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Aligning Lifelong Learning and Continuous Improvement with the Business Direction at SSM Health Care Dawn Runge, Ph.D. Corporate Vice President – Organizational Effectiveness Russ Scalpone, Ph.D. Corporate Director – Organizational Effectiveness October 2012 Good morning! As many of you know I am Dawn Runge, corporate VP of organizational effectiveness. I would like to give you an informational update today on key projects related to leadership development and performance development.

SSM Health Care Mission Through our exceptional health care services, we reveal the healing presence of God. At SSM Health Care everything we do begins with the Mission of the organization – Through our exceptional health care services, we reveal the healing presence of God. Our mission provides the overarching frame by which we measure our effectiveness in day to day activities. Our Core Values Compassion: We reach out with openness, kindness and concern. Respect: We honor the wonder of the human spirit. Excellence: We expect the best of ourselves and one another. Stewardship: We use our resources responsibly. Community: We cultivate relationships that inspire us to serve.

Mission Defined: Characteristics of Exceptional Health Care Services Exceptional Patient Care Clinical: Clinical Composite Indicators Patient Satisfaction: Likelihood to Recommend Safety: Patient Serious Event Rate Exceptional Commitment Employee Engagement Physician Overall Satisfaction Exceptional Financial Performance/ Growth Financial: Operating Margin Growth: Net Patient Revenue

SSM Health Care System Based in St. Louis, Mo., with facilities located in four Midwest states including Missouri, Illinois, Wisconsin, Oklahoma Provides services in inpatient, outpatient, outpatient surgery and emergency department hospital settings, two nursing homes, and home care Traces its roots back to 1872, when Mother Mary Odilia Berger and four sisters migrated to the United States from Germany The congregation, now known as the Franciscan Sisters of Mary, sponsors SSM Health Care 25,600 employees, 7,300 employed and affiliated physicians, 6,750 nurses and nearly 2,400 volunteers all working together to provide exceptional health care services 5

More About SSM Health Care First health-care recipient of the Malcolm Baldrige Award First large health system to go tobacco-free inside and out SSM is implementing an electronic health record in all its hospitals Top 6 percent of hospitals to implement electronic health records Core Competencies: We know how to improve We use values to guide decision-making We take advantage of being a system 6

How are we going to improve? Mission & Strategic Direction Leadership Concept WHY How are we going to improve? Mission & Strategic Direction HOW WHAT For us effective leaders connect the dots – they know how to engage employees by clearly defining the why we do what we do – for us it’s the mission link – and they are very clear about the what we need to do (for us it’s achieving exceptional health care through the characteristics) – but the How we make improvements is left to the creativity and ideas of the employees and other members involved in thee work system. Engaging people in the dialogue.

SSM Health Care Corporate Organizational Effectiveness Corporate Vice President – Organizational Effectiveness Administrative Education Assistant Reports to Senior Vice President – Human Resources Corporate Director – CQI Corporate Director – OE/CQI Corporate Manager – OE Curriculum Development and Instruction Manage SMEs & Faculty Support CQI Effectiveness Measures Manage Corporate Office CQI Projects MBNQA Category Six Co-Manage and Support CQI Workgroup CQI Website Quality Companion Database CQI Knowledge Sharing Curriculum Development and Instruction Education Strategy Evaluation and Assessment Design CQI Effectiveness Measures System CQI Projects MBNQA Category Five Co-Manage CQI Workgroup Knowledge Sharing Curriculum Development and Instruction Manage SMEs & Faculty Physician Leadership Development CME Process for System Member of Physician Leadership Council Manage Leadership Pathways & OD Roundtable Team Corp. Systems Specialist – OE Corp. Education Consultant – OE Corp. Education Specialist – OE Corporate VP responsibilities: Creates and Implements Education Strategy Curriculum Development and Instruction for all Leadership Competencies Performance Development for System Leadership Development at all Levels Succession Planning Programs Coordinates SSM University Policy Board Department Strategy & Operational Functions Policy Formation and Dissemination CQIPlus – Education, Projects & Support for System Create Courses in LMS Create & Maintain Catalog System Admin – Performance Development Track Training Metrics Live Meeting Administrator Member of LMS Team Member of Performance Development Teams Curriculum Development and Instruction Manage SMEs & Faculty Administer School at Work Manage Emerging Leaders Member of Performance Development Teams and Educator’s Roundtable Curriculum Development Create Online Courses Integrate Online Courses with LMS Function Maintain all Online Programs Member of LMS Team Web 2.0 Teamwork Quality Companion Database

