From Good to Great
Service Excellence
University of Missouri Health Care
September 1, 2005
University of Missouri Health Care
The charge for University of Missouri
Health Care is to move from a good
organization to a great one.
We HAVE a sense of urgency to do this.
University of Missouri Health Care
Our employees, our physicians and our patients
ARE our health system’s top priority.
University of Missouri Health Care
UMHC Culture
This commitment requires
people to change.
University of Missouri Health Care
‘Hardwiring Excellence’ by Quint Studer
• Model for organizational excellence
• Guide for best practices, not a mold
University of Missouri Health Care
Becoming a World-Class Organization Requires:
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Committing to excellence
Measuring the important things
Building a culture around excellence
Creating and developing leaders
Focusing on employee satisfaction
Building individual accountability
Aligning behaviors with goals and values
Communicating at all levels
Recognizing and rewarding success
University of Missouri Health Care
Our Commitment to Excellence
The journey to excellence begins with a firm and
measurable commitment from EVERYONE.
We no longer want to be good.
Our goal is to be Grrrreat!
University of Missouri Health Care
Our Commitment to Excellence
There is no ‘THEY’
University of Missouri Health Care
University of Missouri Health Care
Our Mission
As part of a land-grant university, University of Missouri Health
Care’s core mission is to provide education, research and service
to the residents of Missouri with an emphasis on the needs of
rural Missouri.
Our Vision
To offer programs of unsurpassed excellence that will be
integrated into a highly efficient, fiscally sound, professionally
outstanding, service oriented health system that is unified in a
common purpose to be one of the premier comprehensive
academic health systems in the nation.
University of Missouri Health Care
Our Values
Quality. We believe in quality – quality in the patient care
we deliver and the people we hire.
Efficiency. Our goal is to provide the highest quality care
at the lowest possible price.
Caring Attitude. We care about the people who come
here, whether they are patients or visitors. We treat
them with courtesy and respect.
Participation. We encourage and depend on our staff to
help us guide this organization. Their guidance is
accomplished by participating in elected and appointed
committees and task forces.
University of Missouri Health Care
We identified six Columns of Excellence to
provide the foundation for setting goals and
direction for service and organizational excellence
at University of Missouri Health Care
Community w Growth w Finance w Quality w People w Service
University of Missouri Health Care
System Approach to Columns
Service
Quality
People
Patient
Satisfaction
Key Clinical
Indicator
Review
Turnover
Medication
Errors
Reduction of
Patient Falls
Examples
Turnover –
First 90 Days
Employee
Satisfaction &
Retention
Financial
Growth
Operating
Margin
(MTD/YTD)
New Patient
Volume
Growth
Cash
Collection
Surgical
Growth
Employee
Evaluation
Completion
Wins
University of Missouri Health Care
No Shows
Facility Approach to Columns
Service
Patient
Satisfaction
Reward &
Recognize
leaders of
areas scoring
well
Standard of
the Month
Celebration
Patient letters
Quality
People
Key Clinical
Indictors –
results for the
org
Reward &
Recognize
leaders
Reward &
Recognize
staff
Financial
Operating
Margin
Growth
Market Share
Turnover
Cash
Collections
Specific
Service line
growth
Staff forums
AR days
No Shows
Upcoming
hospital
celebrations
Community
Events
Examples
University of Missouri Health Care
Department Approach to Columns
Service
Quality
People
Dept Patient
Satisfaction
Dept Quality
Indicators
Introduce new
employees
Dept
Productivity
Dept
admissions
Patient
comments
R&R
improved
areas
New Tools &
Equipment
Dept supply
costs
Community
Events
Dept
Turnover
Key actions
for staff to
take next 30
days
Hospital
growth YTD
What we have
improved
Where we
need to focus
Ideas from
staff
Key action
steps for staff
to take next
30 days
New tools &
equipment
Examples
Upcoming
training
activities
Reward &
Recognition
Financial
Hospital/Dept
financial
performance
YTD
University of Missouri Health Care
Growth
Building a Culture Around Excellence
• Core Team Formed
– January 2005
• Service Teams Formed
– April 2005
– Approximately 100 employees involved to date
• Quarterly Leadership Retreats
University of Missouri Health Care
Standards Team
Team Members:
Ben Atwell
Karen Broz
Dave Geiger
Michel Hayes
Pam Mulholland
Kay Steward
Shanna Baldridge
Dr Robert Bynum
Marty Hausman
Craig Hosey
Karen Scott
University of Missouri Health Care
What We Do
Purpose : To create the foundation of our culture of
Service Excellence
Goals: We asked ourselves : What kind of behaviors
do we need to become a culture of excellence for
patients, staff, and physicians?
