Creating a Different Future Through the Pursuit of Performance Excellence

Creating a Different Future Through the Pursuit of Performance Excellence HFMA Leadership Event April 11, 2016 David Fox, President Advocate Good Samaritan Hospital

All of Us Face Not Normal Times The dominant pattern of history isn t stability, but instability and disruption. Those of us who came of age amidst stable prosperity in the second half of the 20 th century would be wise to recognize that we grew up in a historical aberration. instability is chronic, uncertainty is permanent, change is accelerating, disruption is common, and we can neither predict nor govern events. there will be no new normal. There will only be a continuous series of not normal times. 2

One of the nation s top 15 health systems Largest health system in Illinois and largest ACO in America Over 250 sites of care with 10 acute care hospitals and 2 integrated childrens hospitals 3.4 million patient served One of the top 10 places to work in Illinois: 34,500 associates, 6000 affiliated physicians, and 10,700 nurses Faith-based sponsored by United Church of Christ and Evangelical Lutheran Church Total Revenue: $4.6 billion -- AA Rating We are first and foremost a safe, clinical enterprise. 3

Advocate Good Samaritan Hospital 300-bed community hospital (15,500 admissions) 1,600 associates, 900 physicians & 500 volunteers Level I Trauma Center (44,000 ED visits) Advanced Perinatal Services (2,000 births) Clinical strengths include Cardiology, Neurosurgery, Surgery, Emergency/Trauma, High-risk Obstetrics 4

In November 2010, Advocate Good Samaritan Hospital was recognized with a Malcolm Baldrige National Quality Award, joining 100 other businesses, including 17 from health care, to have received this award since 1988. 5

BUT GOOD SAMARITAN S QUALITY WASN T ALWAYS SO GOOD 6

Good Samaritan True To Its Name A GOOD Hospital Physician satisfaction was mixed Quality that was generally perceived as good Nursing Care seen as uneven Patient satisfaction that was at best mediocre Quality medical staff of mostly splitting physicians Technology and facilities that were increasingly perceived as slipping behind Associate satisfaction that was pretty good, but not exceptional A PHO that was struggling financially 7

Bloomingdale Glendale Heights Addison Carol Stream PSA 1 (50% of admissions) PSA 2 (25% of admissions) SSA Villa Park Elmhurst Warrenville Wheaton Glen Ellyn Lombard Good Samaritan Hospital Oak Brook Westchester In a Highly Naperville Lisle Downers Grove Westmont Hinsdale Competitive Aurora Naperville Woodridge Darien La Grange Market Willowbrook Naperville Naperville Bolingbrook Bolingbrook Lemont Plainfield Romeoville Lockport 8

Why Companies Don t Become Great Good is the enemy of great. And that is one of the key reasons why we have so little that becomes great. The vast majority of companies never become great, precisely because the vast majority become quite good and that is their main problem. -- Jim Collins, Good to Great 9

Change Versus Transformation CHANGE is about doing or having something better, different, or more with what is already possible or already exists. TRANSFORMATION is about doing what isn t currently possible, unless or until, you change how you are BEING. 10

Transformational Leadership The Way to Do is to BE. (Lao Tzu) Not DO HAVE BE but BE DO HAVE Context Process(es) Results 11

The Being of Transformational Leadership Consistently setting context for the transformation 12

Context Is Decisive The interrelated conditions in which something exists or occurs. (Webster) Premise: One of the most under-appreciated roles of the effective leader is the creation of context for their personal leadership and for their team or organization. * The Elements of Context Purpose Views Values Vision Heart and Mind states * Last Word On Power, Tracy Goss 13

Organizational Transformation Requires Transformational Leadership Achieve breakthrough improvement versus incremental change Make happen what would not have happened without their leadership 14

Rationales for Organizational Transformation Mission Rationale To make good on our promise to be a place of healing Operational Rationale To create a framework for inspiring and integrating our efforts to build loyal relationships and provide great care Strategic Rationale To differentiate ourselves and ensure future success by becoming the best place for physicians to practice, associates to work and patients to receive care 15

