University of Toledo Medical Center Patient Experience Improvement Strategic Plan It works!

1. UTMC Service
Excellence Strategy
2011 - 2012 Plan of Action
Edited as of January 1, 2012

3. UTMC Vision 2015
Clinical Outcomes
Financial Performance
Patient Experience
Physician/Employee Engagement
Market Share Growth

4. UTMC Vision 2015
Cannot achieve one without the other

5. January – December
2010 Performance:
U.S. Department of
Health & Human
Services Hospital
Profile*
*http://www.hospitalcompare.hhs.gov/

6. Narrowing The Gap
Clinical
Outcomes
VS.
Patient
Experience

10. HCAHPS “Rate Hospital 0-10”
2011 Data by Month
100
90
80
70 65
62 62
60 55 55
50 48 48
50 44
40
30
20
10
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)

11. The only effective differentiator
is the patient experience we
provide.
James Merlino, MD
Chief Experience Officer
The Cleveland Clinic Health System

12. Case 4 Change
Enter the era of payment
tied to reported Quality
outcomes

13. Quality-based Payment Initiatives
2010 2011 2012 2013 2014 2015 2016 2017
Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) 2% of APU
VBP VBP Value-based Purchasing (VBP) 2%
Readmissions 3%
Hospital Acquired Conditions (HAC) Hospital Acquired Conditions 1%
Meaningful Use 1%

14. Government’s interest:
Core Measures Satisfaction Outcomes
Acute MI Inpatient Death
(HCAHPS) Re-admission
Heart Failure
Outpatient
Pneumonia Safety
(CGCAHPS)
SCIP Pediatrics Line Infection
Pneumothorax
Asthma (kids) Psychiatry
Surgery Site
Home Health
Emergency

15. Pay for Performance
Proposed charge back model
Value Based Purchasing
 1.00 % 2013
 1.25 % 2014
 1.50 % 2015
 1.75 % 2016
 2.00 % 2017

16. FY2013 Measures
Weighted Distribution of Incentive
Payments
Process
Measures HCAHPS
70% 30%
($850 million)

17. 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 $

18. Value Based Purchasing:
FY2014
2nd 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

19. 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

20. Who’s watching ?
 Accreditation organizations
 Consumers
 Administration (your boss / partners)
 Payers
 Private organizations
 Businesses
 Government (CMS / States)
Everybody is watching!

21. A New Day At UTMC

22. Leaving Behind New Culture
Us Centered Culture Patient Centered

23. Staying the Course
Renewed Engaging
Campus-Wide Positive
Patient Work-Environment
Experience
Focus &
Commitment

24. UTMC’s Continuous Journey
Engaging Patient Sustained
Environment Experience Results

25. We have only just begun.
“It’s a two to three year journey.”
Former CEO and Author Mark Scott

26. Building the UTMC House of
Service Excellence

27. Master builders in need of
Engagement

28. Patient, Employee and Physician
Engagement
.70
.76 .73
Physician
Employee
engagement
engagement
Patient
© 2010 Press Ganey
experience Associates, Inc.

29. Key Stakeholders
Patients/Customers
Expect more
Know their options
In charge
Raising the bar
for everyone

30. Key Stakeholders
Employees
Dedicated (50.9%)
Detached (4.0)
Discontented (19.2)
Distanced (29.9)
National Averages
Press Ganey, 2009

31. Key Stakeholders
Employees
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

32. Key Stakeholders
Employees
They feel the organization is meeting
their needs for the basics such as job
security but they’re not emotionally
involved.

33. Key Stakeholders
Employees
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.

34. Key Stakeholders
Employees
These employees feel both dissatisfied
and disengaged and typically will either
exit the organization voluntarily or
worse – stay and create turmoil for
everyone else.

35. Key Stakeholders
Employees
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)

36. Key Stakeholders
Employees
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 organization's potential for rapid
growth.

37. Key Stakeholders
Employees
Re-recruit the Dedicated employees
Engage the Detached and Discontented
employees
Allow the Distanced employees to
pursue other opportunities

38. Key Stakeholders
Physicians
Patient's 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)

39. Key Stakeholders
Physicians
61% of the variability in patient satisfaction is
tied to physician behaviors. 39% is linked to
nursing behaviors.
(Journal of Surgical Education, 2008)

40. Key Stakeholders
Physicians
Actively recruit Champions
Immediately address top physician
concerns
Answer the WIIFM question
Use trials or pilot projects

41. Key Stakeholders
Physicians
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.

42. Laying a strong foundation

43. 2011 State of the Culture
Venues
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

44. Align on Performance
Excellence
Poor performance not
efficiently addressed by
Leaders strongly aware of leadership. Consistent
patient satisfaction rankings; implementation of action
key metrics identified; area plans still a challenge
specific goals set forward
Need for all
Behavioral Standards employees, physicians &
communicated effectively volunteers to adhere to
Behavioral Standards on a
daily basis

45. Select and Retain an Engaged
Workforce
Some staff engagement activities
exist (surveys, town halls, employee
forums) No comprehensive
organization-wide strategy
Effective recognition program into aimed at engaging the
place: Shining Star & U Rock! employee population at large.
Weekly Senior Leadership Physician engagement
Rounding strategy TBD
First organization wide employee
engagement survey completed Dec.
2, 2011

46. Develop and Maintain a
Service Oriented Culture
Consistency lacks with
Patient experience is tracked respect to taking action in
appropriately and order to improve each areas’
consistently communicated patient experience
throughout the house.
Universal Scripts not used
Universal Scripting deployed throughout the house
across the organization
No patient hourly rounding
Some hourly patient rounding leadership accountability.
with a purpose Expected, however its large
impact on the overall pt. exp.
rankings not demonstrated

47. Develop and Maintain a
Service Oriented Culture
Many departments practice
some form of pre-service/ No Universal Standard for
discharge phone calls to conducting such calls
customers
Lack of consistency in
Communication boards are in utilizing such boards
place in many departments
Lack of Universal Tool for
Service Excellence tracking service recovery
Department assists with opportunities
handling of most service
failures.

