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Newton-Wellesley Hospital Rising From the Ashes!

Pat Jordan Chief Operating Officer Bentley College June 18, 2009

State of the Union – FY01

•$1M per month loss for 54 months •Total clinical revenue $122M •No capital, no training •Limited patient satisfaction surveying •(39 th percentile - Inpatient) •Employee turnover 20+% •Low morale

State of the Union – FY01

15,000 10,000 5,000 0 -5,000 -10,000 -15,000 -20,000 -25,000 FY 1993 FY 1994 FY 1995 FY 1996 FY 1997 FY 1998 FY 1999 FY 2000 NWH Operating Income

FY01 – 02 Increase Volume

•Financial State-of-Emergency •Capital investment •Grow with Partners affiliation •Consumer image campaign •Maintain focus on quality

Partners Collaborations

Clinical Collaborations Mass General Hospital for Children Breast Center/Breast & Ovarian Cancer Risk Assessment Program Spine Center Joint Center Cardiology (EP and ECHO) Vascular Surgery Thoracic Surgery Obstetrics Maternal Fetal Medicine Gyn Oncology Radiation Oncology Endocrinology General Surgery PET/CT MIGS Assisted Reproductive Medicine Psychiatry Teaching Collaborations: Residency program in Surgery Residency program in Pediatrics Residency program in Medicine Residency program in Anesthesia Residency program in Psychiatry (MGH/McLean) 50+ MGH staff physicians on campus 50+ NWH medical staff training with MGH

NWH Growth

New Emergency Department 4 new Operating Rooms Joint Center Bariatric Center Cancer Center/Radiation Oncology Primary Care Cardiology/Vascular Services UCC New Beds ASC

MetroWest Mt. Auburn NWH St. E’s 10 mi BI N Caritas Norwood

The Market

BIDMC BWH NEMC MGH

FY03 Create Loyalty

•Benchmark with Marriott, RMV, Greenwich •Healthcare Advisory Board •Baptist •Management Team to Pensacola •Connect with Quint •Adopt pillar model/balanced scorecard

FY09 Operating Goals & Objectives

CareFirst Service

Top 5% in Patient Satisfaction.

People Quality/ Safety Finance Growth

Voluntary annual turnover rate of 8% or less.

Employee Survey in Q2 FY09.

Plan for Physician Satisfaction Survey FY10 Achieve a patient fall rate below the NDNQI 25 th percentile Implement EMAP for 75% of licensed inpatient beds by Q1 FY10 Achieve 90 % hand hygiene compliance before and after patient contact Achieve Influenza Vaccine Rates, Q2 FY09 80%- eligible employees 80%- eligible inpatients Ambulatory E-Prescribing of 80% by end of Q4 FY09 Maintain transfers due to lack of beds to 9 or less per month Achieve margin of $12.7M for NWH and Affiliates Meet or exceed performance based Achieve budgeted FY09 volume representing 4% growth in inpatient discharges, and 9% growth in outpatient activity.

contract targets: Recruit 10 PCP’s Achieve 100% of withhold Improve patient Achieve $1.625M savings from operations improvement activities through-put to reduce LOS by 4 hrs without a statistically significant increase in re-admission rates Prepare for COMPASS system implementation in Q1FY10 Build Cancer Center and 24 bed I/P unit to increase bed capacity

CareFirst Service

Inpatient Satisfaction

* Compared to MA Peer Group

87.1

100 90 80 30 20 10 0 70 60 50 40 Press Ganey Quarterly Results Quarter To Date Press Ganey Results 85.8

100 90 80 70 60 50 40 30 20 10 0

CareFirst Service

ED Patient Satisfaction

* Compared to MA Peer Group 87.3

86.3

Press Ganey Quarterly Results Quarter To Date Press Ganey Results

100 90 80 70 30 20 10 0 60 50 40

CareFirst Service

Outpatient Satisfaction

* Compared to AHA Region 1

93.1

92.1

Press Ganey Quarterly Results Quarter To Date Press Ganey Results

100 90 80 20 10 0 70 60 50 40 30

CareFirst Service

Ambulatory Surgery Patient Satisfaction

* Compared to AHA Region 1 93.2

93.9

Press Ganey Quarterly Results Quarter To Date Press Ganey Results

50 40 30 20 10 0 100 90 80 70 60

CareFirst Service

Urgent Care Center Patient Satisfaction

* Compared to All Facility DB 87.1

87.9

Press Ganey Quarterly Results Quarter To Date Press Ganey Results

Service Tactics

Greeter Program Tools & Equipment Scripting in Key Areas Support Cards Service Recovery Discharge Phone Calls Service Operations Committee Service Academy

