Pam Beitlich , RN, MSN Studer Group September 16, 2010

1. Hardwiring Excellence A Foundation to Get There Pam Beitlich, RN, MSNStuder Group September 16, 2010

2. Commit To Being An “Excellent” Adult Learner Silence cell phones/beepers Be totally present; engage Listen as if you were going to teach it Write/draw/diagram Participate: laugh, snort, question Relate vs. compare Own it

4. Why are we here today? Understand the foundational principles of Hardwiring Excellence Take away 3 things that you can begin immediately in your workplace

5. The Foundation-

6. Bottom-line Results – Everyone has a role(Balanced Scorecard)

7. Nine Principles® Build Individual Accountability Commit To Excellence Measure The Important Things Align Behaviors With Goals And Values Build A Culture Around Service Communicate At All Levels Create And Develop Great Leaders Recognize And Reward Success Focus On Employee Satisfaction

8. Must Haves® • Aligning Leader Evaluations with Desired Outcomes • Rounding for Outcomes • Employee Thank You Notes • Employee Selection and the First 90 Days • Pre and Post Phone Calls • Key Words at Key Times

9. Healthcare Flywheel® Bottom Line Results (Transparency and Accountability) • Winning • Execution • Prescriptive To Do’s Purpose, worthwhile work and makinga difference ® • Self-Motivation • Courage

10. Rev 6.7.10 Evidence-Based LeadershipSM Breakthrough Foundation STUDER GROUP®: Objective Evaluation System Leader Development Must Haves® Performance Gap Standardization Accelerators Aligned Goals Aligned Behavior Aligned Process Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results (15 pts) • Agreed upon tactics and behaviors to achieve goals • Rounding for Outcomes: (10pts) • Thank you notes: (2 pts) • Selection and the First 90 Days (8 pts) • Key Words at Key Times (5 pts) • Post Phone Calls (10 pts) Re-recruit high and middle performers Move low performers up or out (12 pts) Leader Eval ManagerTM Patient Call Manager TM Processes that are consistent and standardized throughout the company (8 pts) Implement an organization-wide staff/leadership evaluation system to hardwire objective accountability (Must Haves®) (30 pts)

11. Case Study • Journey of achieving personal and organizational excellence Becoming the leader I’ve always dreamed of

12. Why I Care About Making a Difference

13. Building a Culture of ExcellenceA “Roadmap”

14. Creating a great place for employees to work, physicians to practice, and patients to receive care

15. A Culture of Excellence Attracts and retains talent Achieves excellent clinical outcomes Sparks employee generated ideas Perception of care high level – “would recommend” Grows according to plan Financially outperforms competition

16. The Knowing – Doing Gap There is a huge gap between knowing the importance of operational excellence - anddoing it every day. What kind of culture do you really want to create and keep at your organization?”

17. Strategic Direction “To be the best health care organization in the country”

18. Word of Mouth 66% of healthcare choice decisions are based on word of mouth AHA Reality Check II, AHA, 1998

19. A Simple Concept “If the other guy’s getting better, then you’d better be getting better faster than that other guy’s getting better . . . or you’re getting worse.” -- Tom Peters The Circle of Innovation

21. CEO’s Top Issues- 1998 Upgrading technology / Information systems Integrating system / Forming a provider network Developing new services / Diversifying business lines Re-engineering business processes Recruiting physicians Re-engineering clinical services Forming a physician-hospital organization Controlling costs Developing a medical services organization Merging /Consolidating Building / Expanding /Renovating AHA News, March 9, 1998

22. CEO’s Top Issues – 2003 Reimbursement Personnel Shortages Capacity Care for the Uninsured Physician/Hospital Relations Malpractice Insurance Governmental Mandates Quality Technology Patient Safety Patient Satisfaction American College of Healthcare Executives, Nov 26, 2003, CEO Survey Reveals Top Issues Facing Hospitals Biodisaster Preparedness

23. CEO’s Top Issues – 2008 Constant for years Financial challenges Patient safety and quality Care for the uninsured Physician-hospital relations Personnel shortages Moves up and down Governmental mandates Patient satisfaction Capacity Technology Issues about not-for-profit status Disaster preparedness American College of Healthcare Executives, 2008, Annual CEO Survey of Top Issues Confronting Hospitals

