EXCEPTIONAL ALUEVA N N U A L R E P O R TF Y 2 0 1 6

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Table of Contents

Patient Experience .......................................................................................................................................... 51. Improve Patient Access .......................................................................................................................... 62. Enhance Patient Communication ......................................................................................................... 103. Improve Transitions of Care .................................................................................................................. 114. Improve the Clinic Visit Experience ...................................................................................................... 125. Improve HCAHPS Performance ............................................................................................................ 13

Quality ............................................................................................................................................................ 141. Improve Quality Care ............................................................................................................................. 152. Optimize Epic Care ................................................................................................................................ 163. Improve Patient Safety .......................................................................................................................... 175. Continued Implementation of Exceptional Value Initiative ................................................................. 19

Financial Strength ......................................................................................................................................... 241. Grow Clinical Services ........................................................................................................................... 252. Increase Capture Rate of Internal Referrals ........................................................................................ 274. Expand and Strengthen Network Affiliations....................................................................................... 28

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How does University of Utah Health Care improve the value of care we deliver to our patients? We integrate the best principles, methods and structures drawn from other highly successful industries around the world. To name a few, these include the standards designed by the International Organization of Standardization, ISO 9001, process improvement methods drawn from lean/Six Sigma/PDCA, world class data and analytic platforms, and safety science methods. Collectively put together in a way that is uniquely “Utah”, we call the adoption of these principles, controls and structures our Value Management System.Our Value Management System is based on seven principles:1. Focus on the patient. In addition to building

a system and culture that ensures safety to our patients, we systematically gather feedback from our patients to understand their current and future requirements and expectations and we rigorously assess the outcomes and costs of individual patient care. We then constantly seek to improve the value of care we provide our patients.

2. Provide leadership to the organization. Our leaders at all levels establish unity of purpose. Leaders ensure that all strategies, policies, processes and resources are aligned to pursue common direction and achieve common objectives.

3. Engage and involve people. We have built an organization of competent people who we manage through empowerment; engaging their expertise and effort to improve the organization and recognizing their achievements and contributions.

4. Use a process approach. We use a process approach to manage our performance. This means that our leaders manage and control their processes, the interactions between these processes, and the inputs and outputs that tie these processes together. This also means that we manage these processes as a coherent value management system.

5. Encourage improvement. We focus on and promote improvement. We know that improvement is essential to maintain our current levels of performance, respond to a rapidly changing external environment, and to identify, create and succeed in new opportunities.

6. Make data driven decisions. We make decisions using data. We know our decisions are data driven when we gather multiple types of input from multiple sources, identify facts, objectively analyze data, examine cause and effect relationships, and consider potential unintended consequences.

7. Manage our organizational relationships. We carefully manage relationships with our suppliers, partners and other interested parties. These relationships can influence our performance and either undermine or strengthen our success.

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For the past nine years, the organization has had the discipline to focus on three institutional goals: exceptional patient experience, quality and financial strength. In FY2016 University of Utah Health Care achieved greater overall success in these areas than any year prior. This year, University of Utah Healthcare also received its ISO 9001 certification from DNV. FY2016 truly has been a significant year for UUHC and our patients. We are humbled by the contribution and commitment of all the UUHC physicians, leaders and employees. After six years of being recognized in the Top 10 academic medical centers for quality, UUHC was recognized as #1 in Quality through the Vizient Quality and Accountability Award.

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Q4FY16Q3FY16Q2FY16Q1FY16

82 82

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85

Medical Practice Overall RankingPress Ganey UHC Benchmarking

Per

cent

ile

Exceptional Patient Experience. We have maintained and improved upon our long history of delivering and exceeding our patient’s expectations. For the first time this year, the system’s overall patient experience performed above the 80 %tile all four quarters when compared against our academic peers. We are especially proud that we were able to reach 85%tile performance for the fourth quarters

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FY16FY15FY14FY13FY12

Ope

ratin

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argi

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5.4%4.7% 4.8%

10.3% 10.0%

The road to sustained improvement and forward looking innovation is paved with the ability to relentlessly focus on the most important work. Such focus has led to the success and accomplishments of the past decade and most specifically the success of the past year. The purpose of this report is to share the great work of all of our teams and the contribution of those teams to the organization’s success. It documents the outcomes that the organization has achieved through the declared focus of the Operational Plan. We thank you for your

And FY2016 was the most significant financial year for the system ever, with the financial performance of UUMG, SOM departments and hospitals and clinics exceeding expectations.

commitment to making UUHC one of the best academic medical centers in the country. Even more importantly, we thank you for your profound impact on the lives and health of our family members, neighbors and community.

