DON T STOP BELIEVIN! Our Journey to Excellence By: Betsy Scroggins, RN, AVP Nursing & Jayme Tubbs, Service Excellence Coach Jennie Stuart Health Hopkinsville, KY
Execution Framework: Evidence-Based Leadership SM LEADER EVALUATION Implement an organization-wide leadership evaluation system to hardwire objective accountability LEADER DEVELOPMENT Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results MUST HAVES Rounding, Thank You Notes, Employee Selection, Pre and Post Phone Calls, Key Words at Key Times PERFORMANCE GAP Re-recruit high and middle performers, Move low performers up or out STANDARDIZATION Agendas by pillar, peer interviewing, 30/90 day sessions, pillar goals ACCELERATORS Leader Evaluation Manager Validation Matrix SM Provider Feedback System SM Studer Group Rounding Patient Call Manager TM 2
DON T STOP BELIEVIN!
Jennie Stuart Health Who we are: Acute care, community hospital Private Not for profit Licensed for 194 beds Located in Hopkinsville, KY Celebrating 102 years of service to our community Partnered with the Studer Group in 2012 700 employees
Our Journey to Excellence 5
What we have done well. Culture Specific Progress We learned we didn t always have to travel the journey like we originally planned! Ensure that each step you take is the best step for your organization! Dress Code Update and Implementation The focus on quality and patient experience had to be exemplified by how we looked! We are proud that we not only look professional but our clinical teams are easily identified by patients and their family members. 6
What we have done well. RIF Financial environment of healthcare forced us to go through this financial restructuring which was imperative to our survival 13% reduction in force Didn t cut service lines! We used this incredibly difficult situation to utilize our HighMiddleLow training to make strategic choices regarding who remained on our team. Having the RIGHT coach on our bus! From each coach along our journey, we have learned a great deal! Cara joined our team in Q3 2014 and she has been paramount to our success and how quickly we have progressed since then!!! 7
Must Haves we have learned to do well. Building the right Senior Team Service Excellence focus in Orientation both General and Clinical High/Middle/Low (HML) Hourly Rounding / Nurse Leader Rounding / Handoff Communication Skills Labs for Training Reward and Recognition focus Leadership Development Institutes(LDI s) Leader Evaluation Manager (LEM) Patient Call Manager SM (PCM) Validations/Coaching Conference Attendance 8
Leadership Development Institutes 2 days, each quarter since July 2012 Content expert s present: Eric Lee, CEO opens with current issues affecting JSMC Updates on previously trained tactics New tactics are presented Break out sessions Group discussions Have FUN!!! 9
Leadership Evaluation Manager Goals are aligned with organizations annual business plan. Merit increase is tied directly to LEM performance Data is reviewed in Monthly Meetings 2 senior team review meetings happen annually: Year-end review meeting: Discuss each manager s final score and performance Upcoming year review Review the upcoming year LEM for each manager before locking goals 10
Patient Call Manager SM Unit Specific Roll-Out and Execution! All Areas, Jan.2016-April 2016 Contact Rate: 95.04% Completed Rate: 67.53% WILL UPDATE WITH CURRENT DATA PRIOR TO SUBMISSION Patients Attempted Patients Completed Count Percent Count Percent Total 6260 95.04% 4448 67.53% Unit 5Th/Med 546 91.76% 384 64.54% 7Th/Surg 365 89.68% 220 54.05% 8Th/Surg 69 84.15% 57 69.51% Asc 993 98.41% 769 76.21% Conv Care 2632 96.76% 1706 62.72% Icu 33 86.84% 31 81.58% Ob/Gyn 280 94.92% 258 87.46% Pcu 94 78.99% 81 68.07% Sleep Lab 133 67.86% 117 59.69% Surgery 1115 99.02% 825 73.27% 11
