Driving Accountability through Leader Evaluations and the Monthly Meeting Model Bo Boulenger, MHA CEO, Baptist Hospital of Miami (Miami, FL) Mitch Hagins Coach, Studer Group (Gulf Breeze, FL) Presentation Objectives Tell you what worked at Baptist Hospital of Miami and to show you what you can achieve through greater accountability and using the tools. It will change your organization and your life. 1 2008 Studer Group
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Coaching Partnership Miami Style! (Even Tiger Needs a Coach) Preparing for the Headwinds 3 2008 Studer Group
State Case for Accountability Change Our patients (via survey results) say we can do better We know process improvement opportunities exist Address how it will affect employees up front and always connect to mission. Change Management Tool: Harvard Business School Leading in Times of Change by: Kerry Bunker and Michael Wakefield 4 2008 Studer Group
Accountability Requires Focus Use Important Tools: Monthly meeting model - Trust but verify personally review rounding logs in underperforming departments Use data to evaluate team and individual leader performance Steady and consistent to drive results 5 2008 Studer Group
Baptist Hospital of Miami Results Service Weekly Accountability Tool Contains Leader s Names BAPTIST HOSPITAL OF MIAMI Patient Satisfaction Report How to Use this Report Please post these results on the communications board in your unit under the SERVICE pillar by Friday. Carry a copy of this report with you at all times so you can communicate results while rounding with staff and during staff meetings. Our goal is the 90 th percentile for all areas. Outpatient Services # of Quarter-to-date ending on: Feb. 23 Mar. 1 surveys returned Inpatient 96 93 789 Emergency (Adult) 30 33 617 Outpatient Surgery 77 76 158 Outpatient Services 94 91 426 1 East Lake - M. Guignard 99 99 25 2 Tower J. Maloney 90 80 62 3 Tower - M. Suarez-Cantillo 63 59 72 4 Tower - L.Lorenzo 11 19 62 5 Tower - C. Bowling 99 99 38 3 Main - M. Guignard 95 95 68 4 Main - R. Cordo 59 79 32 5 Main - S. Ocon 99 81 26 Rehab - E. Matalon 96 98 13 Women s Srvc - M. Perez 99 99 59 4 BCVI - D. Thomas 99 99 82 OB - B. Roberts, M. Perez 92 90 124 Peds/PICU - L. McCarthy 99 99 85 NICU - M. Olmeda 37 70 12 Short Stay - R. Maluf-Contreras 99 99 50 ICU - B. Stolzenberg 90 90 132 Admissions 72 67 779 Rooms 97 94 788 Meals 98 97 772 Nurses 93 91 789 Tests and Treatments 93 93 759 Visitors and Family 85 73 768 Physicians 84 82 782 Hospitalists - Dr. Villanueva 96 94 84 Discharge 94 94 774 Personal Issues 96 95 776 Emergency Department Decady-Alexis 89 ER Peds - M. 90 300 Arrival 85 85 299 Nurses 91 92 298 Physicians 83 87 298 Tests 87 89 190 Personal Issues 91 91 295 ER Adult - M. Rafuls and 30 33 617 S. Balbosa-Saunders Arrival 15 14 612 Nurses 28 33 608 Physicians 52 57 607 Tests 35 40 551 Personal Issues 32 36 608 # of Quarter-to-date ending on: Feb. 23 Mar. 1 surveys returned Urology Lab - S. Callis 99 32 11 Radiation Therapy - G. Weiss 99 99 25 Sleep Center - A. Vinent 91 72 31 Nuclear Medicine - S. Bracci 99 93 46 PET - S. Bracci 93 98 37 Pulmonary - A. Vinent 99 99 24 BCVI - J. Kiah & D. Rodríguez 92 92 340 Endoscopy - D. Phillips 99 99 23 Ultrasound - S. Bracci 99 99 58 CT - S. Callis 4 8 27 Oncology - C. Bowling 99 99 10 Plain films/flouro - S. Callis 73 89 31 EEG - S. Holan 99 99 7 OP Ortho Rehab - C. Larco 56 46 38 OP Neuro Rehab - R. Mojica 52 48 40 Registration 73 67 413 Facility 89 86 420 Test and Treatments 98 97 423 Personal Issues 89 84 413 Registration Areas IP/OP Registration - 75 72 1051 K. Folkman OPS/BCVI Registration - 80 84 536 M. Sousa ED Registration - M. Basden 71 69 885 HCAHPS Overall Rating 78 77 100 Would you recommend 86 86 99 HCAHPS Results are % of Top Box Responses Priority Index Focus Quarter-to-date: Inpatient Outpatient Surgery Outpatient Services Response to concerns 94 65 74 n/a and complaints Emergency 6 2008 Studer Group
