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Pam Beitlich, RN, MSN Studer Group September 16, 2010 Hardwiring Excellence A Foundation to Get There Hardwiring Excellence A Foundation to Get There.

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Presentation on theme: "Pam Beitlich, RN, MSN Studer Group September 16, 2010 Hardwiring Excellence A Foundation to Get There Hardwiring Excellence A Foundation to Get There."— Presentation transcript:

1 Pam Beitlich, RN, MSN Studer Group September 16, 2010 Hardwiring Excellence A Foundation to Get There Hardwiring Excellence A Foundation to Get There

2 Commit To Being An “Excellent” Adult Learner Silence cell phones/beepers Be totally present; engage Listen as if you were going to teach it Write/draw/diagram Participate: laugh, snort, question Relate vs. compare Own it

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4 Why are we here today?  Understand the foundational principles of Hardwiring Excellence  Take away 3 things that you can begin immediately in your workplace

5 The Foundation-

6 Bottom-line Results – Everyone has a role (Balanced Scorecard) ServiceQualityPeopleFinanceGrowthCommunity Reduced claims Reduced legal expenses Reduced malpractice expense Physician Satisfaction Patient Satisfaction Improved clinical outcomes – decreased nosocomial infections Reduced medically unnecessary days and delays Reduced re- admits Reduced medication errors Reduced turnover Reduced vacancies Reduced agency costs Reduced overtime Reduced physicals & cost to orient Improved operating income Decreased cost per adjusted discharge Improved collections Reduced accounts receivable days Reduced advertising costs Higher volume Increased revenue Decreased left without treatment in the ED Reduced outpatient no-shows Increased physician activity Increased Philanthropy

7 Nine Principles ® Commit To Excellence Build A Culture Around Service Measure The Important Things Create And Develop Great Leaders Focus On Employee Satisfaction Build Individual Accountability Recognize And Reward Success Communicate At All Levels Align Behaviors With Goals And Values

8 Must Haves ® Aligning Leader Evaluations with Desired Outcomes Rounding for Outcomes Employee Thank You Notes Employee Selection and the First 90 Days Pre and Post Phone Calls Key Words at Key Times

9 Purpose, worthwhile work and making a difference ® Healthcare Flywheel ® Bottom Line Results (Transparency and Accountability) Self- Motivation Prescriptive To Do’s Courage Execution Winning

10 StandardizationAccelerators Must Haves ® Performance Gap Objective Evaluation System Leader Development Foundation Breakthrough STUDER GROUP ® : Rev Agreed upon tactics and behaviors to achieve goals  Rounding for Outcomes: (10pts)  Thank you notes: (2 pts)  Selection and the First 90 Days (8 pts)  Key Words at Key Times (5 pts)  Post Phone Calls (10 pts) Re-recruit high and middle performers Move low performers up or out (12 pts) Processes that are consistent and standardized throughout the company (8 pts) Leader Eval Manager TM Patient Call Manager TM Aligned GoalsAligned BehaviorAligned Process Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results (15 pts) Implement an organization- wide staff/leadership evaluation system to hardwire objective accountability (Must Haves ® ) (30 pts) Evidence-Based Leadership SM

11 Case Study Journey of achieving personal and organizational excellence

12 Why I Care About Making a Difference

13 Building a Culture of Excellence A “ Roadmap ”

14 Creating a great place for employees to work, physicians to practice, and patients to receive care Creating a great place for employees to work, physicians to practice, and patients to receive care

15 A Culture of Excellence Attracts and retains talent Achieves excellent clinical outcomes Sparks employee generated ideas Perception of care high level – “would recommend” Grows according to plan Financially outperforms competition

16 The Knowing – Doing Gap There is a huge gap between knowing the importance of operational excellence - and doing it every day. What kind of culture do you really want to create and keep at your organization? ”

17 Strategic Direction “To be the best health care organization in the country”

18 Word of Mouth 66% of healthcare choice decisions are based on word of mouth AHA Reality Check II, AHA, 1998

19 A Simple Concept “If the other guy’s getting better, then you’d better be getting better faster than that other guy’s getting better... or you’re getting worse.” -- Tom Peters The Circle of Innovation