Purpose of the Learning Function Help SSMHC achieve its mission of exceptional health care services by developing leadership and serving as a resource for leaders throughout the System. “At SSM Health Care, we have a saying that was coined by our former President/CEO Sister Mary Jean Ryan: ‘No matter what your title, no matter what your job…you are an SSM Health Care leader.’ For us, leadership is the process of achieving the goals of the organization in a way that reflects our history, heritage, mission and values. Education and training is an integral part of SSM’s culture, and we continue to invest our resources into developing and retaining our employees because we want to further their intellectual, spiritual and emotional well-being at work and home.” Bill Thompson, President/CEO March 2012 What do we do? Well, we are responsible for leadership development at all levels of the organization. SSM University was created out of MBNQA feedback about four years ago and serve the entities as an educational resource. Our programs are designed to enhance job related and interpersonal skills, offering a wide range of programs, including leadership education for executives and new supervisors, education & development programs for all employees, continuing education for the director/manager, succession planning programs, and ongoing development for everyone.

Baldrige Performance Excellence Model Organizational Profile: Environment, Relationships, and Challenges 2: Strategic Planning 5: Workforce Focus 1: Leadership 7: Results 3: Customer Focus 6: Process Management This section, as we know, is essential for our success. “Quality is achieved through people.” 4: Measurement, Analysis, and Knowledge Management

Workforce Management

Areas of Organizational Effectiveness (OE) Leadership Development Performance Development Process Succession Planning Programs Process Improvement Methodology Other Organizational Effectiveness includes the following: Leadership Development Delivered through SSM University Courses link to Mission, Values, Exceptionals, Competency Model and MBNQA Performance Development Process Content of Goals, 360 Degree feedback and Performance Appraisals Success Factors & Share Point Application system administration Succession Planning Programs School at Work Emerging Leaders Leadership Pathways Advancement in Careers & Education (ACEs) Executive Integration Process Improvement Methodology CQIplus training & certification Other Training Effectiveness Measures LMS Support 12

Areas of Organizational Effectiveness (OE) Leadership Development Performance Development Process Succession Planning Programs Process Improvement Methodology Other SSM OE – Leadership Development The strategic purpose for leadership development creating and implementing learning experiences that inspire and enable leadership practices and generate meaningful change. SSM University is the vehicle with which courses are delivered, and remains to help SSMHC achieve its mission of exceptional health care services by helping to develop leadership throughout the organization. Learning programs are linked to System strategic initiatives and the Leadership Competency Model. 13

Core Curriculum at SSM University Built on our Leadership Competency Model and past accomplishments Designed for leaders who drive 85% of organizational change Uses internal resources in design and as faculty Links courses to our Mission, Values, the “Exceptionals,” Competency Model, and MBNQA Updated continuously via a range of needs analysis inputs All core curriculum or courses offered through SSM University is built on our competency model and past accomplishments. Data supported that the middle management level generates much organizational change, therefore we created these leadership development modules to be our core curriculum for managers and directors (which is updated every other year). We realized the untapped expertise in our System and began utilizing senior leaders not only as subject matter experts, but also as faculty. Because of relying on executives such as yourselves, we now have a core curriculum that ties to our mission, values and exceptionals. Be aware—we are always looking for new faculty! 

Needs Diagnosis Process SSM University Policy Board Professional Organizations Universities Fontbonne University ACHE Health Care Advisory Board Press Ganey Healthstream ASQ Organization Capabilities To Implement SSM Strategies SSM Health Care Leadership Competency Model Special Needs Surveys & Executive Fact-Finding SSM Educator & OD Roundtables; CQI Workgroup SSM Satisfaction Results & Drivers LMS Performance Development Results SSM Functional Groups Organizational Development & Curriculum Plan 101 Leader Series 201 Leader Series Leader Development Programs Physician Leadership Other Nursing Physicians Human Resources IHT CQI Other

