Lisa Michaelis Heartland Regional Medical Center Administrator

Lisa Michaelis Heartland Regional Medical Center Administrator
Our Journey Lisa Michaelis Heartland Regional Medical Center Administrator

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

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 3 3

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 4 4

Why We Do what we do It’s my pleasure
Talk about who H is and what we do I think you will see Deep rich journey of discovery That started by understanding the people we serve 6 6

Obesity 65 percent overweight or obese
School district reports an alarming increase in obesity Direct connection between poverty and obesity Let’s talk a little bit about our community. 65% overweight or obese SJSD reports alarming increase in childhood obesity (grade school) Level of poverty in our region is reflected by the rate of free or reduced lunched 50% child SJSD received free or reduced lunches We believe direct connection between poverty and obesity 7 7

Diabetes Nine percent of people in St. Joseph live with diabetes
In the under $15,000 bracket, rate soars to nearly 21 percent Almost 9 percent of people in St. Joseph live with diabetes. The most concerning statistic is that in the under $15,000 income bracket, the diabetes rate soars to nearly 21 %. Most concerning to us. 8 8

Smoking 1 out of 4 people in St. Joseph smoke …
Under $15,000 income bracket, the smoking rate doubles! 1 out of 4 people in St. Joseph smoke! This is well above the national average. In the under $15,000 income bracket , the smoking rate in St. Joseph DOUBLES! 9 9

Our community needs more than a hospital
In responding to these problems, we realized our approach to health care had to be much more than the diagnosis and treatment of acute illness. We realized that we must address unhealthy choices, low education and poverty if we were to improve the health of people in our community. Our community needed more than a hospital. 10 10

because we care Social Responsibility
Included in Strategic Planning Process Community health needs assessment Listen to the voice of the customer because we care Heartland Health’s leadership has always felt very strongly about social responsibility. For many years during the Strategic Planning Process, we conducted a community health needs assessment. The assessment allowed us to listen to our community and it was then that we realized health care begins much sooner than when a patient walks through our doors. 11 11 11

Our Solution – Heartland’s Health Pyramid
Our solution was the Heartland’s Health Pyramid. The Health Pyramid allows all four entities, (HRMC,HC,HF, CHIS) to fully function as a fully integrated health delivery system working towards our ultimate goal – best, safest, healthy, and productive. Most health–care organizations focus on best/ safe We understand that if we wait until you are a cancer patient or a heart attack patient in our hospital we have failed. Our vision for health care is not just a hospital or clinic. It is to educate, partner with community and be accountable for our outcomes 12 12

The Foundation of our Health Pyramid
Let’s start at the base, or the foundation of the Health Pyramid, which IS our foundation. HF focuses on improving health community. HF assumes a very different role than most hospitals found. Most raise $ for the hospital. HF addresses social factors known to be the drivers of poor health, low education and proverty. HF thinks ahead ………knowing that if you are going to change the future healthcare, you have to start with the future. 13 13

EmPower Plant 89 percent of students say they can make a difference
Because education and income level are directly related to the health of our population — Heartland Foundation has programs such as emPower Plant. The emPower Plant provides a hands-on situational education to students on the brink of adulthood. This is the age they begin to decide how engaged they will be in their neighborhoods After successfully completing curriculum, 89% students say they can make a difference The emPower Plant program provides a hands–on experience for students on the brink of adulthood 14 14

Innovative Solutions Youth Health Partnership
Increase childhood immunizations and well–child exams Reduce teen pregnancy Improve oral health care The Health Express •Heartland Foundation partners with local schools to start a healthy life at an early age •We developed youth health partnership which includes initiatives to increase immunization, increase well child exams, decrease teen pregnancies, and increase oral health 15 15

The Middle of our Health Pyramid
In the middle of the Health Pyramid we have created many programs that give individuals the tools to improve their health. 16

Innovative Programs Pound Plunge — 12–week, team approach, weight loss challenge National model for community health improvement events Take pound plunge for example… We created a 12-week weight loss program. Just ending its 5th year. The Pound Plunge has helped more than 7,000 people lose 57,000 pounds. National model for improving health status one person at a time. 17 17