24. Financial Challenges Healthcare Reform Implications Care for the Uninsured Patient Safety and Quality Governmental Mandates Physician Hospital Relations Patient Satisfaction Personnel Shortages Capacity Technology Governance Disaster Preparedness CEO’s Top Issues - 2009 New update Constant for years Moves up and down January 11 Modern Healthcare, American College of Healthcare Executives, 2009 Annual CEO Survey of Top Issues Confronting Hospitals; 525 Hospital CEOs

25. One Hospital’s Journey…

26. Leadership Meetings

27. No more turkeys

28. Can We Change the World? “To be the best Community Hospital and Health System in the United States” To be “The best place to work, practice medicine and be a patient”

29. Focus on Measurements Patient Satisfaction Staff Satisfaction Physician Satisfaction Quality/Safety Financials Beginning of “No-Secrets” Culture

30. Standards of Behavior Always Make a Positive Impression Make Communication Effective Practice Professionalism/Teamwork Develop and Use Service Recovery In 2006, added: Patient Safety Standard for ALL staff

31. It’s all about the leader… Every single one of them “If you want to change the world, you have to start with yourself.”

32. Great Organizations - Have leaders who model behaviors that positively influence employee perceptions Constructively coach others to increase their skill level Mentor new leaders Share lessons learned

33. Good or Great? What differentiates your organization from your competitors? Rude – Good - Memorable

34. Service is Married to Quality…

35. 2’s 3’s 4’s 5’s 1’s 1% 2% 7% 24% 66% 99th Percentile Hospital 1% 2% 8% 34% 55% 64th Percentile Hospital 2% 2% 8% 36% 52% 35thPercentile Let’s look at Service – 4 vs 5 Top Box Loyalty Reference: Sample distribution of inpatient satisfaction score responses to achieve excellence, Press Ganey and Associates, March 2007

36. HCAHPS Recommendations

37. Percentile Rank ComparisonHow do Studer Group Partners Compare vs. Non Partners The graph below shows a comparison of the average percentile rank for Studer Group Partners that have received EBL coaching since 2007 and non-partners for each composite. HCAHPS results are for patients discharged between July 2008 and June 2009. It is sorted to show composites with the highest Studer Group partner average percentile rank on top.

38. Must Haves® • Aligning Leader Evaluations with Desired Outcomes • Rounding for Outcomes • Employee Thank You Notes • Employee Selection and the First 90 Days • Pre and Post Phone Calls • Key Words at Key Times

39. What is Rounding with Outcomes? Proactively, engaging, listening to, communicating with, building relationships with and supporting your most important customers (employees, family, patients, physicians, and other departments)

40. Rounding for Outcomes is NOT… The proverbial wave Management by wandering around Focused on “what’s wrong” Being “out there” Happenstance

41. Rounding Works Rounding will have the biggest impact on your employee and customer satisfaction results Builds the team – elevates performance Breaks down barriers, fixes systems, ensures right tools and equipment are in place Emphasizes the positive instead of negative

42. Turnover and Vacancy Rate New update Source: Florida Hospital System, Admissions=69,107 Total beds = 1,218

43. Employee Satisfaction Increase Source: South Carolina Hospital, Admissions=25,837 Total beds = 594, vendor = PRC

44. When leaders provide follow up on rounding at their staff meetings, they should say: “During the past 30 days, I have rounded on 32 employees. As a result of my rounding we have been able to acquire 3 blood pressure cuffs, 2 key boards, as well as rework the supply cabinet.   I also was able to recognize 10 individuals that you suggested receive recognition. Thank you for your help.”

45. Round With Patients Set clear expectations Focus on key questions Outline what to do if problems are discovered Closing statement Reward and recognize staff

46. Questions for Patients Do you know your nurse’s and CNA's name today? Do you know your schedule? How has your nursing care been? Have we managed your pain well? Do you have any concerns or questions?

47. Leader Rounding on Patients“Did a Nurse Manager Visit You During Your Stay?” New update n= 608 n= 604 n= 561 n= 601 Percentile n= 96 n= 106 n= 104 n= 105 Source: Arizona Hospital, Total beds = 355, Employees = 4,000, Admissions = 10,188; updated 2Q2010

48. Financial Impact

49. Must Have #6 - Key Words Things said and done to “connect the dots” and help patients, staff and physicians understand why we do things and what is going on

50. Studer Group Five Fundamentals - AIDETSM A Acknowledge I Introduce D Duration E Explanation T Thank You