Service - Patient Satisfaction Percentile Ranking P e rc e n tile R a n k 100 90 80 70 60 50 40 30 20 10 0 90th Percentile Q1 FY07 Q2 FY07 Q3 FY07 Q4 FY07 Q1 FY08 Q2 FY08 Inpatient Ambulatory Surgery Outpatient Services Irma Delima 7 2008 Studer Group
Service HCAHPS Recommend this Hospital 100 90 80 70 60 U.S. Average 50 40 30 20 10 0 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Miami Dade Comparison July 2006 - June 2007 Published March 21, 2008 on www.hospitalcompare.hhs.gov National Average: 63% 8 2008 Studer Group
US News & World Report -Honor Roll July 2006 - June 2007 Published March 21, 2008 on www.hospitalcompare.hhs.gov National Average: 63% *OTHER MIAMI DADE HOSPITALS DATA NOT AVAILABLE: DOUGLAS GARDENS HOSPITAL, LARKIN COMMUNITY HOSPITAL, PALM SPRINGS GENERAL HOSPITAL, WESTCHESTER HOSPITAL Why Wait? 9 2008 Studer Group
Service - Adult ED Satisfaction Scores 100 Percentile Rank 90 80 70 60 50 40 30 20 10 0 Goal FY08 Goal FY07 4 5 30 10 12 Hourly Rounding 2 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 2 10 11 42 79 Service Goal #2 Reduce Emergency Department LWBT 1100 1000 900 16 14 12 Minutes 800 700 Goal = 5.5% 10 8 6 Percent 600 4 500 2 400 FY06 Q1 FY06 Q2 FY06 Q3 FY06 Q4 FY07 Q1 FY07 Q2 FY07 Q3 FY07 Q4 0 10 2008 Studer Group
ROI - Emergency Department Hourly Rounding ED Annual Volume Average Patient Revenue Beginning Current ROI 57,500 $474 8.4% 5.0% $926,670 Adult Emergency Department Satisfaction Scores APRIL 2nd PERCENTILE AUGUST 79th PERCENTILE 11% 3% 3% VP P 7% F 9% 41% VG F 14% 55% VG G G 30% 28% VP P F G VG 11 2008 Studer Group
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ED "Doctor Overall" Percentile Rank Jan 06 thru August 07 Percentile Rank 100 90 80 70 60 50 40 30 20 10 0 Goal: 60th percentile (100%) Hourly Rounding New Med. Dir. J 06 F M A M J J A S O N D J 07 F M A M J J A Month Hospitalist Program Director 13 2008 Studer Group
Service Employed Hospitalist Patient Satisfaction rose from the 18 th Percentile To the 98 th Percentile!!! YEAH Service Medical Staff Satisfaction Overall Satisfaction 94 th percentile up from 74 th percentile Satisfaction with Nursing 89 th Percentile from 57 th percentile Would you recommend to friends/family 96 th percentile 14 2008 Studer Group
Quality National Quality Measures Top 10% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% FY03 FY 04 FY05 FY06 FY07 FY08 Q1 FY08 Q2 Did not meet Top 10% Met Top 10% Quality March 2008 The Joint Commission Survey Perfect Score on National Patient Safety Goals. 15 2008 Studer Group
Pre Post Stent 16 2008 Studer Group
Quality Core Measure: Percutaneous Coronary Intervention (PCI) Minutes 90 80 70 60 50 40 30 20 10 0 Miami-Dade Fire Rescue Benchmark at 60 min Miami-Dade County Average at 58 min 80 42 42 57 48 52 44 52 48 38 40 46 April May June July Aug Sept Oct Nov Dec Jan Feb Mar Total of 111 patients from April to March Quality Zero VAP s for 7 months July 07 to January 08 180 days with No VAP 17 2008 Studer Group