2004 An Intentional Decision to Create a Different Future through the Pursuit of Performance Excellence 16

Key Steps in Transformation 1. Establish an inspiring vision and enroll leaders create ownership 17

Establishing An Inspiring Vision To provide an exceptional patient experience marked by superior health outcomes, service and value To BE the best place for physicians to practice, associates to work and patients to receive care 18

Leaders Must Go First Leaders must first enroll themselves in the vision before others will follow. What you are passionate about foretells your future. (Kaiser) Leaders get the behavior they exhibit and tolerate. (Jim Collins) 19

Transformational Improvement Requires Ownership Apathy: Neither for nor against. No interest or energy. Non-Compliance: Does not see the benefits and will not do what s expected. Undermines through resistance and inaction. Grudging Compliance: Does not see the benefits. But also, does not want to lose her job. Formal Compliance: See the benefits. Does what s expected, no more. Genuine Compliance: Does everything expected and more. Follows the letter of the law. Good Soldiers. Ownership & Commitment: Wants it. Owns it. Passionate. Will make it happen. Will do whatever it takes. Inspires and enrolls others through actions & words. 20

Leadership s Greatest Opportunity Changing behavior is less a matter of giving people analysis to influence their thoughts than helping them to see a truth to influence their feelings -- John Kotter, The Heart of Change We should all be thankful for those people in our lives who rekindle the inner spirit. -- Albert Schweitzer 21

Creating Ownership To create alignment and ownership, the Leader must routinely enroll others in the WHY of the strategy or project context is decisive. We enroll and lead others through communication. Communication is the action of Leadership. The leader s job is to enroll, inspire and engage others to voluntarily and passionately do what the leader is asking them to do. Achieving compliance is not enough. 22

Key Steps in Transformation 1. Establish an inspiring vision and enroll leaders create ownership 2. Create alignment, ownership and transparency to drive improvement focus 23

Alignment Creates Possibility For Success The most successful companies, across all industries, have a cohesiveness of purpose, unity of effort, and clarity of direction that are created and driven by their leadership. -- Stephen Beeson MD, Sharp Healthcare 24

Our Need for Alignment and Integration ONE OF THE JOBS OF LEADERS IS TO MAKE AN ALIGNED AND INTEGRATED PICTURE THAT CAN BE UNDERSTOOD AND EMBRACED 25

A Plan to Shape Our Future Launched Moving From Good to Great (G2G) A BALANCED COMMITMENT TO EXCELLENCE Health Outcomes Associate Engagement Patient Satisfaction Physician Engagement Growth Funding Our Future 26

Create Alignment through Cascading of Goals Advocate Goals / Strategy GSam Strategy Regulatory GSAM ET Determines Preliminary Goals & Targets Goal Deployment Worksheet Completed Directors Provide Input into Goals/Targets Goals/Targets Finalized Goals: Online Tracking System Organizational and Department Action Plans Created Goals/Targets Assigned to Frontline, Action Plans Defined Performance Boards 27

2005-06: Path to Achieving Operational Excellence Deeper Deployment of Evidence-based Practices Leadership Development Institutes (LDIs) Goal Alignment & Accountability System Pillar Boards Leader Rounding (Associates & Physicians) Thank You Notes Physician Bookmarks 5 Fundamentals of Service (AIDET) Hourly Rounding Discharge Call Manager Behaviors of Excellence Peer Interviewing High / Solid / Low Conversations (HSL) 29

Evidence-Based Practice: Peer Interviewing Good Samaritan trained 450 of its best employees in how to conduct behavior and values based interviewing Human Resources screens candidates Department managers recommend the best Unit-based peer interviewing teams make the final hiring decision Multiple cycles of improvement driven by data 30

Evidence Based Practice: HSL Differentiate Low, Solid, High Performance to Move the Performance Curve L S H 31

U.S. Employee Engagement: 2014* 32% 51% 18% Engaged Not Engaged Actively Disengaged * 32

