Taking the LEM to Moon and Back Enhancing

Taking the LEM to Moon and Back! Enhancing goals and optimizing the 90 day plan Kelly Dickey, Accountability Coach Specialist June 2017

Lives in Pace FL 10 th year with Studer Group Celebrated 10 years with my sweetheart We have two wonderful children – Kenny (8) and Kyleigh (3) KELLY DICKEY Accountability Coach Specialist / 2

Session Objectives 1 Review the LOM measures for FY 18 2 Discuss rules of thumb for aligning measures for FY 18 CHI St. Vincent 3 Break down silos and discuss ways to partner better together 4 Maximize the use of the 90 day plan as part of the monthly meeting 3

Accountability Tools Let’s review TOOL PURPOSE Evaluation A document with an average of 5 -6 objective, measurable metrics to be achieved by the leader over 12 months. Report Card The portion of the evaluation where measurable results are updated based on the frequency of data reporting. 90 -Day Plan A document of detailed actions a leader commits to complete over 90 days to achieve annual goals. Monthly Meeting Model A structured, monthly conversation to evaluate progress towards annual goals and proactively address barriers or concerns with a direct supervisor. /

Let’s do a quick Process Review… As a table – complete the quiz. The first table to complete the quiz and make 100% will win a prize! / 5

LEM: Episode II The Journey Continues Renee Fazendine & Rachel Kahn / 6

Last year’s LEM – Does this sound familiar? s! l a o g y n ? a k m c i o p s o e t r t a a e h w w Ther o n k I o d How Who’s enteri ng thi Wher e do I s data find m ? y data ? These goals don’t apply to me! / Why did my goal get declined during the LEM audit? 7

Last year’s LEM – Does this sound familiar? s! l a o g y n ? a k m c i o p s o e t r t a a e h w w Ther o n k I o d How You’re. Wnot ho’s e n tering W alone! here d this d ata? o I fin d my d ata? These goals don’t apply to me! / Why did my goal get declined during the LEM audit? 8

LEM: Episode II The Journey Continues Improve Focus Increase Collaboration Decrease Ambiguity w LEM performance drives merit-based raises w LEM Goals may be different than the Market Living our Mission goals w LDI leaders are unlikely to carry the exact Market Living our Mission goals, but instead will carry LEM goals that support Living our Mission performance w 80% of LEM Goals will come from templates – Review of all custom goals by Conveners and CEO w As much as possible, LEM goals will align to Living our Mission. Exceptions will be allowed on a case-by-case basis / 9

LEM: Episode II The Journey Continues Improve Focus Increase Collaboration Decrease Ambiguity w No goal should be weighted above 30% w 30% = Urgency w 20% = Focus w 10% = Awareness w LEM Monthly Data Inputs: w Entity-level goals and above Measurement Team experts input the data into LEM w Department-level goals or below Dept leader inputs individual data into LEM / 10

Developing LEM Goal “Parameters” FY 18 Strategic Plan Focused Strategic Commitments per Pillar Developed by Convener LEM Goal Templates Alignment with Strategic Commitments LEM Goal “Rules of Thumb” / Scope Weights Cascade to Leadership Groups Performance Bands 11

FY 18 Living our Mission Goals & Strategic Commitments Pillar/FY 2018 Goal FY 18 Strategic Commitments Service to the Poor Coworker Engagement Recruitment and retention of coworkers Refine regular communication cadence Continued Studer/LOM Journey implementation Physician Satisfaction Refine regular physician communication cadence Implement physician leadership development Patient Experience Improve internal communication (AIDET, KWKT) Improve internal transfers including managing up Implement Nursing Leader rounding, bedside report, and discharge phone calls Continue LOM rollout across SVMG (CG-CAHPS) FY 18 Goal: 14% FY 18 Goal: TBD FY 18 Goal: 43 rd %tile FY 18 Goal: 75 th %tile / Suicide prevention in service area Outreach to Latino community CHNA Implementation Plan Support lowest paid coworkers Target improvement in equity of hospital care 12