SSM Training Effectiveness Level 1: Reactions Level 2: Learning Level 3: Behavior Level 4: Results Feedback surveys for all courses Overall Satisfaction Relevancy/applicability to job Accomplishment of learning objectives Semi-annual survey of titled leaders CQI needs assessments Special needs assessments Testing (certain courses) Performance demonstration (some courses) Learning applications (most courses) Performance demonstrations (some courses) Documenting, tracking and sharing of learning applications All CQI courses All leader development programs Conduct surveys to assess behavioral change associated with learning objectives Document and track learning goals within the Performance Development Process Assess changes in organizational performance metrics (e.g. financial, operational, patient, and employee measures, etc.) Special studies on Employee and Physician metrics Document improvements in organizational metrics linked to training application All CQI course applications All leader development programs Key Points: Semi-annual survey of titled leaders at SSM Assesses perceptions of needs and satisfaction with training & developmental offerings Random sample of approximately 300 leaders The July sample elicited a 42% response rate (n=126), representative of titled leaders at SSM Have begun semi-annual assessments for other functional groups as well, related to CQI Some key conclusions this year: Satisfaction with SSM University’s range of developmental offerings is good, but could be expanded to better satisfy approximately one sixth of respondents. “Getting work done through other people” and “achieving quality through employee participation, involvement, and engagement” remain key areas of interest and opportunity for new learning offerings Being sufficiently trained in CQI to apply it in one’s work and having a CQI goal in one’s Passport are related, yet more than one third (38%) of respondents did not feel sufficiently trained in CQI. Blended learning (a blend of face-to-face meeting and online learning) is the most popular learning format for pursuing another degree. The most popular option for choosing to pursue an additional college degree is a Masters or Doctorate in Business Administration.

Mission & Values Based Leadership Champion for Clinical Quality, Patient Safety, Physician Professionalism, and Support of Code of Conduct Leads and Manages Change and Ability to Influence Others Committed to Achieving Results Models AEPC Service Standards Demonstrates Integrity & Courage Develops Self through Personal Growth/Learning Maintains Optimistic (Can Do) Attitude Demonstrates Knowledge of SSM History, Traditions and Catholic Social Teachings Demonstrates Flexibility with Industry Changes Holds Self and Others Accountable Engaging an Exceptional Workforce Exceptional Process Improvement Exceptional Planning Exceptional Financial Stewardship Gives and Receives Feedback Communicates Effectively Coaches & Mentors Others Promotes Teamwork & Achieves Results through Others Addresses & Resolves Conflict Develops Others & Builds Trust Holds Self & Others Accountable for Physician and Employee Satisfaction Comprehends & Utilizes CQI Plus Makes Decisions Based on Data Achieves Results through Process Analysis & Modification Holds Self & Others Accountable For Exceptional Clinical Outcomes, Safety and Patient Satisfaction Participates with Clinical and Admin Leadership in Setting Direction & Goals Demonstrates Critical Thinking Skills Sets Priorities & Allocates Resources Develops / Organizes / Implements Strategic Plans Holds Self & Others Accountable for Achieving Strategic Initiatives Understands Health Care Finance Principles Appropriate to Role Comprehends & Utilizes Budgets & Financial Reports Assumes Risk & Responsibility for Financial Decisions Holds Self & Others Accountable for Financial Results

Growth of Leadership Development at SSM Goal is to develop leaders at ALL levels, regardless of title Tuition reimbursement is available for ALL employees after 6 months of employment 18

Leadership Development SSM University Goal is 1,600 courses in 2012 with 95% satisfaction rate with current series (3rd gen) with ILT, on-line and mobile learning options Continuing 2012 School at Work program in all regions – Collaboration with STLCC for courses beyond graduation (pilot in STL) Informal learning programs very successful with increase in hours “Inside Leadership Council” = 4 hrs “Read to Lead” = 36 hrs “Leaders for Lunch” = 24 hrs “Lifelong Learning” policy increase to 80 hrs in 2013 with more opportunities for hours Physician Leadership Development Program has four levels: New Physician Orientation – Pilot Underway at St. Clare New Physician Leader – Curriculum done July 2012 Ongoing Physician Development – September 2012 Advanced Physician Development – Planning in Progress 19

