Developing and Maintaining a HighPerformance Workforce

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1 Session A12/B12 Developing and Maintaining a HighPerformance Workforce December 11, 2012 Kathy Oswald, SVP & CHRO Laurie Jensen, Director OHRD & HFHS University Disclosure Statement: These presenters have nothing to disclose

2 Presentation Objectives Overview of fundamental elements of HR processes that contribute to an awardwinning, high-performance culture Recognize correlations between employee engagement data and quality outcomes Provide insights into use of just culture approach to manage employee behaviors contributing to safety and high performance

3 The biggest learning disability is knowing all the answers Dr. Donald Walker Author & Educator

employed and private practitioners Henry Ford Medical Group Henry Ford

4 Integration Across 9 Business Units 4 acute care hospitals Henry Ford Hospital staffed by Henry Ford Medical Group 3 Community hospitals supported by both employed and private practitioners Henry Ford Medical Group Henry Ford Physician Network Community Care Services Behavioral Health Services Health Alliance Plan

5 The Henry Ford Experience 7 Pillars of Performance

6 Henry Ford Health System $4B revenues 24,322 employees affiliated physicians, volunteers, and students Located in Southeast Michigan Largest hospital in Detroit

7 Henry Ford Health System $4B revenues 24,322 employees affiliated physicians, volunteers, and students Located in Southeast Michigan Largest hospital in Detroit

8 What Differentiates HFHS in the Workforce Category? Diversity Culture of development Community Integration Innovation Leadership Walks the Talk Leaders as Teachers Commitment to our People, especially during difficult economic times (Job Preservation)

9 Cool Place to Work Video

10 Developing and Maintaining a High Performance Workforce - Lessons Learned

Components: Aligned with Baldrige Workforce Capability and Capacity: Recruitment & Retention (5.

11 Lesson 1: Use Best-Practice Framework For Building a High Performance Culture 2012 H.F.H.S. People Pillar Update Strategic Objective: National leader in healthcare employee retention and engagement 2012 Components: Aligned with Baldrige Workforce Capability and Capacity: Recruitment & Retention (5.1a) Workforce Climate: Safety & Wellness; Policies & Benefits (5.1b) Workforce Engagement: Satisfaction; Performance Management; Succession Planning & Development (5.2a/b)

12 Lesson 2: Redefine our Workforce Selection Career Cycle Separation B u s i n e s s U n i t s Workforce Segment Employees Leaders Physicians Medical Group Employed Community Residents/ Students Volunteers Contractors Workforce/ Succession Planning Orientation On-boarding Performance Management Learning & Development Recognition Engagement & Retention Employees Leaders Employed Physicians Community Physicians Residents/Students Volunteers Contractors Health & Safety Mandatory Education Exit Interviews & Knowledge Transfer Diversity & Inclusion

13 Lesson 3: Connect Workforce Initiatives 5.1a Workforce Capability & Capacity 5.1b Workforce Climate 5.2a Workforce Engagement 5.2b Workforce Development to Strategic Advantages Community Diversity Integration Innovation Hire Detroit Needle sticks Recognition Workforce Violence Wellness Volunteer Hours Heart Walk CTO Donation Tuition HF Early College Midtown Hire Candidate Slates Turnover Retention Tailoring Benefits needs to Diverse population Health Equity Engagement Diversity Inc Academies Participants Careers for Life Talent Profiles Physician Turnover Time to Fill All Turnover Workers Compensation OSHA Dart GPA Physician Volunteers Residents Researchers Kirkpatrick metrics $ Spent/Empl. Agency Utilization Health Engagement Flu Mandate Istrive Stress free living Enhanced Flexible Benefits Midtown Health Engagement MTI-Team Up for Wellness Simulation Center Private portals Physician Institute

14 Workforce Diversity Balanced Scorecard Capability/Capacity Demographics Hires Turnover Engagement Engagement Survey EEO Claims ERGS Vision: To eliminate disparities, barriers and/or differences in all segments of the workforce so that all employees are respected, valued and have opportunities for growth Learning & Development Participation in Leadership Academies & University offerings Tuition Reimbursement Promotions Climate HRA Participation 403B Participation Live Midtown Use of Child Care Center & Fitness Memberships 14

System Hospitals HFMG BHS CORP HAP CCS Total Turnover % Lesson 4: Identify and Monitor Well- Defined Metrics and Trends Fig. 7.