Innovative Partnerships and Solutions
Community Health Improvement Solutions’ Wellness Connections program creates health and wellness plans for individual businesses Another way to improve individual health is by engaging businesses. CHIS is our entity that focuses on the middle pyramid – improving individual health 1 component of CHIS is wellness connections program The wellness staff work with local businesses to create a plan to improve health of their workforce. 18 18

The Tip of our Health Pyramid
The tip of the Pyramid is best and safest. HRMC and HC cares for people with acute and chronic illnesses in a variety of settings. 19 19

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

Why Baldrige We’ve talked about today
I’d like to open up a little and talk about what propelled us to this point Ugly 21 21

The First Few Steps Recognition Change course • 22 22 22

Early Approach CEO support Few key leaders spearheaded efforts
Small group assisted • Research - articles - books - field trips • Small group, guiding coalition • Understand what was possible • CEO not sole force • Cx that allows (regardless of leadership changes) the organization to continue its journey • During our site visit CEO here a few weeks • We continue to function 23

Early Changes Organizational Structure Measurement Quality focus
Growth Leadership Changes • Underwent immense amount of change - 9 layers to 4 (not nimble) - leaders reapplied based on competencies - New evaluation system • BSC - What customers saying - clinical quality - outside comparisons • CMS pilot - The Best - Outside • Heartland tripled in size - added over 100 doctors - 30 clinics - 400 mill facility - workforce expanded • Guiding coalition - 5, 1 left 24

Engaging Others Excellence in Missouri Foundation Balanced scorecards
Processes Customers Leadership Performance Improvement Across entire organization • Began with MO Excellence Foundation - Balanced scorecards - Processes - Customers - Leadership • Assess self against State and National Criteria • Across entire organization 25

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

More Changes Shifted to more of a team approach
Category leads and teams formed Focus on integration and learning We made 2 significant improvements: • category leads instead of having a guiding coalitions, • category leads to put teams together and to incorporate the criteria deeper into the organization. • we spent time understanding how one organization affected another organization • how the criteria and the processes were taken to a further and deeper level inside the organization • Interdependency of all the criteria and categories • Focusing on integration • deployment and the category leads, helped us have even better results 27 27

Voice of our Customers Let’s discuss next how Baldrige criteria helped Heartland in our pursuit of Service Excellence by Listening to the voice of the customer. 28 28

Health Pyramid Hospital and Clinic Inpatients Outpatients ER Clinics
Community Health Improvement Solutions Members Community Heartland Foundation Region I’m sure you have had a chance to see our 3 core competencies These define who we are and what we do It’s at a point where we decide “what do we want to be when we grow up” This is when we begin defining our customer groups Our customer groups defined as : Patient Fmembers community 29 29 29

Leadership System 30 30 30 This is our leadership system
Heartland called organizational architecture This is how we lead our organization At the beginning of our leadership system, this is where we talk about where we are going, what is our vision/mission, our competencies We begin infusing VOC at this point to shape strategy Embedded in leadership system is our management model – how we want to lead and manage Heartland thru our key processes It’s in those key processes where we take those customer requirements and translate those into process requirements Our approach to the organization that we lead and manage through key processes where we have translated customer requirements By carrying out our processes we should be meeting our customer needs So we meet our customer needs thru PI and innovation 30 30 30

Strategic Planning Process
I mentioned strategy This is where we begin looking at customer focus We have an 8 step SPP, robust Steps 1-4 strategic development, last 4 steps strategic deployment Let’s talk about how we blend our customer focus/customer engagement throughout our entire SPP 31 31