Support Cards

Support Card

Gina Kline, and Kristy Boyd

Unit Date:

Tanger 4 West 11-Oct-02

Please rate each department on a scale of 1(very poor), 2 (poor), 3 (fair), 4 (good), 5 (very good), or N/A (not applicable) Standard:

Accessibility Timeliness Accuracy Attitude Operations

Can we reach a live person or use an electronic system s tool for reach out?

Response tim e and delivery when prom ised Did we receive the right product or was a variation com m unicated?

Was it a nice experience? Did you receive service with a sm ile?

Day to day operations are run effectively and efficiently?

SHIFT

Day Eve Noc Day Eve Noc Day Eve Noc Day Eve Noc Day Eve

FOOD SERVICES

Kevin O'Connor #57794

SUPPLIES

Charlie Miceli #56584

ENVIRONMENTAL SERVICES

Rudy Viscomi #51460

TRANSPORT

Rudy Viscomi #51460 5 4 5 4 4 4 4 4 N/A 4 3 4 5 4 4 3 3 4 4 4 N/A 4 3 4 5 5 5 3 5 5 5 4 N/A N/A N/A 4 4 5 5 4 4 5 5 4 N/A N/A 5 4 5 5 4 4 5 5 4 4

EQUIPMENT

Rudy Viscomi #51460

BIO-MED ENGINEERING

Charlie Miceli #56584

LINEN

Rudy Viscomi #51460

PHARMACY

Steve Clark #51308

ENGINEERING/MAINTENANCE

Bill Sullivan #57645 4 5 5 5 5 4 N/A N/A 5 5 5 4 N/A N/A N/A 4 5 5 4 5 4 N/A N/A 5 5 5 4 N/A N/A N/A 4 5 5 5 5 4 N/A 5 5 5 4 N/A N/A N/A N/A 4 5 5 5 5 4 N/A 5 5 5 4 N/A N/A N/A N/A 4 5 5 5 5 4 N/A 5 5 5

Comments:

Any score of 1 or 2 should always contain a comment for follow up.

Service Recovery

SOC

Purpose:

Timely review of patient positive/negative comments by all leaders will lead to investigation, service recovery and ultimately service improvement and an increase in patient satisfaction scores

Scope:

All leaders of clinical and support departments Chaired by President of the Hospital

SOC

SOC NAME PHONE POSITIVE COMMENTS SURVEY COMMENT UNIT

(401)780-XXXX (781)237-1648 (508)872-XXXX (508)533-XXXX 280520709 289316175 289317702 289317317 I found *Dr. Keith Isaacson to be very honest and very compassionate. He explained everything - very thoroughly. I am pleased that I chose him and MIGS.

Everything was like "clockwork." *DR. CURTIS AND HIS TEAM were EXCEPTIONAL - efficient, caring and professional.

Everyone I came in contact with was very professional, kind, courteous and knowledgeable ESPECIALLY Reno and Lyn in the radiology dept. MIGS/ART Adult Gi Reno stayed by my side the entire time and was there when I woke up. She was such a comfort to me at a very trying time. She made a BIG difference in my visit. Your entire nursing and volunteer staff is outstanding. Carol in the main Lab was most helpful to me when my scheduling went off track. She made it happen.

I can't say enough about how wonderful Dr. Robinson & his staff are! Dr. Robinson is caring & concerned & I felt confident that he was looking on for both me & my baby.

CT SCAN MFM

SOC

SOC NAME PHON E SURVEY NEGATIVE COMMENTS

(617)308 -XXXX (617)969 -XXXX

COMMENTS

292171147 170510511 The food was not of good quality. It was not very tasty and temperatures were not great. Everything was warm.

Please note, upon entering hospital registration area (8:30 p.m.) I was totally alone found no one for 10 minutes. Person then told me wrong directions & wrong floor to go to: Went back to registration area & had to wait 10 more minutes until someone else finally came & directed me to sleep unit. This should never, ever happen.