Validations/Coaching Primarily focused on Must Haves Multiple layers! VP of Nursing AVP of Nursing Nurse Managers House Supervisors Service Excellence Coach Studer Coach 12
Score Transparency Evolution of our HCAHPS Scorecard! HCAHPS MEASURE 2010 3rd quarter FINAL 2011 3rd quarter FINAL 2012 3rd quarter FINAL 2013 3rd quarter FINAL 2014 3rd quarter FINAL 2015 3rd quarter FINAL 2016 1st quarter FINAL Communication with Nurses 70.70% 76.10% 73.12% 77.21% 79.07% 80.83% 83.26% Communication with Doctors 77.00% 79.50% 79.23% 80.64% 76.99% 80.65% 81.88% 33 Responsiveness of Hospital Staff 55.60% 68.20% 62.71% 66.71% 65.35% 75.52% 73.83% Pain Management 63.20% 69.50% 68.82% 68.65% 69.72% 72.44% 74.48% Communication About Medicines 54.10% 59.90% 55.59% 69.22% 67.26% 67.62% 65.43% Cleanliness of Hospital Environment Quietness of Hospital Environment 66.70% 76.00% 71.51% 70.22% 78.05% 75.63% 79.21% 63.60% 64.80% 56.52% 56.25% 59.51% 61.25% 63.84% Discharge Information 82.60% 82.40% 83.44% 84.02% 86.36% 86.53% 90.52% Overall Rating of Hospital 54.40% 56.90% 55.62% 62.64% 65.64% 68.79% 65.71% Care Transition Measure 48.31% 52.12% 57.69% 54.63% 13
Conference Attendance Since 2012: 31 different attendees 49 total attendees Senior team, board members, managers, and front line staff attend! Used strategically: as a reward and recognition tool To reach those who just need a little push and connection to purpose! 14
But, it s not always unicorns and butterfly's!! 15
Our Bumps in the Road Studer Lite Trying to take this journey without real guidance is incredibly difficult. Like trying to cross the country on a road trip without a map. We had buy-in from a few leaders, but not everyone and it takes everyone starting at the top! RIF Though looking back this was something we ended up doing pretty well, this was still a very difficult time for our organization! A lot of experience was lost with the offer of early retirement that was offered during the RIF
Our Bumps in the Road Physician Alignment This is still under construction! Physicians are resistant to change and finding it difficult to deal with the external pressures that are forcing them to make changes. Medicare Readmissions Physician alignment lacking Need right docs on our bus and accountability!
Our Bumps in the Road Turnover Improving our interviewing and hiring processes. We face a challenge of relocation due to our close proximity to Ft. Campbell Nursing shortage! Service Teams (aka Quality Impact Teams) Roll-Out This was one of the early bumps that taught us about culture specific progress that we talked about earlier! We were not culturally ready to take this exit!
Our Bumps in the Road Dress Code Implementation We updated both the general dress code as well as standardizing the scrub colors by discipline. Implementation was a major challenge for us!... But accountability has been the biggest challenge! Ransomware May 2016 We learned a LOT! Immediate Town Hall meetings a must Needed an incident commander center.
Celebrate the Successes You Have Along the Way! Slide 20 20
Studer Group Partnership Q1 Q3 2012 2012 Q4 2012 Q1 2013 Q3 2013 Q4 2013 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q3 2015 Q4 2015 Q2 2016 Quarterly 2 Day/Off-Site LDI s Dedicated Discharge Education Nurse Patient Call Manager Leader Evaluation Manager Leader Rounding on Employees Hourly Rounding Interdepartmental Rounding Interdepartmental Surveys Service Excellence/AIDET in General Orientation HighMiddleLow Handoff Communication Standardization Service Excellence/Tactics in Clinical Orientation Year 2: HighMiddleLow
86.00% 84.00% 82.00% 80.00% 78.00% 76.00% 74.00% 72.00% 70.00% Communication with Nurses 82.33% 83.26% 76.11% Q1 2014 Q1 2015 Q1 2016 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Responsiveness of Hospital Staff 59.46% 70.98% 73.83% Q1 2014 Q1 2015 Q1 2016 78.00% 76.00% 74.00% 72.00% 70.00% 68.00% 66.00% 64.00% 62.00% Pain Management 75.67% 74.48% 66.74% Q1 2014 Q1 2015 Q1 2016
