Tuesday, January 15, 2013

Transcription

1 Tuesday, January 15, 2013 Board Strategic & Facilities Planning Committee Meeting 456 E. Grand Avenue 6:00 P.M. Escondido, CA (Dinner will be available for Board members and invited guests) Mins Page Call to Order Public Comments 1. * Approval of September 18 th, 2012 Meeting Minutes * FY13 Quarter 2 Initiatives Review January 2013 Strategic Planning Retreat Update Adjournment Distribution: Steve Yerxa, Chairperson Linda Greer Ted Kleiter Jeff Griffith, Alternate Michael Covert, CEO Alan Conrad, M.D. Hue Le L_BOD Michael Shanahan L_EXEC_MGT_TEAM_MTNG NOTE: Asterisks indicate anticipated action; action is not limited to those designated items. If you have a disability please notify us at hours prior to the event, so that we may provide reasonable accommodations."

2 Palomar Health BOARD OF DIRECTORS STRATEGIC PLANNING COMMITTEE Palomar Health 456 E. Grand Ave, Escondido, CA September 18 th, 2012 Meeting Minutes AGENDA ITEM DISCUSSION CONCLUSION / ACTION CALL TO ORDER 6:00P.M. FOLLOW- UP ESTABLISHMENT OF QUORUM NOTICE OF MEETING PUBLIC COMMENTS Present: Directors Kleiter, Bassett, Greer, Kaufman, Yerxa and Rivera The notice of meeting was mailed consistent with legal requirements. No public comments were noted. 1. MINUTES The minutes from the June 19 th 2012 Strategic Planning Committee meeting were approved at the July 9 th Full Board meeting. 2. FY12 Initiatives Final Final review of the Fiscal Year 2012 Strategic Initiatives as follows: Update Gerald Bracht, PMC Chief Administrative Officer, presented initiative 1.1 (a) - Grow Volume in Key Areas. Mr. Bracht stated that the initiative met maximum. Gerald Bracht, PMC Chief Administrative Officer, presented initiative 1.1 (b) - Grow Net Primary Care Base. Mr. Bracht stated that the initiative met maximum. Opal Reinbold, Chief Quality Officer, presented initiative 1.2 (a) - Achieve Maximum Value Based Purchasing (VBP) Reimbursement for CMS Core Process Measures. Ms. Reinbold stated that the initiative met target. Michael Covert, President and CEO, presented initiative 1.3 on behalf of Ann Braun (a) - Realize Capital Campaign Goals. Mr. Covert stated that the initiative did not meet threshold. Opal Reinbold, Chief Quality Officer, presented initiative 2.1 (b) - Integrate, Coordinate, and Redesign Key Processes. Ms. Reinbold stated that the initiative met target. Michael Covert, President and CEO, presented initiative 2.1 (c) - Seek Out Innovations to Support Redesign of Key Processes. Mr. Covert stated that the initiative met target. Paul Peabody, Chief Information Officer, presented 2.1 (d) - Implement Meaningful Use Criteria for Electronic Health Record. Mr. Peabody stated that the initiative met target. Sheila Brown, PHDC Chief Administrative Officer, presented initiative 2.2 (a) -

