1. UTMC ServiceExcellence Strategy2011 - 2012 Plan of Action Edited as of January 1, 2012

2. UTMC Vision 2015Clinical OutcomesFinancial Performance Patient Experience Physician/Employee Engagement Market Share Growth 3. UTMC Vision 2015Cannot achieve one without the other 4. January December2010 Performance:U.S. Department ofHealth & HumanServices HospitalProfile**http://www.hospitalcompare.hhs.gov/ 5. Narrowing The Gap ClinicalOutcomesVS.PatientExperience 6. HCAHPS Rate Hospital 0-10 2011 Data by Month10090807065 62 6260 5555 5048 4850 4440302010 0April MayJuneJuly AugustSeptember October November Decembern = 36n = 48 n = 69 n = 62n = 60n = 58 n = 84n = 60 n = 58 Rate hospital 0-10 Linear (Rate hospital 0-10) 7. The only effective differentiatoris the patient experience we provide.James Merlino, MDChief Experience OfficerThe Cleveland Clinic Health System 8. Case 4 ChangeEnter the era of payment tied to reported Quality outcomes 9. Quality-based Payment Initiatives 2010 2011 2012 20132014 2015 2016 2017Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) 2% of APU VBP VBPValue-based Purchasing (VBP)2%Readmissions3%Hospital Acquired Conditions (HAC) Hospital Acquired Conditions 1% Meaningful Use 1% 10. Governments interest:Core Measures Satisfaction OutcomesAcute MIInpatientDeath (HCAHPS)Re-admissionHeart FailureOutpatientPneumoniaSafety (CGCAHPS)SCIPPediatrics Line Infection PneumothoraxAsthma (kids) Psychiatry Surgery SiteHome HealthEmergency 11. Pay for Performance Proposed charge back modelValue Based Purchasing 1.00 % 2013 1.25 % 2014 1.50 % 2015 1.75 % 2016 2.00 % 2017 12. FY2013 MeasuresWeighted Distribution of IncentivePaymentsProcessMeasuresHCAHPS70% 30%($850 million) 13. Pay for Performance Performance Assessment Model Attainment of benchmarks Improvement in performance Benchmark set at highest 10% of hospitals Reimbursement determined on score 850 million $ 14. Value Based Purchasing:FY20142nd Year of VBP Reporting: April December 2012: Performance period Measures:- 13 Core Measures- 8 HCAHPS- 3 Mortality- 8 Hospital Acquired Conditions New MeasuresFor FY 2014- 2 Composite PSI- 1 Efficiency (spend per beneficiary) $$ impact 2014 15. CMS Direction.Measurement requirements and performanceexpectations will be modified over time to reflect theapplication of evolving technologies and care practicesas they impact the quality and safety of care. Achieving a high performance on set measures notenough Sustain Culture 16. Whos watching ? Accreditation organizations Consumers Administration (your boss / partners) Payers Private organizations Businesses Government (CMS / States)Everybody is watching! 17. A New Day At UTMC 18. Leaving BehindNew CultureUs Centered Culture Patient Centered 19. Staying the CourseRenewedEngagingCampus-Wide PositivePatientWork-EnvironmentExperienceFocus &Commitment 20. UTMCs Continuous JourneyEngaging PatientSustained Environment ExperienceResults 21. We have only just begun.Its a two to three year journey.Former CEO and Author Mark Scott 22. Building the UTMC House ofService Excellence 23. Master builders in need ofEngagement 24. Patient, Employee and PhysicianEngagement .70.76.73PhysicianEmployee engagement engagementPatient 2010 Press Ganeyexperience Associates, Inc. 25. Key StakeholdersPatients/CustomersExpect moreKnow their optionsIn chargeRaising the barfor everyone 26. Key StakeholdersEmployees Dedicated (50.9%) Detached (4.0) Discontented (19.2) Distanced (29.9) National Averages Press Ganey, 2009 27. Key StakeholdersEmployeesThe ideal state in which employees feelthat the organization is providing whatthey need and also feel connected totheir work and the organizationemotionally 28. Key StakeholdersEmployeesThey feel the organization is meetingtheir needs for the basics such as jobsecurity but theyre not emotionallyinvolved. 29. Key StakeholdersEmployeesEmotionally involved, but not satisfiedthat their basic needs are being met.They may feel their pay is too low ortheir input is not sought on mattersthat affect their work. 30. Key StakeholdersEmployeesThese employees feel both dissatisfiedand disengaged and typically will eitherexit the organization voluntarily orworse stay and create turmoil foreveryone else. 31. Key StakeholdersEmployeesIn world-class organizations, the ratioof engaged to actively disengagedemployees is 9.57:1.In average organizations, the ratio ofengaged to actively disengagedemployees is 1.83:1. (Gallup) 32. Key StakeholdersEmployeesWorld-class organizations with anengagement ratio near 8:1 have builtsustainable top performing workenvironments. As organizations movetoward this benchmark, they greatlyreduce the negative impact of activelydisengaged employees while unleashingthe organizations potential for rapidgrowth. 