Areas of Organizational Effectiveness (OE) School at Work (SAW) – Nine-month program for entry level employees to attend courses during work hours to develop leadership & technical skills – Upon graduation, they move to degree-seeking status STLCC & SSM – Created program (pilot) to prepare SAW graduates for college entrance exams through enrollment Emerging Leaders – 10-month leadership development program tailored to the needs of staff and front line leaders to grow into future managers – 95% satisfaction rate with 90% promotion rate upon completion Leadership Pathways – Rigorous, two year development program designed for the top 25 directors to become future executives – 98% satisfaction rate with 92% promotion rate upon completion Executive Integration – Created for new executives to ensure a consistent understanding of our history, mission, values and philosophy of SSM Health Care; and are clear on executive expectations, key operational processes and performance metrics 20

Areas of Organizational Effectiveness (OE) Leadership Development Performance Development Process Succession Planning Programs Process Improvement Methodology Other SSM OE – Leadership Development The strategic purpose for leadership development creating and implementing learning experiences that inspire and enable leadership practices and generate meaningful change. SSM University is the vehicle with which courses are delivered, and remains to help SSMHC achieve its mission of exceptional health care services by helping to develop leadership throughout the organization. Learning programs are linked to System strategic initiatives and the Leadership Competency Model. 21

What is the Performance Development Process? 360 DEGREE FEEDBACK GOAL SETTING Departmental to Support Mission Individual to Develop Leader ANNUAL PERFORMANCE REVIEW DAWN PRESENTS What is the Performance Development Process? Well, it is the automation of goals, 360 Degree Feedback and annual evaluations in Success Factors, the system which houses the process components. Success Factors calls each component a module, and we purchased three main modules. Those modules are: Goal setting – This module is where leaders put in departmental and individual goals. 360 degree feedback process - This is where peers and employees provide feedback based on the leadership competencies. Annual performance review – This is the annual performance reviews which include essential job duties, goals, AEPC service standards and 360 degree results. Put together, these modules make up the automated performance development process. We will look at each of these modules in greater detail in order to better understand the connectivity and to review significant enhancements in each component, including a demonstration of all enhancements in the System.

Translating Mission into Strategy and Action 23

Alignment of Performance Development Process with Strategic/Operational Plans Mission Statement Network Goals Strategic/ Operational Plans Entity Goals Department Plans, Posters & Graphs Department Goals DAWN PRESENTS This is a visual depiction that shows how everything is aligned, coordinated and integrated with the mission. Cascading from the mission, to the strategic and operational plans at the regional and entity basis, to the department level goals, to the individual goals to support these plans. From there, you can see the link from goal achievement to the performance development process. The performance development process includes input of department & individual goals, the 360 process and annual evaluations. One of the biggest enhancements to SF is the ability to print monthly poster graphs out of the system! Let’s take a moment to discuss the poster and passport process and how it links to Success Factors, the system that we utilize for the Performance Development Process. Managers & directors, which are Success Factors users, will be focused on the global perspective of the goal or outcome measures, while the department employees (who would not be typical SF users) would be focused on the department poster which lists the process measures to get to the outcome. For instance, let's use weight watchers as an example. The participants get weighed monthly, but the 'in process' measures daily include caloric intake and minutes exercised. The program manager is looking at total pounds lost. HENCE, AS A DEPARTMENT LEADER YOUR INDIVIDUAL GOALS SHOULD BE THAT OF YOUR DEPARTMENT AND WHAT GOES ON YOUR POSTER. Performance Development Process (Goals, 360 And Evaluations) Passports 24

Connecting Our Work What “we” will do as a department to improve performance What “I” will do to support the department’s improvement goals

Areas of Organizational Effectiveness (OE) Leadership Development Performance Development Process Succession Planning Programs Process Improvement Methodology Other SSM OE – Leadership Development The strategic purpose for leadership development creating and implementing learning experiences that inspire and enable leadership practices and generate meaningful change. SSM University is the vehicle with which courses are delivered, and remains to help SSMHC achieve its mission of exceptional health care services by helping to develop leadership throughout the organization. Learning programs are linked to System strategic initiatives and the Leadership Competency Model. 26

Succession Planning Programs Emerging Leaders In third year, with approximately 150 participants each cycle Approximately two additional training programs per year for alumni Leadership Pathways In fourth year, with approximately 25 participants at one time Alumni enter the ACEs Program Advancement of Careers & Education (ACEs) Began March 2011 – Will continue to grow due to incoming LP graduates Program changes include two courses per year Success is dependent upon the individual Executive Integration Program for new executives to better understand expectations of their role, SSM history, governance, key operational & strategic processes, etc.