120 100 80 60 40 20 0 7 By 2006, The G2G Transformation Had Achieved Breakthrough Results 19 Outpatient Satisfaction 31 24 19 12 17 20 11 7 7 55 37 29 48 67 65 97 98 96 99 91 91 87 86 83 78 6 5 4 3 2 1 0 ICU Ventilator-Associated Pneumonia Per 1,000 Device Days 5.48 3.29 2004 2005 2006 0 3 2 1 0 ICU Central Blood Stream Infections Per 1,000 Device Days 2.70 2.62 0.85 2004 2005 2006 0.80 0.75 0.70 0.65 0.60 0.55 0.50 0.45 0.40 0.35 0.30 Mortality Index (Actual/Expected) 0.73 0.65 0.63 2004 2005 2006 33

MVP 2006: At a Crossroad G2G journey led to: Operational Excellence Innovator Superior Outcomes Cultural Transformation With Vision & Values as our moral compass, we asked How will we achieve repeatable excellence? 34

The Power of a Process-Honoring Culture We are perfectly designed to get the results we are getting. An organization can t achieve repeatable excellence without integrating processes deeply into the culture 35

What You Don t Know That You Don t Know = Baldrige Opportunity What You Know and You Know That You Know KNOW THAT YOU KNOW KNOW THAT YOU DON T KNOW What You Don t Know and You Know That You Don t Know DON T KNOW THAT YOU DON T KNOW Baldrige Opportunity What You Don t Know and You Don t Know That You Don t Know 37

The Baldrige Criteria Framework Defining, Improving, and Integrating Organizational Processes to Achieve High Reliability Strategy Workforce Leadership Integration RESULTS Customers Operations Measurement, Analysis, Knowledge Management State Baldrige Program 38

Key Steps in Transformation 1. Establish an inspiring vision and enroll leaders create ownership 2. Create alignment and transparency to support the vision 3. Deploy evidence-based practices 4. Foster a process-honoring culture 5. Fully deploy a performance improvement approach 39

GSAM s Performance Improvement System: PDSA-A3 PLAN PLAN DO Box 1: Problem Statement Box 4 Root Cause Analysis Box 7: Completion Plan PLAN Box 2: Current State PLAN Box 5: Solutions STUDY Box 8: Confirmed State PLAN Box 3: Ideal State DO Box 6: Rapid Experiments ACT Box 9: Insights Creating a community of problem-solvers 40

The Power of a Systematic PI Approach A3 - Sample Results Admissions process in Critical Care Unit 25% inappropriate admissions to 5% Reduction in surgery cancellations within 24 hours of surgery 7.7% to 0.42% day of surgery Increased capacity: est. 800 additional surgeries per year Improved charge capture $505,000 net revenue (CV Hart) $1,059,912 gross charges (Birth Center) 30-40% reduction in inventory (Surgical Services, ED, CCU, Radiology) $460,000 (to date) Reduced or eliminated unit-based staff time engaged in supply management 262 hours/week (ED, CCU, Med/Surg, Surgery) 41

Key Steps in Transformation 1. Establish an inspiring vision and enroll leaders create ownership 2. Create alignment, ownership and transparency to drive improvement focus 3. Deploy evidence-based practices 4. Foster a process honoring culture 5. Fully deploy a performance improvement approach 6. Build Loyal Relationships the foundation to accomplishment 42

Created A Shift In View Regarding Stakeholders From Stakeholder Satisfaction To Stakeholder Partnership & Loyalty 43

Relationships Are the Foundation for Accomplishment Accomplishment Triangle RESULTS ACTIONS OPPORTUNITIES POSSIBILTIES RELATIONSHIPS The Breadth of Relationship 44

Relationships Are the Foundation for Accomplishment RESULTS ACTIONS OPPORTUNITIES POSSIBILITIES RELATIONSHIPS The Breadth of Relationship 45

Identifying Our Core Competency of Building Loyal Relationships with Patients & Families Physicians Associates Volunteers 46

Ambulatory Surgery Building Loyal Relationships (3Q 2015 percentile) Outpatient Convenient Care 86 th 76 th 94 th 88 th 90 th 79 th Emergency Department 47

LOYAL RELATIONSHIPS DRIVE BREAKTHROUGH RESULTS

Advocate Good Samaritan Hospital National Recognition for Excellence 2009 & 2011 through 2016 2008 through 2014 2012 through 2016 2006 through 2016 49

