Winona Health Accomplishments 2006

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Winona HealtH

2006 accomplisHments

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Winona HealtH2006 accomplisHments

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Emergency Department SatisfactionGoal: Improve the overall quality o Emergency Department

(ED) care and service to increase patient loyaltyResults: Winona Health measures patient satis actionin its hospital, senior services and clinic settings. At thestart o Fiscal Year 2006, Community Memorial HospitalsED satis action scores were average compared to 140peer hospitals. Winona Healths sta , especially its EDphysicians and nurses, changed many processesduring the 12-month period rom implementingbedside registration to having physicians make

ollow-up calls to discharged patients. By the end o the year, the ED was a top per ormer among its peersin its care and delivery o patient services.

Medicare Average Length of StayGoal: Enhance care coordination to ensure optimumclinical service and resource use.

Results: A team o physicians, nurses, dietitians and

social workers care or patients on Community MemorialHospitals Medical/Surgical oor, including on sitephysicians known as hospitalists. Recognizing that mostpeople pre er being at home over being in a hospital, thisCare Coordination Team begins working with patients ona post-hospitalization plan as soon as they are admitted. The team reviews and assesses patient progress and thebest site or their recuperationhome, nursing home,assisted living or home care. This ocus on addressing

patient needs has resulted in a 10% decreaseto4.4 daysin the average length o stay or CMH patients.

Medical Opportunities for ImprovementGoal: Develop a pathway or end-o -li e care to ensure

patient-, resident- and amily-centered care.Results: Winona Healths Medical Opportunity orImprovement centered on ensuring patient-, resident-and amily-centered end-o -li e care. Working with otherlong-term care providers in the community, WinonaHealth sta and volunteers developed and implemented aprocess to increase the number o healthcare directives orlong-term care residents. As a result o these e orts, long-term care residents with healthcare directives increased

rom 26% in 2001 to 74% in 2006. As a result o thesedirectives, more amilies bene ted rom hospice services asthe hospice average daily census increased by 10% to 22.

Operating MarginGoal: Maintain a solid operating margin to balanceWinona Healths mission and costs.

Results: As a community-owned healthcare system,

Winona Health considers it paramount to provide highquality healthcare services to everyone in the Winonaregion. At the same time, it must be a care ul stewardo the communitys resources, ensuring the long-termviability o the organization. Winona Health uses itsoperating margin as one measure o whether it hasachieved a balance between its mission to thecommunity and its costs. This indicator is calculatedby dividing operating income by net revenue. Winona

Healths FY06 operating margin was 5.6%, 2.5%better than the median score or Standard & PoorsA-rated hospitals.

2006 K y i v


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$32 million building project completed on time andon budget.

With completion o the building project, the communitysmajor healthcare providers are all located on one campus.

Twenty- ve tours were held or community members,sta and volunteers during building construction.

A new surgery area brings state-o -the-art surgicaltechnology to Winona area residents.

The remodeled Emergency Department entranceimproves the triage process.

A special unveiling o the Winona Health Foundation

donor wall was held on April 5. The new Outpatient Diagnostic Center centralizesoutpatient surgical procedures, lab tests and imagingservices, so patients have a more convenient healthcareexperience.

About 1,800 area residents helped dedicate the newacility on Sunday, May 21.

Winona Health opened two new clinics on the thirdoor Sports & Orthopaedic Specialists and the Eye

Care Center.

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BuiLding PrOjeCt COntraCtOrs Winona Health recognizes and thanks area contractors for their part inthe successful completion of the building project:

All TradesBauer ElectricBiesanz Stone

Dunn BlacktopFlags & Poles IntlKendell Doors &

HardwareKendell LumberKimosLyles Flooring

Modern Ready MixOLaughlin PlumbingOtomo Engineering

ServicesRalph Scharmer & SonsRiver Valley SweepingRonco EngineeringSchwab CompanyScherbring EnterprisesSeverson Oil

WapashaConstruction

Winona Excavating

Winona GlassReplacementWinona Heating &

VentilatingWinona NurseryWinona Rental


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Seven new providers were recruited to the communityin 2006 and two providers recruited in 2005 beganworking in FY06. Winona Health welcomed the

ollowing new providers.2006:

Tim Gabrielsen, MD, Orthopaedic Surgery; Winona

Health Sports & Orthopaedic SpecialistsLaurel Quinn, MD, Ophthalmology; Winona HealthEye Care Center Laurel Littrell, MD, Radiology; Winona Radiology Kevin Quinn, MD, Child/Adolescent Psychiatry;Winona Health Psychiatric & Counseling ServicesJoel Stevens, PA-C; Winona Health Sports &Orthopaedic SpecialistsJoy Stevens, PA-C; Winona Health Rushford Clinic

Aaron Schilling, PA-C; Winona Health Sports &Orthopaedic Specialists2005:

Edward Malone, MD, Family Practice; Family Medicine of Winona, P.A.Ehab Michael, MD, Internal Medicine; Winona Clinic

Winona Healths new weekend Urgent Care Clinic treatedalmost 2,000 patients in its rst year o operations.

The Winona Health campus became tobacco- ree onJanuary 1, 2006.

Community Memorial Hospitals Emergency Departmentcared or almost 18,000 patients.

Winona Healths website averaged 4,241 unique visitorsper month in FY06, compared to 3,025 per month lastyear. In addition, its KidsHealth website eature has anaverage o 2,675 unique visitors per month, 400% morethan the previous year.

Winona Health hosted ve ocus groups to learn moreabout the healthcare needs o speci c groups, including

seniors, local employers, diverse and at-risk populations,school nurses and area ministers.

Winona Health donated more than $27,000 to areanonpro ts working on projects to bene t thecommunitys youth, health and wellness, or economicvitality.

m r v r u d ur w b K d H h ur rh h du , r , h h w , g d r .(winonahealth.org/kidshealth)

W H h d h Urg c r c r u y db k; 2,000 h v b r d.

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Inpatient and outpatient mental health visits increased

by 12%, addressing a key community need.Winona Health sta contributed $19,426 dollars to theGreater Winona Area United Way. In addition, sta members serve on the local United Way Board o Directors and several o its committees.

Winona Health is a site or student nurse practicums;in FY06, sta worked with 80 Licensed Practical Nursingstudents and 50 Registered Nursing students romMinnesota State-Southeast Technical and 55 RegisteredNursing students rom Winona State University.

Collaboration with Winona State University andWinona Health bene ted Cardiac Rehabilitationpatients, students and outcomes. In addition,Occupational and Physical Therapy sta members

lecture at WSUs sports training and UWLa Crosses

physical therapy programs.Lake Winona Manor worked with area nursing homeson collaborative initiatives, including working with thecounty on coordination o emergency/disaster plans.

Three hundred Back-to-School packets were distributedthrough Winona Health Physician Clinics and itsemergency and outpatient departments. The packetsincluded school supplies and health tips or children inelementary school.

Winona Health sta supported a number o communityevents, including the Lions Club Toy Drive, MerchantBanks 10 Days o Giving, American Cancer SocietysDa odil Sales, Gi ts or Winona, the United Way Day o Caring and a Red Cross Blood Drive.

Winona Health Speakers Bureau placed 58 sta members in schools and be ore civic and pro essionalorganizations to discuss their careers or specialhealthcare topics.Winona Health received editorial coverage in the

ollowing publications:Health Executivemagazine WinonaHealths technologyadvancesMinnesota Healthcare

News ElectronicMedical RecordsHealthcare Financial Management Electronic MedicalRecordsMinnesota Physician Patient bene ts o Electronic Medical

RecordsMinnesota Medicine Retooling FamilyMedicineRiver Valley Business Report Women in BusinessCoulee Region Women In uential Women

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The Minnesota Council or Quality recognized WinonaHealth or two best practices: The rst is Lake WinonaManors mentoring program that pairs new sta members with veterans sta or a systematic series o interactions, and the second is the alignment o WinonaHealths values to its service standards, per ormance

appraisals and sta recognition.

Winona Health received a matching grant rom the stateo Minnesota and installed overhead li ts in the ImagingServices department to improve patient and sta sa etyin an area at high risk or sta back injuries. No injurieshave occurred since implementation.