33. Key StakeholdersEmployeesRe-recruit the Dedicated employeesEngage the Detached and DiscontentedemployeesAllow the Distanced employees topursue other opportunities 34. Key StakeholdersPhysiciansPatients global ratings of their health care arenot tied to the technical quality of theircare, but rather, to the quality of providercommunication (Annals of Internal Medicine, 2006) 35. Key StakeholdersPhysicians61% of the variability in patient satisfaction istied to physician behaviors. 39% is linked tonursing behaviors. (Journal of Surgical Education, 2008) 36. Key StakeholdersPhysicians Actively recruit Champions Immediately address top physician concerns Answer the WIIFM question Use trials or pilot projects 37. Key StakeholdersPhysicians It is imperative that healthcare systems recognize the importance of collaborating with their medical staffs to create an aligned platform that promotes patient care quality and safety as well as drives patient perception of care, and executes an effective reimbursement and growth strategy that is mutually beneficial. 38. Laying a strong foundation 39. 2011 State of the CultureVenues Staff feedback across the organization UTMC Management Team Specialty & Primary Care Clinics Management UTMC Executive Committee Members UTMC Chief Resident Forum UTMC Senior Staff Team Service Excellence Steering Body 40. Align on PerformanceExcellence Poor performance not efficiently addressed byLeaders strongly aware ofleadership. Consistentpatient satisfaction rankings; implementation of actionkey metrics identified; area plans still a challengespecific goals set forward Need for allBehavioral Standards employees, physicians &communicated effectively volunteers to adhere to Behavioral Standards on a daily basis 41. Select and Retain an Engaged WorkforceSome staff engagement activitiesexist (surveys, town halls, employeeforums)No comprehensive organization-wide strategyEffective recognition program into aimed at engaging theplace: Shining Star & U Rock!employee population at large.Weekly Senior Leadership Physician engagementRounding strategy TBDFirst organization wide employeeengagement survey completed Dec.2, 2011 42. Develop and Maintain aService Oriented CultureConsistency lacks withPatient experience is tracked respect to taking action inappropriately and order to improve each areasconsistently communicated patient experiencethroughout the house.Universal Scripts not usedUniversal Scripting deployedthroughout the houseacross the organizationNo patient hourly roundingSome hourly patient roundingleadership accountability.with a purposeExpected, however its largeimpact on the overall pt. exp.rankings not demonstrated 43. Develop and Maintain aService Oriented CultureMany departments practicesome form of pre-service/ No Universal Standard fordischarge phone calls toconducting such callscustomersLack of consistency inCommunication boards are in utilizing such boardsplace in many departmentsLack of Universal Tool forService Excellencetracking service recoveryDepartment assists with opportunitieshandling of most servicefailures. 44. Commit to LeadershipDevelopmentLessons learned duringSome departmental trainingleadership training areopportunities (retreats, etc)consistently not shared withare in place for senior leadersfellow employees(managers, directors andabove)Staff doesnt not feelmentored by leadersiCARE UniversityNeed to establishaccountability for cascadelearning lacking 45. Commit to LeadershipDevelopmentDaily/weekly organization Daily/weekly communicationcommunication needs are not fully aligned with UTMCscovered in part (OLT, Daily Strategic Plan and do notHuddle, Weekly Line-Up, UT consistently reinforce theNews) Behavioral StandardsBest practices are shared No formal procedure forbetween areas and leaders in sharing best practicesan informal way 46. Hardwire Accountability Inconsistency of report cardsSome departments and and area specificleaders utilize monthly report improvement action planscards to track performanceand goalsStaff evaluations do not have Patient Experience and Behavioral Standards goals incorporated into it 47. Toolbox 48. Why Press Ganey? 2010 Press Ganey Associates, Inc. 49. Allowing us to seethe correlationbetweenFinancial, Operational, Process, Outcomeand Experienceperformance down tothe individualphysician and patientlevel in an easy touse web basedportal. 