Customer Relationship Model (CRM)
3.1 - 1, Customer Relationship Management Model Listening , Inputs and Methods ( 3.2 2) Voice of the Customer Customer Groups Patients Members Community Region SPP Step 8 ( 2.1 1) 6.1 Deploy improvement priorities through the BSC and LEM 90 day acti on plans . Deployment of Strategy and Actions Plans SPP Steps 2 6 ( Conduct reviews to determine customer requirements and assess if services, processes, and improvements are meeting customer needs. Translate results of analysis into priorities fo r improvement. SPP Step 1 ( Review customer inputs and analyze processes to refine feedback mechanisms, customer relationship strategies, and action plans (annual/ongoing). Evaluation and Improvement Analysis and Decision Making Customer Relationship Model (CRM) (2) (3) (5) (1) (4) Our customer relationship model is a high level review of how we understand and manage our customer knowledge and relationships to assure that Voice of the Customer and Engagement is present in all our critical processes in the organization. •See blue #1- If you look in the middle-Customer Groups- you see Patient, member and community-region are the center of our customer universe. •See blue #2- At the top of the model is Voice of the Customer- It includes listening, Inputs and Methods of collecting information from customers •See blue #3- Analysis and decision making- Information is flowing through our planning process, and inside of those steps is where we make sure that the Voice of the customer is connected to the planning process and translates the results into priorities for improvement- Including a vital connection to our Performance improvement process, satisfaction and engagement goals •See blue #4- Deployment of strategy and action plans- Deployment of VOC requirements and results are cascaded through our scorecards-And more importantly into our daily work through our leadership system, 90 day action plans and to our frontline care givers •See blue #5- Evaluation and Improvement – the aim is to review and improve all our listening inputs, as well as, our ability make positive changes •The most important part about the model is that you can see a connection to PII and DAILY WORK 32 32 32

If it’s important to them, it’s important to us.
Customer Groups CRM #1 Now I will quickly describe each part of the model Customer Groups CRM #1 3 customer groups: Patients- ER, OP, IP, HC, Home, Members- Community- Region For the purpose of explaining the model I will focus on the patient- otherwise this gets too long If it’s important to them, it’s important to us. 33 33 33

Listening and Input Methods Inpatient Satisfiers/Priorities
Voice of the Customer Requirements CRM #2 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 >> Inpatient satisfiers/priorities are items in our pt sat measurement syst that related to the requirement The first item in Voice of the Customer is a small section from our application that lists the key customer requirements for patients Patients have 4 major requirements: Comfort, Safety, Courtesy and Efficiency This example breaks down Comfort- Relate Key Requirement to IP Satisfiers to Listening Method Items in pt sat measurement sys that r/t requirement It is important to note that there is there is an annual cycle of review to ensure relevant to customers and improvement for each element 34 34 34

Listening to their concerns
Analysis and Decision Making CMR #3 Collect, review and assess voice of the customer data and inputs Performance improvement The relevant point here is- Multiple streams of information from customers are collected and shared w leadership, board, medical staff and community for appropriate levels of input and action Examples include: Survey data (IP, OP,ER,HC, PIM, physicians, youth), complaint data, community forums, employers, regional referral providers, etc that help to determine Customer Requirements and Goal Setting and Action Planning Listening to their concerns 35 35 35

Continuous Analysis Performance Improvement CRM #3
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 OUR Performance improvement model described in cat 6 is linked to customers as well -PASTE is our most common, everyday, practical continuous improvement tool- it is much like PDCA- PASTE is our homegrown version of the same idea -Paste + is our six sigma process and is reserved for large and complex improvement initiatives and involves black belt support -Jade is our techonolgy design tool also w black belt support Key point = Voice of the customer assessment and deliverables are required for each improvement initiative which assures ongoing connection to the customer Continuous 36 36 36

Deployment Strategy and Plans CRM #4
90-Day action plans, Balanced Scorecard (BSC) and goals Requirements shared with the caregivers, medical staff, board Next is Deployment of Strategy and Action Plans- CRM #4 (blue box 4) The rubber meets the road in demonstrating results in our scorecards and then most importantly into our Leadership System, which includes 90 day action plans which are shared with caregivers and appropriate stakeholders The relevant point for customers is 90 day plans addressing satisfaction and engagement are embedded in the process. 37 37

Evaluation and Improvement CRM #5
Opportunities for improvement Cycles of improvement The last step in the model is Evaluation and Improvement CRM #5 (blue box 5) Part of 90 day plans, the annual review cycle, as well as, our Performance Improvement initiatives and service line evaluations is asking the key questions, about what did we learn? How did it impact the customer? And how can we improve processes for customer engagement and satisfaction 38 38 38

Connection to Purpose –
Customer Engagement Putting it all together

Customer Engagement Patient Member Community Region 40 40 40
Now let’s talk a little bit about customer engagement The reason we choose to engage with customers is to develop trusted life long relationship with the customers. Not only when they are sick and interface with us but all throughout all our customer groups (REGION) Pts/Fam present to us at one of the most vulnerable points in their lives We want to help navigate them through all their treatment options and choices With members, we want to help them with lifestyle choices before illness/sickness hits their families With community, we want to set up health improvement initiatives throughout our entire community With the region we want to develop partnerships with school systems and businesses so we can drive health improvement for our region 40 40 40

