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Objectives To provide an overview of the Healthcare Reform Story evolving in the United States. To address the current evolving CT Scan Radiology Accident Issue as an example of leadership opportunities for improvement. To provide an example of leadership development to meet the demands of Healthcare Reform. 2008 TMIT 2006 HCC, Inc. CD000000-0000XX 6

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Quaid Twins Story 2008 TMIT 2006 HCC, Inc. CD000000-0000XX 8

Dennis Quaid: Story Power 2008 TMIT 2006 HCC, Inc. CD000000-0000XX 9

Every Good Story Victim Villain Hero Crisis Resolution 2008 TMIT 2006 HCC, Inc. CD000000-0000XX 10

Extraordinary impact through ordinary things Chasing Zero is the first in a series of documentaries produced by TMIT that targets consumers, caregivers, and healthcare leaders. The goal is to inspire them to act now to prevent healthcare harm. The war on healthcare harm is not targeting bad people, but bad systems. These support systems no longer protect caregivers and patients as healthcare has become more complex and fragmented. Healthcare harm has risen from the 8th leading cause of death to the 3rd leading cause of death when we include infections we have given patients during care. 20 jumbo jets are crashing every week in American healthcare The documentary was shot in multiple locations around the world. Interviews of World Health Organization leaders were undertaken in Geneva and London. Dennis Quaid was filmed on the movie set of Soul Surfer on Oahu, Hawaii. Caregivers were shot in action at their hospitals including the Brigham and Women s Hospital, the Mayo Clinic, the Cleveland Clinic, Johns Hopkins, and the Vanderbilt University Medical Center. Zero is the number Now is the time Narrator Dennis Quaid Our goal is to reinforce role models of great caregivers and healthcare leaders, and to open dialogue among governance and leadership teams at America s hospitals and healthcare organizations so our care will be safer and more reliable. DVD Contents and Bonus Features Chasing Zero documentary feature 53-minute run time Medical articles for background reading and continuing education: Chasing Zero: Can Reality Meet the Rhetoric? by Charles Denham, Peter Angood, Donald Berwick, Leah Binder, Carolyn Clancy, Janet Corrigan, and David Hunt The Chasing Zero Department: Making Idealized Design a Reality by Charles Denham, Peter Angood, Donald Berwick, Leah Binder, Carolyn Clancy, Janet Corrigan, and David Hunt Story Power by Dennis Quaid, Julie Thao, and Charles Denham The No Outcome - No Income Tsunami is Here: Are You a Surfer, Swimmer, or Sinker? by Charles Denham Web links to receive free assets, such as the National Quality Forum 2010 Safe Practices for Better Healthcare, in return for survey responses to safe practices adoption. Messages from funding organization leaders. Web links to view other resource materials from Discovery Channel, AORN, CareFusion, TMIT, and other patient safety organizations. Stories of great healthcare leaders and caregiver role models communicate the actions that we can take to save lives, save money, and deliver value to the communities we serve. Visit DiscoveryChannelCME.com Chasing Zero online at www.chasingzeromovie.com Chasing Zero is a trademark of CareFusion Corporation This program was produced with educational grants funding from CareFusion, AORN, and TMIT.

Mid-Level Managers: Pushing the Envelope 2008 TMIT 2006 HCC, Inc. CD000000-0000XX 12

Magnitude of U.S. Error and Harm 20 preventable deaths per hour 1 of 4 families have had an adverse event causing suffering, disability or death 1 of 3 doctors families - same. 2 of 5 imaging and lab studies done due to missing prior studies 100 prescriptions written, only 60 are filled and of those who even take the medicine, 25% have an adverse drug event. 2008 TMIT 2006 HCC, Inc. CD000000-0000XX 13

A Financial Crisis Post-managed care Health care doubled as a share of GDP Medicare reform US Canada 14 Managed care

