Mission Vision Values Overarching Goals

Transcription

1 Mission Vision Values Overarching Goals

2 Who We Are OU Medicine is the partnership among the University of Oklahoma College of Medicine OU Medical Center The Children s Hospital OU Physicians University Hospitals Authority and Trust and the patient care, medical education and research programs and services they provide. 2

3 Our Mission Leading health care 3

4 Our Vision OU Medicine will be the premier enterprise for advancing health care, medical education and research for the community, state and region. Through our combined efforts we strive to improve the lives of all people. 4

5 Our Values We believe that caring for our patients must be at the center of all we do. We act with honesty and integrity. We respect our colleagues and co-workers. We magnify our effectiveness through teamwork. We improve continually through harnessing innovation and encouraging high performance. We believe in open and effective communication. We are committed to providing outstanding educational programs. We will be a leader in the advancement of basic and clinical research. 5

6 Our Overarching Goals Uncompromising Quality Exceptional Service Innovative Education Advancing Knowledge Institutional Strength 6

7 Achieving the Goals of OU Medicine Over the next 3-5 years, OU Medicine will address its overarching goals by concentrating on the following objectives: Uncompromising Quality Achieve superior measurable clinical outcomes. Constant attention to patient safety, comfort and convenience. Ensure efficient and effective clinical operations. Strive to be among the highest ranked health care providers by both regulatory and health care scoring systems. 7

8 Achieving the Goals of OU Medicine Exceptional Service Create a culture of service excellence. Create efficient and convenient access to our health care system for patients and physicians. Introduce the tools necessary to implement better service and coordination of activities. Insist on responsibility, accountability and courtesy. Uphold performance standards across the enterprise to promote consistently positive experiences with OU Medicine for our patients, staff and community. 8

9 Achieving the Goals of OU Medicine Innovative Education Attract, develop and retain outstanding faculty and students. Continually develop and refine the educational programs for students and trainees. Provide modern, up-to-date and technically sophisticated facilities and equipment for contemporary medical education and training. Conduct high quality continuing medical education programs for health care providers. 9

10 Achieving the Goals of OU Medicine Advancing Knowledge Basic and translational research will be concentrated in four broad focus areas: Cancer Diabetes Infectious Diseases and Immunology Neurosciences and Vision Expand and/or create the infrastructure necessary to support enlarging our clinical research programs strategically. Apply our strengths to developing new therapies and new technologies in carefully selected areas. Through the OU Cancer Institute, create a Phase I Clinical Trials program that ultimately can be expanded into other disease areas. 10

11 Achieving the Goals of OU Medicine Institutional Strength Invest in the people, technologies, and facilities that will enable us to achieve our mission, vision and goals. The Children s Hospital will be the recognized regional provider of outstanding services for children s health care. Grow specific programs to better serve patients and physicians throughout our state and region, including: Cancer Diabetes Neurosciences Orthopedics Vascular Medicine Preserve a focus of fiscal responsibility and multidisciplinary planning. 11

12 Pillar Goals Education Research Quality People Service Growth Finance Strive to develop the highest quality medical education programs for all levels of learners Advance medical and scientific knowledge through basic, transitional, and clinical research Strive to be among the highest ranked health care providers by both regulatory and health care scoring systems Attract, develop and retain outstanding staff, physicians, faculty and students Promote consistently positive experiences for our patients, staff and community. Grow the enterprise to better serve patients and physicians and support the fundamental missions of teaching and research Preserve a focus of fiscal responsibility and multidisciplinary planning Yearly Goals & Objectives Change Pillar Goals Remain Constant 12

13 Changing the Culture EXCEL Program Leadership Development Institutes Tools Patient Satisfaction Benchmarks AIDET Rounding Discharge Call Manager Different evaluation methods Others 13

14 Achieving our Vision and Goals If we are to be successful in pursuing our vision and goals We must have leaders at all levels. That is why you are here today. 14

15 SETTING GOALS May 18, 2010

16 What you will learn today Importance of leader accountability and goal alignment 16

17 Reasons initiatives succeed... Clear and focused goals Top Leadership role model behavior Creation of a guiding coalition Sense of urgency Willingness to review and accept the data High and middle performer are retained and low performers are de-selected Attainment of success which re-motivates No excuses 17

18 Reasons initiatives fail Lack of balanced approach 2. Lack of developing leader competencies 3. Lack of objective accountability system 4. Lack of communication -- connecting dots to purpose, worthwhile work and making a difference 5. Lack of a sequenced approach that is hardwired 6. Inability to re-recruit the high and middle performers and de-select low performers 18

19 What happens when When employees are all on the same page, it can create some awesome capabilities Stephen Covey 19

20 What happens when When we fail to establish, clearly communicate and stick to our goals, it s like changing the sheet music after the orchestra sits down. 20

21 By the Numbers Only 58% feel their organization has decided its most important goals Only 44% say it has clearly communicated those goals Only 37% understand the strategic direction 21

22 The Problem - Not a lack of sincerity about goals Execs think that because a strategy benefits the organization, employees will follow mistake #1 Expecting employees to practice organization s philosophy when managers aren t mistake #2 22

23 The Cure - Create goals for leader evaluation that leaders can communicate and report on monthly. Build a pipeline for talent and match behavior and expectations to organization s vision. Walk the talk employees disengage when they spot leaders who are hypocritical. 23

24 Why have leader evaluations based on objective goals? A Must Have for operational excellence Clearly connects the goals of the organization Reduces unnecessary work and duplication of efforts because clear expectations are set Keeps leaders focused on what is really important 24

25 How Organizational Balance is Defined Education Research Quality People Service Growth Finance Integrating and connecting the vision, value and goals of the organization into daily decisions, behaviors and actions 25

26 Strive to develop the highest quality medical education programs for all levels of learners Advance medical and scientific knowledge through basic, transitional, and clinical research Instill and reinforce standards of behavior that will attract, develop and retain outstanding staff, physicians, faculty and students Strive to be among the highest ranked health care providers by both regulatory and health care scoring systems Promote consistently positive experiences for our patients, staff and community Grow the enterprise to better serve patients and physicians and support the fundamental missions of teaching and research Preserve a focus of fiscal responsibility and multidisciplinary planning All programs meet or exceed national benchmarks Increase COM class size by 15% by 2010 Submit CTSA application by October 2008 Increase sponsored research by 8% Reduce COM turnover rate by 5% Maintain a voluntary turnover rate of 18% or less at OUP and OUMC Maintain or achieve top 10% in publicly reported JCAHO Core Measures Improve ease of obtaining test results to 50th percentile OUP : > 89.5 Improve patient satisfaction scores across the enterprise: OUMC to 2 nd quartile Overall score of > 3.51 OUP to 50 th percentile Adult: > 92.1 Children s: > 89.5 Increase interdepartmental and physician satisfaction scores by 2 ½% Grow overall OU Medicine market share by 0.5% Grow hospital admissions by 3% Grow clinic visits by 4% OUMC: Increase net income before taxes by 7.44% over 2007 pre-tax net income OUP: Increase payments by 5% COM: All departments should meet cash reserve goals and have overall operating margin of 5%