Listening Rounding Satisfaction surveys Community perception survey
Focus groups Everything we do involves listening to our customers, both internally with our caregivers and externally with the community we serve. We use several tools to welcome feedback: Rounding with our patients and our caregivers. Satisfaction surveys for both our customers and caregivers. Community perception surveys. And Focus groups. Our voice of the customer tools are the foundation for performance improvement and used in the Strategic Planning Process. Voice of the Customer 41

Patient/Member Engagement
Keywords Discharge calls Behavioral standards Individual care plan Leader goals Leader action plan Rounding with patients, members and caregivers Service recovery Thank you notes Coaching and teaching >> Thank you notes is a tool used to coach and teach effective engagement / drive perf. Key point is to show methods connection to deeper relationship building purpose •Let’s look at engaging pt/fam/members •What we know by looking at our data (and segment it) we know by VOC what they want from us •What we try to do with every encounter is talk through key words (Privacy, inclusion of family) •After acute stay we f/u with phone call - pretty dramatic safety implication - med management – we believe we impart a safe med plan but they are so stressed its amazing the ?’s we get - due to anxiety the translation doesn’t occur so real purpose is safety • At every engagement point with customers we have behavioral standards that we are held by in our organization • We also drive customer engagement thru individual care plans • Every leader has customer engagement goals they are held to with 90 day action plans if not at goal • Engage with customers daily (every patient has daily leader rounds) 42 42 42

Community Engagement Health improvement programs
Community forums–summits Community Alliance Corporate citizenship Youth health Senior health Employee health Lets Change Gears and address Community Engagement- 1 of 3 core compet. Heartland Health was created by the Community and we act like it- It is why we won the 2009 AHA Foster McGaw Award for community service There are several dozen examples… PICK 2 or 3- Health improvement programs- for youth, seniors, work age, weight loss, women, men Community Forums and Summits- 17th Healthy Community summit attracted 1700 people, about half school age kids to hear 3 nationally know speakers last February Community Alliance- participants in local community planning, development and improvement Corporate Citizenship- We invest in local economic development, business parks, United Way, schools, university, and out leaders, staff and doctors are encouraged to participate in civics through community and government boards and agencies Youth Health- EmPower U and youth development, YHP- joint goal accountability for SJSD health improvement- eg healthy weight, well checks, teen pregnancy Senior Health- part of a large network that is improving senior health w positive results in immunizations and others Employer Health- We are responsive to local employers via our recent partnership with Aetna, where they provide insurance and we created an innovative Community Health Improvement Solutions product to supplement the insurance HI Health Improvement programs - Pound Plunge, Diabetes Expo, Women’s Wellness Initiative, Men’s Tune-Up Human Motion Institute – Spine School, Beautiful Bone – Osteoporosis, Golf Clinic, Joint Health Events Patee Market Dental Clinic emPowerU 43 43 43

Regional Engagement Heartland Foundation regional development
Regional electronic medical record Specialty clinics Regional Engagement and Initiatives At the regional level one of the most important things we do is establish long relationships with employers, communities, schools, local governments, universities; and a regional referral network of hospitals, doctors and other caregivers. Examples- pick 2 or 3 Regional EMR Specialty clinicsSupporting other organizations with human resources, financials, technology Heartland Foundation is an innovator and convener of regional community improvement, and youth development CHIS efforts with local and regional employers, as well as, manages 10,000 Medicaid patients w chronic disease AHEC Transfer line Specialty clinics 44 44 44

Customer Satisfaction Results
7.2-1 Patient Customer Satisfaction- Composite Index of IP, OP, ER and Clinic X= Time and Comparative Y= Mean Score Demonstrating steady improvement since 2006 HH patient satisfaction scores are evaluated from the unit/clinic level and rolled up to the organization level and reported on the BSC. This composite index includes IP, OP, ED and HC patient satisfaction. Mean scores and it is slightly above the PG Baldrige index of past winners. PG = Press Ganey 45 45