An electronic time and attendance system wasimplemented across Winona Health to improve accuracy,minimize errors and increase efciency in processingpayroll. This new system allowed or the transition o 1.5Human Resource employees rom payroll processing torecruiting and orientation.

The hiring process was evaluated and improved,resulting in the average time to ll open positions

being six days aster than the national average (41versus 47 days).

As part o its ongoing commitment to sta , WinonaHealth University was launched to develop sta educational opportunities. Eighty- our percent o sta completed a minimum 20 hours o education in FY06.

Winona Health employee retention rate is 94% versus anational average o 88%.

Direct workers compensation expenses were decreasedor the ourth straight year; Winona Healths workers

compensation expenses were 0.17% o operatingexpenses, compared to the national average o 0.43%.

More than 1,400 applicants applied or open sta positions, with 90% o applications submitted electronicallythrough newly implemented integration o the websiteand Human Resources in ormation systems.

Crucial Conversations training was deployed to allWinona Health directors and managers as a oundation

or leadership development and skill building.

Four Winona Health sta are now trained MinnesotaCouncil or Quality evaluators, with special training inBaldrige quality criteria.

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Fi ty-two employees were trained in Lean principles andcompleted eight Lean team projects as part o a MinnesotaJob Skills Partnership grant received with Winona StateUniversity. Lean in healthcare re ers to eliminating work-related waste in processes. As a result, the organizationwill unction more efciently without extra steps andtasks that do not add value to the patient experience.Eventually all Winona Health sta will be trained in Leanprinciples. Initial Lean projects included:

Discharge Process This teams objective was to recognize, identi y andreduce the wasted time in the discharge process orpatients on the Medical Surgical & Pediatric unit (MSP).A ter observing the process, the team determined that ittook an average o 230 minutes rom the moment aphysician wrote a discharge order until the hospital bedwas cleaned and ready or the next patient.

The team identi ed actors that delayed a patientsdischarge and put an action plan into place to cut outwaste. As a result, the average time was reduced to 162minutes, saving 68 minutes per discharge.

Supply Management Process A ter sta expressed concern about nding supplies in atimely manner, Lean team members analyzed supply storagein Lake Winona Manor to encourage aster response toresident needs. They began by mapping out how sta usethe supply room and determined that it took an averageo 7 minutes 23 seconds to nd a particular item.

The team reorganized the supplies and set up a systemor categorizing, labelling and restocking supplies. It then

took sta an average o just 15 seconds to nd the itemthey were looking or.

Lean PrOjeCts

Living Service Excellence Award recipients or 2006 were:

Scott Fabian, Materials Management Jodie Heim, Lake Winona ManorRobin Hoeg, RN, MSN,Inpatient ServicesDana Marquardt, Human ResourcesSandy Paetzel, LPN, Medical/Surgical/PediatricsBrett Whyte, MD,Emergency Department

Many Winona Health sta members continued theireducational training in 2006, including:

Briana Frisch, Rehab Services, Physical Therapy PhD

and Kinesio Tape Instructor certi cationStela Hristova, Health In ormation Management,Registered Health In ormation Technician certi cationChristina Friederichs, Physician Clinics, Administratorin Physician Practice Management certi cationDeb Norton, Karen Resch and Deb Kahoun ,Registered Nurses, Critical Care certi cationMarie Gernes, Accounting, Healthcare FinancialPro essional certi cation

Alicia Lalim, Heidi Ramsey and Doug Haberman,Rehab Services, Registered Clinical ExercisePhysiologist certi cation

Chris Draper, Sherry Hill, Michelle Stark and Jean

Skime, Senior Services, Hospice and Palliative Carecerti cationLoretta Boyer, RN,Wound, Ostomy and Continencecerti cation

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Winona Health participated in the Center or Medicare/Medicaid Services (CMS) demonstration project and itsmost recent scores show its care o Acute Myocardial

In arction (heart attacks) in the top 10%, CongestiveHeart Failure in the top 20% and Pneumonia in the top10% o 300 participating hospitals.

Community Memorial Hospital completed a success ulstate and ederal survey; o the 468 standards, thehospital received only three minor citations. In addition,the surveyors commented on the acilitys superiorquality initiatives.

