Saving Lives through Performance Excellence

1. Saving Lives through Performance Excellence Priscilla Nuwash, MBA, CLM President, Center for Performance Excellence Poudre Valley Health System

2. Private, locally owned, not-for-profit Full spectrum of healthcare services 2 tertiary hospitals, outpatient campus, numerous satellite clinics Regional medical hub for cardiac, trauma, orthopedic & oncology services, neonatal intensive care & bariatric surgery Poudre Valley Health System

3. Definition of World-Class: Striving for results in the 90th percentile or top 10% of available national comparative databases Poudre Valley Health System Vision: To Provide World-Class Healthcare

4. Service area: Northern Colorado, Wyoming & Nebraska 5,200 employees, 600 primarily independent physicians & 800 volunteers $1.3 billion in annual revenue Poudre Valley Health System

5. Community hospital serving Fort Collins, Colorado 1,500 employees, 300 independent physicians & 575 volunteers 24% annual employee turnover 5 CEOs in 4 years $250 million in annual revenue Changing healthcare market Demand for physician integration Where Our Journey Started (1997)

6. Where Our Journey Started (1997) • Leadership: Find an improvement model • Decision: Baldrige National Quality Program

7. Systems perspective Manage your whole organization, as well as components, to achieve success Feedback Notes major strengths Highlights impact of opportunities for improvement Measures progress Guides improvements Why Baldrige?

8. 2000 Submitted first application, with each Category written by separate team Baldrige happened outside of “normal” work Category teams met just to write Application 2001 Took a year off “to work on improvements” 2002 Applied again, expecting “success” 2003 Repeat the process The Early Years

9. Use Baldrige for a business framework A Turning Point (2004)

10. Communicate Direction Set Direction Our Beliefs

11. New Employee Orientation Forums for Employees & Volunteers Quarterly updates on performance & action plans that support each Strategic Objective Name Badges Meeting Templates Learn & Lead Program Vision/Mission/Values Team Leadership Meetings Medical Executive Committees Communicate Direction

12. Plan & Align

13. Core Competencies

14. Identify strategic opportunities How can we provide a lifetime of care? Align economic incentives & build relationships Outpatient services, home health, sub-acute care, third-party administrator, strategic vendor relationships Win-win for PVHS, other healthcare providers, patients & community Improve clinical quality Partnering: An Innovative Strategy

15. Rural dilemma Insufficient volumes to ensure quality Choice: Revenue or optimal outcomes? New alternative PVHS + Regional West Medical Center = Medical Center of the Rockies Improved outcomes & revenues for all The Ultimate PartnershipPVHS & Regional West Medical Center

16. Interdisciplinary teams: engage the workforce Benchmarking: top 10% Consideration of new ideas: Business Decision Support Process Reward innovation & high performance, support strategy: R&R Program, Optional Performance Plan Build innovation into improvement methodology: PDCA using LEAN Guide best practice inquiry with stakeholder involvement & using the voice of the customer: Building MCR Driving Innovation

17. Execute the Plan & Drive Performance

18. Execute the Plan & Drive PerformanceBalanced Scorecard Process

19. Develop People

20. Performance Review Process Reward & Recognition, including Peer-to-Peer Coupons Optional Performance Plan Learn & Lead, Building Blocks of Leadership Learn & Grow Grand Rounds, Tuesday Afternoon Conferences Mentoring Program Tuition Reimbursement Professional Associations, Conferences Develop People

21. Performance Review Process Best Practice: Integration of Values, Behavior Standards, Core Competencies, Key Customer Requirements & Personal Goal Cards Develop People

22. Execute the Plan & Drive PerformancePersonal Goal Cards

23. Learn, Share & Innovate

24. Performance Excellence Teams Baldrige-driven improvements PDCA Model for Process Improvement Process Design Best practices: Stakeholder involvement & Voice of the Customer Learn, Share & Innovate

25. 20 interdisciplinary teams with staff, physicians, partners, vendors & community members Community focus groups Wayfinding, spirituality, furniture, menus, naming National site visits with physicians, staff & vendors Mock-ups for OR, trauma suite, patient room & elevator Day-in-a-Life Scenarios An Example: Medical Center of the Rockies

26. Healthcare Outcomes Risk-Adjusted Mortality Rate

27. Customer-Focused Outcomes Top Box Scores for Patient Satisfaction 8 years of consistent improvement

28. Customer-Focused Outcomes HCAHPS* *Hospital Consumer Assessment of Healthcare Providers & Systems

29. Financial & Market Outcomes Patient Discharges: 50% increase since 1st Baldrige application 50% increase in PVHS discharges from 2000 to 2008 11% population growth in Larimer County from 2000 to 2008 18% increase in Competitor discharges from 2000 to 2008 39% population growth in Competitor’s home county from 2000 to 2008

30. Workforce-Focused Outcomes Staff Voluntary Turnover

31. Workforce-Focused Outcomes Physician Engagement Scorecard

32. In a "material shift" from previous quarters, Moody's Investors Service issued more downgrades of not-for-profit hospitals and health systems than upgrades in the third quarter, illustrating the industry's ongoing financial pressures. Health Care Advisory Board 10/18/2010 “Moodys: Downgrades outpace upgrades for first time in 2010”

33. Sept 2009: Moody’s andStandard & Poors upgrades PVHS bond ratings, citing strong financial performance. “We expect performance in fiscal year 2010 to be strong as well,” Moody’s stated. May 1, 2010: PVHS receives bond upgrade from Standard & Poor's. S&P's report recognized: continued excellent financial results and robust cash flow improvements a combined effort by staff, physicians and volunteers to drive quality, minimize expenses and reduce capital expenditures Sustainability

34. Ensuring Financial StabilityFinancial Flexibility Index • Total Margin • Return on Investment • Replacement Viability • Equity Financings • Days Cash on Hand • Cash Flow to Total Debt • Average Age of Plant

35. Increased hospital discharges almost 50% with only 11% population growth Doubled the workforce Added 2nd hospital, outpatient campus & numerous offsite clinics Expanded service area from Fort Collins community to 50,000 square miles in Colorado, Wyoming, Nebraska Challenging Times…

36. Top 10% for inpatient mortality, patient satisfaction, employee satisfaction & physician engagement Thomson Reuters Top 100 Hospital for 5 consecutive years Top 100 Best Places to Work, Modern Healthcare 2008, 2009, 2010 Magnet designation since 2000 NDNQI Outstanding Nursing Quality Award for last 3 years World-Class Results

37. Consider it productive time Make it how you do your business De-emphasize the award It’s hard work Start now Lessons Learned: The Journey

38. What’s Next? • Continue with teams • Continue with self-assessment • Assist others in their performance excellence journey

39. To provide world-class health care Our Vision Molly 4th generation treated at PVH

40. Additional Information: PVHS Center for Performance Excellence pjn@pvhs.org 970-237-7132 www.pvhs.org