48. Commit to Leadership
Development
Lessons learned during
Some departmental training
leadership training are
opportunities (retreats, etc)
consistently not shared with
are in place for senior leaders
fellow employees
(managers, directors and
above)
Staff doesn’t not feel
mentored by leaders
iCARE University
Need to establish
accountability for cascade
learning lacking

49. Commit to Leadership
Development
Daily/weekly organization
Daily/weekly communication
communication needs are
not fully aligned with UTMC’s
covered in part (OLT, Daily
Strategic Plan and do not
Huddle, Weekly Line-Up, UT
consistently reinforce the
News)
Behavioral Standards
Best practices are shared
No formal procedure for
between areas and leaders in
sharing best practices
an informal way

50. Hardwire Accountability
Inconsistency of report cards
Some departments and and area specific
leaders utilize monthly report improvement action plans
cards to track performance
and goals Staff evaluations do not have
Patient Experience and
Behavioral Standards goals
incorporated into it

51. Toolbox

52. Why Press Ganey?
© 2010 Press Ganey
Associates, Inc.

53. Allowing us to see
the correlation
between
Financial, Operationa
l, Process, Outcome
and Experience
performance down to
the individual
physician and patient
level in an easy to
use web based
portal.

54. Partners in Improvement
UTMC and Press Ganey
IP, OPSC, ED, Clinics appropriate
surveying positioning
Staff-at-large engagement strategy
Physicians engagement strategy
Skin in-the-game

55. Toolbox
UTMC’s New iCARE University

56. 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

57. 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 well
January 19, 2011

58. 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
40
COMM ABOUT MEDICINES COMM W/ NURSES
20
0
PAIN MANAGEMENT RESPONSE OF HOSP STAFF
Quietness of hospital
COMM W/ DOCTORS
environment
2011 Cleanliness of hospital
environment
2010 (Hospital Compare)

59. All UTMC Service Lines
Large Press Ganey Database
2011 “Standard Overall” Performance
100
Mean 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

60. 2012 Service Excellence Goals
Reach 50th Percentile Nationwide
by December 31, 2012

61. …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

63. Can a Culture be Changed?

64. Culture
Patients
Doctors
CaregiversNurses
Employees

65. Core Hospital
Patient Safety Readmission
HCAHPS Acquired Performance
Indicators Rates Measures Infections
Patient
Safety Experience Quality
Employee, Physician, Resident Experience
CULTURE

66. Sustaining the Walls
Engaging the Master Builders

68. Patient/Customer Engagement Action Team
Establish and maintain UTMC’s
position as “provider of choice”

69. Patient/Customer Engagement Action Team
Pre-service/discharge phone call
process (Inpatient, Clinics)
Universal Service Recovery Program
Service Line Mystery Shopping

70. Physician Engagement Action Team
Establish and maintain UTMC’s
position as the “partner of choice” for
physician practice

71. Physician Engagement Action Team
Physician Engagement Strategy
Physician Performance Scorecard
Physician Communication Protocol

72. Employee Pride & Engagement Action Team
Establish and maintain UTMC’s
position as “employer of choice”

73. Employee Pride & Engagement Action Team
Employee Engagement Strategy (in
partnership with HRTD)
Behaviorally based peer interviewing
Idea generation platform

74. 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)

75. Measurement Action Team
Analyze and communicate patient
experience and internal customers
results to guide service & operational
excellence strategies

76. 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)

77. Culture & Communication Action Team
Facilitate understanding and
enculturation of UT’s
Mission, Vision, Values and Behavioral
Standards through grounded and
balanced communication

78. 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

79. Culture & Communication Action Team
Effectively communicate all ongoing
Service Excellence Action Teams
Initiatives

80. AS Service Excellence Action Team
Effectively differentiate UTMC’s
Ambulatory Surgery as the area’s
“provider of choice”

81. 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)

82. ED Service Excellence Action Team
Deliver a memorable patient experience
within the Emergency Department

83. 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

84. Service Excellence Steering Body
Service Excellence Executive Sponsor

85. UTMC’s New iCARE University

86. UTMC’s new
cultural transformation
center
to turn the
mundane
into the
memorable.

88. The space will be used for
• Patient experience training
• New employee orientation
• Nurses continued education
• Physician/Resident patient
engagement training
• Middle management
development

89. Programming will
evolve in
2012
from technical
training to a
transformational
experience.

90. Personalize Humanize Demystify

91. What is Fish Camp?
Fish Camp welcomes the Freshman class to Texas A&M each year with the purpose of giving them an
opportunity 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 upperclassmen
counselors. Your camp will share a special bond as you spend time getting to know one
another, attending programs that highlight the opportunities and services available on campus and
participating in Aggie Traditions such as Yell Practice, Aggie Muster, and Silver Taps.
Why should I go to Fish Camp?
We'll 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 was
meant 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 the
traditions of Aggieland.

92. The goal is to develop
programming
that is
Transformational
like industry leaders (Disney, The
Ritz-Carlton, Mid-Columbia
Medical Center, and Texas A&M
University).

94. Executing Improvement

95. Servant Leaders Leading Change
When top performing organizations (>85th
percentile) were asked what they could have
handled better, they said…
Accountability

96. Improved Outcomes
Why 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

97. …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

98. 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

99. It begins at the Top
And 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

100. 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.