Purpose of Emerging Leaders & Leadership Pathways Improve overall quality of high potential leaders Provide overview of talent in the organization Repository of information regarding employee ability and performance coupled with career interests Provide recruiting information when key positions are open Identifies key developmental areas Provides opportunity for long term development of high potential individuals: Training Coaching Developmental assignments Networking and visibility

Areas of Organizational Effectiveness (OE) Leadership Development Performance Development Process Succession Planning Programs Process Improvement Methodology Other SSM OE – Leadership Development The strategic purpose for leadership development creating and implementing learning experiences that inspire and enable leadership practices and generate meaningful change. SSM University is the vehicle with which courses are delivered, and remains to help SSMHC achieve its mission of exceptional health care services by helping to develop leadership throughout the organization. Learning programs are linked to System strategic initiatives and the Leadership Competency Model. 29

Areas of Organizational Effectiveness (OE) Continuous Process Improvement (CQIplus) SSM utilizes the CQIplus model for designing, innovating and improving work processes to meet key customer/patient requirements and achieve better performance, reduce variability, and improve outcomes. This model is based on SSM’s five quality principles: Patients and other customers are our first priority Quality is achieved through people All work is part of a process Decisions should be based on facts Quality requires continuous improvement 30

We Use CQIplus to Improve The Science of Becoming Exceptional

Applied CQIplus Education Titled Leaders Teams and Departments Executives Individual Contributors Physicians CQIplus Overview & Simulation Applying Lean Principles for Process Improvement Process Management (Module 5) Operational Team Leader Training (OTL) Project Team Leader Training (PTL) Advanced Project Team Leader Training (APTL) CQIplus for Executives CQIplus for Physicians Additional CQI Related Training – All Staff Creativity & Innovation Leading and Managing Change Key Process Metrics Measuring Health Care Quality Through Statistical Process Control

Workforce-Level Integration Improvement Goals included in Passport Participates in CQI Teams Training in CQIplus Tools & Methods

Entity/Region Level Integration All AC members Champion CQI Projects PTL Projects in Every Department CQI Projects Support Strategic & Operational Plans CQI Metrics Monitored by AC CQI Director Input into Strategic & Operational Plans Entity Teams Participate in Regional & System Level Sharing Events

System-Level Integration Educational Curricula: Staff OTL PTL/ATL Train-The Trainer, Curriculum Administration, & Evaluation Organizational Learning/Performance Improvement Interventions Entity-Level Unit/dept.-level Training Policy CQI Project Tracking & Metrics CQI Mentoring & Coaching Community Building & Knowledge Transfer CQI Directors CQI Practitioners/PTLs

Science in a Toolbox Team Facilitation Tools Lean Tools Six-Sigma Tools Change Management Tools CQIplus is a set of tools, techniques and training to improve processes. Depending on the problem or opportunity identified, teams use the appropriate mix of tools to achieve the project objectives. This “Mix” is the Methodology.

Why Focus on Variation? Our patients and other customers don’t feel the average they feel the variation ! S P R Average E A D

How Do We Know We Are Effective?

Performance Management: Linkage of PIR to Other Performance Reports

Performance Management: How Our Data Links With Our Planning Process

More Than Just Data… Why do we collect the information we do? Analysis Communication Application Data Information Knowledge Wisdom Why do we collect the information we do? What do we do with it? How do we use it to set goals? How do we share it? How do we ensure that it is accurate and timely? But it’s more than just data

Areas of Organizational Effectiveness (OE) Leadership Development Performance Development Process Succession Planning Programs Process Improvement Methodology Other SSM OE – Leadership Development The strategic purpose for leadership development creating and implementing learning experiences that inspire and enable leadership practices and generate meaningful change. SSM University is the vehicle with which courses are delivered, and remains to help SSMHC achieve its mission of exceptional health care services by helping to develop leadership throughout the organization. Learning programs are linked to System strategic initiatives and the Leadership Competency Model. 42

Other ICD-10 training under way Created ‘LMS Road Show’ to educate new and current users on system functionality Installation of Badge Card Readers for easy course registration & influenza vaccination processing Working with IHT on single sign-on for all physicians into LMS Training effectiveness measures noted as strength on MQA & MBNQA Feedback Reports Continue to refine the way in which we measure & deliver training so as to assess the business effects of the training 43

Questions? That’s it! Does anyone have any questions?