Presentation given at the American Medical Group Association (AMGA) national meeting in New Orleans in March 2010.

1. Patient Satisfaction Dashboards: Transitioning Accountability

2. Speaker Info 2 Glen Halverson, MBA, MS, CHE Chief Operating Officer Sutter Gould Medical Foundation 600 Coffee Road Modesto, CA 95355 (209) 521-6097 x4286 HalverG@sutterhealth.org Richard Buchler, MHA Senior Analyst Sutter Gould Medical Foundation 600 Coffee Road Modesto, CA 95355 (209) 329-5771 BuchlerR@sutterhealth.org I, Glen Halverson, have no actual or potential conflict of interest in relation to this presentation. I, Richard Buchler, have no actual or potential conflict of interest in relation to this presentation. Our presentation will not include discussions of off-label, experimental or investigational use of drugs or devices.

3. First Steps Patient Satisfaction Dashboards:Transitioning Accountability Dashboards Action Plans Next Steps

4. Sutter Gould Medical Foundation: Quick History Founded in 1948 by Maino Brothers Mayo Clinic Trained Became Sutter Affiliate in 1993 Today 260 providers, 22 Clinics, 27 specialties in Stanislaus and San Joaquin Counties, 1200 Employees

5. California Foundation Structure Foundation not for profit Medical Group for profit separate corporation Exclusive PSA agreement Productivity driven system Late 90’s eighty five percent managed care

6. SGMF in 2006 Managed Care minority share of business SGMF most productive Sutter Affiliate Worst Patient Satisfaction Score: 26th percentile COO position open for over one year

7. Early Observations Regional VP comments Doctors comments Management Culture Staff Culture Strategy First Six Months Pt. Sat. Survey twice a year

8. Management Retreat “Firing Up Commitment During Organizational Change” Justify the Struggle Address the WIFM Need you people Fill People’s longing for belonging Feed the need to achieve Assign Generous Responsibility for Results Out run the resisters Make membership hard to come by Be Intolerant of Weak Commitment Reciprocity principle

9. Preparing to Launch Learn Studor Principles, Elements and Tools 5 work Groups (build commitment through involvement) Measures and Accountability Employee Recognition and Activities Communication and Marketing Leadership Development and Org. Alignment Customer Service Training

10. Prep continued Build momentum towards kick off date Launch Monthly Newsletter SMF Site Visit Monthly Leadership Team updates Oversight Team

11. Key Philosophies “It’s Your Ship” mentality Kick off: Create a burning platform Contests Start Simple: ten foot rule Teaching in small chunks with monthly deliverables

12. Key Quote Management doesn’t change culture. Management invites the workforce to change the culture. Louis Gerstner Who Says Elephants Can’t Dance

13. First Year and a HalfA baseball analogy Homeruns Base Hits Foul Balls Errors

14. Key Initiatives Stars Program Employee Activities Work Group Rounding “HEAL” DVD Thank You Cards High Middle Low performance reviews

15. Themes for ‘09 Vision, Mission, Values Review, Reinforce SWEET Training Principles and Concepts (Hardwire) SWEET Leadership Accountability through Transparency Best Practice Proliferation

16. Sullivan Luallin Press Ganey Point in Time survey methodology Two Weeks a Year Once a year Statistically valid results Results available two months after surveys distributed Relatively small data base for comparisons Continuous Surveying Results viewable on line Huge data base for comparisons Ability to survey special clinical areas: UC, Lab, Imaging Quarterly Report with recommendations Switch made in 2008

17. First Steps Patient Satisfaction Dashboards:Transitioning Accountability Dashboards Action Plans Next Steps

18. Patient Satisfaction Report ComponentsMedical Practice Report

19. Patient Satisfaction Report ComponentsMedical Practice Report % Ranking compared to AHA region 8,9 Mean Score Respondents (n) 9 8

20. Which of these metrics are important? 20

21. Utility of Trend Lines Site 1 Site 2 60% 60%

22. Rolling Averages Three Month Rolling Average January February March April May June January February March Average February March April Average March April May Average

23. Challenges with Patient Satisfaction Data Snapshot in time Complicated interface Cannot control data integrity Variable providers/sites Variable benchmarking Mean score changes daily

24. SGMF’s Patient Satisfaction Dashboard

25. Patient Satisfaction Dashboard

26. Patient Satisfaction Dashboard Trend Over 6 Months

28. Opportunity for Improvement

30. Interactive Dashboards 29 Care Center Dashboard

31. Dashboards in Action 30

32. Transparency for Results 31

33. Priorities 32

34. First Steps Patient Satisfaction Dashboards:Transitioning Accountability Dashboards Action Plans Next Steps

35. Patient Satisfaction Action Plans Question-Specific Action Plans SWEET Observation Tool Action Plan Tool Department Action Plan SGMF Action Plan Playbook

36. Patient Satisfaction Action Plans

37. Action Plan“Courtesy of Staff in the Registration Area”

38. Action Plan“Courtesy of Staff in the Registration Area”

39. Action Plan“Courtesy of Staff in the Registration Area”

40. Action Plan“Courtesy of Staff in the Registration Area”

41. Action Plan“Courtesy of Staff in the Registration Area”

42. Action Plan“Courtesy of Staff in the Registration Area”

43. Action Plan“Courtesy of Staff in the Registration Area”

44. Department Action Plan

45. First Steps Patient Satisfaction Dashboards:Transitioning Accountability Dashboards Action Plans Next Steps

46. Physician Involvement and Commitment ’08-’09 Pilot Section Chief – Manager partnership Development and rollout of Physician Compact Press Ganey results Transparent 2010 New physician leadership, management realignment

47. Physicians continued… Physician communication workshops Physician Dashboard

48. 47 In Summary It starts with a burning platform “It’s Your Ship” Rollout Strategy What gets measured gets managed The power of recognition Providing the leadership team with toolkits Making Results Transparent