FY 18 Living our Mission Goals & Strategic Commitments Pillar/FY 2018 Goal FY 18 Strategic Commitments Quality Lead CAUTI and CLABSI teams to improve performance Engage MDs to improve AMI and CHI outcomes Engage physician leaders in infection prevention Establish regular meetings with coding, CDI, and quality Safety Lead CAUTI and CLABSI teams to improve performance Improve PSI 90 performance using EHR platform tools Stronger process around review of HACs Identify and improve in areas of opportunity Organic Growth Work with APMI to strengthen MSO offering Implement Surgical Oncology Service line Support growth of ANI and SVI backfill Support SVHS growth efforts in OB-GYN, Gen. Surg, & Neuro Lead effort to create and promote single Access center Evaluate ambulatory and FSED presence in Saline County FY 18 Goal: 75 th %tile FY 18 Goal: 6. 9% / 13

FY 18 Living our Mission Goals & Strategic Commitments Pillar/FY 2018 Goal FY 18 Strategic Commitments Transformation Operating EBIDA Improve revenue realization by $15 million Reduce premium labor by $10 million Achieve supply chain savings of $(TBD) FY 18 Goal: 76, 731 FY 18 Goal: 10. 4% Grow AHN’s portfolio of covered lives by 10% Provide MACRA education to AHN and independent MDs Implement PHM platform to help manage cost of care Move 70 PCPs into a private ACO network Meet and exceed cost and quality metrics for value-based contracts Recruit and retain personnel to support AHN initiatives Evaluate paths to expand CHI-SV to statewide presence / 14

FY 18 LEM Goals – Rules of Thumb (EXAMPLE) Coworker Engagement Two types of goals – Organizational Engagement (PCA) and Turnover Organizational Engagement – Composite Score Only – Over 5 Employees - Required minimum 10% weight, Dept. goal – 5 or less Employees – Required minimum 5% weight, Facility goal Turnover – Only applicable to departments with 10+ employees – If turnover rate is above a set threshold (TBD) Required to carry a turnover goal Finalized FY 18 Rules of Thumb will be provided in July 15 /

FY 18 LEM Goals – Rules of Thumb (EXAMPLE) Quality Creating more focus and increasing collaboration CAUTI/CLABSI – Primary Quality goal for clinical leadership – Managers (where applicable) will carry facility-level goal – System leaders (where applicable) will carry Market goal – Majority of leaders will be measured by SIRs (no rates). Exceptions may be permitted for different outcome measures most relevant to your department which impact CAUTI/CLABSI System Quality Composite – Expected to be carried only by select leaders / Finalized FY 18 Rules of Thumb will be provided in July 16

FY 18 LEM Goals – Rules of Thumb (EXAMPLE) Growth Caring for more patients through improved throughput and volume growth Improved Throughput - Multiple goal options depending on role – Percent of Discharges Written by 11 am – Facility-level goals – Left-Without Being Seen Rate – Facility-level goals Volume Growth - Multiple goal options depending on role – Inpatient Admissions – Facility-level goals – Budgeted Volume – Primary/Specialty Care Visits, Ancillaries – IP Surgery Volume – Exceed prior year – New Consumers (Clinics Only) System Year-over-Year Revenue Growth Goal – Executive Council only / Finalized FY 18 Rules of Thumb will be provided in July 17

FY 18 LEM – Global View 200 Leaders in LEM – Approximate Distribution of FY 18 Goals Coworker Engagement Finance 200 Leaders Quality 100 Leaders Transformation Patient Experience Growth Phys Sat. 150 Leaders 100 Leaders 5 -10 Leaders / Safety 50 Leaders 5 -10 Leaders Service to Poor & Vulnerable 18

Pillar Goal Decision Matrix “Do you have direct control or influence over the organizatio nal goal? ” / * Repeat this process for each Pillar goal on the organizational scorecard If “Yes”: Assume the goal or sculpt a goal that reflects the portion of the goal you have influence over If “Yes”: Sculpt a goal that reflects the area of influence. If “No”: Ask, “Do you have indirect control or influence over the organizatio nal goal? ” If “No”: Ask, “Do you have any other departmental goal that is important to track that represents an important part of the work of your unit? “ If “Yes”: Sculpt a goal that reflects this work If “No”: It may be appropriate not to a have a goal under that pillar