15 System Hospitals HFMG BHS CORP HAP CCS Total Turnover % Lesson 4: Identify and Monitor Well- Defined Metrics and Trends Fig : Overall Employee Turnover 20% 15% Turnover Improves to 75th %ile in Areas w ith Comparison Good 10% 5% 0% Fig : Employee Engagement /11 YTD Saratoga 75th 2009 Saratoga 90th

Metrics Aligned With Business Outcomes 5.00 Bottom qtile Top qtile (n=361) (n=362) 4.79 4.83 4.68 4.50 4.00 3.69 3.80 3.81 3.50 3.00 C09.

16 Metrics Aligned With Business Outcomes 5.00 Bottom qtile Top qtile (n=361) (n=362) C09. Management shows that patient safety is a top priority C10. Encouraged to speak up concerning patient safety C11. I'd feel safe being treated at a HFHS healthcare facility

17 Lesson 5: Ensure Results (LAG Metrics) Drive Process (Lead Metrics) and Initiatives 2012 Plan 5.1a Workforce Capability and Capacity; Recruitment and Retention Lag Lead 2012 Initiatives: Workforce Voluntary Turnover metrics are at 90 th percentile or better by 2013 Track quality of hire (target >4.0 rating) and first-year retention (target >90%) in pilot groups Implement New Hire Assessment tool in pilot areas by end of second quarter 2012 Convert turnover metrics from percentage to cost HFHS University and Talent Selection team partner to launch Structured Behavior-Based Interview training Launch SBBI in Leader Academies; ensure all HR Business Partners and Talent Selection team members are well-versed in Structured Behavior-Based Interviewing Implement Realistic Job Previews in two highest turnover areas (considering pilot programs in Housekeeping and Home Health Care) Responsible Leaders NB/AP/BU Leads AP LJ/NB LJ/BU Leads WB Lead/PS First Year Nurse Turnover >90 th percentile by 2013 Track quality of hire (target >4.0 rating) and first-year retention (target >90%) in pilot groups Convert turnover metrics from percentage to cost Require Nurse Managers to have retention target in performance goals Train Nurse Managers to conduct Structured Behavior-Based Interview training AP BU Leads LJ/NB/BU Leads

18 Lesson 6: Realize It s a Journey, Not a Destination It doesn t happen overnight Understand strengths and opportunities What we ve learned over time Category 5.1 Workforce Capability, Change Management, Workplace Environment, Policies and Benefits Category 5.2 Workforce Performance, Engagement and Development

19 Workforce Category Deployment Timeline Category 5.1 1/2003 1/2004 1/2005 1/2006 1/2007 1/2008 1/2009 1/2010 1/2011 1/2012 Jan 2002 Apr 2012 Baldrige Journey 11/16/2006-4/16/2012 Category 5.2 1/2003 1/2004 1/2005 1/2006 1/2007 1/2008 1/2009 1/2010 1/2011 1/2012 Jan 2002 Apr 2012 Baldrige Journey 11/16/2006-4/16/2012

20 Workforce Category 5.1a Capability, Work Accomplishment & Change Management 9/07 Henry Ford Early College 3/09 Workforce Planning WB Hosp Opening 1/11 Employee Resource Groups 2/10 Talent Selection Redesign 6/11 Professional Development Program 3/12 Workforce Planning Warren Hosp Closure 1/1/2007 1/1/2008 1/1/2009 1/1/2010 1/1/2011 1/1/2012 Workforce Planning Labs & Pathology 5/09 Volunteer Tracking 5/10 4/16/2012 Diversity Council 6/10 Hire Detroit 4/11

21 Workforce Category 5.1a Capability, Work Accomplishment & Change Management Henry Ford West Bloomfield Hospital

22 Workforce Category 5.1b Employee Health, Safety and Wellness 6/07 "Smoke Free" Campus 7/08 Blood-Borne Pathogen Program 8/09 Health Engagement 5/10 AHA Safety Fellowship 9/11 Workplace Violence Policy & Reduction Team 1/11 Live Midtown 2/12 Merged Employee Health 1/13 No Hire Smokers- Smoke-Free Work Day 7 1/08 1/09 1/10 1/11 1/12 Medical Advisory Team 7/09 Wellness Resource Guide 10/09 Flu Compliance Mandate 9/10 4/11 1/ Year Employee Safety Strategy

Level 1 Level 2 Level 3 Must (within 90 days): Must (within 90 days): Must (within 90 days): *

Complete HRA * Complete MQF (score 85 or >) Level Agree to treatment plans to achieve wellness

up-to-date on preventive services (20 Points) Must be a non-tobacco user (20 Points) Must have

<140/90; if diabetic <130/80 (15 Points) Cholesterol normal or treatment plan (15 Points) Blood

MQF points: Must be up-to-date on preventive services Must be a non-tobacco user Must have BMI of