50. Partners in ImprovementUTMC and Press GaneyIP, OPSC, ED, Clinics appropriatesurveying positioningStaff-at-large engagement strategyPhysicians engagement strategySkin in-the-game 51. ToolboxUTMCs New iCARE University 52. The Strategy: Raising the Bar! Set specific organization goals Partner with the UTMC Champions across all levels Empower Service Excellence Action Teams (leader shaped, employee driven) Engage Physician & Employee populations at large Specific tactics & strategies developed by the SE Teams, Clinical Chairs, CNO, CMO, HRTD Department, Clinics Ops Senior Leader, SVP/Executive Director Effectively evolve & utilize UTMCs New iCARE University 53. SE Strategic Plan & Structure (Action Teams & SteeringCommittee) Press Ganey Partnership Physician Specific Assessment (Admitting, Attending, Discharge) Yearly Physician Engagement Survey Yearly Employee Engagement Survey Physician & iCARE University Leadership Retreat Q4 Patient Training and Accountability Scripting (Universal Scripts) CampaignUniversal Service RecoveryProgram (in-the-works) Physician Communication Protocol Revised Complaint Daily Huddles Management ProcessWork force Recruitment & EngagementTalent Plus H, M, L ProjectArea specific SE Road Maps inclusive ofspecific goals & timeline Hourly Comfort Rounding with a purposeHCAHPS & VBP Awareness Campaign Weekly Patient Experience Line-UpSelected Front line staff to attend as wellJanuary 19, 2011 54. HCAHPS Current hospitalcompare.hhs.gov Jan - Dec 2010 vs.Cumulative Jan - Dec 2011 scoresRate hospital 0-10 100DISCHARGE INFORMATION Recommend the hospital 80 60 40COMM ABOUT MEDICINES COMM W/ NURSES 200PAIN MANAGEMENTRESPONSE OF HOSP STAFFQuietness of hospitalCOMM W/ DOCTORSenvironment 2011 Cleanliness of hospital environment 2010 (Hospital Compare) 55. All UTMC Service LinesLarge Press Ganey Database2011 Standard Overall Performance100Mean Percentage 9592.4,91,91.4, 91.2, n = 9189.9,n = 99 n = 8289.5, 90.1,89.7, n = 7090.6, n = 65n = 100 n = 113 n = 94 88.8,n = 100 9085.9, n = 106n = 1684.9, 83.5,83.3, 83,n = 121 83, 85 82, 81.3, n = 126n = 103 n = 86n = 100 n = 36 82.4, n = 83 79.9, 80.8,n = 83 n = 135 n = 87 78.6, n = 122 8083, 80.4,79.9, 82.1, 80.2, 79.7,78.7,n = 164 n = 199 n = 163 n = 18679.4, 80.7,80.3, 79.9,n = 155n = 79 n = 145 n = 198 n = 221n = 180 n = 170 75February MarchAprilMayJuneJulyAugustSeptember October November DecemberInpatient Ambulatory Surgery Emergency Department 56. 2012 Service Excellence Goals Reach 50th Percentile Nationwide by December 31, 2012 57. beyond the low hanging fruits2012 Key Tactics Define and Deploy UTMCPhysician/Resident/Nurse/Staff Integrated CareDelivery Model Daily Operational Protocol Reposition UTMC Nursing Care Delivery System Systematic elimination of TOP historical challenges Clinical hourly rounding/responsiveness (HCHAPS) Care coordination across all supporting disciplines Choreograph and Launch The UTMC ExperienceCampaign. Hardwiring Excellence SMaC Recipe for success = Cultural Transformation All Inclusive: all staff, physician, resident indoctrination 58. Can a Culture be Changed? 59. Culture Patients Doctors CaregiversNursesEmployees 60. Core HospitalPatient Safety ReadmissionHCAHPSAcquiredPerformance Indicators RatesMeasuresInfections Patient SafetyExperience Quality Employee, Physician, Resident Experience CULTURE 61. Sustaining the WallsEngaging the Master Builders 62. Patient/Customer Engagement Action TeamEstablish and maintain UTMCsposition as provider of choice 63. Patient/Customer Engagement Action TeamPre-service/discharge phone callprocess (Inpatient, Clinics)Universal Service Recovery ProgramService Line Mystery Shopping 64. Physician Engagement Action TeamEstablish and maintain UTMCsposition as the partner of choice forphysician practice 65. Physician Engagement Action TeamPhysician Engagement StrategyPhysician Performance ScorecardPhysician Communication Protocol 66. Employee Pride & Engagement Action TeamEstablish and maintain UTMCsposition as employer of choice 67. Employee Pride & Engagement Action TeamEmployee Engagement Strategy (inpartnership with HRTD)Behaviorally based peer interviewingIdea generation platform 68. Employee Pride & Engagement Action TeamRepositions new employee orientationprogram (in partnership with HRTD)Recognize employees achievementsthrough facility-wide celebrationsRepositions yearly performanceevaluation process (in partnership withHRTD) 69. Measurement Action TeamAnalyze and communicate patientexperience and internal customersresults to guide service & operationalexcellence strategies 70. Measurement Action TeamWeekly Line Ups EngagementMonthly Site & Departmental scorecardperformance (in partnership with Pt. & Cust.)Quarterly Patient Experience SiteReviewsPhysician Performance Score Card (inpartnership