Cascading/Aligning to Improve ED Flow • ED Leader: Admit Decision Time to ED Departure for Admitted Patients - 20% • Med. Surg Leader: Admit Decision Time to ED Departure for Admitted Patients - 12% • EVS Leader: Admit Decision Time to ED Departure for Admitted Patients - 10% /

Cascading a goal to decrease LOS Sample: • Case Management / Discharge Planning / Social Work. Increase % of patients discharged day the order is written • Ancillary Department Leaders-Increase the number of inpatient procedures completed the day the order is written • Inpatient Nurse Managers-X% of patients discharged by (fill in appropriate time) • Medical Staff Leaders-Increase the % of discharge orders written by (fill in appropriate time) • House Supervisors-Increase % of ED admissions to inpatient bed within XXX hours • EVS-Improve bed turnaround time after 3 pm /

HCAHPS Sample Cascade Nurse Comm Doctor Comm Responsi veness Pain Mgmt Comm of Meds Disch Info Hospital Env Overall Rating Senior Leadership X Nursing Leadership X EVS Laboratory X Hospitalists X X X X X Food & Nutrition X Radiology X Discharge Planning X Pharmacy X X Information Tech Support Services Survey Human Resources Support Services Survey / Care Transition X X X

OASCAHPS Sample Cascade Before your procedure Senior Leadership About the facility and staff Communication about your procedure Your recovery X X EVS Leadership X Anesthesia Leadership X Central Services / Supply Chain X Nursing Leadership X Physician Leadership X X X X Pharmacy Leadership Perioperative Services Leadership Overall Experience X X Patient Access Leadership X X X Business Office Leadership X X X Surgery Clinic Manager X /

CGCAHPS Sample Cascade Provider Access to Care Communication Senior Leadership (CEO, CMO, Medical Directors, etc. ) Practice Leadership (Director of Operations, Office Managers, Service Line Leaders, etc. ) Patient Experience and Service Excellence Patient Access/scheduling Leadership X Test Results Office Staff X Overall Provider Rating X X X X Provider X Nursing Leadership X X Environmental Service Leadership X Building Maintenance Leadership X Diagnostics / Testing Leadership (Imaging, Lab, Respiratory, etc. ) / X

Getting to the moon On each table, please find your worksheet and the LOM measure assigned to your table. This is your ticket to the moon. In order to get to the moon – all leaders must have a goal that aligns to the LOM measure and all goals must be outcomes. If a goal is deemed not appropriate or aligned to the leader, specify why. / 25

Accountability tools Let’s review TOOL PURPOSE Evaluation A document with an average of 5 -6 objective, measurable metrics to be achieved by the leader over 12 months. Report Card The portion of the evaluation where measurable results are updated based on the frequency of data reporting. 90 -Day Plan A document of detailed actions a leader commits to complete over 90 days to achieve annual goals. Monthly Meeting Model A structured, monthly conversation to evaluate progress towards annual goals and proactively address barriers or concerns with a direct supervisor. /

Steps to creating a 90 -day plan Annual Goal Identifies the overall improvement metric you are expected to achieve over the next 12 months. 90 Day Goal Identifies the portion of the annual improvement metric you are expected to achieve in each quarter. Action Steps Identifies what behaviors, processes or tasks you will complete to help you achieve your goal. Communication Level Identifies what you and your direct supervisor have agreed upon regarding your autonomy to move forward with these actions. 1. Full speed ahead: you do not need prior approval for this action 2. Full speed ahead, but keep your supervisor informed before you move forward with this action 3. Do Not move forward without prior approval on this action Results Identifies what portion of your action items you have completed and the impact you are seeing as a result of your actions. (Updated monthly) Status Identifies if your committed action items are Completed, On-target to be completed by deadline, or Behind schedule. / 27

Identify Specific Action Steps • Focus on 2– 3 priority actions that will drive multiple outcomes (practices that get results) • Clearly define actions you are committing to in each step • Don’t set yourself up to fail; set a realistic date to accomplish each step • Define when within the quarter would you will accomplish a task. Tip: Engage your staff and other stakeholders in the 90 -day goal when creating action items /

Moving results If the action item cannot move results; remove it! Verbs that do not indicate action: • • Review Continue / ongoing Start Attend / Verbs indicating actions that move results: • • • Validate Train Observe Recognize Coach Diagnose 29