2167

2167 The number of times the phrase the Secretary shall.. appears in the bill

Dr. Don Berwick New Medicare Leader

Cost Containment from Every Angle Provider incentives to promote value ACOs, bundling, readmissions, P4P, pilots Comparative effectiveness and IT Reduce provider prices Independent Payment Advisory Board (IPAB) Reduce consumer demand - tax on Cadillac plans Exchanges Malpractice demonstrations? Prevention? 2008 TMIT 2006 HCC, Inc. CD000000-0000XX 20

One Focus Area: NQF Safe Practices Culture Consent & Disclosure Consent and Disclosure Workforce Information Management and Continuity of Care Medication Management Healthcare-Associated Infections Condition- & Site-Specific Practices 2010 TMIT 2006 HCC, Inc. CD000000-0000XX 21

Press Broke Story New York Times Los Angeles Times

VENN Leaders Leadership Practices 2008 TMIT 2006 HCC, Inc. CD000000-0000XX Technologies 23

CT Scans and Imaging 70 Million CT Scans done per year 30% over utilization 40% inappropriate Studies 2% of Cancers due to Imaging Hundreds of reported burns in multiple states California Legislation just passed Minimal Regulation Malpractice Cases Mounting 2008 TMIT 2006 HCC, Inc. CD000000-0000XX 24

Saturn Ring Burn Pattern Hundreds of Cases Multiple States Many Law Suits

The 4 A s Innovation Adoption Model Awareness: of performance gaps Accountability: of those who must change behavior to close the gaps Ability: of those who must act to close the gaps Actions: that must be taken to close the gaps 2008 TMIT 2006 HCC, Inc. CD000000-0000XX 26

Leaders-Practices-Tech and 4 A s AWARENESS ACCOUNTABILITY ABILITY ACTION Leaders Investing in Ability of Organization to Close the Gaps Leaders Assuring that Action are Being Taken to Close Gaps LEADERSHIP Leaders Aware of Performance Gaps Leaders Personally Accountable to Close Gaps PRACTICES Organization Aware of Best Practice Key Actors Personally Accountable to Adopt Best Practice Key Actors Able to Adopt Best Practice (Know How and Resources) Key Actors Reliably Acting on Practices Consistently Staff AND Leaders Accountable for Safety Envelope of Technologies Staff AND Leaders Able to Assure Existing and New Technologies are Safe Key Actors AND Leaders ensuring that Technologies are Reliably Safe _ TECHNOLOGIES Organization Aware of Benefits AND Risks of Current and New Technologies being Adopted 27

CT Accident Sites AWARENESS LEADERSHIP PRACTICES ACCOUNTABILITY ABILITY ACTION Leaders Aware of Performance Gaps Leaders Personally Accountable to Close Gaps Leaders Investing in Ability of Organization to Close the Gaps Leaders Assuring that Action are Being Taken to Close Gaps Organization Aware of Best Practice Key Actors Personally Accountable to Adopt Best Practice Key Actors Able to Adopt Best Practice (Know How and Resources) Key Actors Reliably Acting on Practices Consistently Staff AND Leaders Accountable for Safety Envelope of Technologies Staff AND Leaders Able to Assure Existing and New Technologies are Safe Key Actors AND Leaders ensuring that Technologies are Reliably Safe _ TECHNOLOGIES Organization Aware of Benefits AND Risks of Current and New Technologies being Adopted 28

Surprised Thought Leader Site AWARENESS LEADERSHIP PRACTICES ACCOUNTABILITY ABILITY ACTION Leaders Aware of Performance Gaps Leaders Personally Accountable to Close Gaps Leaders Investing in Ability of Organization to Close the Gaps Leaders Assuring that Action are Being Taken to Close Gaps Organization Aware of Best Practice Key Actors Personally Accountable to Adopt Best Practice Key Actors Able to Adopt Best Practice (Know How and Resources) Key Actors Reliably Acting on Practices Consistently Staff AND Leaders Accountable for Safety Envelope of Technologies Staff AND Leaders Able to Assure Existing and New Technologies are Safe Key Actors AND Leaders ensuring that Technologies are Reliably Safe _ TECHNOLOGIES Organization Aware of Benefits AND Risks of Current and New Technologies being Adopted 29

