UTMC Vision 2015Cannot achieve one without the other
January – December2010 Performance:U.S. Department ofHealth & HumanServices HospitalProfile**http://www.hospitalcompare.hhs.gov/
Narrowing The Gap Clinical Outcomes VS. Patient Experience
HCAHPS “Rate Hospital 0-10” 2011 Data by Month100908070 65 62 6260 55 55 50 48 4850 4440302010 0 April May June July August September October November December n = 36 n = 48 n = 69 n = 62 n = 60 n = 58 n = 84 n = 60 n = 58 Rate hospital 0-10 Linear (Rate hospital 0-10)
The only effective differentiatoris the patient experience we provide. James Merlino, MD Chief Experience Officer The Cleveland Clinic Health System
Case 4 ChangeEnter the era of payment tied to reported Quality outcomes
Government’s interest:Core Measures Satisfaction OutcomesAcute MI Inpatient Death (HCAHPS) Re-admissionHeart Failure OutpatientPneumonia Safety (CGCAHPS)SCIP Pediatrics Line Infection PneumothoraxAsthma (kids) Psychiatry Surgery Site Home Health Emergency
Pay for Performance Proposed charge back modelValue Based Purchasing 1.00 % 2013 1.25 % 2014 1.50 % 2015 1.75 % 2016 2.00 % 2017
FY2013 MeasuresWeighted Distribution of IncentivePayments Process Measures HCAHPS 70% 30% ($850 million)
Pay for Performance Performance Assessment Model Attainment of benchmarks Improvement in performance Benchmark set at highest 10% of hospitals Reimbursement determined on score 850 million $
Value Based Purchasing: FY20142nd Year of VBP Reporting: April – December 2012: Performance period Measures: - 13 Core Measures - 8 HCAHPS - 3 Mortality - 8 Hospital Acquired Conditions New Measures For FY 2014 - 2 Composite PSI - 1 Efficiency (spend per beneficiary) $$ impact 2014
CMS Direction….“Measurement requirements and performance expectations will be modified over time to reflect the application of evolving technologies and care practices as they impact the quality and safety of care.” Achieving a high performance on set measures not enough – Sustain Culture
Who’s watching ? Accreditation organizations Consumers Administration (your boss / partners) Payers Private organizations Businesses Government (CMS / States) Everybody is watching!
Key StakeholdersEmployees The ideal state in which employees feel that the organization is providing what they need and also feel connected to their work and the organization emotionally
Key StakeholdersEmployees They feel the organization is meeting their needs for the basics such as job security but they’re not emotionally involved.
Key StakeholdersEmployees Emotionally involved, but not satisfied that their basic needs are being met. They may feel their pay is too low or their input is not sought on matters that affect their work.
Key StakeholdersEmployees These employees feel both dissatisfied and disengaged and typically will either exit the organization voluntarily or worse – stay and create turmoil for everyone else.
Key StakeholdersEmployees In world-class organizations, the ratio of engaged to actively disengaged employees is 9.57:1. In average organizations, the ratio of engaged to actively disengaged employees is 1.83:1. (Gallup)
Key StakeholdersEmployees World-class organizations with an engagement ratio near 8:1 have built sustainable top performing work environments. As organizations move toward this benchmark, they greatly reduce the negative impact of actively disengaged employees while unleashing the organizations potential for rapid growth.
Key StakeholdersEmployees Re-recruit the Dedicated employees Engage the Detached and Discontented employees Allow the Distanced employees to pursue other opportunities
Key StakeholdersPhysicians Patients global ratings of their health care are not tied to the technical quality of their care, but rather, to the quality of provider communication (Annals of Internal Medicine, 2006)
Key StakeholdersPhysicians 61% of the variability in patient satisfaction is tied to physician behaviors. 39% is linked to nursing behaviors. (Journal of Surgical Education, 2008)
Key StakeholdersPhysicians Actively recruit Champions Immediately address top physician concerns Answer the WIIFM question Use trials or pilot projects
Key StakeholdersPhysicians It is imperative that healthcare systems recognize the importance of collaborating with their medical staffs to create an aligned platform that promotes patient care quality and safety as well as drives patient perception of care, and executes an effective reimbursement and growth strategy that is mutually beneficial.
