Hardwiring Excellence
A Foundation to Get There
Pam Beitlich, RN, MSN
Studer Group
September 16, 2010
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
Why are we here today?
 Understand the foundational
principles of Hardwiring Excellence
 Take away 3 things that you can
begin immediately in your workplace
The Foundation-
Bottom-line Results – Everyone has a role
(Balanced Scorecard)
Service
Reduced
claims
Reduced
legal
expenses
Reduced
malpractice
expense
Quality
People
Improved
clinical
outcomes –
decreased
nosocomial
infections
Reduced
turnover
Physician
Satisfaction
Reduced
medically
unnecessary
days and
delays
Patient
Satisfaction
Reduced readmits
Reduced
medication
errors
Reduced
vacancies
Reduced
agency
costs
Reduced
overtime
Reduced
physicals
& cost to
orient
Finance
Improved
operating
income
Decreased
cost per
adjusted
discharge
Improved
collections
Reduced
accounts
receivable
days
Reduced
advertising
costs
Growth
Higher
volume
Increased
revenue
Decreased
left without
treatment in
the ED
Reduced
outpatient
no-shows
Increased
physician
activity
Community
Increased
Philanthropy
Nine Principles®
Commit To
Excellence
Build Individual
Accountability
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
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
Healthcare Flywheel®
Bottom Line
Results
(Transparency and
Accountability)
Winning
Prescriptive
Execution
To Do’s
Purpose,
worthwhile work
and making
a difference
SelfCourage
Motivation
®
Rev 6.7.10
Evidence-Based LeadershipSM
Foundation
STUDER GROUP®:
Objective
Evaluation
System
Leader
Development
Aligned Goals
Implement an
organizationwide
staff/leadership
evaluation
system to
hardwire
objective
accountability
(Must Haves®)
(30 pts)
Must
Haves®
Aligned Behavior
Agreed upon
Create
tactics and
process to
behaviors to
assist leaders
achieve goals
in developing
skills and
 Rounding for
Outcomes: (10pts)
leadership
competencies  Thank you notes:
necessary to
(2 pts)
attain desired  Selection and the
results
First 90 Days (8
(15 pts)
Performance
Gap
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)
Standardization Accelerators
Aligned Process
Processes
that are
consistent
and
standardized
throughout
the company
(8 pts)
Leader Eval
ManagerTM
Patient Call
Manager TM
Case Study
Journey of achieving personal and organizational
excellence
Why I Care About Making a Difference
Building a Culture of
Excellence
A “Roadmap”
Creating a great place
for employees to work,
physicians to practice,
and patients to receive care
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
The Knowing – Doing Gap
There is a huge gap
between knowing the
importance of
operational excellence
- and doing it every
day. What kind of
culture do you really
want to create and
keep at your
organization?”
Strategic Direction
“To be the best health
care organization in
the country”
Word of Mouth
66% of healthcare
choice decisions are based on
word of mouth
AHA Reality Check II, AHA, 1998
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
CEO’s Top Issues- 1998
99%
Upgrading technology / Information systems
91%
Integrating system / Forming a provider network
Developing new services / Diversifying business lines
88%
Re-engineering business processes
88%
85%
Recruiting physicians
82%
Re-engineering clinical services
58%
Forming a physician-hospital organization
54%
Controlling costs
50%
Developing a medical services organization
Merging /Consolidating
13%
Building / Expanding /Renovating
12%
0%
AHA News, March 9, 1998
10 %
20%
30%
40%
50 %
60%
70 %
80%
9 0 % 10 0 %
CEO’s Top Issues – 2003
73%
Reimbursement
58%
Personnel Shortages
28%
Capacity
Care for the Uninsured
26%
Physician/Hospital Relations
26%
24%
Malpractice Insurance
Governmental Mandates
18%
Quality
17%
12%
Technology
9%
Patient Safety
American College of
Healthcare Executives, Nov
26, 2003, CEO Survey
Reveals Top Issues Facing
Hospitals
7%
Patient Satisfaction
Biodisaster Preparedness
1%
0%