27 Strive to develop the highest quality medical education programs for all levels of learners Advance medical and scientific knowledge through basic, translational, and clinical research Instill and reinforce standards of behavior that will attract, develop and retain outstanding staff, physicians, faculty and students Strive to be among the highest ranked health care providers by both regulatory and health care scoring systems Promote consistently positive experiences for our patients, staff and community Grow the enterprise to better serve patients and physicians and support the fundamental missions of teaching and research Preserve a focus of fiscal responsibility and multidisciplinary planning COM: Student educational programs will meet or exceed national performance benchmarks. COM: Residency and fellowship programs will meet or exceed national performance benchmarks. COM: Conduct institutional self-study in preparation for LCME accreditation site visit. COM: Increase sponsored research by 6% COM: Enhance infrastructure to support clinical research COM: Reduce turnover rate by 5% OUP: Maintain a voluntary FT/PT turnover rate of 15% or less OUMC: Decrease voluntary FT/PT turnover rate to 15% or less OUMC: Increase employee engagement to 83% OUMC: Increase performance on publically reported core measures to top 10 th percentile as measured by composite scores for AMI, Heart Failure, Pneumonia, SCIP, Outpatient SCIP and Children s Asthma Care. OUMC: Decrease facility-wide mortality rate to CHOIS benchmark for actual vs. expected mortality OUP: Improve ease of obtaining test results to 50th percentile OUP: Improve patient satisfaction scores to the 60 th percentile OUP: Increase interdepartmental and physician satisfaction scores by 2 ½% OUMC: Achieve inpatient satisfaction rating equal to or greater than HCA % Top 2 Box (9's&10's) for the indicator "Overall Rating of Hospital" OUMC: Achieve consolidated Emergency Dept patient satisfaction rating equal to or greater than HCA % Top 2 Box (9's&10's) for the indicator "Overall Rating of Hospital" OUMC: Increase hospital adjusted admissions by 2% OUP: Grow clinic visits by 3.5% OUMC: Increase net income before taxes by 5% over prior year. OUP: Increase payments by 4% COM: All departments will meet cash reserve goals and have overall operating margin of 5%

28 What is goal alignment? Insuring that individual leader activities are consistent with the goals of the organization. 28

29 ENTERPRISE GOALS ENTITY GOALS DIVISION / DEPT GOALS LEADER / UNIT GOALS

30 Why Alignment is Important Builds relationships Clearly connects the values, goals and vision of the organization Aligns individual activities with the goals of the organization and focuses the energy of the organization Reduces rework, redundancy and duplication Harnesses the creative energy of the organization Creates a sense of urgency Builds trust Sets up a Sustainable - Results Driven culture Aligns leader actions to the goals of the organization 30

31 Goal Development

32 Goal Development Process for OU MEDICINE Senior leaders set entity or area goals Goals are shared with all leaders Each leader determine their goals and preliminary weights Goals are reviewed by each leader s reporting senior Goals are shared to insure everyone's needs are addressed Leaders finalize their evaluations 32

33 Goal Development Tips Develop quantitative goals. Use language that everyone understands. Connect goals to purpose. Fewer, rather than more goals, are better. 33

34 Non-negotiable goals Examples: Budget for finance measure of success Patient satisfaction for clinical units Turnover 34

35 Goal Cascading Do you impact the organizational goal directly? If no Do you have an indirect influence of the goal? If no If yes If yes Assume the goal as directly stated or the increment of it you influence Then sculpt a goal that reflects this incremental part or your influence If no direct or indirect influence is there any other goal for that strategic area that is appropriate for your department? If yes Sculpt a goal that reflect the departmental area of focus If no Obtain approval for no goal in this Pillar 35

36 Example Goals

37 Physician Practice - Example Pillar Weight Practice Goal Service 25% Achieve 80th percentile rank for overall satisfaction for the fiscal year. People 20% Reduce turnover to 15% annualized by end of fourth quarter. Finance 20% Reduce bill-holds by 15% Quality 15% Growth 20% Improve ease of obtaining test results to 65 th percentile Increase number of visits by 3% by end of fiscal year 37

38 Goal Development Worksheet 38

39 Some Tools of Accountability Leader Performance Evaluation Leader Report Card 90 Day Work Plan 39

40 Leader Performance Evaluation 40

41 Leader Performance Evaluation 41

42 Leader Performance Evaluation 42

43 Leader Report Card 43

44 90 Day Plan 44

45 No Surprises

46 Accountability Recap Importance of leader accountability and goal alignment How to develop effective goals The basics on accountability tools 46

47 Change Change has a considerable psychological impact on the human mind. To the fearful it is threatening because it means that things may get worse To the hopeful it is encouraging because things may get better To the confident it is inspiring because the challenge exists to make things better. King Whitney Jr 47

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49 Leadership Development Institutes Tim Schoelen, Executive Director Joint Office of Planning and Strategy May 18, 2010

50 Key Initiatives to Achieve Goals Strategic Growth Focus and prioritize the Enterprise on key programmatic and systemic areas. Branding / Image Service Celebrate and leverage our strengths with one OU Medicine brand. Implement EXCEL; an initiative focuses on creating a culture of service, operational and clinical excellence. 50

51 Leadership Development Change the culture of OU Medicine Create a process to assist leaders in developing skills and leadership competencies necessary to attain desired results Recognize and develop future leaders 51

52 Evidence-based Leadership Foundation Leader Evaluation Leader Development Must Haves SM Performance Gap Standardization Accelerators Implement an organizationwide leadership evaluation system to hardwire objective accountability Pillar Goals Standards Aligned Goals Aligned Behavior Aligned Process Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results LDI Rounding Re-recruit Thank You Notes high and Employee middle Selection performers Pre and Post WHAT WILL Phone Calls YOU Key Words at TOLERATE? Key Times ~AIDET ALWAYS LEADERSHIP Agendas by pillar 1:1 meeting model Peer interviewing 30/90 day sessions Staff Eval Mgr (SEM) Discharge Call Manager (DCM) Leader Eval Mgr (LEM) Rounding Mgr Idea Express 52

53 Leadership Development Timeline March 7, 2008 Kick Off of EXCEL Oct. 17, 2008 Leader Rounding, AIDET & Standards May 1, 2009 Transparency & Discouraging Unprofessional Behavior Nov. 13, 2009 Physician Engagement & Improving Performance July 18, 2008 Pillar Goals & Leader Evaluations Feb. 13, 2009 Critical Conversations & Accountability Aug. 7, 2009 Bus Stop Conversations Feb. 26, 2010 Quality, Safety & Patient Handovers 53

54 OU Physician s Overall Scores OVERALL PATIENT SATISFACTION ALL FACILITIES PERCENTILE RANK Percentile Ranking Began monitoring results through Press- Ganey Partnered with Studer Group. Launched EXCEL to leadership at first LDI Completed AIDET training in outpatient clinics 10 0 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Standards Rolled out to employees GOAL = Improve Patient Satisfaction Scores to 60th %tile 54

55 Your Leadership I know you are, but what am I? Pee Wee Herman 55

56 10 MINUTE BREAK 56

57 OU Medicine Behavioral Standards 57

58 OU MEDICINE ~ E X C E L EXCEL is a campus-wide undertaking by OU MEDICINE with the help of our Studer Consultants to improve our service to patients and each other, and to become more effective and efficient in our work through goal oriented focus on seven major Pillars: People, Service, Quality, Growth, Finance, Education, and Research The Behavior Standards were formed to support the Pillars of People & Service 58

59 The Standards Team The Standards Team was the first team formed, and was challenged with a task that should change the OU Medicine culture to one that is more professional, caring and service oriented. 59

60 Standards Team Charter To create a document that describes the standard expected behavior across the enterprise. These standards will help us live the mission, vision and values of OU Medicine. Further, this group will give the standards life on a go-forward basis. 60