Discharge Information Communication with Doctors 92.00% 91.00% 90.00% 89.00% 88.00% 87.00% 86.00% 85.00% 87.02% 88.41% 90.52% 84.00% 82.00% 80.00% 78.00% 76.00% 74.00% 72.00% 70.00% 68.00% 72.98% 79.88% 81.88% 84.00% Q1 2014 Q1 2015 Q1 2016 66.00% Q1 2014 Q1 2015 Q1 2016 66.50% 66.00% 65.50% 65.00% 64.50% 64.00% 63.50% 63.00% 62.50% Communication About Medicines 65.95% 63.85% 65.43% Q1 2014 Q1 2015 Q1 2016
Environment of Care Care Transition Measures 73.00% 71.00% 69.00% 68.96% 71.53% 60.00% 50.00% 40.00% 43.08% 54.54% 54.63% 67.00% 65.00% 65.31% 30.00% 20.00% 63.00% 10.00% 61.00% Q1 2014 Q1 2015 Q1 2016 0.00% Q1 2014 Q1 2015 Q1 2016 70.00% 68.00% 66.00% 64.00% 62.00% 60.00% 58.00% 56.00% 54.00% Overall Rating of Hospital 67.98% 65.71% 59.15% Q1 2014 Q1 2015 Q1 2016
HCAHPS MEASURE 2010 3rd quarter FINAL 2011 3rd quarter FINAL 2012 3rd quarter FINAL 2013 3rd quarter FINAL 2014 3rd quarter FINAL 2015 3rd quarter FINAL 2016 1st quarter FINAL Communication with Nurses 70.70% 76.10% 73.12% 77.21% 79.07% 80.83% 83.26% Communication with Doctors 77.00% 79.50% 79.23% 80.64% 76.99% 80.65% 81.88% 33 Responsiveness of Hospital Staff 55.60% 68.20% 62.71% 66.71% 65.35% 75.52% 73.83% Pain Management 63.20% 69.50% 68.82% 68.65% 69.72% 72.44% 74.48% Communication About Medicines 54.10% 59.90% 55.59% 69.22% 67.26% 67.62% 65.43% Cleanliness of Hospital Environment Quietness of Hospital Environment 66.70% 76.00% 71.51% 70.22% 78.05% 75.63% 79.21% 63.60% 64.80% 56.52% 56.25% 59.51% 61.25% 63.84% Discharge Information 82.60% 82.40% 83.44% 84.02% 86.36% 86.53% 90.52% Overall Rating of Hospital 54.40% 56.90% 55.62% 62.64% 65.64% 68.79% 65.71% Care Transition Measure 48.31% 52.12% 57.69% 54.63%
Successes of our Journey so far.. Return to consistent profitability! 7 out of 10 HCAHPS Composites are improving at a 75 th -90 th percentile Rate of Change Strategic Affiliation with Vanderbilt Medical Center 26
Our TRUE success our Patient s Experience at JSMC! "Upon arrival to the 7th floor the staff made me feel like they were very concerned about me." I did not receive much rest, but it was because the staff was so attentive and concerned about me." On the 7th floor they did their job. When they left my room they informed me when they would be coming back. All the staff and Respiratory Therapy on the 7th floor did their job. I received outstanding care, always on time with my treatments. The care I received makes me want to come back to the 7th floor!! Care was excellent. Best care I have received in a very long time, and I have been in a lot of hospitals. The entire nursing staff was excellent everyone was patient, polite, and concerned. Just flat out GREAT and the best care I have received!! 27
Our TRUE success our Patient s Experience at JSMC! "I wasn't a fan of Jennie Stuart due to my experience in the past but I have no complaints about my stay this time. They were very nice to me. Gina my nurse the first night helped calm me down and took great care of me. Jennifer was my nurse the day I left and she was very helpful with my dressing change and making sure I felt comfortable with it before I left. I would recommend you to anyone now. I was very happy with my stay. I received good care. Everyone was very attentive. There are some awesome nurses on the 7th floor. Ya ll have made some great changes. I had a wonderful stay." "I've been in the hospital in Alabama, Nashville, Bowling Green and Jennie Stuart is the best hospital I've ever been in. Everybody did a really good job." 28
We have not arrived at our destination yet but we are more determined than ever! We must keep reminding ourselves--- DON T STOP BELIEVIN!! We are here! 29
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Betsy Scroggins, RN, AVP Nursing bscroggins@jsmc.org Jayme Tubbs, Service Excellence Coach jtubbs@jsmc.org