Percent Results of Loyal Relationships GSAM Market Share For Overlapping Markets Overall Inpatient: 2006-2011 25% 20% 17.0% Increase 7.4% Decrease 15% 25.6% Decrease 6.9% Decrease 8.4% Decrease 10% 5% 0% GSAM Hosp A Hosp B Hosp C Hosp D Source: CompData 50

Percentile Transforming Our Patients Experience (2003-2014) Patient Satisfaction Percentile (Press Ganey) 100 93 91 80 79 82 63 60 54 40 38 20 18 18 0 Outpatient Inpatient Emergency Amb Surg Conv Care 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 51

Rate of Improvement Creating a Culture of Patient Safety 100 80 60 100th Percentile for Patient Safety 40 20 0 0 20 40 60 80 100 Performance Source: Thomson Reuters 2004-2008 52

JAN-12 FEB-12 MAR-12 APR-12 MAY-12 JUN-12 JUL-12 AUG-12 SEP-12 OCT-12 NOV-12 DEC-12 JAN-13 FEB-13 MAR-13 APR-13 MAY-13 JUN-13 JUL-13 AUG-13 SEP-13 OCT-13 NOV-13 DEC-13 JAN-14 FEB-14 MAR-14 APR-14 MAY-14 JUN-14 JUL-14 AUG-14 SEP-14 OCT-14 NOV-14 DEC-14 FEB-15 MAR-15 APR-15 MAY-15 JUN-15 JUL-15 Mortality Index (Observed/Expected) Good 1.00 0.90 GSAM Mortality Index 0.87 Top 10% In American Hospitals 0.80 0.70 90th Percentile 0.60 0.50 0.67 0.40 0.30 0.20 0.10 0.00 Jan 2012 Approximately 206 Patients Walk Out of GSAM That Were Not Expected To Live July 2015 53

GSAM Acute Care 30 Day Readmission Rate Dec 2010 Aug 2015 8.8% 54

Vent Ratio (Actual / Expected) GOOD GSAM Vent Day Index (Actual / Expected) 2011 4QTR 2014 1.45 1.44 1.35 1.25 1.19 1.20 1.15 1.05 1.06 1.02 Current Performance: Top Decile 0.95 0.96 0.93 0.85 0.87 0.83 0.88 0.75 2011 1 QTR 2012 2 QTR 2012 3 QTR 2012 4 QTR 2012 1 QTR 2013 2 QTR 2013 3 QTR 2013 4 QTR 2013 4QTR 2014 Source: APACHE 55

Rate of RBC Transfused 70.00 60.00 62.80 GSAM Rate of RBC Transfused 2011/2014 Rate of RBC Transfused per 1,000 Adjusted Patient Days 50.00 40.00 61% decrease in rate of RBC utilization 30.00 20.00 24.45 10.00 0.00 Baseline Data - Jan to Jun 2011: 58.57 monthly rate of RBC utilization Sep 2013 to Feb 2014: 27.27 monthly rate of RBC utilization 56

Final Thoughts Sustaining Performance Excellence in a Continual Series of Not Normal Times Requires 57

A Conscious Choice & Discipline Greatness is not a function of circumstance. Greatness, it turns out, is largely a matter of conscious choice, and discipline. We are not imprisoned by our circumstances. We are not imprisoned by the luck we get or the inherent unfairness of life. We are not imprisoned by crushing setbacks, selfinflicted mistakes or our past success. We are free to choose, free to become great by choice. -- Jim Collins (from Great By Choice) 58

Embracing Change & Innovation While Preserving Our Core Purpose & Values Enduring great organizations are characterized by a fundamental duality. On the one hand, they have a set of timeless core values, and core reason for being, that remain constant over long periods of time. On the other hand, they have a relentless drive for change and progress. Great organizations keep clear the difference between their core values, which never change, and operating strategies and cultural practices which endlessly adapt to a changing world. -- Jim Collins & Jerry Porras Built to Last 59

Thank You David S. Fox, President Advocate Good Samaritan Hospital Downers Grove, Illinois david.fox@advocatehealth.com 60