61 Standards Team Selection The Standards Team was comprised of approximately 25 employees and physicians representing a cross-section of OU Medicine. The diverse Team was formed by people who: are respected by their peers exhibit a strong work ethic are articulate and demonstrate service excellence 61

62 Team Members Samantha Adams Sr. Medical Assistant - OUCP Jim Barrett, MD - Professor - Family Medicine OUP Ben Cowley, MD - Professor of Medicine, Nephrology Section Chief -OUP Doug Folger, MD - Assoc. Dean COM - Chief Medical Officer - OUP Robin Germany, MD - Asst. Prof. of Medicine, Medical Director HLV, OUP Morris Gessouroun, MD Assoc. Professor & Vice Chairman Dept. of Pediatrics, Pediatric Critical Care Medicine - OUCP Bethney Grove - Sr. Medical Asst., HLV Faculty Clinics - OUP Mary Hallman, RN Clinic Mgr. OUP Women's Clinics - OUP Jon Hayes - Business Administrator - Dept. of Pediatrics Londa Hollowell Clinic Manager, Medicine Specialty, Senior Health and Pain Medicine clinics - OUP Camilla Schumacher Administrative Coordinator, OUP Carrie Sommer - Clinics Administrator - OUCP Ruth Wanser Joseph Young JOPS Office - Sr. Mgr of Billing, Dept. of Medicine 62

63 Team Members John W. Karlin, RN - Clinical RN Neonatal ICU, - Children s Hospital Kathryn Talley, BS, CNMT - Coordinator Children's Nuclear Medicine Children s Hospital Doug Myers- Mgr, Parking & Transportation Services - OUHSC Sarah Washam Accounts Payable Manager Financial Services - OUHSC Robin Anderson, RN - Clinical RN, 7 th Floor Oncology Unit - OUMC Becki Benoit - Chief Operating Officer of Adult Services for OUMC Marilyn Conley, RN - Supervisor Clinics/Educator - Medicine Clinic - OUMC Debra Kumm - Clinical Coordinator Investigational Drug Service Pharmacy- OUMC Nadason Mariappan MPH, MT (ASCP) Lead Clinical Lab Scientist, Pathology Lab-OUMC Janet Moore - Admin Assistant Food & Nutrition Svcs- OUMC Anthonia Onuorah - Mgr, Admin & Support Svcs, Adult Cardiology- OUMC 63

64 Standards shall be: Measurable Observable Rolled Out to all employees Signed by all employees Lived by all employees 64

65 Standards Team in Action Meet bi-weekly to discuss and brainstorm ideas Define Standards of Behavior that represent the Mission and Vision of OU Medicine Create an ongoing awareness of the relationship between the standards and optimal patient care Identify 5 major categories Roll out the Standards Have all employees sign the Standards 65

66 Key Words Standards Team brainstormed to develop a long list of key words that would characterize the desired qualities of the people in OU MEDICINE that would lead to our success as a world class organization. Examples: Integrity, Honesty, Caring, Empathy, Considerate, Articulate, Responsible, Trustworthy, Reliable, Innovative, etc. 66

67 Review of other Academic Center Standards Behavior Standards from other Medical Centers were reviewed for content and format 67

68 Standards Criteria Standards lumped into Categories Standards describe what key words look like Standards should fit on a single 8.5 x 11 page 68

69 Headers for the Standards Professionalism Caring Communication Quality Innovation 69

70 Finalization Bi-weekly meetings were held from April through August, A final copy of the OU Medicine WE WILL EXCEL Behavioral Standards were drafted and presented to EXCEL Steering Committee in September Roll-out Ceremony was presented to the OU Medicine leadership at the October 17, 2008 LDI Retreat. 70

71 Professionalism We approach our work in a professional manner: I will model integrity by being honest and trustworthy in my work. I will promote accountability by being responsible for my own actions. I will discuss confidential and personal information in a private area. I will work together with my colleagues to achieve our common goals. I will demonstrate respect by treating others as I would expect to be treated. I will treat our facilities and equipment as I would treat my own. I will be on time for work, meetings and other commitments. I will abide by the organization s dress code. I will accept constructive feedback. 71

72 Caring We are sensitive to the need of those we serve: I will always act with compassion, kindness, empathy and patience. I will be respectful and courteous to everyone because they are important to our organization. I will make myself available to those in need. I will respect cultural, religious and social backgrounds. 72

73 Communication We believe communication is fundamental to everything we do: I will explain the expected duration of procedures, visits and delays to patients. I will share appropriate information with people in a timely manner. I will communicate effectively by speaking clearly and actively listening while learning and sharing information. I will wear my ID badge where it can easily be seen. I will introduce myself to patients, families, visitors and colleagues. I will communicate effectively through all levels of our organization. I will communicate with sincerity, honesty and cultural understanding. 73

74 Quality We are committed to quality service: I will be committed to understanding and applying best practices. I will continually review my performance and strive to improve myself and the outcome of my work. I will be committed to everyone s safety. I will pursue my duties to completion. I will strive to be helpful in every situation. I will demonstrate and encourage positive behaviors. 74

75 Innovation We always look for better ways to take care of our patients: I will take pride and ownership in innovation within OU Medicine by committing to new technology and research. I will be committed to developing new knowledge and sharing it with others. I will promote innovation that will benefit those we serve. I will actively support, mentor and coach to foster a constructive learning environment. I will pursue opportunities to learn and grow. 75

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77 Following Roll-out Ceremony The Standards will be presented to each department and every employee will sign the Standards. 77

78 Service Excellence in the Medicine Specialty Clinic Karen Groff, MSN, RN,C, CNL Clinical Nurse Manager, OUP Medicine Specialty/GI, Endocrinology & Pain Medicine Mike Bronze, MD Chairman, Department of Medicine, OUHSC College of Medicine

79 Medicine Specialty Clinic Located in the OUPB, 2 nd Floor Multi specialty clinic consisting of Nephrology, Rheumatology & GI 17 physicians & 9 staff Approximately 5,200 annual visits 50% Medicare population, 20% new patient rate

80 Clinic Transformation Moved to new location in October 2008 Implemented EXCEL principles in summer 2008 Staff AIDET training in July month orientation and ramp up period Rolled out OU Medicine Standards of Behavior

81 Hurdles Need for culture change Independent specialty clinics under one roof Low patient satisfaction scores Taking ownership of the data Physician and staff buy in Gaining and sustaining momentum

82 Laying the Foundation

83 Standards of Behavior We Will EXCEL PROFESSIONALISM CARING COMMUNICATION QUALITY INNOVATION We approach our work in a professional manner: I will model integrity by being honest and trustworthy in my work. I will promote accountability by being responsible for my own actions. I will discuss confidential and personal information in a private area. I will work together with my colleagues to achieve our common goals. I will demonstrate respect by treating others as I would expect to be treated. I will treat our facilities and equipment as I would treat my own. I will be on time for work, meetings and other commitments. I will abide by the organization s dress code. I will accept constructive feedback. We believe effective communication is fundamental to everything we do: I will introduce myself to patients, families, visitors and colleagues. I will explain the expected duration of procedures, visits and delays to patients. I will share appropriate information with people in a timely manner. I will communicate effectively by speaking clearly and actively listening while learning and sharing information. I will wear my ID badge where it can easily be seen. I will communicate effectively through all levels of our organization. I will communicate with sincerity, honesty and cultural understanding. We are sensitive to the needs of those we serve: I will always act with compassion, kindness, empathy and patience. I will be respectful and courteous to everyone because they are important to our organization. I will make myself available to those in need. I will respect cultural, religious and social backgrounds. We are committed to quality service: I will be committed to understanding and applying best practices. I will continually review my performance and strive to improve myself and the outcome of my work. I will be committed to everyone s safety. I will pursue my duties to completion. I will strive to be helpful in every situation. I will demonstrate and encourage positive behaviors. We always look for better ways to take care of our patients: I will take pride and ownership in innovation within OU Medicine by committing to new technology and research. I will be committed to developing new knowledge and sharing it with others. I will promote innovation that will benefit those we serve. I will actively support, mentor and coach to foster a constructive learning environment. I will pursue opportunities to learn and grow.