2011 State of the CultureVenues Staff feedback across the organization UTMC Management Team Specialty & Primary Care Clinics Management UTMC Executive Committee Members UTMC Chief Resident Forum UTMC Senior Staff Team Service Excellence Steering Body
Align on PerformanceExcellence Poor performance not efficiently addressed byLeaders strongly aware of leadership. Consistentpatient satisfaction rankings; implementation of actionkey metrics identified; area plans still a challengespecific goals set forward Need for allBehavioral Standards employees, physicians &communicated effectively volunteers to adhere to Behavioral Standards on a daily basis
Select and Retain an Engaged WorkforceSome staff engagement activitiesexist (surveys, town halls, employeeforums) No comprehensive organization-wide strategyEffective recognition program into aimed at engaging theplace: Shining Star & U Rock! employee population at large.Weekly Senior Leadership Physician engagementRounding strategy TBDFirst organization wide employeeengagement survey completed Dec.2, 2011
Develop and Maintain aService Oriented Culture Consistency lacks withPatient experience is tracked respect to taking action inappropriately and order to improve each areas’consistently communicated patient experiencethroughout the house. Universal Scripts not usedUniversal Scripting deployed throughout the houseacross the organization No patient hourly roundingSome hourly patient rounding leadership accountability.with a purpose Expected, however its large impact on the overall pt. exp. rankings not demonstrated
Develop and Maintain aService Oriented CultureMany departments practicesome form of pre-service/ No Universal Standard fordischarge phone calls to conducting such callscustomers Lack of consistency inCommunication boards are in utilizing such boardsplace in many departments Lack of Universal Tool forService Excellence tracking service recoveryDepartment assists with opportunitieshandling of most servicefailures.
Commit to LeadershipDevelopment Lessons learned duringSome departmental training leadership training areopportunities (retreats, etc) consistently not shared withare in place for senior leaders fellow employees(managers, directors andabove) Staff doesn’t not feel mentored by leadersiCARE University Need to establish accountability for cascade learning lacking
Commit to LeadershipDevelopmentDaily/weekly organization Daily/weekly communicationcommunication needs are not fully aligned with UTMC’scovered in part (OLT, Daily Strategic Plan and do notHuddle, Weekly Line-Up, UT consistently reinforce theNews) Behavioral StandardsBest practices are shared No formal procedure forbetween areas and leaders in sharing best practicesan informal way
Hardwire Accountability Inconsistency of report cardsSome departments and and area specificleaders utilize monthly report improvement action planscards to track performanceand goals Staff evaluations do not have Patient Experience and Behavioral Standards goals incorporated into it
The Strategy: Raising the Bar! Set specific organization goals Partner with the UTMC Champions across all levels Empower Service Excellence Action Teams (leader shaped, employee driven) Engage Physician & Employee populations at large Specific tactics & strategies developed by the SE Teams, Clinical Chairs, CNO, CMO, HRTD Department, Clinics Ops Senior Leader, SVP/Executive Director Effectively evolve & utilize UTMC’s New iCARE University
SE Strategic Plan & Structure (Action Teams & Steering Committee) Press Ganey Partnership Physician Specific Assessment (Admitting, Attending, Discharge) Yearly Physician Engagement Survey Yearly Employee Engagement Survey Physician & iCARE University Leadership Retreat Q4 Patient Training and Accountability Scripting (Universal Scripts) Campaign Universal Service Recovery Program (in-the-works) Physician Communication Protocol Revised Complaint Daily Huddles Management Process Work force Recruitment & Engagement Talent Plus H, M, L Project Area specific SE Road Maps inclusive of specific goals & timeline Hourly Comfort Rounding with a purpose HCAHPS & VBP Awareness Campaign Weekly Patient Experience Line-Up Selected Front line staff to attend as wellJanuary 19, 2011
HCAHPS Current hospitalcompare.hhs.gov Jan - Dec 2010 vs. Cumulative Jan - Dec 2011 scores Rate hospital 0-10 100 DISCHARGE INFORMATION Recommend the hospital 80 60 40COMM ABOUT MEDICINES COMM W/ NURSES 20 0PAIN MANAGEMENT RESPONSE OF HOSP STAFF Quietness of hospital COMM W/ DOCTORS environment 2011 Cleanliness of hospital environment 2010 (Hospital Compare)
All UTMC Service Lines Large Press Ganey Database 2011 “Standard Overall” Performance 100Mean Percentage 95 92.4, 91, 91.4, 91.2, n = 91 89.9, n = 99 n = 82 89.5, 90.1, 89.7, n = 70 90.6, n = 65 n = 100 n = 113 n = 94 88.8, n = 100 90 85.9, n = 106 n = 16 84.9, 83.5, 83.3, 83, n = 121 83, 85 82, 81.3, n = 126 n = 103 n = 86 n = 100 n = 36 82.4, n = 83 79.9, 80.8, n = 83 n = 135 n = 87 78.6, n = 122 80 83, 80.4, 79.9, 82.1, 80.2, 79.7, 78.7, n = 164 n = 199 n = 163 n = 186 79.4, 80.7, 80.3, 79.9, n = 155 n = 79 n = 145 n = 198 n = 221 n = 180 n = 170 75 February March April May June July August September October November December Inpatient Ambulatory Surgery Emergency Department
2012 Service Excellence Goals Reach 50th Percentile Nationwide by December 31, 2012
…beyond the low hanging fruits 2012 Key Tactics Define and Deploy UTMC Physician/Resident/Nurse/Staff Integrated Care Delivery Model Daily Operational Protocol Reposition UTMC Nursing Care Delivery System Systematic elimination of TOP historical challenges Clinical hourly rounding/responsiveness (HCHAPS) Care coordination across all supporting disciplines Choreograph and Launch “The UTMC Experience Campaign”. Hardwiring Excellence SMaC Recipe for success = Cultural Transformation All Inclusive: all staff, physician, resident indoctrination