3 AGENDA ITEM DISCUSSION CONCLUSION / ACTION Increase Patient Loyalty. Ms. Brown stated that the initiative did not meet threshold. FOLLOW- UP 3. FY13 Initiatives Quarter 1 Update Opal Reinbold, Chief Quality Officer, presented initiative 2.2 (b) - Continue to Enhance the Culture of Patient Safety Through Integration with all Key PPH Initiatives and by Using National Best Practices. Brenda Turner, Chief Human Resource Officer, presented initiative 2.2 (c) - Create a Culture of High Employee Engagement. Ms. Turner stated that the initiative exceeded maximum. Duane Buringrud, Chief Medical Quality Officer, presented initiative 2.2 (d) - Create a Culture of High Physician Engagement. Dr. Buringrud stated that the initiative met threshold. Lorie Shoemaker, Chief Nurse Executive, presented initiative 2.3 (a) - Realize Transition and Move Plan for PMC West. Ms. Shoemaker stated that the initiative met target. Sheila Brown, PHDC Chief Administrative Officer, presented initiative 2.3 (b) - Create a Destination Campus at PMC Downtown. Ms. Brown stated that the initiative met target. Review of the Q1 Fiscal Year 2013 Strategic Initiatives updates as follows: Opal Reinbold, Chief Quality Officer, presented an update on initiative 1. - Create a Culture of Accountability for Engagement, Quality, Safety and Service. Two groups attended the VHA/IHI Leadership Quality Session VHI/IHI Home Team and Travel Teams populated; kick-off meeting held on August 27 th. Two patient safety outcomes measures questions were added to the AHRQ National Patient Safety survey. Ms. Reinbold stated that work on Milestone 2 create a plan of action for inclusion of patients and families into the process for improving the patient experience will commence shortly Sheila Brown, PHDC Chief Administrative Officer, presented an update on initiative 2. - Stabilize and Optimize Operations PMC & Palomar Health Downtown. Patients successfully moved on 8/19 Sentact system in use to collect operational issues, prioritize and address. The entries to date are being consolidated for prioritization. Coordinating Council of Leaders established and meeting weekly to align response to common issues. Transition Champions engaged in post-move stabilization with staff. Escondido Surgery Center relocated on 9/6/2012 Ms. Brown stated that Ms. Reinbold to present survey data at the October 23 rd Annual Board Quality Review Committee meeting

4 AGENDA ITEM DISCUSSION CONCLUSION / ACTION Milestones 1 6 are already completed (with the exception of number 4). The initiative is halfway to target within the first quarter of the fiscal year. FOLLOW- UP Robert Hemker, Chief Financial Officer, presented an update on initiative 3. - Expense Management. Milestone #1: The HR Strategic plan has been developed and is being implemented. Milestone #2: Savings opportunity discussions and strategies underway with key members of the medical staff and supply chain services department. Milestone #5: Multidisciplinary work-team completed planning meeting July 18 th, including assessment of current state, needs and interrelationships. Mr. Hemker commented that competing priorities will impact when this initiative will kick in, with economic benefits from the initiative expected to be realized in the 2 nd and 3 rd quarter. He noted that Opal and Shannon have revitalized the utilization review committee; data will direct the efforts and cue responses. The goals will be aligned; nurse leaders to also bubble up ideas this year. Duane Buringrud, Chief Medical Quality Officer, presented an update on initiative 4. - Strengthen Physician Leadership and Integration. Facilitate monthly Physician Leadership Council meetings Assessing new Medical Director contracts Develop Assessment Tool for Physician Leadership skills RN and physician collaborative rounding will build bridges to drive patient satisfaction and uncover opportunities for improvement. Mr. Covert suggested that a form of integration and follow up should be in place for when these issues are uncovered. Gerald Bracht, PMC Chief Administrative Officer, presented an update on initiative 5. - Grow Business. Milestone 1 Physician Recruitment is complete. Recruitment the Critical Care contract is almost signed for start October 1 with a new hire committed in November. Neurologist and EP physician recruitment completed. Neurosurgery and hand surgery outstanding. Primary Care Development - One physician has been recruited to Graybill and is working. Also, exploring a link with OB/GYN up the 15 corridor as well as the Laborist group has brought in two new female physicians to grow the model. Net when staff applications complete +2. New Program Development - EP and Valve Clinic business plans approved, with January as target for commencing. Health System purchase of 5% stake in RB surgery Center is completed.