84 Consistent Communication Safety A Acknowledge Decrease Anxiety Increase Compliance Quality I D E Introduce Duration Explanation Patient Loyalty T Thank You

85 Validating AIDET Rounding on employees Competency evaluations / direct observations Rounding on patients Staff holding each other (and physicians) accountable!!

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90 Manager, Physician, and Staff Collaboration Own the data- the good, the bad, and the ugly Push ownership and accountability out to physicians and staff Regular meetings between the Chair, Clinic Manager & Department Administrator. Objective assessment of overall clinic performance utilizing Clinic Operations Dashboard. Strong line of communication and alignment of goals & operating objectives. Share patient satisfaction data on regular basis with physicians and staff. Celebrate the wins!

91 Engaging Physicians in Service Improvement Physicians will partner with administration when trust and confidence in the leadership team are built, clinical efficiency is demonstrated, and physicians have meaningful input on organizational efforts Inspiration is important and necessary to make an organization great, but inspiration along, without accountability, will not assure a culture of execution. Trust in the leadership team precedes physician collaboration, participation, and alignment, and will be a vital element to the physician engagement process. Source: Engaging Physicians: A Manual to Physician Partnership. Stephen Beeson, M.D.

92 9 Stages of Physician Engagement 1. Create and communicate organizational vision and goals (OU Medicine Pillar Goals & Clinic Communication Boards) 2. Leadership development and accountability for Performance (LDI s & LEM) 3. Establishing physician confidence & trust (leader rounding on physicians) 4. Building physician leadership Source: Engaging Physicians: A Manual to Physician Partnership. Stephen Beeson, M.D.

93 9 Stages of Physician Engagement cont. 5. Training physicians (Dr. Folger & AIDET training) 6. Physician measurement and report cards (less blinding of physician specific patient satisfaction data). 7. Implementing physician behavioral standards (opportunity) 8. Managing disruptive physicians (OU Physician policy) 9. Recognize physicians (thank you cards, rounding) Source: Engaging Physicians: A Manual to Physician Partnership. Stephen Beeson, M.D.

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96 Key Ingredients for Success Consistent execution of AIDET Know the patient satisfaction data, believe the data, own the data, share the data Consistently round on patients, staff, and physicians Support and engage physicians and staff Build relationships with physicians and staff Have faith and believe in your staff Keep your eye on the prize- the 99 th percentile

97 Making a Difference One Patient at a Time The staff introducing themselves is something new - I like it I considered writing some type of note after my last visit because I was so impressed. So, I'm happy to do this survey. Keep up the good work I used to wait 45 minutes or longer to see the dr. I even gave up & walked out a time or two in the past. Not any more. Past 2 visits have been top notch all around!

98 Making a Difference One Patient at a Time I am so impressed at the noticeable improvements in the past few years! I used to have to wait over an hour each visit & the staff was not friendly I'm just so happy and pleased to have the people at OU Physicians helping me with my health. I wouldn t want to be any place else. Everyone is just so nice

99 Thank You Notes & Managing Up Laura Land Chief Human Resources Officer OU MEDICAL CENTER May 18, 2010

100 Question: What will improve your department recruitment, retention, morale, productivity, and profitability, you have complete control over it AND you do not have to put it in the capital budget? 100

101 Answer: REWARD AND RECOGNITION 101

102 Committing to EXCEL! Hardwiring based on Nine Principles: Commit to Excellence Measure the Important Things Build a Culture Around Service Create and Develop Great Leaders Focus on Employee Satisfaction Build Individual Accountability Align Behaviors with Goals and Values Communicate at All Levels Recognize and Reward Success 102

103 Evidence Based Leadership (EBL) Foundation STUDER GROUP: Leader Evaluation Leader Development Must Haves SM Performance Gap Standardization Accelerators Implement an organizationwide leadership evaluation system to hardwire objective accountability PILLAR GOALS LEM Aligned Goals Aligned Behavior Aligned Process Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results LDI Rounding Thank You Notes Employee Selection Pre and Post Phone Calls Key Words at Key Times ~AIDET ~ Managing Up Re-recruit high and middle performers WHAT WILL YOU TOLERATE ALWAYS LEADERSHIP Agendas by pillar 1:1 meeting model Peer interviewing 30/90 day sessions Discharge Call Manager (DCM) Leader Eval Mgr (LEM) 103

104 Challenge: We ve got the evidence! We know what to do! It s easy, right? Everyone feels recognized! Some research shows that Not feeling valued and Lack of professional respect are among the top reasons for turnover. 104

105 Solution: Recognition It s not a natural skill it must be taught. 105

106 Lessons from AIDET A Acknowledge (eye contact) I Introduce (manage up yourself & others) D E T Duration (how long) Explanation (what to expect) Thank You 106

107 Top 5 Workplace Incentives 1 2 Written Thanks From Manager Personal Thanks From Manager 3 Promotion for Performance 4 Public Praise 5 Morale-Building Meetings Study conducted by Dr. Gerald Graham, Management Professor at Wichita State University Motivating Today s Employees, Bob Nelson Talent+,

108 The Best Thank You Note Timely Specific Sincere At OU Medicine Handwritten and Mailed to the Employee s Home 108

109 Thank You Notes Manage Up means communicate the recognition opportunity up the chain of command Leader Type Thank You Note Responsibility Commitment Guidelines Senior Leadership Write notes to those managed up to you by managers or other leaders Write notes to those you yourself want to recognize Write as provided. Or, may choose another method of recognition other than thank you note if more appropriate. Directors Managers Write notes to those managed up to you by managers or other leaders Write notes to those you yourself want to recognize Manage up thank you note recognition to your supervisor Manage Up persons and specific details that you feel are best acknowledged by a thank you note. Writing thank you notes is optional for managers May want to write own notes to physicians as well but can manage them up, too. As provided. May choose another method of recognition other than thank you note if more appropriate. Manage up a few thank you notes per month to your supervisor Dependent on size of department. If large department, manage up 2 per week. If smaller department manage up a few per month. May manage up persons outside of your own department or physicians. 109

110 Rounding on Employees This form is located on the website 110

111 Employee Thank You Notes 111

112 Compliment to Criticism Ratio 3 to 1 3 compliments 1 criticism Positive! 2 to 1 2 compliments 1 criticism Neutral 1 to 1 1 compliment 1 criticism Negative Source: Tom Connellan, Inside the Magic Kingdom, pgs

113 The Rewards Improved employee satisfaction Improved patient satisfaction Improved leader job satisfaction Improved recruitment and retention Improved productivity and ownership 113

114 Rounding For Outcomes

115 The Number One Action To Drive Employee Satisfaction =

116 Rounding What does it mean to you?

117 Rounding up?

118 Rounding up the herd?

119 Rounding with the Chief?

120 Making the rounds on the talk show circuit?

121 Patient Rounding? (from the patient s point of view)

122 Rounding is Going from place to place Sharing information from person to person

123 Patient Satisfaction Employee Retention Employee Satisfaction Physician Loyalty

124 39% of staff leave jobs due to a poor relationship with their supervisors

125 What is your staff looking for? A good relationship Approachabililty Willingness to work side by side Efficient systems Training & development Tools & equipment to do the job Appreciation

126 How do you get started?

127 5 Key Rounding Q s What is working well today? Any individuals you would like to recognize? Any physicians you would like to recognize? Anything we can do better? Have the tools and equipment to do your job?