High Performer Site AWARENESS LEADERSHIP PRACTICES ACCOUNTABILITY ABILITY ACTION Leaders Aware of Performance Gaps Leaders Personally Accountable to Close Gaps Leaders Investing in Ability of Organization to Close the Gaps Leaders Assuring that Action are Being Taken to Close Gaps Organization Aware of Best Practice Key Actors Personally Accountable to Adopt Best Practice Key Actors Able to Adopt Best Practice (Know How and Resources) Key Actors Reliably Acting on Practices Consistently Staff AND Leaders Accountable for Safety Envelope of Technologies Staff AND Leaders Able to Assure Existing and New Technologies are Safe Key Actors AND Leaders ensuring that Technologies are Reliably Safe _ TECHNOLOGIES Organization Aware of Benefits AND Risks of Current and New Technologies being Adopted 30

LEAD Healthcare Fellowship PROGRAM SUMMARY CORE CURRICULUM WHO: Mid to Upper Level Managers from non-clinical and clinical areas. They will be interested in engaging and developing leaders within their organizations and focus on high performance Applied Leadership WHAT: A 2 year fellowship delivering high impact clinical, operational, and financial performance. Fellows must deliver ROI to hospital to sit a certification exam. Off site meetings, a distance learning system, and weekly coaching will help fellows drive high performance projects. People Systems WHERE: Work will be undertaken on-site at their own organizations through projects and 8 off site meetings with Leadership R&D Partners. WHEN: Soft launch of program July 2010, Applications open Oct 1, 2010, and Kick Off July of 2011. HOW: The know how fellows gain is in Applied Leadership, People Systems, Performance Improvement, and Hospital Systems. They will drive performance improvement in safety delivering clear financial results. Enterprise Performance Performance Improvement LEADERSHIP R & D PARTNERS TIMELINE Corporate Sponsorship Discussions: Ongoing Now Public Soft Launch: July 2010 Public Open of Applications Submission: September 2010 Fellow Corporate and Public Selection : Starting September 2010 and ongoing through Q2 of 2011 HCC HARVARD UNIVERSITY Fellowship Kick Off: July 2011 Boston Mass. 2010 TMIT 2006 HCC, Inc. CD000000-0000XX TMIT 31

Four Major Curricular Elements Applied Leadership: Best practices in high performance project impact. People Systems: Talent recruitment development, retention, and rewards. Applied Leadership People Systems Enterprise Performance: Hospital systems performance of OR, ED, Radiology, Laboratory, Pharmacy, Administration and Nursing. 2010 TMIT 2006 HCC, Inc. CD000000-0000XX Enterprise Performance Performance Improvement 32 Performance Improvement: Project focused integrated performance with sustained gains.

Leadership Engagement And Development HARVARD UNIVERSITY Applied Leadership People Systems Enterprise Performance HCC Performance Improvement TMIT

Learn Our Lessons Make sure to prevent passive deterioration of support systems. Make sure active short-term cost cutting in leadership, practices, or technology does not risk your future. Overcome denial, pride, or fear of your own goliath in order to win your war on preventable healthcare harm. Invest in leaders, adoption of safe practices that have predictable outcomes, and technologies that enable leaders and practices. Practice the 4 A s: Be vigilant in your awareness of performance gaps, make people accountable, invest in ability, and drive action. Unify a team platform to surf the next quality wave. 2008 TMIT 2006 HCC, Inc. CD000000-0000XX 34

Out of the Danger Zone Documentary

We Welcome Your Articles Please Bring Safety and Leadership Articles to the Journal

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The Surf is Up!

The Surf is Up!