5 AGENDA ITEM DISCUSSION CONCLUSION / ACTION Areas of Focus results for first two months show behind target by - 9.6%, likely due to the PMC West move. Target areas above projection are GYN Robotics, Joint Replacement, Heart Surgery and Breast Surgery. 4. External Health System Relationships Michael Covert, President and CEO, reported on the recent Loma Linda University Medical Center and Murrieta Campus site visit attended by Palomar Health leadership. He stated that there are many opportunities to align our goals with theirs, and to participate in being part of the inland healthcare network. FOLLOW- UP Site visit participant roundtable input: Begin with small ventures so each organization may gain a comfort level; then expand from that platform. Confirm that Loma Linda is not invested in any partnerships that would draw market share from Palomar Health. Working with Loma Linda would be of benefit to our Managed Care program. Loma Linda is on the same trajectory re: Accountable Care Organization status as Palomar Health. Loma Linda is thinking ahead toward strategy partners who can cover frontier spaces. They have the hub and core but are weaker in outreach Palomar Heath can bring that to table for them (be sure to include Murrieta). Loma Linda currently outsources post-acute care; Palomar Health could help fill this niche. Loma Linda has shown that they are highly flexible in partnering with other organizations; their social culture is excellent. Mr. Covert noted that he will be meeting with the CEO of UCSD Medical Center, and will also extend a reciprocal invitation to Loma Linda to visit the Palomar Health campuses. He allowed there may be other organizations to consider partnering with; those that would be of benefit to our evolution. COMMITTEE MEMBER COMMENTS (IF ANY) FINAL ADJOURNMENT The next Strategic Planning Committee meeting is scheduled for 6:00 p.m. Tuesday, October 16 th, 2012 at Innovation Drive, San Diego, CA Chairman Kleiter adjourned this meeting at 7:49 p.m. SIGNATURES Chairperson Ted Kleiter Committee Secretary Debbie Hollick

6 FY13 Initiative: 1. Create a culture of accountability for engagement, quality, safety and service. Jul 12 Sept 12 Nov 12 Jan 13 Mar 13 May 13 Jun Report Date: September 18, 2012 Reporting Committees: EMT Quality, EMT Service Excellence, BRQC EMT Sponsors: Opal Reinbold/Lorie Shoemaker Initiative Managers: Tina Pope, Deborah Barnes, Leslie Solomon 1. HCAHPS Real Time Top Box Results for Rate Hospital 0-10 for each hospital. FY13 Last Quarter (4/13-6/13) 2. Management Support for Patient Safety - Increase the current baseline (71.9%) per annual survey results Supervisor/Manager actions promote safety - Increase the current baseline (73.2%) per annual survey results Milestones: 1. Participate in the VHA WC IHI Leadership Quality Academy Collaborative to identify strategies and best practices for improvement. (18 months) 2. Create a plan of action for inclusion of patients and families into the process for improving the patient experience. 3. Create a Customer Focused Accountability Dashboard to hardwire standards. 4. Develop a plan to engage the hearts and minds of staff and medical staff in developing respectful partnerships with patients/families and each other. 5. Conduct AHRQ National Patient Safety Survey 6. Reinforce the use of leadership coaching skills to commend and correct behavioral standards in real time. (throughout the year) Initiative Budget: Budgeted Budget Status: PDSA Cycles in process for nurse communication, physician communication and executive leadership rounding Patient and Family-Centered Care (PFCC) definition approved by Home team Elevator speech for PFCC developed; education to staff in process Adaptive Design Champions identified and trained on methodology Patient stories integrated into key organizational meetings Initiative Risks: Competing priorities Organization in transition 1. HCAHPS Outcomes: Threshold - 50% Top Box Percentage for both hospitals Target - 75% Top Box Percentage for both hospitals Maximum - 80% Top Box Percentage for both hospitals FY2013 Q1 Results: PMC = 53% FY2013 Q1 Results: POM = 66% FY2013 Q2 Results: PMC = pending FY2013 Q2 Results: POM = pending 2. Patient Safety Outcomes: current baseline + the percentage Management support for patient safety Baseline 71.9% Threshold - 7% Target - 10% Maximum - 12% Supervisors/Managers actions promote patient safety - Baseline 73.2% Threshold - 7% Target - 10% Maximum - 12%

