Hardwiring Leader Evaluations Flagler Hospital Bill Bielenda What

Hardwiring Leader Evaluations Flagler Hospital 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 Prescriptive To Do’s (Transparency and Accountability) Purpose, worthwhile work and making a difference Self. Motivation ®

Rev 4. 8. 11 Execution Framework Evidence-Based Leadership. SM rough h t k a Bre Foundation STUDER GROUP®: Objective Evaluation System Leader Development Aligned Goals Implement an organization-wide staff/leadership evaluation system to hardwire objective accountability (Must Haves®) Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results Must Haves® Performance Gap Aligned Behavior Agreed upon tactics and behaviors to achieve goals Standardization Accelerators Aligned Process Re-recruit high Processes that and middle/solid are consistent performers and standardized Process Move low Improvement performers up or out PDCA Lean Six Sigma Baldrige Framework Software

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 / Provider of Choice Employer of (patient Choice (employee Issue Improve Financial Performance satisfaction) Achieve financial margins of: – 4. 0% in FY ’ 06 – YTD 4. 6% more detail> – 5. 0% in FY ‘ 07 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 Reduce overall turnover of: – “permanent” positions to 11% – 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 = 62 nd Current = 51 st Increase Patient Satisfaction (Ambulatory) Goal = 62 nd Current = 65 th People Reduce Annualized Turnover Goal = 14. 5% Current = 16. 7% Increase Employee Satisfaction Quality Decrease Mortality Index Goal =. 77 Current =. 77 Finance Operating Margin Goal = 5% Current = 5. 6% Reduce FTE per Adjusted Discharge Goal = 1. 15 Current = 1. 15 Growth Increase Inpatient Admissions Goal = 2. 7% Current = 7. 6% Increase Outpatient Visits 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 Metric Hospital Acquired Infections 156 Incremental Costs $1. 93 million Bed Days Avoided Percent of HAI Over Admissions Reduction 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 DEPARTMENT GOALS

How Organizational Balance is Defined Finance Innovation Community Service Quality 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 Each leader determines their goals and preliminary weights Goals are reviewed by each leader’s reporting senior Goals are shared within leadership team to insure everyone's needs are addressed Goals are audited for continuity Leaders finalize their goals 3. 4. 5. 6. 7.

Goal Development

Goal Development Tips Develop quantifiable goals.

Goal Scales 5 = Stretch 4 = Partial Stretch 3 = Goal 2 = Partial Accomplishment 1 = No Accomplishment

Example Goal with Rating Scale Goal Rating Scale Increase the number of visits to 200 5 is ≥ 250 4 is 225 to 249 3 is 200 to 224 2 is 150 to 199 1 is ≤ 149

LEM Score Distribution 3 3 1 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 quantifiable 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 4 th 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 Management Common Goals (Examples) Budget Patient Perception of Care Interdepartmental Satisfaction Employee Engagement Core Measures Patient Fall Rate

Tools of Accountability Leader Performance Evaluation Leader Report Card 90 Day 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