The answer: The Standards of Performance
University of Missouri Health Care
The Commitment
Current Staff
• All signing is cascaded down through executive
Leadership, then their direct reports, etc…
• All staff are to have signed by September 30, 2005
New staff
• HR – on line Standards prior to application access
• Departmental signing as well and departmental
orientation (added to orientation checklist)
University of Missouri Health Care
Our Projects
Education:
A traveling carnival : UH, CRH, EFCC, QD
• Positive Learning Environment
• Fun and Interactive
• Different Booths to Represent each Standard
• Prizes, candy, etc. for winners
Standard of the Month
University of Missouri Health Care
Patient Satisfaction Team
Team Members:
Laura Phillips
Barb Barrett
Bonnie Potter
Deb Calder
Linda Robb
Jan Degraffenreid
Dan Smith
Paula Flandermeyer
Susan Straatmann
Shawn McGrew
Patty Wells
Ellen McKenzie
Darian Younger
Nakia Moore
Katherine Payne
University of Missouri Health Care
What We Do
Purpose
• Ensure highest level of service is consistently provided
• Develop new ideas to continually improve the service and to
share best practices among departments to help others learn
Goals
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Look for ways to “wow” patients and families
Solicit input on ways to improve care
Develop & implement “key words at key times”
Implement communication boards in patient rooms
Implement nurse leader rounding
Implement discharge phone calls
University of Missouri Health Care
Our Projects
• Cascade Learning Packets
– Interest, Concern, Apologize, Respond, and Educate
• Quick Wins for specific areas
University of Missouri Health Care
Physician Satisfaction Team
Team Members:
Pete Ackerman, MD
Karen Calhoun, MD
Steve Calloway, RPh
Kevin Dellsperger, MD
Jessica Hardy
Nancy Jones, RN
Melissa Lyons, M3
Dennis McGowan
Marty McCormick
David Mountjoy
Sue Scott, RN
Tom Selva, MD
Beth Van Hove
Jennifer Wallace, RN
Andrew Wheeler, M3
Mary Williamson, RN
University of Missouri Health Care
What We Do
Purpose:
Responsible for “wowing” physicians and
improving the level of service to them and their
patients
Goals:
• Implement action steps with outcomes that will
be seen by medical staff as a “win”
• Modify key processes within the institutions that
will allow for ease in patient care delivery
University of Missouri Health Care
Our Projects
Quick Wins:
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House Phone Conversions
Replacing Tone Pagers with Text Capabilities
On Call Schedules – On Line, One Reference Point
Hospital Marketing for Physician Providers
Facility Improvements – Hit Squad concept
Nurse Call Line
University of Missouri Health Care
Priority Focus: “Patient Care Made Easier”
Hypothesis:
Addressing Patient Care Made Easier will improve
physician, staff and patient satisfaction levels
Action Steps:
• Identified discharge planning process as area for redesign
• PSTF team joins forces with nursing administration
to reach key goals for discharge planning revisions
• Blitz Session to address key goals scheduled for
September 30, 2005
University of Missouri Health Care
Employer of Choice Team
Team Members:
Anissa Leaseburg
Mindy Cherrington
Lezlie Dahlke
Linda Davis
Gayla Maier
Ramonna McKinzie
Theresa Nation
Brenda Quinlan
Carey Smith
Randy Wade
Angela Waller
David Wiss
University of Missouri Health Care
What We Do
Purpose
Implement programs and opportunities to help
employees feel they are doing meaningful,
purposeful and worthwhile work
Goals
To make UMHC the “destination employer”,
not a stepping stone
University of Missouri Health Care
Our Projects
Our projects will focus on system wide policies,
procedures and programs that can be implemented to
make UMHC an Employer of Choice. Future
recommendations:
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Encouraging opportunities for employees to be involved in
decision making about issues that affect them, such as hiring
decisions and work space and facility decisions