23 Workforce Category 5.1b Employee Health, Safety and Wellness Closing the Gap Health Engagement Next Gen 2012 Criteria Level 1 Level 2 Level 3 Must (within 90 days): Must (within 90 days): Must (within 90 days): * Complete HRA * Complete MQF (score 85 or >) * Complete HRA * Complete MQF (score 85 or >) * Complete HRA * Complete MQF (score 85 or >) Level Agree to treatment plans to achieve wellness targets Represents the year the member joined Health Engagement For MQF points: Must be up-to-date on preventive services (20 Points) Must be a non-tobacco user (20 Points) Must have BMI of <30 or lose 5% of body weight within 12 months (15 Points) Must have blood pressure of <140/90; if diabetic <130/80 (15 Points) Cholesterol normal or treatment plan (15 Points) Blood Sugar normal or treatment plan (10 Points) Alcohol use normal or treatment plan (5 Points) For MQF points: Must be up-to-date on preventive services Must be a non-tobacco user Must have BMI of <30 or lose 5% of body weight within 12 months. Must have blood pressure of <140/90; if diabetic <130/80 Must have acceptable LDL-C Cholesterol level Must have normal or acceptable HbA1C (<8.0) 1 AHA Fellowship

24 2011 Employee Injuries System-Wide Workplace Violence Focus 2,360 Employee injuries for the System 2696 days away from work, 11 FTE equivalent 9343 restricted days 2011 Claims for Employee Injuries Medical, Loss Wages and Expense = $932,904 Internal Charges = $1,240,899 Total = $2,173, Data retrieved from RedForm

Cost of Employee Harm System-Wide $5,000,000 $4,500,000 $4,000,000 $3,500,000 $3,000,000 $2,500,000 $2,000,000 $4,319,260 $3,121,761 $2,791,100 Thorough initial evaluation

compensation if not indicated Maintaining a focus on appropriate care Increased collaboration across the clinics Partnership with our Workers Compensation vendor and close

25 Cost of Employee Harm System-Wide $5,000,000 $4,500,000 $4,000,000 $3,500,000 $3,000,000 $2,500,000 $2,000,000 $4,319,260 $3,121,761 $2,791,100 Thorough initial evaluation to identify source of injury and appropriate course of treatment Allowing for restrictions so employee remains productive rather than a quick referral to workers compensation if not indicated Maintaining a focus on appropriate care Increased collaboration across the clinics Partnership with our Workers Compensation vendor and close monitoring of all employee injuries $1,500,000 $1,319,763 $1,000,000 $500,000 $- Year 2009 Year 2010 Year through 3rd Qtr COST OF CLAIMS: Data provided by CRS; Includes reserves

26 Workers Compensation- Employee Injuries & Cost of Claims by BU Opportunity Data provided by CRS; Does not includes reserves

27 Employee Safety: Frequency of Trips/Falls, Backs, Sharps Injury by BU (2011) Falls Backs Sharps Macomb Warren sharp injuries are incorporated into Macomb Clinton Frequency Rate = # of injuries x 200,000 / employee hours of work

28 Moving Forward Crisis Response Coordinator address the opportunity within Workplace Violence by developing a new role to address events post incident Shared Best Practices with data being reviewed across all Business Units monthly, opportunities arise where great progress is being made within the system that can be shared Pilot at Macomb a back injury strategy is being piloted out at Macomb with the intent to roll out learnings to the rest of the system System Deployment of several employee safety strategies based on findings from a deeper dive into our employee data 28

29 7/07 Leadership Competencies Workforce Category 5.2a Workforce Performance 2/09 Executive Competencies 1/11 Employee Performance Management 1/1/2007 1/1/2008 1/1/2009 1/1/2010 1/1/2011 1/1/2012 Online Performance Management System (PMS) 12/07 Leadership PMS 3/08 Team Member Standards Updated 10/10 4/16/2012

Process Management/ Focus on Safety Performance Analysis & Knowledge Management Aligned

30 Specific Competencies & Standards: Leadership Competency Model Leadership Patient/ Customer Focus Staff Focus Accountability for Results/ Execution Strategic Planning Process Management/ Focus on Safety Performance Analysis & Knowledge Management Aligned with The Henry Ford Experience, Organizational Framework, & Malcolm Baldrige Model for High Performance

31 Team Member Standards

32 System-wide Performance Management

33 Workforce Category 5.2b - Workforce Engagement 5/08 Employee Engagement Surveys & Impact Plans 4/10 Volunteer Engagement 11/10 Engagement Coaching 1/12 Physician Engagement 1/2007 1/2008 1/2009 1/2010 1/2011 1/2012 April 2012