Inpatient Satisfaction Results
Key Drivers 7.2-2 This is Inpatient Customer Satisfaction X= key drivers of inpatient satisfaction by time and comparison group note Press Ganey and Baldrige Index comparisons Y= Mean score There is a steady improvement since 2006 IP overall is within 2 mean points of both comparatives and has steadily improved each of the key drivers from FY06 to FY09. PG = Press Ganey 46 46 46

Willingness to Recommend

Regional Referrals 48

Net Revenue 49

Connection to Purpose -
Workforce Engagement Let’s discuss next how Baldrige criteria helped Heartland in our pursuit of Service Excellence by engaging our workforce 50 50

Our Caregivers Employees Physicians Volunteers
One thing holds true no matter what you are doing, nothing is possible without the right people It takes all departments, employees, doctors, volunteers, and board members to make a difference. At HH every one is a caregiver Here to serve Employees Physicians Volunteers Everyone is a caregiver at Heartland 52 52

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. Our workforce Approximately 3300 caregivers to support/reinforce our culture of caring: Over 120 employed physicians w/ 250+ members of medical staff And Greater than 500 dedicated, engaged, loyal and community based volunteers Our workforce journey and aspiration Read slide 53 53 53

Heartland’s People Plan: Workforce Alignment
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 Hear Excellence Appearance Responsibility Teamwork •how we bring our Core Competencies and OA to life •OUR PEOPLE PLAN aligned to our organizational core competencies • and encompasses all of our workforce, each entity and is rooted in each aspect of each role and interaction. 54 54

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 •Our People Plan is aligned to our strategy of EOC •measures of capacity (# of caregivers to match need of work) And capability (caregivers w/ right skills, attributes to match need) •Major focus on soft skills. Our HEART Behaviors are the foundational, non-negotiable components of caring for those we serve and team members •We can teach skills/competencies but, cannot teach “niceness” and a “servants heart”. 55 55 55

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 HEART Behaviors Hear – Listen to the Voice of the Customer Excellence – Chase learning and development in order to improve throughout your career Appearance – Establish confidence of your customer through your personal and workplace appearance Responsibility – Come to work on time; meet your deadlines; solve problems Teamwork – Interact effectively within your team and across the organization

Workforce Strategies Alignment
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 • 57 57 57

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 58 58 58

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 •All of our leaders attend quarterly leadership development institutes •implemented a fellowship program in partnership with the Advisory Board. •Six high performing leaders are recognized annually and attend the Washington DC-based program, •30 administrative and physician leaders attend a local fellowship offering—all designed to offer a “mini-MBA” experience in a time efficient manner. •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

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

HEART Behavior Standards
HEART Behaviors: Critical Conversations HEART Behavior Standards •implementation of a model similar to GE’s vitality curve has provided our leaders with learning and tools to conduct crucial conversations •held twice per year to provide feedback to our leaders, caregivers and volunteers relative to our HEART behavioral standards. •Our goals: To recognize, retain and grow our top performers To retain and develop our middle performers To improve or deselect our low performers. •Like many organizations we have attended to our poor performers at the expense of our best performers. •We are now positioned to build our talent pipeline for advanced clinical and technical roles along with management succession •Our learning focus over the past two years has translated to very strong results which we will review later in this presentation. RARELY FREQUENTLY ALWAYS ALWAYS Caregivers go to Staff Development Institutes; are offered stretch assignments and wear an “Always Badge” 61

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 • philosophy on Rewards and Recognition is around providing valued, efficient and effective supports for our workforce at all times including critical times of need that promotes our caring environment. Examples include: Competitive Comp & Benefits Variable Comp Program – SHAARING SUCCESS - Customer Service - Operating Margin Wellness>>we walk the talk here as demonstrated by premium discounts for non-tobacco and BMI Touchstone>>Not only are caregivers crisis covered by also a dependent scholarship program (help dependent = help caregiver) funded by organization based upon .50 cents for every dollar our caregivers give to our local United Way 62 62 62