Ensuring that UMHC has a market competitive compensation
program that encourages and rewards superior performance
and shares gains with rank and file employees
Enhancing an already strong benefits program
Sustaining a culture that holds everyone in the organization, at
all levels, accountable for their performance
University of Missouri Health Care
Measurement Team
Team Members:
Kim Bass
Karen Cox
Christine Heath
Will Kiehl
Michele Schutte
Barb White
Amy Camp
Rachel Haverstick
Bruce Horwitz
Manuel Navarro
David Sohl
University of Missouri Health Care
What We Do
Purpose:
• To correctly measure, interpret, and communicate
progress toward the organization’s objectives
Goals:
• To develop and distribute performance data in a clear
and useful format to all departments and administration
• Work with leadership to promote understanding and
utilization of data
• Assist other teams by providing information for
planning, decision-making and reward/recognition
University of Missouri Health Care
Our Projects
Current and future projects/actions:
• Design patient satisfaction reports for each unit,
department and facility
• Create a presentation to provide an overview and
explain the data to departments
• Review/evaluate current survey tools
• Develop methodology for distribution and review of
survey comments
University of Missouri Health Care
Sample Reports
Medical Practice (Clinics)
University Hospital and Children's Hospital
Mean Score on Waiting Times
Mean Score on Response to Concerns and Complaints
100
100
95
95
90
Goal: 87.6
90
Goal: 85.9
85
85
78.7
77.8
Mean Score
Mean Score
79.5
78.8
78.5
75
70.7
70
80
Goal: 86.4
84.1
83.8
81.9
80.5
80.3
80
81.3
80.8
79.2
80.8
80.4
80.7
78.6
80.6
78.6
78.5
76.7
75
70
65
65
60
60
55
55
50
50
26-Jun
n=52
3-Jul n=53
10-Jul
n=55
17-Jul
n=48
24-Jul
n=34
31-Jul
n=51
7-Aug
n=46
14-Aug
n=52
21-Aug
28-Aug
4-Sep
11-Sep
18-Sep
26-Jun
n=157
25-Sep
3-Jul
n=139
10-Jul
n=139
17-Jul
n=126
24-Jul
n=86
31-Jul
n=208
7-Aug
n=178
Wait before going to exam room
100
100
92.6
89.8
87.5
85.7
85
88.6
86.4
87.0
Goal: 81.5
Goal: 90.6
90.3
86.8
85.5
85
77.8
79.0
Mean Score
76.1
25-Sep
100.0
84.2
82.1
75
18-Sep
Wait in exam room to see Care Practitioner
90
84.1
78.6
11-Sep
Goal: 90.8
89.5
80
4-Sep
95
94.6
92.4
91.3
28-Aug
Mean Score on Response to Concerns and Complaints
M ean Score on Waiting Times
90
21-Aug
Outpatient (Ancillary Services)
Columbia Regional Hospital Emergency Room
95
14-Aug
n=114
Week and Number of Responses
Week and Number of Responses
Mean Score
82.4
81.1
70
80
79.6
80.6
75
70
65
65
60
60
55
55
50
26-Jun
n=23
3-Jul
n=27
10-Jul
n=14
17-Jul
n=22
24-Jul
n=11
31-Jul
n=27
7-Aug
n=14
14-Aug 21-Aug 28-Aug
n=19
4-Sep
11-Sep 18-Sep 25-Sep
Week and Num ber of Responses
50
26-Jun
n=14
3-Jul n=9
10-Jul
n=19
17-Jul
n=11
24-Jul n=9
31-Jul
n=17
7-Aug
n=19
14-Aug
n=18
21-Aug
Week and Number of Responses
Waiting Time to Treatment Area
Waiting Time to See Doctor
University of Missouri Health Care
28-Aug
4-Sep
11-Sep
18-Sep
25-Sep
More Sample Reports
Five Best - Patient Satisfaction
ER
Mean
CRH
Mean
UHC
Mean
UHC Peds
Mean
Clinics
Mean
Outpatient
Mean
Best
CRH ER
85.8
Well Baby
88.3
CICU
87.9
PSSC
86.9
ORAL SURG EF
94.8
Chemo
91.8
2nd
UHC ER
80.5
3OB
86.9
Stepdown
85.1
PICU
86.2
HALLSVILLE CL
93.4
Radthrp
91.6
3rd
NICU
86.6
Oppu
82.6
Peds
81.5
CANCER SCR EF
92.4
CardRhb
91.0
4th
5Central
85.9
SICU
81.1
Adol
80.9
FERTILITY CL
91.6
Lab
90.2
5th
4North
84.7
Emo
79.8
LOZ CL
91.0
Echocard
89.4
Five Best - Employee Satisfaction
UHC
Employees
Mean
CRH
Employees
Guest House
88.4
Human Resources
79.5
CPG Brookfield
84.7
Ortho Rehab
75.4
Endoscopy
76.4
Data Processing, TSS/ITS
71.7
PM&R Clinic
76.1
Pharmacy
66.6
OMER
73.9
Admitting
66.1
Mean
University of Missouri Health Care
Service Recovery Team
Team Members:
Anita Beall
Kim Brucks
Lorna Carver
Karen Harris
Candace Hawkes
Mickie Kummer
Susan Lee
Velma Moore
Carol Nierling
Dan Smith
Tracie Wideman
Amanda Wood
University of Missouri Health Care
What We Do
• To provide staff with information to enhance