Quality ROI on VAP Reduction March 2006 March 2007 = 11 VAP Cases March 2007 March 2008 = Net Reduction 6 VAP Cases 5 VAP Cases Savings x $40,000 $200,000/Yr * Source = CDC Guidelines for Preventing Healthcare Associated Pneumonia Quality Improve Clinical Resource Utilization: ALOS Fiscal Year '05 - Fiscal Year '07 6 Days 5.8 5.6 5.4 5.2 5 Budget ALOS FY 07 = 5.73 Mean FY 05 Q1 FY 05 Q2 FY 05 Q3 FY 05 Q4 FY 06 Q1 FY 06 Q2 FY 06 Q3 FY 06 Q4 FY 07 Q1 FY 07 Q2 FY 07 Q3 FY 07 Q4 FY 08 Q1 ALOS 18 2008 Studer Group
Quality Pillar Award Winners! Patient Throughput Team (aka "The Slowskys") Reduced ALOS by 0.5 Days-which had the effect of opening a 40 bed unit at BHM. Awarded the Greatest Customer Impact team by sister Baptist Health Hospitals $2,000,000 ROI Quality Improve Clinical Resource Utilization: Ischemic Stroke LOS LOS (Days) 11.5 9.5 7.5 5.5 3.5 LOS Rounds Started Premier LOS Apr '06 May Jun Jul Aug Sep Oct '06 Nov Dec Jan '07 Feb Mar Apr May Jun Jul Aug Sep Oct '07 Nov Dec LOS 19 2008 Studer Group
Quality ROI on Stroke LOS Reduction LOS Reduction of 2.3 Days Direct Cost Reduction of $2,600/case x 500 cases Savings $1,300,000 Patient Falls with Injury Hourly Rounding Initiated 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% 2002 2003 2004 2005 2006 2007 2008 Q1 N=2 20 2008 Studer Group
Falls = $3.9 Million (Settlement value only) 2002-present Total Mean Median Hip (5) $675,000. $135,000. $100,000. Head/brain (4) $2,605,000. $651,250. $465,000. Shoulder (3) $165,000. $55,500. $50,000. Pressure Ulcer % of Adjusted Admissions 1.5 Hourly Rounding Initiated 1.25 1 0.75 0.5 0.25 0 2003 2004 2005 2006 2007 2008 Q1 Total reports Hospital acquired 21 2008 Studer Group
Decubitus Ulcers (Settlement value only) 2002- present Decubitus (8) Ulcers Total $1,265,000. Mean $158,125. People - Baptist Hospital Change in Top Box Scores 2006 2007 GrandMean Percentile: 76th 72nd Baptist Baptist Hospital 2006 Change from Hospital 2007 GrandMean: 4.22 2006 to 2007 4.21 (n=2,609) (n=2,829) %5s % 5s Opportunities to learn and grow 59 +1 60 Progress in last six months 57 +4 61 Best friend 54 0 54 Coworkers committed to quality 53 +3 56 Mission/Purpose of company 60 +2 62 My opinions count 44 +2 46 Encourages development 55 +3 58 Supervisor/Someone at work cares 60 +1 61 Recognition last seven days 52 +2 54 Do what I do best every day 61 +2 63 Materials and equipment 55 0 55 I know what is expected of me at work 78 +2 80 Note: Percentiles based on Gallup s Q¹² Healthcare database from survey year Copyright 1993-1998, 2007 Gallup, Inc. All rights reserved. 22 2008 Studer Group
People Old Goal: All Leaders Below Gallup 75% Required to do Impact Plan with staff 13 Leaders above the 75 th did not do an Impact Plan with staff; 10 of 13 went down. Results: 11 did not; of 11 only 4 remain with us. New Goal: Everyone does an Impact Plan with staff. People NDNQI RN Survey Job Enjoyment Scale T-Score Baptist Hospital All Units Average T-Score: <40 low satisfaction; 40-60 mod. Satisfaction >60 high satisfaction 60 58 56 54 52 50 48 46 44 42 40 Top Quartile 60 2005 2006 2007 23 2008 Studer Group
Finance Hospital Margin 8.0% 7.7% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 3.3% 2.3% 0.0% '07 Actual '07 Budget '06 Actual Growth Develop Blood Conservation Program Surgeries Outpatient Procedures ED Volume with Efficiency Improvements 24 2008 Studer Group
Growth Growth 25 2008 Studer Group
Say Ahhhh... Thank You! Bo Boulenger, MHA CEO, Baptist Hospital of Miami (Miami, FL) Mitch Hagins Coach, StuderGroup (Gulf Breeze, FL) 26 2008 Studer Group