Engaging a Changing

Workforce through Evidence-

Based Practice and HR

Analytics

September 29, 2014

Joseph Cabral

Chief Human Resources Officer

North Shore-LIJ Health System

• 16 Hospitals/more than $7 billion operating margin

• Opened a new Medical School in 2011

• Nation’s third largest, non-profit, secular health system

• Service area of 7 million people

• Recipient of the National Quality Forum’s 2010 National

Quality Healthcare Award

• More than 48,000 employees – the largest employer on

Long Island the 3rd largest private employer in New York

City

2013

Operating Statistics:

• More than 9,440 physicians*

• More than 10,000 nurses*

• More than 3,200 volunteers

• More than 6,000 hospital

and long-term care beds*

• 4 million patient contacts

• 25,600 births

• 283,700 hospital discharges

• 640,000 emergency visits

• 133,400 ambulatory

surgeries

• 91,400 ambulance transports

* Does not include affiliate organizations

1.0M 0.7M

0.8M0.6M

(Wyoming)

(Montana) (N. Dakota)

(S. Dakota)

0.6M

1M

(Washington DC)

(Vermont)

(Delaware)

(Rhode

Island)

0.9M

0.6M

North Shore LIJ has a service area of 7 million

people in Manhattan, Queens , Staten Island and

Long Island0.7M

(Alaska)

Fortune 500 – Potential Ranking (2012)

$8.5B - $6.1B

$8.53

$8.29

$8.07

$7.93

$7.12

$6.71

$7.0

$6.33

$6.31

$6.26

$6.19

$6.11

303

309

319

324

354

370

384

385

388

391

400

Ranking Revenue

Tertiary

Hospitals

Community

Hospitals

Nursing &

Rehabilitation

LabsCommunity

Health

Centers

Home Care

& Hospice

Assisted

Living

Physician

Offices

Specialty

Hospitals

Ambulance

Services

Tertiary Hospitals

Specialty

Hospitals

Community

Hospitals

Nursing &

Rehabilitation

Specialty

Centers

Physician

Offices

Community

Health Centers

Assisted

LivingHome Care &

Hospice

Patients &

Families

Community

Health

An Integrated System• Not just a collection of distinct, individual entities

• Administratively and clinically integrated

BUSINESS ENVIRONMENT

7

HEALTHCARE

DELIVERY’S

PERFECT

STORM

External Pressures

8

Health Care Reform Crisis

The Business Environment

9

Uncertainty

National & Regional

Physician Shortages

Consumerism &

Transparency

Increasing Costs

Increasing

Government Oversight

Fragmented Care

Health Reform Aging Population

Growing Diversity

Increasing Life

Expectancy

Declining

Reimbursement

Questionable Quality

& Satisfaction

Increased Need for

Skilled Workforce

Medical Technology

Advancements

Higher Costs Higher Quality

The Aging Population

• Significant trends in New York State

Growing Diversity

The Educated Consumer

• Patients are prepared with media and internet information

• Informed questions about diagnosis and treatment options

• Drug advertising

• Consumer cost concerns

• Options

Age of Transparency

Change in the Business Model

• Shifts lower acuity case load from inpatient to

outpatient setting

• Advancements in minimally invasive techniques and

procedures

• Diagnostic efficiencies

• Patient satisfaction

• “Boutique” services

• Health Clinics located inside pharmacies

Shift To Ambulatory

Dissatisfied Patients

NYC Area Hospital Closures Since 2000

19

In 10 years, 20 hospitals (4,562 beds) have closed,

putting added pressure on remaining hospitals in the

N.Y. metropolitan area to raise performance

standards.

Healthcare Reform and

Value Based Care

U.S. Healthcare System

Let’s Start at the Beginning…

“The only thing we know about the future is

that it will be different.”

“The best way to predict the future is to

create it.”

- Peter Drucker

Our Workforce, the Driver of

Change

24

July 21, 2011

Companies are Laying Off

Companies are laying off employees at a

level not seen in nearly a year, hobbling

the job market and heightening fears

about the pace of economic recovery.

October 28, 2008

Time Inc. Plans 600 Layoffs

Time Inc., the world’s largest magazine

publisher, plans to cut 6% of its work

force—more than 600 positions.