their customer service skills
• To provide staff with the tools necessary to
“recover” when a customer’s expectations
have not been met
University of Missouri Health Care
Our Projects
• Develop a brochure for staff that provides key
words/scripting to promote good customer service
skills
• Develop an educational video with case scenarios
depicting excellent customer service delivery
• Provide each department with a “tool kit” that will
provide immediate access to resources for service
recovery
• Develop a log for each department to document service
recovery occurrences and to determine trends for
process improvement
University of Missouri Health Care
Our Projects
• The educational brochure attached will give staff
information to enhance their customer service skills
and includes the “I CARE” document
• This brochure will also list specific measures to take
when service recovery is needed
• It will also be used during new staff orientation to
promote appropriate customer service skills with new
staff and will reinforce our Standards of Performance
University of Missouri Health Care
Communications Team
Team Members:
Cindy Alverson Freese
Jennifer Coffman
Janice Gartman
Mary Jenkins
Scott Stever
Tina Taylor
Clay Anderson, M.D.
Rosemary Frank
Paula Heaviland
Julie McKay
Susan Straatmann
Carol Wilhite
University of Missouri Health Care
What We Do
Purpose:
To encourage and facilitate open, truthful and timely
communication using a wide variety of communication
sources
Goals:
• To ensure all University of Missouri Health Care employees
have easy and convenient access to both system-wide and
department-specific information
• To help other Service Excellence teams communicate their
initiatives, projects and progress with the entire University
of Missouri Health Care staff and, when appropriate, the
community at large
University of Missouri Health Care
Team Principles
Six principles should guide all communication
Be truthful
Be transparent
Be kind
Be an active listener
Be respectful
Be timely
University of Missouri Health Care
Our Projects
Communication Boards:
Step one: Place one public communication board in each of the
seven major facilities, including:
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University Hospital
University Physicians Medical Building
Columbia Regional Hospital
Ellis Fischel Cancer Center
Quarterdeck
School of Medicine
Missouri Rehabilitation Center
Step two: Place one department-specific communication board in
every department within University of Missouri Health Care
University of Missouri Health Care
Our Projects
Public Communication Boards will contain:
System-wide and facility-specific Communication
that falls under one of the six columns of Service
Excellence
Department Communication Boards will contain:
Department-specific information that falls under
one of the six columns of Service Excellence
University of Missouri Health Care
Future Projects
Training for Managers:
Cascade learning on how to hold staff meetings
Communication Support:
Help other teams construct communication plans for
disseminating information about their programs,
plans, progress and people
University of Missouri Health Care
Reward & Recognition Team
Team Members:
Kevin Anderson
Karen Calhoun, MD
Justin Delap
Louise Harvey
Sarah Knoerr
Jane Nelson
Catherine Price
Deneal Sullivan
Barb Brucks
Carol Clark
Deborah Harvey
Ron Hausheer
Cheryl Kyle
Kym Pieper
Wayne Richards
Ceresa Ward
University of Missouri Health Care
Our Purpose
Goal:
Impact staff, physician and patient satisfaction by:
• Reinforcing desired behaviors by rewarding & recognizing
employees
• Building a culture of ownership and responsibility with
regards to reward and recognition
Actions:
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Work with leaders to identify recognition opportunities
Evaluate and improve existing programs
Implement new programs for areas where there are gaps
Assist with other celebrations as needed
“Compensation is a right; Recognition is a gift.”