128 Tell me what is working well today?

129 Harvesting wins

130 More ways to harvest wins.

131 Question # 3:

132 Question #4:

133 Question #5:

134 Getting started with rounding Be disciplined & focused Have a set time for rounding 5 questions don t take long Document Initially reactive Later proactive

135 Rounding for Outcomes on Patients

136 Start with AIDET Acknowledge Address patient by last name Introduce Use your first & last name, skill set, professional certification and training Duration Estimate how long this will take Explanation Why you are doing this Thank you Thank you for coming to our clinic today.

137 Key Words at Key Times A must have to build a culture on service and operational excellence Informs patients about why we do the things we do May be used in the form of a statement, a question, a reassurance, or managing up

138 Rounding on Patients = P.O.S. Learning Customize your questions Who registered you today? How was this process? Were you informed of any delays for your appt? Who is your nurse today? Did we explain our process for test results? Did every caregiver wash their hands prior to providing care? Are there any staff or physicians you would like to recognize for doing exception work? Are there any clinic/dept managers that need to be contacted to address issues today?

139 End with AIDET Thank you for choosing OU Physicians for your healthcare needs! Here is my business card should you need to contact me.

140 Practice Thank you notes, Rounding, and Managing Up 140

141 Everyday Leadership Jon Brightbill, Project Mgr Office of the Dean, College of Medicine 141

142 Everyday Leadership How to make a positive difference no matter what you are doing or where you are doing it!

143 Overview Capability Leader s Charge How does One Inspire? How it Should Work Andrews Maxims

144 Where do You Fall on the Capability Line? Capability is Task Related and Transitional

145 The Leader s Charge Capability is driven by: Training What someone brings to the table Motivation The Leaders job is to move people along that line, no matter what the task, with the ultimate goal of putting themselves out of a job Inspire!!!

146 How does One Inspire? Communication Have to know your people Set them up for success Leadership is situational Every task may involve different leadership tactics Leadership is an evolutionary process Remember, you have to work for a manager, you want to work for a leader

147 How it All Should Come Together Inspiration leads to productivity Productivity leads to success Success leads to positive outcome Positive outcome leads to pride Pride leads to inspiration This gives you a pretty good cycle!

148 Stewardship of a Leader (Andrews Maxims) Set the tone and expectations (Train/Know your People) Create a vision (Train/Know your People) Try to recruit people who are better than you (Know yourself/train/know your People/Set up for Success) Help people learn how to accomplish more with less (Train/Set up for Success) Bask in reflected glory (Put yourself out of a job!?)

149 Questions???

150 2007 Studer Group Practicing Excellence by Practicing AIDET

151 2007 Studer Group AIDET VIDEO PRESENTATION

152 A I D E T Acknowledge Introduce Duration Explanation Thank You 2007 Studer Group

153 Your Thoughts?? 94.0 OUP GROUP PATIENT SATISFACTON OVERALL MEAN SCORE Jan-07 Mar-07 May-07 Jul-07 Sep-07 Nov-07 Jan-08 Mar-08 May-08 Jul-08 Sep-08 Nov-08 Jan-09 Mar-09 May-09 Jul-09 Sep-09 Nov-09 Jan-10 Mar Studer Group

154 Patient Satisfaction Questions 2007 Studer Group

155 Top Box / Frequency Analysis AIDET = EVERY PATIENT EVERY TIME 2007 Studer Group

156 Priority Index 2007 Studer Group

157 Evidence Based Leadership (EBL) Rev 6.07 Foundation STUDER GROUP: Leader Evaluation Leader Development Must Haves SM Performance Gap Standardization Accelerators Implement an organizationwide leadership evaluation system to hardwire objective accountability (Principle 7) Aligned Goals Aligned Behavior Aligned Process Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results (Principle 4 & 8) Must Haves SM Rounding Thank You Notes Employee Selection Pre and Post Phone Calls Key Words at Key Times (Principle 3, 5, 6, & 9) Re-recruit high and middle performers Move low performers up or out (Principle 4) Agendas by pillar Peer interviewing 30/90 day sessions Pillar goals (Principle 1 & 2) Leader Eval Mgr (LEM) Staff Eval Mgr (SEM) Discharge Call Manager (DCM) Rounding Mgr Idea Express 2007 Studer Group

158 OU Physician's Overall Scores OVERALL PATIENT SATISFACTION ALL FACILITIES PERCENTILE RANK Percentile Ranking Began monitoring results through Press-Ganey Partnered with Studer Group. Launched EXCEL to leadership at first LDI Completed AIDET training in outpatient clinics 0 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Standards Rolled out to employees GOAL = Improve Patient Satisfaction Scores to 60th %tile

159 OUP Patient Satisfaction Rankings ADULT CLINICS FY09-Q4 FY10-Q1 FY10-Q2 Q3-TD Adult Endocrinology Clinic Breast Institute Dermatology Clinic Edmond General Internal Medicine N/A N/A N/A 65 Edmond Multispecialty Clinic Enid Dermatology Family Medicine (Blue & Rose) Family Medicine (Green & Purple) General Internal Medicine Gynecology Oncology Infusion Center Heart Lung & Vascular Clinic Hematology Infusion Center IDI Clinic Medicine Specialty/GI Clinic Nephrology Neurology Clinic Neurosurgery Clinic ObGyn Clinic ORL Clinic Orthopedic Surgery Clinic OU Physicians at Norman Pain Medicine Clinic Plastic Surgery Clinic Prenatal Diagnostic Center Psychiatry Clinic Senior Health Clinic Surgery Clinic Urology Clinic W Facial Aesthetics Women's Pelvic & Bladder Health Adult Overall

160 OUCP Patient Satisfaction Rankings CHILDREN'S CLINICS FY09-Q4 FY10-Q1 FY10-Q2 Q3-TD Adolescent Clinic Child Study Center Dental Clinic N/A N/A Jimmy Everest Center Latino Clinic Mercy Satellite Clinics Orthotics & Prosthetics OUCP Diabetes/Endocrine Clinic OUCP General Surgery Clinic OUCP Neurology Clinic OUCP Orthopedic Surgery Clinic OUCP Otolaryngology Clinic N/A N/A OUCP Plastic Surgery Clinic Pediatric Eye Clinic Pediatric Gastroenterology Clinic Pediatric Heart Center Pediatric Pulmonary/Cystic Fibrosis Pediatric Specialty Clinic Pediatric Urology Clinic Sooner Pediatric Clinic Children's Overall GROUP

161 100 Adult Clinics Overall and Care Provider Percentile Rankings Cumulative data beginning 4/1/2009-3/31/10 Total n's for all = 6543 Average n size per clinic = Percentile Ranking Clinic 1 Clinic 2 Clinic 3 Clinic 4 Clinic 5 Clinic 6 Clinic 7 Nephrology Clinic 8 Clinic 9 Clinic 10 Medicine Specalty & GI Clinic 12 Clinic 13 Clinic 14 Clinic 15 Clinic 16 Clinic 17 Clinic 18 Std Overall Clinic 19 Clinic 20 Clinic 21 Clinic 22 Clinic 23 Clinic 24 Std Care Provider Clinic 25 Clinic 26 Clinic 27 Clinic 28 Clinic 29