January 26, 2009

Layoffs Spread to More

Sectors of the Economy

Furloughs, wage reductions, hiring

freezes and shorter hours did not do

enough. A year into this recession,

companies across the board are

resorting to mass job cuts.

February 8, 2009

Economy Shed 598,000

Jobs in January

In a bleak report on Friday, the Labor

Department said that almost 600,000

jobs disappeared in January and that a

total of 3.6 million jobs had been lost

since the beginning of the recession

in December 2007.

27

Focusing on Talent Management

Why Talent Management?

• Roughly 62% of our revenue is spent on

Human Capital

• Critical for business continuity

• High correlation between customer

satisfaction and employee satisfaction

• 20% of our workforce are over the age of

55 and nearing retirement

• 32% of our leaders are over the age of 55

The U.S. Healthcare Workforce

TABLE 1A.3

Prospects for Growth in

the U.S. Health Care

Workforce, 2008–2018Note: Columns may not add to total due to omission of occupations with small employment.Source: U.S., Department of Labor. Bureau of Labor Statistics. (2010). National employment matrix, 2008–18. Retrieved September 16, 2010, from

http://www.bls.gov/oco/cg/cgs035.htm.

Physician Workforce

• Growing shortage

- Specialists in high demand

- Primary Care

• Greatest demand

• Lowest compensation

Projected Shortfalls of Physicians Relative to

Demand

Source: Advisory Board; Recruiter Benchmarking Survey; 2009 Report

based on 2007 data

Nursing Workforce

• Recession delays retirement giving false sense

of security

- Mean age of Nurses in NY State = 47.3

- 75.5% of NY state nurses are >40 years old

- Applicants turned away from RN schools due to

lack of faculty

Source: HANYS; June 2010 Nursing Workforce Survey

Allied Health Workforce

• Growing demand particularly for Nurse

Practitioners and Physician Assistants

• Difficulty recruiting

• Demand will continue to rise due to

Health Care reform and physician

shortage

- Will play vital role in improving access

to primary care

Health System Mid Level Provider- Growth

2003- 2012

YearNurse

Practioner Headcount

Physician Assistant

Headcount

2003 156 228

2004 166 233

2005 206 295

2006 225 333

2007 223 354

2008 313 435

2009 333 443

2010 376 524

2011 433 604

2012 540 673

*Includes all business units in the system

Driving Performance through

Your Workforce

Alignment

BaldrigePerformance Appraisal

Employee Survey

36

Linking Metrics to Performance

• Establish the

organization’s line of sight

and direction

• Create clear measures

• Communicate the metrics

Dashboard

Organizational

ScorecardMonth/Year

Date

Linking Metrics to Individual Performance

38

ScorecardQUALITY

Financial

PerformancePatient

Experience

Dashboard

Month/Year

Date

Linking Metrics to Performance

Do not forget

to focus on the

values!

“If you throw your

heart over the fence,

the rest will follow.”

-Anonymous

Patient Experience

Excellence Integrity

Caring TeamworkInnovation

Organizational Alignment

Smith, Anne, RN NSUH

Incentive Compensation

NSLIJ Health System - Annual Incentive Plan CalculationYOUR NAME AND TITLE HERE

Base Salary $200

20.0% $40

Target Total Cash Compensation $240

Actual Bonus as of 13.5% $27

Actual Total Cash Compensation as of $227

Above (Below) Target ($13)

SYSTEM (100% Weight)

Weight Thr. Tgt. Max.

Patient Experience 25% 85.1 85.1 86.1 84.3 0% Weight * Result * Target Bonus $0.0

Quality 25% 85% 85% 95% 70% 0% Weight * Result * Target Bonus $0.0

Quality/Financial Perf. Excess Days 25% 8,244 10,305 12,367 11,162 121% Weight * Result * Target Bonus $12.1

Financial Performance 25% 0.3% 0.4% 0.7% 1.1% 150% Weight * Result * Target Bonus $15.0

System Results $27.1

OK

Target Bonus

Result Payout

Likelihood to Recommend (Inpatient)

September 17, 2007

Goal

CMS Overall Indicators

Controllable Margin

100%Target

Maximum

50%Threshold

Payout

150%

Performance

Link between performance and bonus payout:

Circuit breaker is assumed to be "achieved".

Talent Management Cycle(Hardwiring)

•Performance Reviews for Sr.