7 FY13 Initiative: 2. Stabilize and Optimize Operations PMC & Palomar Health Downtown Campus Report Date: September 18, 2012 Reporting Committees: Board Strategic Planning Cmte, EMT Transformation Cmte EMT Sponsor: Sheila Brown, Gerald Bracht Initiative Manager: TBD Completion of Milestones Milestones: 1. Establish mechanism to identify, prioritize, resolve and track issues post move 2. Complete successful patient move to PMC on Evolve Physician Advisory Council charter to create a joint physician/hospital leader council to assure safe continuing operations at PHDC 4. Re-purpose executive rounding to focus on Transition and Service Excellence 5. Re-purpose Transition Champions for post occupancy issues and actions identification and communication 6. Complete evaluation and possible transition of Escondido Surgery Center to Palomar Health Downtown Campus 7. Integrate transformation component into Culture Forums planning 8. Submit PHDC plan including business cases for program/service optimization and expansion 9. Conduct drills simulating patient care scenarios between the campuses. Create a plan for ongoing competency maintenance 10. Submit for approval the 5 year PHDC facility capital plan 6 Jul 12 Sept 12 Nov 12 Jan 13 Mar 13 May 13 Jun Initiative Budget: Budget Budget Status: TBD Patients successfully moved on 8/19 Sentac system in use to collect operational issues, prioritize and address. The entries to date are being consolidated for prioritization. Coordinating Council of Leaders established and meeting weekly to align response to common issues. Transition Champions engaged in post-move stabilization with staff. Escondido Surgery Center relocated on 9/6/2012. Initiative Risks: Funding Internal Resource Capacity Process Re-design Target 90% Completion of Milestones Maximum 100% Completion of Milestones Milestones continued: 11. Hold a grand reopening of PHDC for the community 12. Submit plan to celebrate the 1 year anniversary of PMC-West 13. Continue external communication efforts to distinguish campuses

8 FY13 Initiative: 3. Expense Management Jul 12 Sept 12 Nov 12 Jan 13 Mar 13 May 13 Jun A B Report Date: January 15, 2013 Reporting Committees: Board Finance and Board HR; EMT Finance and EMT Workforce EMT Sponsors: Bob Hemker, Brenda Turner Initiative Managers: LeAnne Cooney, Paul Peabody Expense reduction of $2.5 million from current FY12 baseline Milestones: 1. Design and begin implementing a strategic workforce plan - Evaluate make/buy decisions (consultants, SMEs, etc.) - Evaluate skill mix, work status, premium pay - Evaluate and implement tools to manage labor expense (i.e., position control, minimum core staffing, labor standards, leadership development) - Evaluate benefit plan structure/strategy 2. Evaluate and begin implementation of consensus driven Physician Preference Item opportunities 3. Continue to implement an effective and cost-efficient patient throughput process 4. Develop Union contract structure strategy (4A) and Finalize contract negotiations (4B) 5. Implement an effective multidisciplinary decision support system 6. Evaluate medication management (i.e. formulary, charge capture, waste) 7. Align the efforts of Medical Directors, hospital based physicians, hospitalists, laborists and intensivists with the financial objectives of the organization Initiative Budget: Included in FY13 Operating Budget Budget Status: Milestone #1: Research and reporting has been developed to evaluate labor issues. The Labor Optimization Committee is being reformed with meetings beginning in January. Milestone #2: Initial strategy discussions (1 st Qtr) with key members of the medical staff and supply chain services department. Discussions underway on EndoMechanical product opportunities. Pending discussions on Spine, Peripheral Interventional, Diagnostic Cardiology, and Electrophysiology product opportunities. Milestone #4: Areas of focus have been identified for negotiations which begin the 2 nd week of January. Milestone #5: Multidisciplinary work-team completed planning meeting July18 th including assessment of current state, needs and interrelationships. Milestone #6: Formulary evaluated for cost saving opportunities and submitted through P&T Committee. Charge capture optimization underway. New regulation (AB377) passed to allow centralization of products and services - implementation underway. Initiative Risks: Competing priorities of Leaders during first and second quarters for move to and operationalization of Palomar Medical Center Threshold $2.0 million Target $2.5 million Maximum $3.0 million

