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1 Driving Accountability through Leader Evaluations and the Monthly Meeting Model Bo Boulenger, MHA CEO, Baptist Hospital of Miami (Miami, FL) Mitch Hagins Coach, Studer Group (Gulf Breeze, FL) Presentation Objectives Tell you what worked at Baptist Hospital of Miami and to show you what you can achieve through greater accountability and using the tools. It will change your organization and your life Studer Group
2 Studer Group
3 Coaching Partnership Miami Style! (Even Tiger Needs a Coach) Preparing for the Headwinds Studer Group
4 State Case for Accountability Change Our patients (via survey results) say we can do better We know process improvement opportunities exist Address how it will affect employees up front and always connect to mission. Change Management Tool: Harvard Business School Leading in Times of Change by: Kerry Bunker and Michael Wakefield Studer Group
5 Accountability Requires Focus Use Important Tools: Monthly meeting model - Trust but verify personally review rounding logs in underperforming departments Use data to evaluate team and individual leader performance Steady and consistent to drive results Studer Group
6 Baptist Hospital of Miami Results Service Weekly Accountability Tool Contains Leader s Names BAPTIST HOSPITAL OF MIAMI Patient Satisfaction Report How to Use this Report Please post these results on the communications board in your unit under the SERVICE pillar by Friday. Carry a copy of this report with you at all times so you can communicate results while rounding with staff and during staff meetings. Our goal is the 90 th percentile for all areas. Outpatient Services # of Quarter-to-date ending on: Feb. 23 Mar. 1 surveys returned Inpatient Emergency (Adult) Outpatient Surgery Outpatient Services East Lake - M. Guignard Tower J. Maloney Tower - M. Suarez-Cantillo Tower - L.Lorenzo Tower - C. Bowling Main - M. Guignard Main - R. Cordo Main - S. Ocon Rehab - E. Matalon Women s Srvc - M. Perez BCVI - D. Thomas OB - B. Roberts, M. Perez Peds/PICU - L. McCarthy NICU - M. Olmeda Short Stay - R. Maluf-Contreras ICU - B. Stolzenberg Admissions Rooms Meals Nurses Tests and Treatments Visitors and Family Physicians Hospitalists - Dr. Villanueva Discharge Personal Issues Emergency Department Decady-Alexis 89 ER Peds - M Arrival Nurses Physicians Tests Personal Issues ER Adult - M. Rafuls and S. Balbosa-Saunders Arrival Nurses Physicians Tests Personal Issues # of Quarter-to-date ending on: Feb. 23 Mar. 1 surveys returned Urology Lab - S. Callis Radiation Therapy - G. Weiss Sleep Center - A. Vinent Nuclear Medicine - S. Bracci PET - S. Bracci Pulmonary - A. Vinent BCVI - J. Kiah & D. Rodríguez Endoscopy - D. Phillips Ultrasound - S. Bracci CT - S. Callis Oncology - C. Bowling Plain films/flouro - S. Callis EEG - S. Holan OP Ortho Rehab - C. Larco OP Neuro Rehab - R. Mojica Registration Facility Test and Treatments Personal Issues Registration Areas IP/OP Registration K. Folkman OPS/BCVI Registration M. Sousa ED Registration - M. Basden HCAHPS Overall Rating Would you recommend HCAHPS Results are % of Top Box Responses Priority Index Focus Quarter-to-date: Inpatient Outpatient Surgery Outpatient Services Response to concerns n/a and complaints Emergency Studer Group
7 Service - Patient Satisfaction Percentile Ranking P e rc e n tile R a n k th Percentile Q1 FY07 Q2 FY07 Q3 FY07 Q4 FY07 Q1 FY08 Q2 FY08 Inpatient Ambulatory Surgery Outpatient Services Irma Delima Studer Group
8 Service HCAHPS Recommend this Hospital U.S. Average Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Miami Dade Comparison July June 2007 Published March 21, 2008 on National Average: 63% Studer Group
9 US News & World Report -Honor Roll July June 2007 Published March 21, 2008 on National Average: 63% *OTHER MIAMI DADE HOSPITALS DATA NOT AVAILABLE: DOUGLAS GARDENS HOSPITAL, LARKIN COMMUNITY HOSPITAL, PALM SPRINGS GENERAL HOSPITAL, WESTCHESTER HOSPITAL Why Wait? Studer Group
10 Service - Adult ED Satisfaction Scores 100 Percentile Rank Goal FY08 Goal FY Hourly Rounding 2 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug Service Goal #2 Reduce Emergency Department LWBT Minutes Goal = 5.5% Percent FY06 Q1 FY06 Q2 FY06 Q3 FY06 Q4 FY07 Q1 FY07 Q2 FY07 Q3 FY07 Q Studer Group
11 ROI - Emergency Department Hourly Rounding ED Annual Volume Average Patient Revenue Beginning Current ROI 57,500 $ % 5.0% $926,670 Adult Emergency Department Satisfaction Scores APRIL 2nd PERCENTILE AUGUST 79th PERCENTILE 11% 3% 3% VP P 7% F 9% 41% VG F 14% 55% VG G G 30% 28% VP P F G VG Studer Group