Execs (IDP’S)

•Salary Increases (across the

board)

•Sr. Leadership retreat

•Mail W2’s to employees

•NYSNA Negotiations

•High Potentials Kickoff

•Cascading of Goals-

CEO/COO

•EHS Annual Health Review

•Leadership Immersion Program

•360º process for high

potentials

•Application for President’s

Award

•Annual Educational Mandatorys

•Employee engagement

survey

•Applications for Summer

Interns

•403(b) auto enrollment

•Handbook for staff

•Health & Welfare benefit review

•Annual Mandatory Compliance

Training

•President Award Winner(s)

Announced

•Employee self-service-setting

up kiosks at each site (Summer)

• Resident On-boarding

• Review of metrics for Service

• Progress measured for

financial and operational

efficiency

•Quality measures tracked

•Succession Planning – key

positions identified

•High Potentials identified and

assessed

•EEO Reports to the

Department of Labor

•Finalize 2009 HR Budget

•Open Enrollment meetings

•Performance Reviews for all

employees (IDP’s)

•Flu shot distribution

•Performance Reviews for

Dept Heads/Mgrs (IDP’s)

•Open Enrollment

•High Potentials selected

AUGUST

SEPTEMBER

OCTOBER

NOVEMBER

JULY JUNE MAY

APRIL

MARCH

FEBRUARYJANUARYDECEMBER

Employee LifeCycle

eApplications eOnboarding eOrientation

ePerformance Management eSuccession Planning

Evidence-Based Practice

• Team STEPPS (Strategies & Tools to enhance Performance

and Patient Safety)

- An innovative infrastructure

- A systematic approach to improve quality safety

efficiency through optimizing team performance

• What is Team STEPPS – Empowerment through education

- Overall improvement in care

- Decrease in mortality

- Lower incidence of patient harm

- Reduced infection rate

Cost avoidance was over $21 million

Meaningful Metrics

Meaningful metrics refer to those

data that actually are used to drive

change or influence management

decisions.

Recruitment Metrics

• Turnover Rates

• Vacancy Rates

• Openings

• Promotions

• Transfers

• Terminations 30 – 90 days

• Terminations 360 days

• Total Terminations

• Cost Per Hire

• Total Hires

• Employee Referrals

• Resumes Received

• Interviews Conducted

• Advertisements

• Job Fairs

• Open Houses

• Diversity

• Sourcing Effectiveness

• Time to Fill

• Agency Fees

• Candidates in Pipeline

• Demographics

• Recruiter Effectiveness

• Declined Job Offers

Talent Management: Keeping it Simple

Effective

Talent

Management

Engaged

Employees

Satisfied

Customer/

Patient

Strategy

Execution

Business

Results

“However beautiful the strategy, you

should occasionally check the

results.”

-Winston Churchill

Outcomes

Executive Summary Sample

Employee Engagement & Service Excellence

*Excludes hospitals/facilities that did not have patient and operational performance metrics. Green shading represents top three facilities for

each metric, red shading represents bottom three.

Facilities with higher aggregate organizational commitment scores have

higher patient satisfaction scores…Going forward, orienting your facilities and the System in general toward these elements will be an important

step in building an ongoing case for the value of investing in people

Organizational Commitment

9080706050

Overa

ll E

ntity

Mean: In

patient 2002 q

4

84

82

80

78

76

74

72

70 r = 0.803

Patient: Service

Employee* Excellence

Overall Entity

Organizational Mean Score:

Commitment Inpatient Q4

Score 2002

Hospital A 87.5% 82.6%

Hospital B 79.0% 82.5%

Hospital C 77.7% 79.0%

Hospital D 75.2% 77.4%

Hospital E 74.9% 82.5%

Hospital F 69.6% N/A

Hospital G 67.6% 81.3%

Hospital H 66.2% 78.7%

Hospital I 60.1% 71.6%

Hospital J 57.1% 72.0%

59% Healthcare Benchmark

‘Agree / Disagree: I

am a valued

employee here’

Employee Survey Results

88% Healthcare Benchmark

Employee Survey Results

‘I understand how

my work

contributes to the

goals of my

hospital/facility’