162 100 Children's Clinics Overall and Care Provider Percentile Rankings Cumulative data beginning 3/1/2009-3/31/2010 Total n's for all = 3185 Average n size per clinic = Percentile Ranking Clinic 1 Clinic 2 Clinic 3 Clinic 4 Clinic 5 Clinic 6 Clinic 7 Clinic 8 Clinic 9 Clinic 10 Clinic 11 Clinic 12 Clinic 13 Clinic 14 Clinic 15 Clinic 16 Clinic 17 Clinic 18 Clinic 19 Clinic 20 Clinic 21 Clinic 22 Std Overall Std Care Provider

163 Five Fundamentals of Consistent Communication Key Words Safety A Acknowledge Decrease Anxiety Increase Compliance Quality I D E Introduce Duration Explanation Patient Loyalty T Thank You 2007 Studer Group

164 Changes in Patient Perception of Care Increase of 28%ile points Increase of 17%ile points Outpatient Inpatient ED Source: 2007 AIDET product evaluation survey of PARTNERS and NONPARTNERS, N=68 Increase of 16%ile points Baseline 6 Months Post 2007 Studer Group

165 AIDET - Quality 72% of patients unable to list medications they take 58% of patients unable to recite their own diagnosis -Mayo Clinic Proceedings, Studer Group

166 AIDET - Safety Because greetings are one way to ensure proper identification of patients, they may well be considered a fundamental component of patient safety. Source: Arch Intern Med. 2007;167(11): An Evidence-Based Perspective on Greetings in Medical Encounters by Gregory Makoul, PhD; Amanda Zick, MA; Marianne Green, MD 2007 Studer Group

167 AIDET People - Physician Retention Physician turnover is a top concern and an important priority for leaders. Groups were asked to rank their concern of physician turnover. Forty-seven percent (47%) of all respondents indicate a strong concern about physician turnover. ~The most important determinant of clinician global satisfaction is the clinician-patient relationship. (275 AMGA Medical Groups) -Suchmann et al, Studer Group

168 AIDET - Finance - Decrease Litigation IN THIS ARTICLE The most common cause of malpractice suits is failed communication with the patients and their families. Explore ways that better communication could lead to fewer malpractice claims and allow health care organizations to reduce litigation costs. The Physician Executive, June 2004, Reducing Litigation Costs Through Better Patient Communication Focus on Issues: Rounding, AIDET, Key Words, DCM Educate the Patient: Rounding, AIDET, Verify with DCM Enlist the Patient: Rounding, AIDET, Patient Visit Guide, IPC Share Decisions: AIDET, Key Words, IPC 2007 Studer Group

169 AIDET Finance - Decrease Litigation % decrease in complaints # of Complaints # of Compliments 0 1Q07 2Q07 3Q07 *Data provided by University Medical Center, Tucson, AZ **Source: 2007 AIDET product evaluation survey of PARTNERS and NONPARTNERS 2007 Studer Group

170 AIDET - Finance and Growth For every customer that complains, 20 dissatisfied customers do not Of those dissatisfied customers who do not complain, 90% do not return The average wronged customer will tell 25 others It is 10 times more expensive to recruit new patients than to keep old ones -Zimowski Studer Group

171 AIDET - Patient Loyalty In fact the only path to profitable growth may lie in a company s ability to get its loyal customers to become its marketing department. -THE ONE NUMBER YOU NEED TO GROW Frederick F. Reichheld - Harvard Business Review Dec Studer Group

172 Five Fundamentals of Consistent Communication Key Words Safety A Acknowledge Decrease Anxiety Increase Compliance Quality I D E Introduce Duration Explanation Patient Loyalty T Thank You 2007 Studer Group

173 Advantages of AIDET SM Improve Clinical Outcomes Decrease Anxiety Increased + Compliance = Improved clinical outcomes and increased patient and physician satisfaction 2007 Studer Group

174 OU Physician's Overall Scores OVERALL PATIENT SATISFACTION ALL FACILITIES PERCENTILE RANK Percentile Ranking Began monitoring results through Press-Ganey Partnered with Studer Group. Launched EXCEL to leadership at first LDI Completed AIDET training in outpatient clinics Standards Rolled out to employees 0 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 GOAL = Improve Patient Satisfaction Scores to 60th %tile 2007 Studer Group

175 OUP EXCEL Scorecards & Leader Accountability Toolkit Holly C. Adams, FACHE, FACMPE Executive Director of Operations OU Physicians & OU Children s Physicians Holly-Adams@ouhsc.edu X cell

176 Objectives Provide overview of OUP EXCEL scorecards. Provide an overview of the OU Physicians Leader Accountability Tool Box and how these tools can be utilized to substantially impact patient satisfaction and other key performance indicators.

177 Aligning the Enterprise

178 OUP EXCEL Scorecards Initiated in January 2007 Based on clinic performance over 6-month periods. Opportunity to earn incentive compensation based upon the clinic/department s overall progress toward meeting goals. Heavy emphasis on patient satisfaction.

179 OUP EXCEL Scorecard

180

181

182 FY 11 OUP EXCEL Incentive Targets

183 100 Patient Satisfaction Monthly Trend Percentile Rank Target = 60th %tile Initiated Press Ganey Surveys Partnered with Studer Group Launched EXCEL at 1 st Leadership Development Institute Implemented CPR Meetings 10 0 Completed AIDET Training Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Rolled Out Standards to Employees Benchmarked Against Press Ganey All Facilities Peer Group

184 100 OUP Overall Patient Satisfaction Percentile Rank Group Adult Children's Q Q Q Q Q

185 100 OUP Information About Delays Percentile Rank Group Adult Children's Q Q Q Q Q

186 100 OUP Ease of Obtaining Test Results Percentile Rank Group Adult Children's Q Q Q Q Q

187 Physician Satisfaction Survey

188 Leader Accountability Tool Box Provide an overview of leader accountability tools used to substantially impact patient satisfaction and other key performance indicators

189 Leader Accountability Tool Box Monthly Meeting Model (MMM) LEM & Leader Report Cards Leader Rounding on Patients & Staff Leader Communications Clinic Operations Dashboard Clinic Performance Review (CPR) Meetings

190 Monthly Meeting Model (MMM) Manager Target = Update monthly & bring to meeting with Executive Director

191 Leader Evaluation Manager (LEM) Performance management system software The LEM aligns individual leader resources, energy and behaviors to an organization s goals which allows leadership to: Prioritize goals through an automated weighting system Establish a consistent goal-setting process, where goals are specific, measurable, timebound, and outcome-based Hardwire the process of holding leaders accountable for results through goal locking and continuous progress measurement and ranking Access, share and distribute goals amongst a leader s direct reports Monthly leader report cards are produced and shared at monthly meetings with direct supervisor

192 Leader Report Cards Manager Target = Update LEM monthly & bring to meeting with Executive Director

193 Leader Rounding on Patients Manager Target = Round on 20 patients per clinic per week

194 Leader Rounding on Staff Manager Target = Round on 100% of Staff Monthly

195 Leader Communications Clinic Managers are asked to provide: Bi-weekly updates to clinic staff & physicians to share patient and staff feedback, patient satisfaction score updates, and to provide reward and recognition. Updates at monthly staff meetings to share progress on EXCEL scorecards. At least monthly meetings with clinic medical directors to review clinic progress. Regular feedback regarding survey comments to staff and physicians. What we recognize, we see repeated!

