Hardwiring
Leader Evaluations
Bill Bielenda
What you will learn today…
Importance of leader accountability
and goal alignment
How to develop effective goals
The basics on accountability tools
Healthcare Flywheel®
Bottom Line Results
(Transparency and
Accountability)
Prescriptive
To Do’s
Purpose,
worthwhile work
and making
a difference
SelfMotivation
®
Evidence-Based LeadershipSM (EBL)
Objective
Evaluation
System
Leader
Development
Aligned Goals
Implement
objective
accountability
system
Better align
training to
outcomes
Must
HavesSM
Performance
Gap
Aligned Behavior
Sequence
tools and
techniques
Retain High
Performers,
Coach Mid
Performers,
Help deal
with low
performers
Standardization Accelerators
Aligned Process
Hardwire
consistency
Healthcare is trying to build
world class performance on
prehistoric evaluation
systems.
Quint Studer
Leader Evaluation:
Comparison of those organizations that have the leader
evaluation process hardwired and those that do not
Source: Studer Group® October 2008 Measurement Spreadsheet; Organizations that hardwire the leader evaluation
process in their organization, show patient perception of care ratings that are significantly higher than those that do not.
Patient perception of care mean score average includes all partner selected vendors including Arbor, Avatar, Gallup,
HCAHPS, Healthstream, Jackson, NRC, PRC Picker, Press Ganey, RPM, and Statisquest.
Year 1 – Goals
Reduce Costs /
Issue Improve Financial
Performance
Achieve financial
margins of:
– 4.0% in FY ’06
– YTD 4.6%
more detail>
–5.0% in FY ‘07
Provider of
Choice (patient
satisfaction)
Achieve
organization-wide
average patient
satisfaction scores
of:
– 93.7 for “Overall
quality of
care/services”
– YTD 93.5
– 76.1 for “Would
Goals
you recommend”
– YTD 73.5
Employer of
Choice (employee
satisfaction)
Reduce overall
turnover of:
– “permanent”
positions to11%
– YTD 14%
more detail>
– “permanent” core
RN positions to 13%
– YTD 16%
Improve Care
(Quality, Safety,
Effectiveness)
Achieve 90%
compliance with CMS
measures:
Community Acquired
Pneumonia
3>90% - 5<90%
Surgical Infection
Prevention
1
>90% - 2<90%
Heart Failure
2>90% - 2<90%
Acute Myocardial
Infarction
5>90% - 2<90%
Achieve 90% compliance
with evidence-based
practice for prophylaxis of
the following: DVT/PE,
Post-op UTI, Post-op
Pneumonia, Post-op AMI,
Pressure Sores, Post-op
Sepsis
Information
Management
– Implement
Employee
Satisfaction
Assessment process
during 2005
– Create projected
timeline for the
implementation of
the Advanced Point
of Care (APOC)
clinical system
Leader Evaluation Results – Year 1
Year 2 – Goals
Excellence
Service
Increase Patient
Satisfaction
(Inpatient)
Goal = 62nd
Current = 51st
People
Reduce
Annualized
Turnover
Goal = 14.5%
Quality
Decrease
Mortality
Index
Goal = .77
Current = .77
Finance
Operating
Margin
Goal = 5%
Increase
Inpatient
Admissions
Current = 5.6%
Goal = 2.7%
Current = 7.6%
Current = 16.7%
Increase Patient
Satisfaction
(Ambulatory)
Increase
Employee
Satisfaction
Growth
Reduce FTE
per Adjusted
Discharge
Increase
Outpatient
Visits
Goal = 1.15
Goal = 62nd
Current = 65th
Current = 1.15
Goal = 5%
Current = 8.0%
Leader Evaluation Results – Year 2
Note: Percentages noted account for 93% of the leaders who have entered data as of
6.7.07.
Financial Impact:
Hospital Acquired Infections
Percent of HAI Over Admissions
Metric
Reduction
Hospital Acquired
Infections
156
Incremental Costs
$1.93 million
Bed Days Avoided
Tactic and Tool Implemented:
Objective Evaluation System
Source: Arizona Hospital, Total beds = 355, Employees = 4,000, Admissions = 10, 188
HFMA article, “When Hospital Infections Go Down, Pay Raises and Bonuses Go Up at UMC”, July 2009
984
Why Have Leader Evaluations Based on
Objective Goals?