54

Sample Data Only

Current data does not meet/exceed goal

Performance Metrics ScorecardPerformance Metrics Executive Summary

Health System For the Period Ending 7/31/2008

Priority Indicators Current Data Targets Trends

Rolling Average Annual Annual Annual 3 Month

(Apr 08 - Jun 08) Threshold Goal Stretch Goal Trend

• Likelihood to Recommend (Inpatient Score) 85.6 85.6 86.0 86.9

• Likelihood to Recommend (Inpatient Percentile) 23 21 27 38

Apr 08 Annual Annual Annual 3 Month

(Preliminary) Threshold Goal Stretch Goal Trend

• CMS Blended (AMI, PNE, HF, SCIP) 97.4% 85.0% 90.0% 95.0%

Blended = applying a weight of 75% to the

CMS overall (AMI, PNE, HF) and 25% to SCIP.

3 Mo. Variance

YTD YTD YTD YTD (YTD Actual

Actual Threshold Goal Stretch Goal to YTD Goal)

• Operating Margin (in thousands) $ 29,939 $ 16,825 $ 18,694 $ 22,433

3 Mo. Variance

YTD YTD YTD YTD (YTD Actual

Actual Threshold Goal Stretch Goal to YTD Goal)

• Reduction in Excess Days 16,170 7,237 9,649 12,061

favorable/(unfavorable)

Current data meets or exceeds goal

Current data does not exceed goal

1 Patient Experience (Press Ganey)

2 Quality

3 Financial Performance

4 Productivity

0

0

0

0

0

Excess Days – LOS Reduction

5.26 5.20

5.024.91 4.93

4.00

4.20

4.40

4.60

4.80

5.00

5.20

5.40

2007 2008 2009 2010 March 2011

There has been a decrease of 96,213 days, which has resulted in a

increase of 275 beds of capacity

Occ % 89.5% 89.2% 89.4% 87.3% 90.2%

(Excl. Newborn, exempt units and pediatrics)

Service Excellence

* Through February 2011

65

70

75

80

85

90

95

100

2007 2008 2009 2010 2011*

ER Satisfaction 6.6% Improvement

Inpatient Satisfaction 1.4% Improvement

Service• Glen Cove Hospital percentile rank

Core Measure Composite Score

Source: Premier

Q1 2006 – Q1 2008

80.0

85.0

90.0

95.0

100.0

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2006 2007

North Shore - Long Island Jewish Health System

Core Measure Composite Score

AMI

HF

PNE

SCIP

11.6 %

9.3 %

3.2 %

8.2 %

Improvement

Improvement

Improvement

Improvement

2008

70% Reduction ICU Central Line Associated

Bacteremia Index

ICU Ventilator Associated

Pneumonia Index

Surgical Site Infection

(Class I & II) Rate

MRSA (Methicillin-Resistant

Staphylococcus) Index

50% Reduction

24% Reduction

23% Reduction

Source: NSLIJHS Quality Management

Quality Outcomes

$0

$2

$4

$6

$8

2003 2006 2009 2012

Source: Finance

North Shore-LIJ Health SystemRevenue

(in

billio

ns)

Employee Engagement Pays Off

-Companies with high levels of

employee engagement show turnover

rates that are 40% lower than

companies with low levels of

engagement. Estimated cost of

replacing employees is between 50%

and 150% of salary.

-Hay Group Research

“Disengaged employees can

undermine the success of an

organization - they are not strongly

committed to achieving a company’s

goals and objectives, and may not be

motivated to act in accordance with its

mission/values.”

-Enterprise Engagement Alliance

National Quality Healthcare Award

- “Today the National Quality Forum (NQF) announced North Shore Long Island Jewish (LIJ) Health System as the recipient of the 2010 NQF National Quality Healthcare Award for its ongoing commitment to providing high-quality, transparent, patient-centered healthcare.”

-“North Shore-LIJ is a clear leader in striving to make high-quality care commonplace for every patient and a central part of its culture. We are at the precipice of change in healthcare in America, which will have implications for every healthcare facility in every community.”

~Janet Corrigan, President & CEO, NQF

-“For us to succeed as a healthcare organization and strengthen public trust, we recognized long ago that quality must be a top priority for every employee, regardless of whether they’re cleaning patients’ rooms or performing surgery in the operating room.

~Mr. Dowling, President & CEO, North Shore-LIJ

Our Workforce is Our

Competitive Advantage!

`

Every Life Deserves World Class Care