196 Clinic Operations Dashboard

197 Clinic Performance Review (CPR) Meetings Scheduled for clinics with patient satisfaction rankings below target for 3 consecutive quarters. Clinic Manager & Medical Director present action plans to CEO, CMO, Executive Director of Operations, and Department Chair. Meeting Agenda: Presentation of current rankings & clinic performance Discussion of barriers to desired performance outcomes Presentation of current action plan Follow up meetings in 3 months to review progress toward action plan.

198 CPR - Adult Clinics ADULT CLINICS FY10-Q1 FY10-Q2 FY10-Q3 Adult Endocrinology Clinic Breast Institute Dermatology Clinic FOCUS Edmond General Internal Medicine N/A N/A + Edmond Multispecialty Clinic Enid Dermatology Family Medicine (Blue & Rose) PRIORITY FOCUS Family Medicine (Green & Purple) General Internal Medicine FOCUS Gynecology Oncology Infusion Center Heart Lung & Vascular Clinic PRIORITY FOCUS Hematology Infusion Center IDI Clinic PRIORITY FOCUS Medicine Specialty/GI Clinic Neurology Clinic PRIORITY FOCUS Neurosurgery Clinic ObGyn Clinic ORL Clinic Orthopedic Surgery Clinic OU Physicians at Norman Pain Medicine Clinic Plastic Surgery Clinic Prenatal Diagnostic Center PRIORITY FOCUS Psychiatry Clinic Senior Health Clinic PRIORITY FOCUS Surgery Clinic Urology Clinic PRIORITY FOCUS W Facial Aesthetics Women's Pelvic & Bladder Health Adult Overall # Clinics Meeting/Exceeding Target Recent 2 quarters not at target (FOCUS) 3 quarters not at target (PRIORITY FOCUS)

199 OU Children s Physician Clinics Clinic Name FY10-Q1 FY10-Q2 FY10-Q3 Adolescent Clinic Child Study Center Dental Clinic N/A + + Jimmy Everest Center Latino Clinic PRIORITY FOCUS Mercy Satellite Clinics Orthotics & Prosthetics OUCP Diabetes/Endocrine Clinic OUCP General Surgery Clinic OUCP Neurology Clinic OUCP Neurosurgery Clinic N/A N/A - FOCUS OUCP Orthopedic Surgery Clinic PRIORITY FOCUS OUCP Otolaryngology Clinic N/A + + OUCP Plastic Surgery Clinic Pediatric Eye Clinic Pediatric Gastroenterology Clinic PRIORITY FOCUS Pediatric Heart Center Pediatric Pulmonary/Cystic Fibrosis Pediatric Specialty Clinic PRIORITY FOCUS Pediatric Urology Clinic Sooner Pediatric Clinic Children's Overall # Clinics Meeting/Exceeding Target Recent 2 quarters not at target (FOCUS) 3 quarters not at target (PRIORITY FOCUS)

200

201 Putting the Pieces Together Monthly Meeting Model Clinic Operations Dashboard Leader Scorecard Rounding on Patients CPR Meetings Rounding on Staff

202 Making a Difference

203 Questions? Comments? Holly C. Adams, FACHE, FACMPE Executive Director of Operations OU Physicians & OU Children s Physicians Holly-Adams@ouhsc.edu

204 15 minute break 204

205 Improving Organizational Performance with Bus Stop Conversations E A L

206 Learning Objectives Prepare OU Medicine leaders for next steps required to align behaviors, and build the EXCEL culture, throughout the enterprise by.. Closing the Performance Gap! Re-recruiting Excelling and Achieving performers Moving Lagging performers up or out You will learn to.. Differentiate and identify Excelling, Achieving and Lagging Performers Conduct EAL (or Bus Stop) conversations with direct reports Use effective strategies to overcome the challenges that may occur during these conversations Successfully implement Bus Stop Conversations to achieve intended results 206

207 Why Organizations Do Not Sustain Excellence Do not achieve critical mass - Lack of balanced approach Leaders do not have the training to be successful Absence of an objective accountability system Dots are not connected consistently to purpose, worthwhile work and making a difference Too many new behaviors introduced at once need sequenced approach No process in place to rerecruit the high and middle performers and address low performers Inability to take best practices and standardize across organization Failure to have physician leaders always do desired behaviors 207

208 Evidence-Based Leadership SM Rev Foundation STUDER GROUP : Objective Evaluation System Leader Development Must Haves Performance Gap Standardization Accelerators Aligned Goals Aligned Behavior Aligned Process Implement an organizationwide staff/ leadership evaluation system to hardwire objective accountability (Must Haves ) Create processes and assist leaders in developing skills and leadership competencies necessary to attain desired results Agreed upon tactics and behaviors to achieve goals Rounding for Outcomes: Thank You Notes: Physician Selection, Selection and the First 90 Days Key Words at Key Times AIDET Post Phone Calls Re-recruit excelling and achieving performers Move lagging performers up or out Processes that are consistent and standardized throughout the enterprise Leader Eval Manager TM Staff Eval Manager TM Discharge Call Manager TM Rounding Manager TM Idea Express TM 208

209 Where Do Bus Stop Conversations Fit? Goals are outlined in LEM Behavior Standards are in place Rounding on Employees and Physicians is hardwired to assure that everyone has tools and equipment to take care of our patients Critical Conversation Training helps us as leaders have conversations in real time regarding goals and behaviors for those that report to us Coffee Cup conversations help us have conversations in real time regarding goals and behaviors with colleagues Bus Stop Conversations are structured coaching and performance conversations that are based on patterns of behavior and they re-recruit, retain and make expectations clear 209

210 highmiddlelow Survey Design & Response July 2008 a personal invitation was sent to 43 Studer Group hospital partners identified by Studer Group coaches that conducted highmiddlelow conversations at their organization. Interviews were scheduled and completed with participants by telephone. A total of 30 surveys were completed for a response rate of 69%. Source: 2008 highmiddlelow Research Study 210

211 highmiddlelow Respondents All respondents worked for a hospital and full time equivalent employees ranged from 40 to 15,000; average number of employees = 2,112; median (midpoint) number of employees = 1,000. From 30 organizations surveyed, an average of 92% of employees received an HML conversation. Almost half (46%) of organizations surveyed, conducted HML conversations in 2007 or Source: 2008 highmiddlelow Research Study 211

212 highmiddlelow Organizational Results How would your rate your organization's ability to: (1=Very Poor, 10=Excellent) Retain High Performers Further Develop Middle Performers 4.0 Move Out Low Performers Before implementing HML After implementing HML Source: highmiddlelow Research Study 8/08 Before HML, N=26; After HML, N=25 for Retaining High Performers Before HML, N=25; After HML, N=25 for Further Developing Middle Performers Before HML, N=25, After HML, N=25 for Moving Out Low Performers 212

213 highmiddlelow & Organizational Results Source: highmiddlelow Research Study 8/08 Before HML, N=25; After HML, N=25 213

214 highmiddlelow and Annualized Turnover Rates Source: highmiddlelow Research Study 8/08 N=24 for Turnover rates before and after HML conversations; N=15 for Current Turnover Rate 214