Bob PendletonChief Medical Quality OfficerUniversity of Utah Hospitals and Clinics

Dan LunderganInterim Chief Operating OfficerUniversity of Utah Hospitals and Clinics

Dayle BensonExecutive DirectorUniversity of Utah Medical Group

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Patient Experience

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1. Improve Patient AccessIncrease the number of new patient visits by 5%.

New Patient Visits

FY 2013 180,517

FY 2014 195,247

FY 2015 212,525

FY 2016 242,011

How do we make it easier for our patients to come here? A seemingly simple question – but improving access has required both a system focus and local innovation. System Achievements:

• We increased new patient visits by 13.87% from FY15. This has required us to sustain the gains of the past four years, with additional incremental growth.

• We established standards and measures of access performance across the system.

• We maximized our EPIC scheduling system through standard training for all staff.

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Extend hours of clinic availability across the system (10% of clinics will have availability from 7 am to 7 pm).

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Achieve overall 50th percentile for ease of new patient scheduling by the fourth quarter.

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Expand Urgent Care capacity to 5 sites by the end of the FY.

Num

er o

f Vis

its

Urgent Care is spreading across the Wasatch Front in order to improve access to appropriate, higher value care where the demand is greatest. Quarterly urgent care visits have continued to expand, nearly doubling between Q1FY16 and Q3FY16. Urgent Care added two additional locations in FY2016, Westridge Health Center and the University of Utah Hospital.

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2. Enhance Patient CommunicationReduce No-Show Rates by 10% (i.e. text, email, etc.).

This effort was gated for FY2015 due to contingent projects on template optimization, guest communications center and online scheduling.

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Develop a post-acute care strategy that meets our quality standards and supports future reductions in hospital readmissions.

3. Improve Transitions of Care

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4. Improve the Clinic Visit ExperienceAchieve overall 70th percentile for “wait time in clinic” for 2 quarters.

Develop a patient friendly process to share pricing for imaging services and ambulatory procedures by the third quarter FY15.Pricing Strategy: The pricing estimator process went live September 1, 2016.

• Price Estimates are calculated in EPIC, for hospital and physicians, in a combined output.

• 3,000 price estimates are given per month

• Three primary categories of patients call for estimates: cosmetic, shoppers and existing patients.

• 80% of UUHC departments use central financial counseling and the EPIC tool.

• 18 specialties currently publish prices on their webpage.

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5. Improve HCAHPS Performance60th percentile pain management60th percentile MD communication60th percentile nurse communication

Lessons learned: RN Communication: Focus on Process

• Develop a reliable process approach to communication: Bedside Shift Report (BSR)

• Engage frontline staff: EPIC workflow does not support current BSR approach

• Redesign EPIC workflow to promote more efficient and integrated document and record control

MD Communication: Voice of Customer• Patients who know the doctor in charge of their care

are more likely to rate communication as meeting expectations.

• Use of whiteboards to communicate

Pain Management: Misaligned focus• Focus on always managing pain conflicting with state

and national focus to reduce opioid dependency.

Despite not meeting FY16 goals, there has been incremental improvement over the pas t4 years.

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Quality

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1. Improve Quality Care

2016 AMC Quality and Accountability Performance Scorecard

2016 Ambulatory Quality and Accountability Performance Scorecard

Univsersity of Utah Hospitals and Clinics University of Utah Health Care and University of Utah Medical Group

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2. Optimize Epic Care

Implement nurse triage module.

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3. Improve Patient SafetyReduce/maintain hospital acquired infections (ICU CLABSI, ICU CAUTI, and SSI) from FY14 baseline to a Standardized Infection Rate (SIR) of <= 0.5 CLABSI, <= 1.0 CAUTI and <= 1.5 SSI by January 2016.

