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

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

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)
Meeting Title Here (on Notes Master)
Service
Quality
People
Finance
Growth
Community
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
© Studer Group®

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

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)
Winning
Execution
Prescriptive To Do’s
Purpose, worthwhile work
and making a difference
Self-Motivation
Courage

10. Evidence-Based LeadershipSM
Rev
Meeting Title Here (on Notes Master)
Breakthrough
Foundation
STUDER GROUP®:
Objective Evaluation System
Leader Development
Must Haves®
Performance Gap
Standardization
Accelerators
Aligned Goals
Aligned Behavior
Aligned Process
Implement an organization- wide staff/leadership evaluation system to hardwire objective accountability (Must Haves®)
(30 pts)
Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results
(15 pts)
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 ManagerTM
Patient Call Manager TM
© Studer Group®

11. Meeting Title Here (on Notes Master)
Case Study
Meeting Title Here (on Notes Master)
Journey of achieving personal and organizational excellence
Becoming
the leader
I’ve always
dreamed of
© Studer Group

12. Why I Care About Making a Difference

13. Building a Culture of Excellence A “Roadmap”

14. 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?”  
Now there is not that much “new” and exciting in this. In fact, there are over 9,000 articles on the internet about customer service. But as one of my favorite CEO’s says here
There is a huge gap between knowing or believing in something and doing it every day.

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

18. choice decisions are based on 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

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

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

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

24. Meeting Title Here (on Notes Master)
CEO’s Top Issues
Meeting Title Here (on Notes Master)
New update
Constant for years
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
Moves up and down
January 11 Modern Healthcare, American College of Healthcare Executives, 2009 Annual CEO Survey of Top Issues Confronting Hospitals; 525 Hospital CEOs
© Studer Group®

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

34. Service is Married to Quality…

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

36. HCAHPS Recommendations
HCAHPS CATEGORY
TACTIC TO MOVE OUTCOME
Doctors always communicated well
Physician Note Pad
Nurses always communicated well
Hourly Rounding
Pain was always well controlled
Patients always received help as soon as they wanted
Staff always explained about medicines before giving them to patients
Key Words at Key Times
Yes, patients were given information about what to do during their recovery
Post Visit Phone Call
Patients who gave a rating of 9 or 10
Leader Rounding on patient
Yes, Patients would definitely recommend the hospital

37. Meeting Title Here (on Notes Master)
Percentile Rank Comparison How do Studer Group Partners Compare vs. Non Partners
Meeting Title Here (on Notes Master)
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.
+22%
+24%
+26%
+20%
+18%
+13%
+7%
+9%
+6%
Studer Group Average includes EBL partners since 2007
Non-partner Average includes all hospitals in the Hospital Compare database with 300 or More Survey Responses
© 2010 Studer Group

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
Meeting Title Here (on Notes Master)
2009
Overall RSFH
99%tile
Corporate Services
100%tile
Bon Secours St. Francis
Roper
Source: South Carolina Hospital, Admissions=25,837 Total beds = 594, vendor = PRC
© Studer Group®

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. Meeting Title Here (on Notes Master)
Leader Rounding on Patients “Did a Nurse Manager Visit You During Your Stay?”
Meeting Title Here (on Notes Master)
New update
n= 608
n= 604
n= 561
n= 601
Tactic and Tool Implemented:
Leader Rounding
Percentile
n= 106
n= 104
n= 96
n= 105
Source: Arizona Hospital, Total beds = 355, Employees = 4,000, Admissions = 10,188; updated 2Q2010
© Studer Group®

48. Meeting Title Here (on Notes Master)
Financial Impact
Meeting Title Here (on Notes Master)
Metric
Impact
Reduction
Falls
Quality
50%
Decubitus Ulcers
14%
First Year Turnover
People
66%
Readmissions
Growth
33%
No Shows
70%
Tardies
60%
Call Lights
38%
© Studer Group®

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 - AIDETSM
Acknowledge I
Introduce D
Duration E
Explanation T
Thank You

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

55. Studer Group – Lessons learned Since 2000
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
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 hardwiredSM
Difference between cookie-cutter approach and evidenced-based leadershipSM

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. Meeting Title Here (on Notes Master)
CEO’s Top Issues
Meeting Title Here (on Notes Master)
New update
Constant for years
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
Moves up and down
January 11 Modern Healthcare, American College of Healthcare Executives, 2009 Annual CEO Survey of Top Issues Confronting Hospitals; 525 Hospital CEOs
© Studer Group®

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

65. Pam Beitlich www.studergroup.com (850) 934-1099
Thank You!
Pam Beitlich
(850)