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21 CEO’s Top Issues Building / Expanding /Renovating Developing new services / Diversifying business lines Merging /Consolidating Developing a medical services organization Controlling costs Forming a physician-hospital organization Re-engineering clinical services Recruiting physicians Upgrading technology / Information systems Re-engineering business processes Integrating system / Forming a provider network AHA News, March 9, 1998

22 CEO’s Top Issues – 2003 Biodisaster Preparedness Capacity Patient Safety Technology Quality Governmental Mandates Malpractice Insurance Physician/Hospital Relations Reimbursement Care for the Uninsured Personnel Shortages American College of Healthcare Executives, Nov 26, 2003, CEO Survey Reveals Top Issues Facing Hospitals Patient Satisfaction

23 Care for the uninsured Technology Capacity Patient satisfaction Governmental mandates Personnel shortages Financial challenges Physician-hospital relations Patient safety and quality American College of Healthcare Executives, 2008, Annual CEO Survey of Top Issues Confronting Hospitals CEO’s Top Issues – 2008 Constant for years Moves up and down Issues about not-for-profit status Disaster preparedness

24 January 11 Modern Healthcare, American College of Healthcare Executives, 2009 Annual CEO Survey of Top Issues Confronting Hospitals; 525 Hospital CEOs CEO’s Top Issues Constant for years Moves up and down Care for the Uninsured Technology Capacity Patient Satisfaction Physician Hospital Relations Governmental Mandates Financial Challenges Patient Safety and Quality Healthcare Reform Implications Governance Disaster Preparedness Personnel Shortages New update

25 One Hospital’s Journey…

26 Leadership Meetings

27 No more turkeys

28 Can We Change the World? “To be the best Community Hospital and Health System in the United States” To be “The best place to work, practice medicine and be a patient”

29 Focus on Measurements Patient Satisfaction Staff Satisfaction Physician Satisfaction Quality/Safety Financials Beginning of “No-Secrets” Culture

30 Standards of Behavior Always Make a Positive Impression Make Communication Effective Practice Professionalism/ Teamwork Develop and Use Service Recovery In 2006, added: Patient Safety Standard for ALL staff

31 It’s all about the leader… Every single one of them “If you want to change the world, you have to start with yourself.”

32 Great Organizations - Have leaders who model behaviors that positively influence employee perceptions Constructively coach others to increase their skill level Mentor new leaders Share lessons learned

33 What differentiates your organization from your competitors? Rude – Good - Memorable Good or Great?

34 Service is Married to Quality…

35 99th Percentile Hospital 64th Percentile Hospital 1’s 2’s3’s4’s5’s 1%2%7%24%66% 1%2%8%34%55% 2% 8%36%52% 35th Percentile Reference: Sample distribution of inpatient satisfaction score responses to achieve excellence, Press Ganey and Associates, March 2007 Let’s look at Service – 4 vs 5 Top Box Loyalty

36 HCAHPS Recommendations

37 Percentile Rank Comparison How do Studer Group Partners Compare vs. Non Partners The graph below shows a comparison of the average percentile rank for Studer Group Partners that have received EBL coaching since 2007 and non-partners for each composite. HCAHPS results are for patients discharged between July 2008 and June It is sorted to show composites with the highest Studer Group partner average percentile rank on top.

38 Must Haves ® Aligning Leader Evaluations with Desired Outcomes Rounding for Outcomes Employee Thank You Notes Employee Selection and the First 90 Days Pre and Post Phone Calls Key Words at Key Times

39 What is Rounding with Outcomes? Proactively, engaging, listening to, communicating with, building relationships with and supporting your most important customers (employees, family, patients, physicians, and other departments)

40 Rounding for Outcomes is NOT… The proverbial wave Management by wandering around Focused on “what’s wrong” Being “out there” Happenstance

41 Rounding Works Rounding will have the biggest impact on your employee and customer satisfaction results Builds the team – elevates performance Breaks down barriers, fixes systems, ensures right tools and equipment are in place Emphasizes the positive instead of negative

42 Turnover and Vacancy Rate New update Source: Florida Hospital System, Admissions=69,107 Total beds = 1,218

43 Employee Satisfaction Increase Source: South Carolina Hospital, Admissions=25,837 Total beds = 594, vendor = PRC 2009 Overall RSFH 99%tile Corporate Services 100%tile Bon Secours St. Francis 99%tile Roper99%tile

44 When leaders provide follow up on rounding at their staff meetings, they should say: “During the past 30 days, I have rounded on 32 employees. As a result of my rounding we have been able to acquire 3 blood pressure cuffs, 2 key boards, as well as rework the supply cabinet. I also was able to recognize 10 individuals that you suggested receive recognition. Thank you for your help.”