CAUTIICU YTD SIR

CLABSIICU YTD SIR

FY16 Q1 0.746 0.368

FY16 Q2 0.519 0.299

FY16 Q3 0.833 0.274

FY16 Q4 0.957 0.286

An interdisciplinary team developed a comprehensive protocol of standardized best practices for management of urinary catheters (2535 views on Pulse). They also developed standardized clinical skills and created a nurse-driven catheter removal process. The team updated EPIC to document standardized care.

Throughout FY16, baseline investigation and subsequent improvements in processes to reduce SSI were actively implemented by an interdisciplinary team.

SSIOverall SIR

FY16 Q1 1.99

FY16 Q2 1.79

FY16 Q3 2.00

FY16 Q4 1.76

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4. Fully Implement the Value Management System in Order to Meet Accreditation Requirements of Being ISO-9001 Compliant

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5. Continued Implementation of Exceptional Value InitiativeImplement 10 value-driven care processes with a goal impact of measurably improved quality and $5M cost savings.

$8.7 Million Savings

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Sepsis Project

0

$

$$

$$$

$$$$

$$$$$ no

yes*

Aug 2016Jul 2016Jun 2016May 2016Apr 2016Mar 2016Feb 2016Jan 2016Dec 2015Nov 2015Oct 2015

*Perfect Care was achieved if the following occured within 180 minutes: Lactate lab Blood culture Antibiotics IV fluid

Sepsis (mEWS>5) Mean Cost Per Case and Perfect Care

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UHPP Initiatives Annual System Savings

0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

TRANSPLANTPULMONARYPM&RPEDIATRICS

ORTHO / NEUROSURGERYONCOLOGYOBGYNNEUROSURGERY

NEUROLOGYGENERAL SURGERYGENERAL IMCARDIOVASCULARANESTHESIOLOGY

201620152014201320122011

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Supply Chain - Standardizing SuppliesCumulative System Savings

0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

CAPITALPURCHASED SVCSSUPPLY OTHERORTHOPEDICS

OR GENERALNEUROSCIENCESIMAGINGENDOSCOPYCARDIOVASCULAR

FY16FY15FY14FY13FY12

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Identify and develop Value Driven Outcomes (VDO) scorecards for 15 top clinical conditions.

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Financial Strength

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1. Grow Clinical Services

Increase outreach clinical services outside the Wasatch Front by 5 sites, which could include virtual TeleHealth.

TeleHealth Sites Location Services

Forte Strong St. George, UT Mental Health

Four Corners Regional Care Center Blanding, UT Physical Medicine and Rehabilitation

Green River Medical Center Green River, UT Burn

Learning Services Corporation Riverton, UT Physical Medicine and Rehabilitation

Lost Rivers Medical Center Arco, ID Burn and ICUPower County Hospital District American Falls, ID BurnSouthwest Counseling Center Rock Springs, WY Mental HealthSteele Memorial Medical Center Salmon, ID Burn

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Increase inpatient referrals from targeted regions by 5% over prior two year baseline.

OverallGrowth

5%increasein cases

13%increase

in margins

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Increase pharmacy prescription capture rate by 25% from the UUHC clinics FY14 baseline.

2. Increase Capture Rate of Internal Referrals

3 Month Rolling Average

Single Month Totals

11.75% Increase

9.7% Increase

At the end of: June 2015 June 2016

Scripts Ordered 55,114 61,225

Scripts Filled 18,822 21,034

% Scripts Filled 34.15% 34.35%

At the end of: June 2015 June 2016

Scripts Ordered 55,136 60,495

Scripts Filled 18,667 20,479

% Scripts Filled 33.86% 33.85%

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4. Expand and Strengthen Network Affiliations

Implement Epic Connect with 2 entities.

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Go LiveImplentationPlanning

Community Clinic 3

Community Clinic 2

Community Clinic 1

Hospital 4

Critical Access Hospital 2

Critical Access Hospital 1

Hospital 3

Hospital 2

Hospital 1