Sustaining the WallsEngaging the Master Builders
Patient/Customer Engagement Action Team Establish and maintain UTMC’s position as “provider of choice”
Patient/Customer Engagement Action Team Pre-service/discharge phone call process (Inpatient, Clinics) Universal Service Recovery Program Service Line Mystery Shopping
Physician Engagement Action Team Establish and maintain UTMC’s position as the “partner of choice” for physician practice
Physician Engagement Action Team Physician Engagement Strategy Physician Performance Scorecard Physician Communication Protocol
Employee Pride & Engagement Action Team Establish and maintain UTMC’s position as “employer of choice”
Employee Pride & Engagement Action Team Employee Engagement Strategy (in partnership with HRTD) Behaviorally based peer interviewing Idea generation platform
Employee Pride & Engagement Action Team Repositions new employee orientation program (in partnership with HRTD) Recognize employees’ achievements through facility-wide celebrations Repositions yearly performance evaluation process (in partnership with HRTD)
Measurement Action Team Analyze and communicate patient experience and internal customers results to guide service & operational excellence strategies
Measurement Action Team Weekly Line Ups Engagement Monthly Site & Departmental scorecard performance (in partnership with Pt. & Cust.) Quarterly Patient Experience Site Reviews Physician Performance Score Card (in partnership with Physician Engagement)
Culture & Communication Action Team Facilitate understanding and enculturation of UT’s Mission, Vision, Values and Behavioral Standards through grounded and balanced communication
Culture & Communication Action Team Raise awareness to…New Culture of Service in concert with UTMC’s “Patient Centeredness” concept Hardwire Behavioral Standards Hardwire Daily Huddles Practice
Culture & Communication Action Team Effectively communicate all ongoing Service Excellence Action Teams Initiatives
AS Service Excellence Action Team Effectively differentiate UTMC’s Ambulatory Surgery as the area’s “provider of choice”
AS Service Excellence Team AS Pre-Calls & Pre-Calls “Plus” AS Discharge Calls Develops and deploys specific Service & Operational AS training modules to AS staff/physician population at large (in partnership with ICARE University staff)
ED Service Excellence Action Team Deliver a memorable patient experience within the Emergency Department
ED Service Excellence Action Team Innovate, deploy & hardwire process aimed at significantly reducing wait times: 0 wait Publicly display wait time on the world wide web (www), partnership with Div. of External Affairs Establish continuous patient rounding Establish clear Service Excellence expectations & accountability systems for all staff impacting daily operations (in conjunction with Service Excellence leadership) Establish & implement customer discharge follow up calls
Service Excellence Steering BodyService Excellence Executive Sponsor
What is Fish Camp?Fish Camp welcomes the Freshman class to Texas A&M each year with the purpose of giving them anopportunity to learn about life at Texas A&M and finding their place in the Aggie Family.What do you do at Fish Camp?Freshmen are split into large "camp" groups of approximately 120 students and 24 upperclassmencounselors. Your camp will share a special bond as you spend time getting to know oneanother, attending programs that highlight the opportunities and services available on campus andparticipating in Aggie Traditions such as Yell Practice, Aggie Muster, and Silver Taps.Why should I go to Fish Camp?Well let the class of 2012 tell you...I LOVED Fish Camp! It was probably the best way to come into the Aggie family. I really felt as if I wasmeant to be here.Most amazing experiences of my entire life. The perfect way to begin my new life at Texas A&M.The Aggie Spirit was able to take hold of me and allow me to become one with the student body and thetraditions of Aggieland.
The goal is to develop programming that is Transformationallike industry leaders (Disney, The Ritz-Carlton, Mid-Columbia Medical Center, and Texas A&M University).
Servant Leaders Leading Change When top performing organizations (>85th percentile) were asked what they could have handled better, they said…Accountability
Improved OutcomesWhy the 50th Percentile? It’s our core mission and vision There are payer financial incentives for Value We need to become a high performing organization in service to survive & grow It’s the right thing to do
…Outcomes Memorable patient experience: reflected by comments and scores Culture of Excellence Place of choice For customers to receive medical treatment For staff to work For physicians to practice Improved market positioning Increased market share Financial growth
Lead the Way!Leadership Imperatives Model UTMC iCARE….Hold each Behavioral Other Accountable Standards for Engagement Service Excellence Lead colleagues and Champions & Action staff toward the Teams vision, not away from it
It begins at the TopAnd it begins at the Bottom Model the Behavioral Standards Demonstrate teamwork at all leadership levels Support and work the Service Excellence Action Team Model Best practice oriented, leader shaped, employee driven Use Service Excellence Steering Body and Executive Sponsor for barrier removal Hold Self & direct reports Accountable 90-day plan alignment discussions at regular intervals Patient/Customer, Employee and Physician Engagement Balance
It will not be WE will deal an easy journey… the with DIFFICULT …but with much EFFORT… and a lot of TEAMWORK …WE can OVERCOME the impossible…and ACHIEVE our goal… excellence.