9 FY13 Initiative: 4. Strengthen Physician Leadership and Integration Jul 12 Sept 12 Nov 12 Jan 13 Mar 13 May 13 Jun Report Date: January 15, 2013 Reporting Committees: Board Strategic EMT Sponsor: David Tam, MD, Duane Buringrud, MD Initiative Manager: Leslie Solomon Physician Leadership Assessment Score Milestones: 1. Create and Charter a Physician Leadership Council 2. Prepare and execute a Physician Leadership Skills Assessment 3. Review results of Assessment and identify targeted areas for improvement 4. Develop and implement a comprehensive training module for Physician Leaders 5. Modify / Develop Contract addendum for Medical Directors 6. Reassess Physician Leadership Skills Initiative Budget: Current Physician Development Funds Budget Status: TBD Facilitate monthly Physician Leadership Council meetings Assessing new Medical Director contracts Develop Assessment Tool for Physician Leadership skills Initiative Risks: Medical Staff transitioning to PMC-W Identification of applicable Physician Leadership Skills Assessment Tool Nursing Management Structure not completed Medical Directors not fully identified Improvement of Physician Leadership Skills Aggregate Score Threshold 10 % improvement Target 15 % improvement Maximum 20 % improvement

10 FY13 Initiative: 5. Grow Business Jul 12 Sept 12 Nov 12 Jan 13 Mar 13 May 13 Jun Report Date: January 2, 2013 Reporting Committees: Board Finance Cmte, EMT Finance Cmte EMT Sponsor: Gerald Bracht Initiative Managers: Lisa Hudson, Robert Trifunovic, Ann Koeneke, Margie D. Contribution Margin Milestones: 1. Physician Recruitment Recruit 5 specialty physicians to support targeted service lines: Neurosurgery, Hand Surgery, Pulmonary/Critical Care, Neurology, EP. 2. Primary Care Development Expand referral base via primary care recruitment for Arch Health Partners and other aligned medical groups to achieve a minimum net core growth of 3 additional PCPs. Focused PCP sales efforts. 3. New Program Development Submit for approval to proceed 3 new programs: EP, Valve Clinic. 4. Fulfill Sub-initiatives in Areas of Focus: a. Cardiovascular d. Specialized Surgery: Robotics, b. Orthopedic/Spine Bariatric c. Neuroscience 5. Contracting Continue with Managed Care contracting expansion. Initiative Budget: $775,000 Budget Status: 1. Recruitment: Pulmonary/Critical Care, Neurologist, EP physician recruitment completed. UCSD has placed a Neurosurgeon in Dr. Stern office to operate locally at PMC. Additional Neurosurgery recruit for Dr. Stern & Hand Surgeon is still outstanding. 2. Primary Care Development: Two MDs have been brought to Graybill and working. OB group has brought in 2 new (F) physician laborists for model growth along with a replacement for one gone. Net year is a -1 due to the Vista OB group leaving. 100% done for a realignment of a 7 FP group to Arch & proceeding for a solo FP review for purchase. 3. New Program Development: EP and Valve Clinic business plans approved. Feb/Mar is the target date for commencing. Health System purchase of 5% stake in RB surgery Center is completed. 4. Areas of Focus: Results of first (5) months are above target by 7,7%. Target areas at or above projection are Neurosurgery, Joint Replacement, Cath Lab, Cardiology Outpatient,Vascular and Breast Surgery. Below Target is CV Surgery, Spine, Bariatrics, General Med. 5. Contracting: Health Net cap effective Jan 1 with 3 Groups(SCMG,Graybill,ARCH) total of about 8,000 additional live to cap. Sharp Health Plan-in review of cap additional lives 7500 to cap. Aetna, in discussions on a narrow network adding new lives in North County to Palomar Health. Threshold $1.5 M Target $ 2.0 M Maximum - $3.0 M