Clearly connects the goals of the organization to
individual leader
Provides prioritization roadmap for leader
Reduces unnecessary work and duplication of efforts
because clear expectations are set
Keeps leaders focused on what is really important
Allows senior leader to continuously monitor leader
performance
Provides for organizational agility
Competencies do not guarantee desired outcomes
Goal Alignment & Balance
What is goal alignment?
Insuring that
individual leader
activities are
consistent with
the goals of the
organization.
Vertical Alignment
ORGANIZATION
GOALS
DIVISION
GOALS
DEPARTMENT
GOALS
LEADER / UNIT
GOALS
Horizontal Alignment
ORGANIZATION
GOALS
DIVISION
GOALS
DEPT X
GOALS
DEPARTMENT
GOALS
DEPT Y
GOALS
How Organizational Balance is Defined
Research
Education
Growth
Finance
Quality
Service
People
MISSION
Integrating
and
connecting
the vision,
value and
goals of the
organization
into daily
decisions,
behaviors and
actions
Goal Development Process
1.
Senior leaders set organizational goals
2.
Organizational goals are shared with all leaders
3.
Each leader determines their goals and
preliminary weights
4.
Goals are reviewed by each leader’s reporting
senior
5.
Goals are shared within leadership team to
insure everyone's needs are addressed
6.
Goals are audited for continuity
7.
Leaders finalize their goals
Goal Development
Goal Development Tips
Develop quantitative goals.
Goal Scales
5 = Stretch
4 = Partial Stretch
3 = Goal
2 = Partial Accomplishment
1 = No Accomplishment
Example Goal with Rating Scale
Growth
Rating Scale
Increase the
number of
procedures to
200.
5 is ≥ 250
4 is 225 to 249
3 is 200 to 224
2 is 175 to 199
1 is ≤ 174
LEM Score Distribution
3
3
1
2
3
4
2
3
4
Opportunity
Target
5
Excellent
Example LEM Results
147
Average Score = 3.07
72
39
17
0
1
1
2
2
3
3
4
4
5
5
Goal Development Tips
Develop quantitative goals.
Use language that everyone
understands.
Connect goals to purpose.
Fewer, rather than more goals, are better.
Goal Development Tips – Cont.
It is not always practical to have a goal
under each pillar.
Goals should be aggressive yet realistic.
Focus on results, not tactics or projects.
Goal or Tactic?
Conduct employee evals on time
Improve staff productivity
Round on 100% of inpatients
Attend all leadership development
sessions
Pass OSHA inspection
Define how much time goal must be
sustained
For fiscal year-to-date (FYTD)
For the month of December
For the 4th quarter
For last 6 months of the year
SMART Goals are
Specific
Measurable
Attainable
Realistic
Time-bound
What might not fit as goals:
Standards of performance
Subjective and vague statements
Tactics to achieve goals
Maintaining regulatory compliance
Routine job activities
Middle Manager Common Goals
Examples:
•Budget
•Patient satisfaction
•Employee satisfaction
•Patient Falls
Example Goals
Laboratory - Example
Pillar
Weight
Laboratory Goal
Service
25%
Achieve a percentile rank of 99 for test and treatments for the
fiscal year.
People
20%
Reduce turnover to 15% annualized for entire fourth quarter.
Finance
20%
Meet expense budget of $2.10 per test for fiscal year.
Quality
10%
Reduce repeat test below 2% for last 6 months of fiscal year.
Growth
25%
Increase lab outreach tests by 5% for fiscal year.
Patient Care Unit - Example
Pillar
Weight
Med/Surg Unit Goal
Service
30%
Achieve a percentile rank of 99 for nursing care for the fiscal
year.
People
30%
Reduce turnover to 25% annualized for fiscal year.
Finance
25%
Meet productivity target of 6.5 hours per patient day for fiscal
year.
Quality
15%
Decubiti rate of 0% achieved by last 6 months of fiscal year.
Growth
0%
N/A
Medical Records - Example
Pillar
Weight
Medical Records Goal
Service
20%
Achieve an average 4.8 on support services evaluation for fiscal
year.
People
20%
Maintain turnover level at or below 5% annualized for fiscal year.
Finance
30%
Achieve A/R days of 65 by year-end.
Quality
20%
Reduce inpatient denials by 20% for fourth quarter.
Growth
10%
In-house transcription revenue to increase 10% for fiscal year.
Tools of Accountability
Leader Performance Evaluation
Leader Report Card
90 Day Work Plan
No Surprises
MONTHLY
QUARTERLY
YEAR END
Thank You!
For valuable tips on creating a culture of
organizational excellence, visit our web site at
www.studergroup.com
Bill Bielenda
850-934-1099