strategy SIX LDI’s across eighteen months focused on leader skill-building, practice and stories Dr. Mark Laney, CEO (hired in summer, 2009) unconditionally supported full implementation Human Resources on Deck

61. RARELY FREQUENTLY ALWAYS HEART Behaviors: Critical Conversations HEART Behavior Standards ALWAYS Caregivers go to Staff Development Institutes; are offered stretch assignments and wear an “Always Badge”

62. Many ways to reward and recognize: Competitive benefits/compensation Sharing Success Wellness programs (walking the talk) Touchstone All designed to reinforce Heartland’s strategic priorities and align to organizational core competencies Workforce Strategies Alignment

63. A key priority Selection of Physician CEO in 2009 Leadership Structure: Dyads Quality Management Committee – leading quality, PI and capital expenditures Physician Leadership Development aligned with the rest of our leadership offerings Physician Engagement

64. A critical extension of our workforce HEART expectations aligned Assignments based upon organizational “Fit” and interests Involvement in operational value activities Patient visitors Guest Services Discharge Transport Volunteer Engagement

66. Auxiliary of the Year (Missouri Hospital Association) Volunteer Engagement

67. Caregiver Satisfaction Results

68. Goal: 80th PercentileCOMPARISON Organization 2010 Organization Mean 2010 Percentile 2010 All Hospital DB (393) 2010 2001-3000 FTE DB (22) Baldrige Facilities (12) HH76.283 rd 95 th 82 nd HRMC 75.580 th 90 th 78 th HC79.394 th 99 th 90 th CHP/CHIS80.095 th 99 th LTACH66.520 th 16 th 1 st HF71.652 nd 49 th 21 st Caregiver Satisfaction

69. Caregiver Engagement

70. Leadership Effectiveness

72. Physician Engagement Percentile performance improved from the 23 rd Decile in 2008 to 81 st Decile in 2010!

73. Lessons Learned Focus on behavior to drive engagement/ satisfaction Engagement of physicians in robust leadership learning Quarterly LDIs and our Fellowships build leadership skill with demonstrable improvement in engagement and patient satisfaction SDIs develop informal leaders and contribute to succession management

74. Planned Cycles of Improvement Transition from satisfaction to a Patient Experience focus Improve engagement and partnerships with medical staff and physician leadership Improve linkage of learning initiatives to application in day to day work Accelerate leadership learning to assure caregivers, medical staff are ready for health- care reform

75. Key Points Every element of our People Plan is with an eye on supporting the strategic priorities of Heartland Engaging all members of our workforce — caregivers, physicians and volunteers — assures we meet our service area’s health-care needs now and in the future Our strong focus on leadership development at all levels will help us navigate uncertainties posed by healthcare reform and a shift toward more value for health care dollars spent

76. What People are Saying About Us “Engaged in the community” “Demonstrates performance excellence” “Provides patient safety” “Best in value”

77. Lessons Learned Balance process and customer relationships Long–term health improvement and illness prevention is the model for health-care reform It takes a team Lead with a servant’s heart What is best for the customer

78. Key Points Transparency Develop systems and key processes Listen & Engage Link strategy, customer, workforce and performance improvement

79. November 11 – 12, 2010 January 13 – 14, 2011 March 3 - 4, 2011 Register at www.heartland-health.com/baldrige Heartland Health Sharing Days