12 Studer Group
13 ED "Doctor Overall" Percentile Rank Jan 06 thru August 07 Percentile Rank Goal: 60th percentile (100%) Hourly Rounding New Med. Dir. J 06 F M A M J J A S O N D J 07 F M A M J J A Month Hospitalist Program Director Studer Group
14 Service Employed Hospitalist Patient Satisfaction rose from the 18 th Percentile To the 98 th Percentile!!! YEAH Service Medical Staff Satisfaction Overall Satisfaction 94 th percentile up from 74 th percentile Satisfaction with Nursing 89 th Percentile from 57 th percentile Would you recommend to friends/family 96 th percentile Studer Group
15 Quality National Quality Measures Top 10% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% FY03 FY 04 FY05 FY06 FY07 FY08 Q1 FY08 Q2 Did not meet Top 10% Met Top 10% Quality March 2008 The Joint Commission Survey Perfect Score on National Patient Safety Goals Studer Group
16 Pre Post Stent Studer Group
17 Quality Core Measure: Percutaneous Coronary Intervention (PCI) Minutes Miami-Dade Fire Rescue Benchmark at 60 min Miami-Dade County Average at 58 min April May June July Aug Sept Oct Nov Dec Jan Feb Mar Total of 111 patients from April to March Quality Zero VAP s for 7 months July 07 to January days with No VAP Studer Group
18 Quality ROI on VAP Reduction March 2006 March 2007 = 11 VAP Cases March 2007 March 2008 = Net Reduction 6 VAP Cases 5 VAP Cases Savings x $40,000 $200,000/Yr * Source = CDC Guidelines for Preventing Healthcare Associated Pneumonia Quality Improve Clinical Resource Utilization: ALOS Fiscal Year '05 - Fiscal Year '07 6 Days Budget ALOS FY 07 = 5.73 Mean FY 05 Q1 FY 05 Q2 FY 05 Q3 FY 05 Q4 FY 06 Q1 FY 06 Q2 FY 06 Q3 FY 06 Q4 FY 07 Q1 FY 07 Q2 FY 07 Q3 FY 07 Q4 FY 08 Q1 ALOS Studer Group
19 Quality Pillar Award Winners! Patient Throughput Team (aka "The Slowskys") Reduced ALOS by 0.5 Days-which had the effect of opening a 40 bed unit at BHM. Awarded the Greatest Customer Impact team by sister Baptist Health Hospitals $2,000,000 ROI Quality Improve Clinical Resource Utilization: Ischemic Stroke LOS LOS (Days) LOS Rounds Started Premier LOS Apr '06 May Jun Jul Aug Sep Oct '06 Nov Dec Jan '07 Feb Mar Apr May Jun Jul Aug Sep Oct '07 Nov Dec LOS Studer Group
20 Quality ROI on Stroke LOS Reduction LOS Reduction of 2.3 Days Direct Cost Reduction of $2,600/case x 500 cases Savings $1,300,000 Patient Falls with Injury Hourly Rounding Initiated 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% Q1 N= Studer Group
21 Falls = $3.9 Million (Settlement value only) 2002-present Total Mean Median Hip (5) $675,000. $135,000. $100,000. Head/brain (4) $2,605,000. $651,250. $465,000. Shoulder (3) $165,000. $55,500. $50,000. Pressure Ulcer % of Adjusted Admissions 1.5 Hourly Rounding Initiated Q1 Total reports Hospital acquired Studer Group
22 Decubitus Ulcers (Settlement value only) present Decubitus (8) Ulcers Total $1,265,000. Mean $158,125. People - Baptist Hospital Change in Top Box Scores GrandMean Percentile: 76th 72nd Baptist Baptist Hospital 2006 Change from Hospital 2007 GrandMean: to (n=2,609) (n=2,829) %5s % 5s Opportunities to learn and grow Progress in last six months Best friend Coworkers committed to quality Mission/Purpose of company My opinions count Encourages development Supervisor/Someone at work cares Recognition last seven days Do what I do best every day Materials and equipment I know what is expected of me at work Note: Percentiles based on Gallup s Q¹² Healthcare database from survey year Copyright , 2007 Gallup, Inc. All rights reserved Studer Group
23 People Old Goal: All Leaders Below Gallup 75% Required to do Impact Plan with staff 13 Leaders above the 75 th did not do an Impact Plan with staff; 10 of 13 went down. Results: 11 did not; of 11 only 4 remain with us. New Goal: Everyone does an Impact Plan with staff. People NDNQI RN Survey Job Enjoyment Scale T-Score Baptist Hospital All Units Average T-Score: <40 low satisfaction; mod. Satisfaction >60 high satisfaction Top Quartile Studer Group
24 Finance Hospital Margin 8.0% 7.7% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 3.3% 2.3% 0.0% '07 Actual '07 Budget '06 Actual Growth Develop Blood Conservation Program Surgeries Outpatient Procedures ED Volume with Efficiency Improvements Studer Group
25 Growth Growth Studer Group
26 Say Ahhhh... Thank You! Bo Boulenger, MHA CEO, Baptist Hospital of Miami (Miami, FL) Mitch Hagins Coach, StuderGroup (Gulf Breeze, FL) Studer Group
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