10 %
20%
30%
40%
50 %
60%
70 %
80%
9 0 % 10 0 %
CEO’s Top Issues – 2008
43%
Patient safety and quality
41%
Care for the uninsured
32%
Physician-hospital relations
30%
Personnel shortages
Moves up
and down
26%
Governmental mandates
22%
Patient satisfaction
16%
Capacity
Technology
Constant
for years
77%
Financial challenges
9%
Issues about not-for-profit status
2%
Disaster preparedness
1%
American College of Healthcare Executives, 2008, Annual
0% 10% 20%
CEO Survey of Top Issues Confronting Hospitals
30% 40%
50% 60% 70% 80%
90% 100%
CEO’s Top Issues - 2009
New
update
Financial Challenges
76%
53%
Healthcare Reform Implications
Care for the Uninsured
37%
32%
Patient Safety and Quality
Governmental Mandates
30%
Physician Hospital Relations
Moves up
and down
25%
Patient Satisfaction
15%
Personnel Shortages
13%
Capacity
7%
January 11 Modern
Healthcare, American
College of Healthcare
Executives, 2009 Annual
CEO Survey of Top
Issues Confronting
Hospitals; 525 Hospital
CEOs
Technology
7%
Governance
Disaster Preparedness
2%
1%
0%
Constant
for years
10%
20%
30%
40%
50%
60%
70%
80%
90% 100%
One
Hospital’s
Journey…
Leadership Meetings
No more turkeys
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”
Focus on Measurements
Patient Satisfaction
Staff Satisfaction
Physician Satisfaction
Quality/Safety
Financials
Beginning of
“No-Secrets” Culture
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
It’s all about the
leader…
Every single one
of them
“If you want to change the world,
you have to start with yourself.”
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
Good or Great?
What differentiates your
organization from your
competitors?
Rude – Good - Memorable
Service is Married to Quality…
Top Box
Loyalty
Let’s look at Service – 4 vs 5
1’s
2’s
3’s
4’s
5’s
99th
Percentile
Hospital
1%
2%
7%
24%
66%
64th
Percentile
Hospital
1%
2%
8%
34%
55%
35th
Percentile
2%
2%
8%
36%
52%
Reference: Sample distribution of inpatient satisfaction score responses to achieve
excellence, Press Ganey and Associates, March 2007
HCAHPS Recommendations
HCAHPS CATEGORY
TACTIC TO MOVE OUTCOME
Doctors always communicated well
Physician Note Pad
Nurses always communicated well
Hourly Rounding
Pain was always well controlled
Hourly Rounding
Patients always received help as soon as they
wanted
Staff always explained about medicines before
giving them to patients
Yes, patients were given information about what
to do during their recovery
Hourly Rounding
Patients who gave a rating of 9 or 10
Leader Rounding on patient
Yes, Patients would definitely recommend the
hospital
Post Visit Phone Call
Key Words at Key Times
Post Visit Phone Call
Percentile Rank Comparison
How 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.
+22%
+24%
+26%
+20%
+18%
+13%
+7%
+9%
+7%
+6%
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
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)
Rounding for Outcomes is NOT…
The proverbial wave
Management by wandering around
Focused on “what’s wrong”
Being “out there”
Happenstance
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
New
update
Turnover and Vacancy Rate
Vacancy Rate
Turnover
12.0%
12.0%
10.0%
10.0%
10.0%
8.0%
8.0%
5.5%
6.0%
Percentile
Percentile
8.0%
6.0%
4.2%
4.0%
4.0%
2.0%
2.0%
0.0%
0.0%
FY10
Goal
1Q FY10TD
(annualized)
Source: Florida Hospital System, Admissions=69,107 Total beds = 1,218
FY10
Goal
1Q FY10TD
(annualized)
Employee Satisfaction Increase
2009
Overall
RSFH
Corporate
Services
99%tile
100%tile
Bon
Secours
St.
Francis
99%tile
Roper
99%tile
Source: South Carolina Hospital, Admissions=25,837 Total beds = 594, vendor = PRC
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.”
Round With Patients
Set clear expectations
Focus on key questions
Outline what to do if
problems are discovered
Closing statement
Reward and recognize staff
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?
Leader Rounding on Patients
“Did a Nurse Manager Visit You During Your Stay?”