- Rosaveth Moss Kanter University of Missouri Health Care
Proposed Basic Structure
Program
How
When
Legends
extraordinary efforts or contributions above
and beyond the scope of ones job
requirements or for sustained outstanding
achievement for consistent efforts within
one's professional discipline
- Annual
- No numerical limit
- Balance of all functions
Heroes
efforts or contributions above and beyond the
scope of ones job requirements or for
sustained outstanding achievement for
consistent efforts within one's professional
discipline
- 4 Heroes of the month
- 8 other individuals or teams
recognized
- Balance of all functions
Delivering the
Difference
Leadership Thank
You Notes
Peer Thank Yous
Verbal Thank Yous
- Upon event
- Approved by managers or
designee
As needed
any positive action that is aligned with the
core values or six columns of excellence
Anytime (All the time)
Anytime (All the time)
University of Missouri Health Care
Department Based Proposal
• Budgeting for department based recognition
• Spontaneous recognition for “crunch time” effort
• Other department based activities
University of Missouri Health Care
Support Requested
Making This Work
• Consistently give verbal Thank You’s and write Thank
You Notes
• Nominate staff, peers, and leaders for Heroes/Legends
• Tell great stories at meetings and events
• Harvest the celebrations – collect stories from your
direct reports and expect them to collect from their
staff
“Never underestimate the difference you can make!”
- Quint Studer University of Missouri Health Care
Leadership Development Team
Team Members:
Kevin Anderson
Lynne Hedrick
Linda Lightfoot
LuAnn Tandy
and…
Kim Bass
Susan Heimsoth
Juni Muhota
Ceresa Ward
Your Participation is Requested
University of Missouri Health Care
Leadership Development
Goal:
For our organization to go from good to great, we
must have great leaders who
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Learn
Grow in their knowledge and role
Share information, time and recognition
Model the way
Lead the charge
University of Missouri Health Care
Leadership Development
Actions:
• Work with Executive Team to establish Leadership
Retreat outcomes
• Coordinate Leadership Retreat delivery and
implementation
• Communication – Pre and Post Leadership Retreat
• Ensure that leadership retreats are creative and fun
• Assist with development of Cascade Learning
University of Missouri Health Care
Cascade Learning
Purpose:
Communication and Training
Goal:
Consistent basic message with ability to meet departmental needs
Delivery:
1.
2.
3.
4.
Leaders first learn/hear the message
Receive a cascade learning packet
Present and discuss the message with department
Report completion to Associate Director
University of Missouri Health Care
Must Haves
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Cascade Learning
Employee Thank You Notes
Rounding for Outcomes
Discharge Phone Calls
Key Words / Key Actions
Alignment of Organizational Goals
Selection and Retention of Staff
University of Missouri Health Care
Rounding
Satisfied employees do a better job. To increase
employee satisfaction, we use a process called
“rounding for outcomes” involving senior leadership
and department managers.
Information will be used to improve the environment.
University of Missouri Health Care
Rounding
When managers make rounds with purpose,
they ask:
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Tell me what is working well today?
Are there any individuals I should be recognizing?
Are there any physicians I should be recognizing?
Is there anything we can do better?
Do you have the tools and equipment to do your job?
University of Missouri Health Care
Renters vs. Owners
A sense of ownership in the organization, builds
individual accountability. Ways to create a sense
of ownership and accountability include:
• Allowing employees to participate in peer interviews
• Asking their feedback in 30- and 90-day new
employee meetings
• Requiring them to sign a Standards of Performance
Agreement
• Encouraging employees to share their ideas for best
practices
University of Missouri Health Care
Communication
Communication is key to our success. We will
employ the following measures to achieve
improvement:
• Managing up – positioning people well
• Employee forums – quarterly, led by senior leaders
• Communication boards – department-level, key
information on progress toward the organization’s goals
• Storytelling – sharing stories about everyday acts of
heroism that take place in our facilities
We want to duplicate positive behavior.
University of Missouri Health Care
The Magic Bus
“First, you have to get the right people on the bus,
the wrong people off the bus, and the right people
in the right seats – and then you figure out where
to drive it.”
- Jim Collins - Author of “Good to Great”
University of Missouri Health Care
Summary
Our actions speak much more clearly than
our words…
“We are not in the health care business – we
are in the life enhancement business.”
- Timothy Jarm President /CEO Jewish Hospital
University of Missouri Health Care
Our Future
“A journey of a
thousand miles
begins with a
single step.”
- Confucius -
University of Missouri Health Care