with Physician Engagement) 71. Culture & Communication Action TeamFacilitate understanding andenculturation of UTsMission, Vision, Values and BehavioralStandards through grounded andbalanced communication 72. Culture & Communication Action TeamRaise awareness toNew Culture ofService in concert with UTMCsPatient Centeredness conceptHardwire Behavioral StandardsHardwire Daily Huddles Practice 73. Culture & Communication Action TeamEffectively communicate all ongoingService Excellence Action TeamsInitiatives 74. AS Service Excellence Action TeamEffectively differentiate UTMCsAmbulatory Surgery as the areasprovider of choice 75. AS Service Excellence TeamAS Pre-Calls & Pre-Calls PlusAS Discharge CallsDevelops and deploys specific Service& Operational AS training modules toAS staff/physician population at large(in partnership with ICARE Universitystaff) 76. ED Service Excellence Action TeamDeliver a memorable patient experiencewithin the Emergency Department 77. ED Service Excellence Action TeamInnovate, deploy & hardwire process aimed atsignificantly reducing wait times: 0 waitPublicly display wait time on the world wide web(www), partnership with Div. of External AffairsEstablish continuous patient roundingEstablish clear Service Excellence expectations &accountability systems for all staff impacting dailyoperations (in conjunction with Service Excellenceleadership)Establish & implement customer discharge follow upcalls 78. Service Excellence Steering BodyService Excellence Executive Sponsor 79. UTMCs New iCARE University 80. UTMCs newcultural transformation center to turn the mundaneinto thememorable. 81. The space will be used for Patient experience training New employee orientation Nurses continued education Physician/Resident patientengagement training Middle managementdevelopment 82. Programming willevolve in 2012from technicaltraining to atransformationalexperience. 83. Personalize Humanize Demystify 84. What is Fish Camp?Fish Camp welcomes the Freshman class to Texas A&M each year with the purpose of giving them anopportunity to learn about life at Texas A&M and finding their place in the Aggie Family.What do you do at Fish Camp?Freshmen are split into large "camp" groups of approximately 120 students and 24 upperclassmencounselors. Your camp will share a special bond as you spend time getting to know oneanother, attending programs that highlight the opportunities and services available on campus andparticipating in Aggie Traditions such as Yell Practice, Aggie Muster, and Silver Taps.Why should I go to Fish Camp?Well let the class of 2012 tell you...I LOVED Fish Camp! It was probably the best way to come into the Aggie family. I really felt as if I wasmeant to be here.Most amazing experiences of my entire life. The perfect way to begin my new life at Texas A&M.The Aggie Spirit was able to take hold of me and allow me to become one with the student body and thetraditions of Aggieland. 85. The goal is to develop programmingthat is Transformationallike industry leaders (Disney, TheRitz-Carlton, Mid-Columbia Medical Center, and Texas A&MUniversity). 86. Executing Improvement 87. Servant Leaders Leading Change When top performing organizations (>85th percentile) were asked what they could have handled better, they saidAccountability 88. Improved OutcomesWhy the 50th Percentile? Its our core mission and vision There are payer financial incentives for Value We need to become a high performing organization in service to survive & grow Its the right thing to do 89. Outcomes Memorable patient experience: reflected by comments and scores Culture of Excellence Place of choice For customers to receive medical treatment For staff to work For physicians to practice Improved market positioning Increased market share Financial growth 90. Lead the Way!Leadership Imperatives Model UTMCiCARE.Hold each Behavioral Other Accountable Standards for EngagementService Excellence Lead colleagues and Champions & Actionstaff toward the Teams vision, not away from it 91. It begins at the TopAnd it begins at the Bottom Model the Behavioral Standards Demonstrate teamwork at all leadership levels Support and work the Service Excellence Action Team Model Best practice oriented, leader shaped, employee driven Use Service Excellence Steering Body and Executive Sponsorfor barrier removal Hold Self & direct reports Accountable 90-day plan alignment discussions at regular intervals Patient/Customer, Employee and Physician Engagement Balance 92. It will not beWE will deal an easyjourneythe withDIFFICULTbut with muchEFFORT and a lot ofTEAMWORKWE canOVERCOME the impossibleand ACHIEVEour goalexcellence.