150401752 256928543 Bed & furniture were very uncomfortable. Room noise level was constantly high. Impossible to get rest or sound sleep.

The doctors whom stood in for my main doctor, need to rethink there bedside manors. I glad to say that they aren't my doctors & they happen to be women doctors.

(508)234 -XXXX (978)451 -XXXX (978)725 -3855 259349241 230422821 264089872 One nurses' assistant was HORRIBLE - rude, mean-spirited, insensitive - after mentioning it to the regular nurse, she dismissed it as "just being her way." Very unpleasant.

Would've been nice if someone explained how the bed worked & showed me where all the lights were. In the morning I discovered the subtle over-the bed lights that I would've liked to have used the previous night.

Metal staples were used even though I told the doctor of METAL ALLERGY. Got a BAD INFECTION!!

UNIT

Usen 6 NEURO/ ASL Usen 4 Usen 6 Usen 6 5 West 3 West

ASSIGNED TO

Kevin O’Connor Mary Murray Judy Thorpe/ Bill Sullivan Fred Millham/ Priscilla Velardo Priscilla Velardo Mary Ellen Olson Fred Millham

People

Annualized Employee Turnover Rate

12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Annulized Turnover Rate FY09 Mar-09 Apr-09 May-09 FY09 Turnover Goal Jun-09 Jul-09 Aug-09 Sep-09

People Tactics

Thank You Cards 45 & 90 Day Interviews 180 Day President’s Lunch Reward & Recognize Fitness Center Cambridge College EFAP Enhance Employee Orientation Physician & Employee Satisfaction Survey

People Tactics-Employee Survey

- Surveyed in October 2005 (Sperduto) 1205 employees participated in the survey (56% response rate) 73% of employees surveyed showed positive morale – 93d percentile New England - Key areas of strength: NWH image, goals/mission, meaningful work, pride in working at NWH, would recommend NWH as place to get care, value in Partners affiliation

People Tactics-Physician Satisfaction

- Surveyed in June 2006 (Press Ganey) - “Overall facility” scored in the 99 grouping & 99 th th percentile of All Facility in the Community Hospital grouping - “Quality of patient care” scored in the 99 th both grouping percentile for - “Quality of the nursing staff” scored in the 99th percentile in both benchmark groups - “Likelihood of recommending to family & friends” scored in the 99 th percentile

Management Relative Performance Rankings

NAME

5 6 7 1 2 3 4 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38

TITLE

Dept. 1 Dept. 2 Dept. 3 Dept. 4 Dept. 5 Dept. 6 Dept. 7 Dept. 8 Dept. 9 Dept. 10 Dept. 11 Dept. 12 Dept. 13 Dept. 14 Dept. 15 Dept. 16 Dept. 17 Dept. 18 Dept. 19 Dept. 20 Dept. 21 Dept. 22 Dept. 23 Dept. 24 Dept. 25 Dept. 26 Dept. 27 Dept. 28 Dept. 29 Dept. 30 Dept. 31 Dept. 32 Dept. 33 Dept. 34 Dept. 35 Dept. 36 Dept. 37 Dept. 38

DOH

02/11/85 02/25/02 07/16/01 02/10/03 11/25/85 06/28/76 02/11/03 08/01/99 12/03/01 05/13/02 04/22/02 04/24/00 10/21/02 02/16/98 09/09/96 07/05/01 03/26/01 9/20/2004 9/9/2002 03/25/96 07/18/88 10/16/95 11/17/97 06/03/91 05/27/86 04/05/93 01/03/01

Mean Feb-03

2.4

3.0

2.6

2.5

2.0

2.8

2.9

2.5

1.9

2.5

2.5

2.1

2.5

2.1

2.8

2.3

2.1

2.7

2.1

2.6

2.1

2.3

1.6

2.1

07/09/01 08/27/01 1.5

2.0

Mean Nov-03

2.8

2.9

2.3

2.3

1.8

2.7

2.5

2.7

2.3

1.2

2.0

2.6

1.8

2.3

1.5

2.8

1.7

1.8

1.3

2.5

1.7

1.3

1.0

1.3

1.3

RIF RIF 1.4

Mean Jan-05

2.8

2.7

2.7

2.6

2.6

2.6

2.6

2.5

2.5

2.5

2.4

2.3

2.3

2.3

2.3

2.3

2.3

2.3

2.0

1.9

1.9

1.8

1.8

1.7

1.6

1.1

08/31/98 06/13/01 07/26/99 05/29/01 12/09/72 1.9

2.8

2.7

2.0

1.7

PIP 2.4

2.3

RIF RIF

High, Medium, and Low

Attitude Appearance Commitment to Customer Needs Customer Waiting Privacy Safety Awareness Sense of Ownership