Physician Engagement 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 •We recognize that the future sustainability of our organization will depend on engaging our physicians to move from a business model based on volume to one focused on providing more value for every healthcare dollar spent. •Physician engagement is a key priority for Heartland. Recognizing this, when our Board of Directors conducted a replacement search for our 25 year tenured CEO, they were highly intent on finding an executive who could not only build on his previous successes, but they wanted a CEO who would clearly focus on improving relationships and engaging physicians at the highest level of our strategic conversations. •Among four outstanding finalists, the Board chose Dr. Mark Laney, signaling a clear commitment to our medical staff that their input would be essential to our future strategic success. His previous Mayo training and executive leadership development not only perpetuates our strong quality focus but also brings a “servant’s heart” to our organization. •Our organizational structure driving clinical quality and service utilizes dyads of service line administrators paired with physician leaders. Our PALS structure is accountable for oversight of quality, performance improvement and the capital expenditures processes. •Finally, just as we have invested extensively in leadership development across the organization, we have established fellowship and physician leadership learning to help our physicians combine their exceptional clinical oversight with the management and business principles to drive our strategic priorities. •As Dr. Laney says, physicians do not make for good employees, but they can be great partners. The investment of time in learning and development forms the basis for more successful partnering into the future 63 63 63

Volunteer Engagement 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 •500+ volunteers, both adult and students present us our opportunity to engage both the workforce members of tomorrow as well as those who have defined our community and continue to have the commitment to serve. •HEART-Servant Expectations •We align our caregiver expectations to those of our volunteers and are increasing the value impact as well. 64 64 64

Volunteer Engagement Auxiliary of the Year
(Missouri Hospital Association)

Caregiver Satisfaction Results

Caregiver Satisfaction
Goal: 80th Percentile COMPARISON Organization 2010 Mean Percentile All Hospital DB (393) FTE DB (22) Baldrige Facilities (12) HH 76.2 83rd 95th 82nd HRMC 75.5 80th 90th 78th HC 79.3 94th 99th CHP/CHIS 80.0 LTACH 66.5 20th 16th 1st HF 71.6 52nd 49th 21st

Caregiver Engagement

Leadership Effectiveness

Percentile performance improved
Physician Engagement Percentile performance improved from the 23rd Decile in 2008 to 81st Decile in 2010! This metric offers our most significant opportunity for improvement. In the past, physician selection, engagement, and development was not aligned with the rest of our development focus. In the past year, we have made organizational and structural changes to centralize much of our physician development and retention and to make sure we align the rest of our organization development and learning to this critical stakeholder group. •Improved %ile performance from 23rd decile to 81st %ile 72 72 72

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 73 73 73

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 We take our feedback from our site-visit and continuing to move forward on our journey. READ SLIDE These cycles of improvement will allow us to further integrate and engage today’s and future members’ of our workforce. 74 74 74

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 75 75

What People are Saying About Us
“Engaged in the community” “Demonstrates performance excellence” “Provides patient safety” “Best in value” Our relentless focus on performance excellence is shown in our results. We have been recognized by several outside entities Top decile EBM 09 Malcolm Baldrige National Quality Award Sole recipient 09 Foster McGaw Award for community engagement 6 time winner of Healthgrades Patient safety award 09 Commonwealth Fund rated us in top 20 of Best Hospitals in the country 2 time winner MQA 3 time winner MO team Quality Award 76 76 76

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 With every step you take, there are lessons learned. Take risks, make mistakes and learning from them has been critical to our success A few lessons: Balance process with relationships (process + passion = a champ) Long term Health Improvement and illness prevention is a model for Health care reform We know it works We’ve seen the results Lead with a servants heart We are here to help people Listen to what they need It takes a team Executives need good staff Doctors need good nurses Hospitals need good doctors Community needs great healthcare All decisions made should answer the ? What is best for the patient Keep focused on doing the right thing 77 77

Key Points Transparency Develop systems and key processes
Listen & Engage Link strategy, customer, workforce and performance improvement I would like to end with 3 points Relentless pursuit of transparency builds trust Be open and honest Value systems and processes If system and process are in place and effective you will meet the needs of those you serve Listen and engage customer groups and workforce Link leadership, PI 78

Register at www.heartland-health.com/baldrige
Heartland Health Sharing Days November 11 – 12, 2010 January 13 – 14, 2011 March 3 - 4, 2011 Register at If you would like to hear more about us….

Lisa Michaelis Heartland Regional Medical Center Administrator

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