45 Round With Patients Set clear expectations Focus on key questions Outline what to do if problems are discovered Closing statement Reward and recognize staff

46 Questions for Patients Do you know your nurse’s and CNA's name today? Do you know your schedule? How has your nursing care been? Have we managed your pain well? Do you have any concerns or questions?

47 Leader Rounding on Patients “Did a Nurse Manager Visit You During Your Stay?” Tactic and Tool Implemented: Leader Rounding Percentile Source: Arizona Hospital, Total beds = 355, Employees = 4,000, Admissions = 10,188; updated 2Q2010 n= 608 n= 106 n= 604n= 561n= 601 n= 104 n= 96 n= 105 New update

48 Financial Impact MetricImpactReduction FallsQuality50% Decubitus UlcersQuality14% First Year TurnoverPeople66% ReadmissionsGrowth33% No ShowsGrowth70% TardiesGrowth60% Call LightsPeople38%

49 Must Have #6 - Key Words Things said and done to “connect the dots” and help patients, staff and physicians understand why we do things and what is going on

50 Studer Group Five Fundamentals - AIDET SM A Acknowledge I Introduce E Explanation T Thank You D Duration

51 Managing Up Positioning Others in a Positive Light... Makes you better Makes your organization better Aligns everyone

52 The Great Erasers “We’re short-staffed” “Can’t; But; No; Our policy” “That’s not my patient” “You know how Administration is around here” “That’s not my job (problem)” “I can’t believe they kept you waiting so long” “No one told me you were here” “We have real emergencies ahead of you” “We can’t get good help”

53 Health Care Initiatives Have Not Been Sustained...

54 Why Organizations Do Not Achieve Desired Results 1. Dots are not connected consistently to purpose, worthwhile work and making a difference 2. Do not achieve critical mass - Lack of balanced approach 3. Absence of an objective accountability system 4. Leaders do not have the training to be successful 5. Too many new behaviors introduced at once – need for sequenced approach 6. No process in place to re-recruit the exceeding and achieving performers and address low performers (HML) 7. Inability to take best practices and standardize across organization 8. Failure to have leaders “always” do desired behaviors Rev 3.08

55 Studer Group – Lessons learned Since 2000 Objective evaluation is the sustainer Sequencing of tools are vital One should not move on to the next tool/tactic if the preceding tool/tactic is not hardwired SM Difference between cookie-cutter approach and evidenced-based leadership SM This is a lot harder than anyone thought – Why?  Trying to align behavior of more people than other initiatives  As your organization improves, inconsistencies become apparent  Non-documented performance issues It is not a patient satisfaction/service excellence program. It is putting into place an operational framework for:  Alignment of resources  Accountability of people  Execution/Implementation of plans and processes

56 “Everything Rises and Falls on Leadership”

57 The only legacy we leave behind is to those we teach - Quint Studer

58 It is all about Results…

59 January 11 Modern Healthcare, American College of Healthcare Executives, 2009 Annual CEO Survey of Top Issues Confronting Hospitals; 525 Hospital CEOs CEO’s Top Issues Constant for years Moves up and down Care for the Uninsured Technology Capacity Patient Satisfaction Physician Hospital Relations Governmental Mandates Financial Challenges Patient Safety and Quality Healthcare Reform Implications Governance Disaster Preparedness Personnel Shortages New update

60 Consider… What do you want to be known for? Do you create memories for your patients? Can you be exceptional or extraordinary?

61 Leaders capture the hearts and minds of their staff… “You cannot lead by hitting people over the head – that is assault, not leadership.” – Dwight Eisenhower

62 You must keep raising the bar – everyone else is

63 Connect to Purpose… Our patients depend on us and we depend on you. Yours might be the first face they see when they come through our door. Yours might be the voice they hear right after a surprise diagnosis. Yours might be the eyes they look into as they are pushed in a wheelchair to a frightening procedure. Your attitude reflects us and everything we are proud of in this organization. You have chosen to help serve our patients and we appreciate you. Thank you.

64 ~ Quint Studer ~ Never Underestimate the Difference You Can Make

65 Thank You! Pam Beitlich (850)


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