Percentile
100
90
80
70
60
50
40
30
20
10
0
94
90
81
n= 608
New
update
87
n= 604
n= 561
n= 601
Tactic and Tool Implemented:
Yes
Leader Rounding
n= 106
9
No
n= 104
n= 96
14
n= 105
13
1
Overall
Nurses Section
Response to
Concerns/
Complaints
Likelihood to
Recommend
Source: Arizona Hospital, Total beds = 355, Employees = 4,000, Admissions = 10,188; updated 2Q2010
Financial Impact
Metric
Falls
Impact
Quality
Reduction
50%
Decubitus Ulcers
First Year Turnover
Readmissions
Quality
People
Growth
14%
66%
33%
No Shows
Tardies
Call Lights
Growth
Growth
People
70%
60%
38%
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
Studer Group Five Fundamentals - AIDETSM
A
Acknowledge
I
Introduce
D
Duration
E
Explanation
T
Thank You
Managing Up
Positioning Others in a
Positive Light . . .
Makes you better
Makes your organization
better
Aligns everyone
The Great Erasers
“We’re short-staffed”
“Can’t; But; No; Our policy”
“That’s not my patient”
“You know how Administration is around here”
“That’s not my job (problem)”
“I can’t believe they kept you waiting so long”
“No one told me you were here”
“We have real emergencies ahead of you”
“We can’t get good help”
Health Care
Initiatives Have Not
Been Sustained . . .
Why Organizations Do Not Achieve
Desired Results
1.
2.
3.
4.
Dots are not connected
consistently to purpose,
worthwhile work and making a
difference
Do not achieve critical mass Lack of balanced approach
Absence of an objective
accountability system
Leaders do not have the
training to be successful
5.
6.
7.
8.
Rev 3.08
Too many new behaviors
introduced at once – need for
sequenced approach
No process in place to re-recruit
the exceeding and achieving
performers and address low
performers (HML)
Inability to take best practices
and standardize across
organization
Failure to have leaders “always”
do desired behaviors
Studer Group – Lessons learned
Since 2000
Objective evaluation is the
sustainer
Sequencing of tools are vital
One should not move on to the
next tool/tactic if the preceding
tool/tactic is not hardwiredSM
Difference between cookie-cutter
approach and evidenced-based
leadershipSM
This is a lot harder than anyone
thought – Why?
 Trying to align behavior of more
people than other initiatives
 As your organization improves,
inconsistencies become apparent
 Non-documented performance
issues
It is not a patient satisfaction/service
excellence program. It is putting into
place an operational framework for:
 Alignment of resources
 Accountability of people
 Execution/Implementation of plans
and processes
“Everything Rises and Falls on Leadership”
The only legacy we
leave behind is to those
we teach
-Quint Studer
It is all about Results…
CEO’s Top Issues - 2009
New
update
Financial Challenges
76%
53%
Healthcare Reform Implications
Care for the Uninsured
37%
32%
Patient Safety and Quality
Governmental Mandates
30%
Physician Hospital Relations
Moves up
and down
25%
Patient Satisfaction
15%
Personnel Shortages
13%
Capacity
7%
January 11 Modern
Healthcare, American
College of Healthcare
Executives, 2009 Annual
CEO Survey of Top
Issues Confronting
Hospitals; 525 Hospital
CEOs
Technology
7%
Governance
Disaster Preparedness
2%
1%
0%
Constant
for years
10%
20%
30%
40%
50%
60%
70%
80%
90% 100%
Consider…
What do you want to be
known for?
Do you create memories
for your patients?
Can you be exceptional
or extraordinary?
Leaders capture the
hearts and minds of their staff…
“You cannot lead by hitting
people over the head –
that is assault,
not leadership.”
– Dwight Eisenhower
You must keep
raising the bar
– everyone
else is
Connect to Purpose…
Our patients depend on us and we depend on
you. Yours might be the first face they see
when they come through our door. Yours might
be the voice they hear right after a surprise
diagnosis. Yours might be the eyes they look
into as they are pushed in a wheelchair to a
frightening procedure. Your attitude reflects us
and everything we are proud of in this
organization. You have chosen to help serve our
patients and we appreciate you. Thank you.
Never Underestimate
the Difference You
Can Make
~ Quint Studer ~
Thank You!
Pam Beitlich
www.studergroup.com
(850) 934-1099