215 HML Impact Line of service Before HML After HML Advocate Good Samaritan, Downers Grove, IL Beds = 303, Admissions = 17,486, Employees = 2500 Employee satisfaction Month before months after - 81 Inpatient satisfaction 2 months before months after - 87 Outpatient satisfaction 2 months before months after 98 United Regional Health Care, Wichita Falls, TX Beds=357, Admissions = 15,995, employees=1,788 Inpatient satisfaction 1 st Quarter th Quarter - 91 Outpatient satisfaction 1 st Quarter th Quarter - 69 ED satisfaction 1 st Quarter th Quarter - 83 Homestead Hospital, Florida Employee engagement as measured by Gallup

216 Positive Results of highmiddlelow We have a LEM goal to retain high performing nurses and this resulted in reducing RN turnover from 21% to 15% (2006 to 2007). This also produced a return on investment of $1 million dollars! Kristi Faulkner United Regional Health Care System Wichita Falls, TX Source: highmiddlelow Research Study 8/08 216

217 Results That Last Spending 92 percent of your time retaining the 92 percent of your employees who want to be on board, and 8 percent of your time dealing with the 8 percent who don t. The outcome is results that last. Results That Last, Quint Studer, Chapter 1, Pg 4 217

218 Who Are You Spending Time With? 218

219 Performance Curve Excelling-Achieving-Lagging L A E 8% 58% 34% 219

220 Tool Five: Excelling E 220

221 Tool Five: Achieving A 221

222 Tool Five : Lagging L 222

223 Phase 1:The Honeymoon What to expect: Sense of excitement Right to do list Things will get better (hope) Quick fixes are implemented Skeptics Key Action Steps: Provide more communication (information) Acquire tools and improve systems Start to hardwire selected behaviors Roll out Behavior Standards Implement new accountability system (LEM) Begin Leadership Development Sessions Start Teams 223

224 Phase 2: Reality Sets In What to expect: We/they Inconsistency Bigger than I thought This will impact me Some are getting it Some are not Key Action Steps: Leadership training gets more focused Re-recruit excelling performers Increase substance of communication to stakeholders Prepare to have conversations with excelling-achieving-lagging performers Increase reward and recognition 224

225 The Gap Becomes Evident E A L E A Gap is uncomfortable L Hoping that: More time will help More coaching will help More focus will help A transfer will help They will leave 225

226 The Gap is Intolerable E A L E A Gap is uncomfortable L E A Gap is Intolerable L The Wall 226

227 Phase 3: The Uncomfortable Gap What to expect: The performance gap is evident Tougher decisions must be made Process improvement increases Inconsistencies become obvious Key Action Steps: Tough questions are responded to and hardwired by leaders EAL Completed The right people are in the right places 227

228 Over the Wall E E E A The Wall A E A L A Gap is uncomfortable L Gap is intolerable L 228

229 Phase 4: Consistency What to expect: High performing results Everyone understands the keys to success Disciplined people and disciplined processes Proactive leadership Key Action Steps: Push for innovation Standardize and repeat key behaviors Next generation of tools/techniques 229

230 Excelling Performance Conversation ENGAGE: Tell them where the organization is going APPRECIATE: Thank them for their contribution and articulate the specific value of their work SUPPORT: Outline why they are so important Ask them what they need to be a long-term employee and what you can do for them 230

231 Moving the Excelling Performers GAP L A E Performance 231

232 Achieving Performance Conversation Reassure individual goal is to retain S : Support Describe what they do well be specific C : Coach Identify one thing they can improve, provide specifics and benefit of doing this. Ask for their ideas for training or support S : Support Ask them how you can assist or support them in developing this skill. Reaffirm good qualities. 232

233 Moving the Achieving Performers GAP L A E Performance 233

234 Lagging Performance Conversation Do not start meeting on a positive note D : Describe Describe what has been observed. E : Evaluate Evaluate how you feel. S : Show Show what needs to be done. K : Know Know consequences of continued same performance. Schedule follow up conversation within the improvement time frame 234

235 Tool Seven Remember to be prepared for the conversations! 235

236 What Has Been Accomplished? Leader demonstrates concern and care for those that report to them Leader demonstrates commitment to team member professional development Leader affirms and shows appreciation for excelling and achieving Leader lets people with sub-par performance know exactly where they stand and next steps for their performance Leader role models value driven leadership 236

237 We have learned that the reluctance to address low/sub-par performance keep an organization from being the best. Quint Studer 237

238 Practice D.E.S.K. Model 238

239 Achieving and Maintaining the 99 th Percentile Pediatric Urology OU Medicine Leadership Development Institute

240 Pediatric Urology Donald B. Halverstadt center for excellence in Pediatric Urology opened in 1998 Referrals are received from Oklahoma and three neighboring states Outreach clinics in Tulsa, OK and Wichita, KS Consistently over 5200 patients seen yearly 50% new patients 266 clinic procedures last year 840 Surgical procedures last year

241 Pediatric Urology Team Bradley Kropp, M.D. Dominic Frimberger, M.D. William Reiner, M.D. Jake Klein, NP Valari Cathey, NP Stephanie Harding Antoinette Piggee, M.A. Amy McIntire, R.N. Dorothy Brunson Krystin Corrujedo Tracy Roberts Misty Owens Rotating Residents (2) and Fellow

242 Pediatric Urology - Challenges Busy practice: Up to 500 patients per month Many complex patients requiring extensive counseling Scheduling patients in a timely manner Potential for long wait time

243 Pediatric Urology - Goals Delivery of excellent, state-of-the-art care Serve the state of Oklahoma and surrounding states. Improve patient experience by improving patient satisfaction Growth- retain patients and increase practice Teach residents and students Provide a positive work environment for the team

244 Why change? We tend to think patients are happy and satisfied with our care But then PRESS-GANEY And the Studer Group

245 Pediatric Urology - Scores Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09 Q1 10 Std Overall Std Access to Care Std Visit Std Nurse/Assistant Std Care Provider Std Personal Issues Std Overall Assessment

246 Road to success Believe Press-Ganey Implement AIDET Get the whole team on board Institute a team leader Implement changes Adjust as suggested by patients comments Keep it up!!

247 Clinic Restructure Strict adherence to AIDET rules Regular staff meetings Inform team about progress and make adjustments Motivate team Everybody has to accept change Providers, staff and residents Secret Shopper

248 Clinic Restructure Check in Inform about delays upon patient arrival Information board Offer refreshments / coffee or water Volunteer services to interact with patients I was impressed with the friendliness & professionalism on the phone. Details on board showing the doctors time frame was informative. We were told about the dr. being 1 hr behind because of emergencies. We understand.

249 Clinic Restructure Exam room timers / Time tracking board Patient rounding in exam rooms Offer refreshments, games, toys Continue to inform of any delays Provider approach to patient by fulfilling AIDET Nurse check out with patient Post-op calls I really appreciate that I can speak to a nurse before I have to come in with an appt. Saves time! Every time we come to our appt. there are always smiles on everyone s face. Very helpful.

250 Pediatric Urology- Challenges Difficult balance between patient access and wait time Less patients decrease wait time but limit access Q4 07 Q1 08 Std Access to Care Ease of scheduling appointments Std Visit Wait before going to exam room Wait in exam room to see CP Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09 Q1 10 Information about delays

251 How was it?? Change is always difficult Counter frustration with team motivation Feels great to see improvements in numbers and patient comments

252 ...but most of all Improvement in patient satisfaction is very apparent to the whole team!! Personal growth of each team member Becomes easier to deal with difficult situations Definitely improved our patient care

253 Consistency is Key!!! Everybody was extremely nice and very helpful. Super sweet, friendly people and they re always willing to help. Loved the toys in the exam rooms. I have already told people that I would recommend to bring children there for treatment.