Strong or Weak Action Items? / 30

Co-Worker Engagement Action Plans: 90 day goal: Increase Co-worker Engagement from X to Y… Action Steps: • Round on co-workers (< 30 = monthly, 31 -60 = e/o month, > 61 quarterly) • Communicate with co-workers actions from rounding by posting stoplight reports on communication boards and reviewing progress during huddles. • Send 4 thank you notes per month to co-workers who demonstrate standards of performance. • Increase attendance at department meetings by offering multiple opportunities for night and weekend shifts to attend. / 31

Expense Budget Action Plans: 90 day goal: Maintain budget to 100% or better… Action Steps: • Review staffing matrix to ensure peak hours are staffed • In the department meeting on 4/1 conduct an exercise with co-workers to harvest ideas from them on how we can reduce cost in the department / 32

Patient Experience Action Plans: 90 day goal: Increase Patients Perception of Care from X to Y… Action Steps: • Round on 100% of patients prior to discharge (nonclinical) or Round on 100% of patients daily (IP RN Manager) • 100% of co-workers trained on hourly rounding • 100% of co-workers trained on AIDET • Observe and validate 100% of co-workers using AIDET in encounters with internal or external customers (patients or co-workers). / 33

GOOD Improve “Courtesy and Respect” question from 55% top box to 60% top box. Improve Nurse Communication Composite to 75%ile ACTION RESULT 50% as of 12/5/15 Round on 100% of patients daily Complete Focus on courtesy and respect in daily shift huddles Ongoing Conduct AIDET® training for nurses and techs TBD Give staff feedback after nurse leader rounds Ongoing / 34

BETTER Improve “Courtesy and Respect” question from 55% top box to 60% top box. Improve Nurse Communication Composite to 75%ile ACTION RESULT 56% as of 12/5/16 NLR includes questions to patients “Have the Trend identified: nurses do not regularly ask staff introduced themselves to you and explained patients about their personal goals, wishes and their role and purpose of their interactions? Have requests—this is interpreted as courtesy. they respected your wishes and requests? Is everyone from our staff being helpful? ” Review Standards of behavior with staff and identify specific standards that have impact on patients perspective of courtesy and respect Validate all staff on AIDET® competency / Completed. All staff are familiar with SOB’s that impact courtesy and respect. Ongoing 35

BEST Improve “Courtesy and Respect” question from 55% top box to 60% top box. Improve Nurse Communication Composite to 75%ile ACTION RESULT 59% top box as of 12/5/16 Educate all staff on wording of questions for this areas of focus; prepare specific key words such as “You deserve our courtesy and respect. You are in good hands ” Review Standards of behavior with staff and identify specific standards that have impact on patients perspective of courtesy and respect Held departmental meeting 11/15/16. Added key words to Hourly Rounding® validation form to add competency during rounding. During each morning huddle, team members share reward and recognition for those who demonstrate this courtesy and respect. NLR includes questions to patients “Have the staff introduced themselves to you and explained their role and purpose of their interactions? Have they respected your wishes and requests? Is everyone from our staff being helpful? ” Incorporated into NLR 11/1/16 Trend identified: nurses do not regularly ask patients about their personal goals, wishes and requests—this is how patients define “Courtesy. ” Monitor use of AIDET® with specific focus on Validated 50% of day-shift nurses on AIDET®. acknowledging the patient by name and Introduction with Opportunities exist to manage-up self and use key the required manage up. words around courtesy and respect. / 36

OH NO – Now we are stuck… Your mission, should you choose to accept it. Using the blank 90 day plan worksheet, develop an action plan that will help you and your colleagues get back to earth before your 90 day supply of food is gone! / 37

Deliverable Grid Expectations from today’s learning: Review your goals for FY 17 with your 1 -up leader and identify ways you can further refine your goals for FY 18. Review the rules of thumb and populate your FY 18 goals in LEM by June 30, 2017. Develop your 1 Q action plan in LEM. Review this plan during your June or July Monthly Meeting. Mark your 90 day plan approved by July 31, 2017. / 38

Thank you! • Kelly Dickey: Kelly. dickey@studergroup. com • 850 -898 -3862 CHI St. Vincent