Winona Healths assisted living acilities were inspectedby the State o Minnesota and received no de ciencies. The surveyor noted that Watkins, Adith Miller and RogerMetz Manors are doing exceptionally well at medicationadministration and sta training. Clients interviewedwere pleased with the activities o ered and enjoyedliving in the Manors.

Watkins, Adith Miller and Roger Metz Manors averageoverall customer satis action score in 2006 was 85.4 versus the national peer group score o 81.

Winona Health Home Care was in the top 8% o per ormers in the Home Care Hospitalization ReductionStudy, making it a best practice site.

Transcription services or ICU patients were completedwithin seven hours o admission, compared to abenchmark time o twelve hours. The reduced time-

rame ensured attending physicians had access tocritical in ormation in a more timely manner.

Patients with abnormal mammograms received resultswithin 48 hours o testing, thanks to changes in ImagingServices protocols.

In FY06, Winona Health provided low-cost prostatecancer screenings to 122 area men.

Sta -led e orts to live service excellence, contributed toa 43% decrease in patient complaints.

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Winona Healths Community MemorialHospital (CMH) received the PremierAward or Quality or superior careo Acute Myocardial In arction (heartattack) patients. The hospital earned

the award or its high quality, cost efcient treatment o AMI. The award criteria included clinical process measures(administering aspirin and beta blockers), clinical qualityoutcome measures ( or example, readmission rates), andresource utilization actors (cost per case and length o stay). Community Memorial Hospital was recognized roman eligible pool o 400 hospitals.

In addition, Premier highlighted Winona Healths success inreducing mortality rates in its February 2006 newsletter.A clinical team rede ned admission criteria, engagedphysicians, improved documentation and worked withcommunity resources or appropriate patient placement.As a result, Winona Healths inpatient mortality ratedropped rom 2.3% to 1.21% and continues to be at least0.5% below its peer group.

The American Association orRespiratory Care presented the 2006Quality Respiratory Care RecognitionAward to Winona Healths CommunityMemorial Hospital.

Winona Health was recognized MostWiredSmall and Rural Hospital or the

th consecutive year.

Winona Health continued its quality journey and was recognized by theMinnesota Council or Quality witha Minnesota Quality AwardAdvancement Level.

With e ective processes in place to ensure patientsa ety, Community Memorial Hospital again had noreportable State o Minnesota adverse events.

E orts to improve outcomes as reported in the CMSHome Health Compare Data resulted in Winona HealthHome Care having eight out o 10 measures equal to orbetter than the state average, with ve scores equal toor better than the national average.

In an e ort to improve resident satis action, LakeWinona Manor began serving made-to-order break astswhere residents request their ood as in a restaurant.

Lake Winona Manor redesigned its work model, reeingup 2 additional ull-time employees to work directlywith residents.

Lake Winona Manor sta averaged 2 minutes 45 secondsresponding to resident call lights, besting their goal by 55%.

Microso t eatured Winona Health in its marketingvideo at the Health In ormation Management Societyscon erence and on its website.

2006 awards & reCOgnitiOn

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Co o : s hStandard and Poors raised its rating o Winona Healths$19.1 million health revenue bonds to BBB, citing asolid balance sheet, improved operating and excessmargins and good market position.

Winona Healths gain rom operations was $3.8 million(5.6% operating margin), outper orming budget or the

ourth consecutive year while unding:Charity Care to quali ed patients o $624,000Write-o s o bad debt totaling $1,636,000Start-up o new physician clinics or the community

Operating expenses were within 2% o budget or theourth year in a row.

Winona Healths balance sheet remains stable andcompares avorably to similar hospitals:

Cash-to-Debt ratio: 103%Days Cash on Hand: 160Debt-to-Capitalization ratio: 29.2%

Parkview Pharmacy revenue grew 3%, while itsoperating margin improved by 100%.

$2.4 million o capital was deployed to und patient careand operations, including new equipment or surgery,lab, cardiac rehabilitation, respiratory care and physicianclinics; in ormation technology; and physical plantin rastructure upgrades.