34 Dilbert on Engagement

35 Employee Engagement Hierarchy Q 12 Engagement Items: Q12. Opportunities to learn and grow Q11. Progress in last six months Q10. I have a best friend at work Q9. Coworkers committed to quality Q8. Mission/Purpose of company Q7. At work, my opinions seem to count Q6. Someone encourages my development Q5. Supervisor/Someone at work cares Q4. Recognition last seven days Q3. Do what I do best every day Q2. I have materials and equipment Q1. I know what is expected of me at work How do we grow? Do I belong? What do I give? What do I get? Source: Gallup Consulting

36 Workforce Engagement

Note: Percentiles based on Gallup s 2012 Healthcare Company

37 Employee Engagement: Quality Impact Analysis We are striving for higher Employee Engagement and better outcomes Note: Percentiles based on Gallup s 2012 Healthcare Company level database 81st 53rd 25th Workforce Engagement (Baldrige 5.2)

38 HFHS Engagement Ratio Has Doubled Since 2008 Ratio of Engaged to Actively Disengaged: 6.1:1 4.2:1 2.9:1 4.4:1 Neutralization is a 4.0:1 ratio Engagement Index Across Time 38 Copyright 2012 Gallup, Inc. All rights reserved.

Notable increases and accomplishments: Q12 Items: 11 of 12 items increased significantly & 7 are above 75 th percentile Performance Management: 5 of the 6 items linked significantly increased Q 12

35% 80 th Best friend 45% 37% 30% 73 rd Coworkers committed to quality 49% 42% 36% 77 th Mission/Purpose of company 50% 44% 39% 66 th My opinions count 37% 31% 26% 81 st Encourages development 48%

39 Notable increases and accomplishments: Q12 Items: 11 of 12 items increased significantly & 7 are above 75 th percentile Performance Management: 5 of the 6 items linked significantly increased Q 12 Strengths and Weaknesses (%5) Across Time HFHS Overall 2012 HFHS Overall 2010 HFHS Overall Percentile Opportunities to learn and grow 52% 43% 39% 74 th Progress in last six months 55% 45% 35% 80 th Best friend 45% 37% 30% 73 rd Coworkers committed to quality 49% 42% 36% 77 th Mission/Purpose of company 50% 44% 39% 66 th My opinions count 37% 31% 26% 81 st Encourages development 48% 41% 36% 78 th Supervisor/Someone at work cares 57% 52% 47% 78 th Recognition last seven days 42% 36% 30% 74 th Do what I do best every day 50% 45% 41% 72 nd Materials and equipment 44% 39% 36% 78 th I know what is expected of me at work 67% 64% 61% 77 th 2012 Percentile Compared to Gallup's Healthcare Company Level 75 th Note: Percentiles based on Gallup s 2012 Q 12 Healthcare Company Level Database by %5 results; / indicates +/- 5% change from previous survey 39 Copyright , 2012 Gallup, Inc. All rights reserved.

32 (2012) Encouraged to Speak Up With Concerns About Patient Safety (2012) 4.41 (2010) Would Feel Safe Being Treated at HFHS Facility as a Patient (2010) 4.

40 Engagement Improved on All Culture of Safety items in 2012 (2010) Management Shows by Actions That Patient Safety Is Top Priority 4.25 (2012) Management Shows by Actions That Patient Safety Is Top Priority 4.34 (2010) Encouraged to Speak Up With Concerns About Patient Safety (2010) 4.32 (2012) Encouraged to Speak Up With Concerns About Patient Safety (2012) 4.41 (2010) Would Feel Safe Being Treated at HFHS Facility as a Patient (2010) 4.16 (2012) Would Feel Safe Being Treated at HFHS Facility as a Patient (2012) 4.22 Mean (2010) Staff Free to Question Decisions/Actions of Those With Authority New Question for 2012, No 2010 Data Available (2012) Staff Free to Question Decisions/Actions of Those With Authority 3.73 Note: Numerical values shown when 5% or higher; due to rounding, percentages may sum to 100% +/-1% Copyright , 2012 Gallup, Inc. All rights reserved.