Winona Healths investment returns or the 36-monthperiod since consolidating to three investment

managers was 34.7%, besting the benchmark o 26.1%.An independent audit was completed with a cleanopinion and no material adjustments made to nancialstatements, indicating Winona Healths processes orrecording transactions, compiling nancial statementsand reporting nancial in ormation is e ective andinternal controls are working.

The Winona Health Foundation awarded $24,100 inCommunity Engagement Grants to six local nonpro tsworking to improve the communitys health and well-being. The nonpro ts that received the awards include:

Winona Volunteer Services $6,500 towardconstruction o a kitchen to educate Food Shel customers about healthy, whole oodsWinona Senior High School $4,500 to purchasede bulators or the high school and middle school

i 20 h y r rv h u y, W H hp rkv w ph r y r v u gr w 3%.

i 2006, h B & ad h m r p c r Fu d r y

d ub d d r v r h r v u y r.

Dollars awarded from theBen & Adith Miller Patient Care Fund

$600,000

$500,000

$400,000

$300,000

$200,000

$100,000

$0

2002 2003 2004 2005 2006

$87,000 $113,000

$164,000

$263,000

$528,000


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Goodview Elementary School $600 to engagechildren in physical activitiesProject FINE $5,000 to provide prenataleducation to migrant workersHiawatha Valley Mental Health Center $4,000 toprovide an on-site day treatment acility or middle-school-aged childrenWinona Area Public Schools $3,500 to und anongoing elementary health curriculum

The Foundation also awarded $30,000 to three internalprojects under its Quality & Excellence program. The

unding provided pressure-relieving mattresses orLake Winona Manor and Community Memorial Hospital,a ceiling li t system to help in moving patients/residentsand a NuStep exercise machine or use by Lake WinonaManor residents.

The Ben & Adith Miller Patient Care Fund provided$528,000 o assistance to 230 people in 2006, comparedto $263,000 or 81 people in 2005.

The Ben & Adith Miller Classic, which supports thePatient Care Fund, raised $150,000 in 2006, a 10%increase over the previous year.

The Winona Health Foundation received $606,494 indonations rom individuals, amilies and businesses,allowing it to urther its mission o support to Winona Health.

The Winona Health Foundation inducted 19 membersinto its Circle of Visionaries, which re ers to people whohave remembered the Foundation with a planned gi t.

The Winona Health Auxiliary gi ted $69,100 to WinonaHealth or a patient/resident educational televisionsystem, Cardiac Rehab telemetry equipment, andremodeling o the Watkins Manor kitchen. In addition,it awarded $15,000 in scholarships to 18 individuals.Four Auxiliary volunteers were recognized or contributingmore than 5,000 hours o service to Winona Health: JanWanek, Diane Barge, Lynn Siebenaler, and Jenny Kahl.

The Winona Health Auxiliary was busy in FY06:Conducting its rst annual garage sale, which raisedmore than $5,000Holding its 44th annual Birthday Ball, with proceeds

exceeding $20,000Adding three new service points South EntranceIn ormation Desk, Boyer Lounge Reception, andOutpatient ReceptionOrienting 144 new volunteers 34 more than in theprevious year and ve times more than in 2003.

th B & ad h m r c r d r rd $150,000 w rdh p c r Fu d.

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Ancillary Department Satisfaction(Laboratory, Imaging, Rehabilitation)Goal: Improve the overall quality o the Laboratory, Imaging and RehabilitationDepartments care and service to increase patient loyalty.

Target: Three standard deviations above peer mean scores

Employee Health and Well-beingGoal: Decrease employee musculoskeletal incidents related to patient/residenthandling and trans ers.

Target: 10% decrease in injuries over 2006

Computerized Provider-Order Entry (CPOE)Goal: Launch and ully deploy CPOE in a single Winona Health clinical department.

Target: 80% o orders in one department submitted electronically

Operating MarginGoal: Maintain a solid operating margin to balance Winona Healths missionand costs.

Target: 4.0%

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winonahealth.org

C ommunity m emorial H ospital ~ l ake W inona m anor ~ W atkins m anor a ditH m iller and r oger m etz m anors ~ H ome C are and H ospiCe s erviCes

p HysiCian C liniCs ~ p arkvieW p HarmaCy ~ W inona H ealtH F oundation

Winona Health Accomplishments 2006

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