Turnover is Significantly Lower Among Engaged Employees (particularly for RNs) Rate of

42 Increasing Cost Center Engagement Also Improves Perceptions of Patient Safety 42

43 Employee Engagement: Goal for Leaders at HFH, HFMG, and HFWH were cascaded. Performance Goal: Goal Part 1 First half of 2012: Leaders driving engagement using the 2011 pulse survey results based on their accountability index (AI) score. Goal Part 2 Second half of 2012: Leaders driving engagement using the April 2012 engagement results. Specific focus on the results of Q12 item scores. Action step of 2nd level supervisor sign off on the impact plan for each leader and driving positive engagement results. Ratings: 3 - Goal Part #1: Leaders achieves the minimum goal of AI Score on 2012 Engagement Survey = 50 th 75 th percentile or documents in Gallup Online actions taken to drive engagement with supervisor sign off on actions. AND Goal Part #2: Leader meets minimum goal of actions taken to meet with team as described in further explanations document. Business Unit 2008 Gallup Mean 2010 Gallup Mean 2010 Gallup Acct Idx 2010 Dec Pulse n 2010 Dec. Pulse Mean 2011 Sept Pulse (Acct Idx) n 2011 Sept Pulse Mean (Acct Idx) Pulse Trend 2012 Gallup 2012 Gallup Mean - Direct Acct Idx - Direct 2012 Gallup Mean - Rollup 2012 Gallup Acct Idx - Rollup Henry Ford Medical Group #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A Henry Ford Medical Group #N/A #N/A Henry Ford Medical Group Henry Ford Medical Group #N/A #N/A Henry Ford Medical Group #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A Henry Ford Medical Group #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A Henry Ford Medical Group #N/A #N/A Henry Ford Medical Group #N/A #N/A #N/A #N/A #N/A Henry Ford Medical Group #N/A #N/A Henry Ford Medical Group #N/A #N/A Henry Ford Medical Group #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A Henry Ford Medical Group #N/A #N/A Henry Ford Medical Group #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A Henry Ford Medical Group #N/A #N/A #N/A #N/A #N/A #N/A Henry Ford Medical Group #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A Henry Ford Medical Group #N/A #N/A Henry Ford Medical Group #N/A #N/A Henry Ford Medical Group #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A Henry Ford Medical Group #N/A #N/A Henry Ford Medical Group #N/A #N/A Henry Ford Medical Group #N/A #N/A #N/A #N/A #N/A #N/A Henry Ford Medical Group #N/A #N/A Henry Ford Medical Group #N/A #N/A Henry Ford Medical Group Henry Ford Medical Group #N/A #N/A Henry Ford Medical Group Henry Ford Medical Group #N/A #N/A Henry Ford Medical Group Henry Ford Medical Group #N/A #N/A Henry Ford Medical Group #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A Henry Ford Medical Group Henry Ford Medical Group #N/A #N/A Henry Ford Medical Group #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A Henry Ford Medical Group Henry Ford Medical Group #N/A #N/A Henry Ford Medical Group Henry Ford Medical Group #N/A #N/A Henry Ford Medical Group #N/A #N/A #N/A

44 2/2006 Leader ntation Workforce Category 5.2c - Workforce 7/08 Just Culture Rollout 9/07 Simulation Center Development 2/10 Succession Planning 8/10 Advanced Leadership Academy 8/11 Pvt Physician U Portal 4/11 Physician Leadership Institute 4/2012 New Phys Leader Workshop 1/2007 1/2008 1/2009 1/2010 1/2011 1/2012 Levels 3-4 Kirkpatrick s 9/09 New Leader Academy 6/10 Careers For Life 2/11 April 2012 Physician Succession Planning 6/11

46 = Admin & Nursing Leaders = Physician Leaders = Employees

47 Just Culture

48 Behavior Define by Manage through Manage by Human Error Inadvertent Action (Lapse, mistake) Did not choose the behavior Changes in: Processes Procedures Training Design Environment Console Just Culture At-Risk A Choice (Risk not recognized or believed justified) Removing: Incentives for at-risk behavior Creating: Incentives for healthy behaviors Education Coach (Console) Reckless Conscious Disregard of Unreasonable Risk (Includes repeated at-risk behavior) Corrective Action HR Policy 5.17 Corrective Action (Coaching) 48 *Outcomes do not predicate how we manage behaviors!

49 Safety Champs BHS CCS CORP HFCH HFH HFMG HFMH HFMH- WC HFWB HFWH Just Culture Training Effectiveness: % Correct Responses to Case Studies Pre and Post Training 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 94% 97% 96% %Correct Pre Training %Correct Post Good 87% 87% 94% 99% 95% 94% 93% 91% 78% 77% 73% 74% 67% 72% 71% 69% 70% 76% 71%

50 Escalator Video

Henry Ford Health System s Baldrige Journey: Driving Accountability for Excellence. June 25, Kathy Oswald Chief Human Resources Officer

Henry Ford Health System s Baldrige Journey: Driving Accountability for Excellence June 25, 2012 Kathy Oswald Chief Human Resources Officer Henry Ford Health System Core Services: Four acute med/surg and