Low

(Rarely meets standards)  Points out problems in a  negative way Positions leadership poorly  Thinks they will outlast you

Medium

(Sometimes meets standards)  Loyal most of the time  Influenced by low and high performers  Could just need more experience

High

(Consistently meets standards)  You relax when you know  they are scheduled Good influence on others  Strong sense of ownership

Leader Evaluation

CAREfirst Standards Compassion Attitude Responsibility Excellent & Quality Accomplishment of Goals & Objectives Service People Quality, Regulatory, and Safety Finance Growth Leadership & Management Competencies Practices & promotes ethical behavior Problem solving/Decision-making Leadership Communications & Interpersonal Skills Accountability Vision & Strategic Planning

Leader Evaluation

Leader Report Card

Leadership Institutes

• •

26 LI’s conducted

• •

Invitees include 180 leaders (supervisors and above, including Chief s and Chairs) Quarterly for two day’s and off site Creating a Culture of Service Excellence Roger Dow, Sr. V.P. Marriott Corporation Dan Grabouskas, MA Registrar of MV Largely in house trainers with key note speakers

October 2002 January 2003

The Goal of Champions Jeff Taylor, Founder, Monster.Com

Robin Brown, G.M. Four Seasons Hotel (

May 2003

Balancing Dollars and Sense Barry & Eliot Tatelman, Jordan’s Furniture Kate Walsh, COO, Novartis

External Leader Development

Studer Group

Pensacola Baptist Hospital

Greenwich Hospital

Multidisciplinary teams with executive management

Typically 3 days away

Goal is to train in Service Excellence and re-recruit good employees

Since 2003 we have sent nearly 1,400 trainees to training in places like Pensacola, San Diego, LA, Dallas, Las Vegas, Orlando, etc..

NWH Time-Line

Service

Discharge Phone Calls in Surgery

Infrastructure

Care First, EMT RPR

People

CF Awards, NEO, Cambridge College Masters Program, EFAP

Pre

Purposeful Rounding, Expand PG to Outpatient Arena, Support Cards, Service Recovery Program, Discharge Phone Calls in Inpatient, Greeter Program Service Hotline G&O, LI Leader Report Card, Communication Boards Thank You Cards 45 & 90 Day Interviews, Presidential Lunch Care Teams, OE EE Sat. Survey, Team Awards Peer Bright Idea's, Tool Interviewing Time, Six Sigma 1 Standards of Excellence Leader Eval SOC, Enhanced Leader Rounding, MHQP Satisfaction Survey in Primary Care, Roll-out Discharge Phone Calls to Additional Service for Patient Care Areas, Patients, Enhancements to Service Recovery ST RPR, Empl. Eval, & HML MD Sat Survey, Six Sigma 2, EE Sat Survey, Shipley Fitness Center Outlook Mtg Request Concierge Visitors, EE Bonus Program MD Sat. Survey, CF Service Academy, Lean

FY03 FY04 FY05 FY06 FY07

What Have we Learned?

•Leadership from the top •Focus •Perseverance not brain surgery •Accountability •Start with people •Reward and recognition •Low performers

Financial Results

$15.0

$10.0

$5.0

$0.0

($5.0) ($10.0) ($15.0)

FY99 FY00 FY01 FY02 FY03 FY04 FY04 FY06 Finance - Operating Income (000’s omitted) FY07 FY08 FY09

Outcomes

• Double digit growth-410M in revenue • Gross revenues tripled since FY01 • Market share growth of 6 points • Top 100 Hospital 5 of past 7 years • Consumers Digest Top 50 hospitals for Patient Safety 2005 • BBJ Best Places to Work 2007, 2008

Outcomes

• Patient satisfaction 80th – 95th percentile • Employee Turnover 8% • Employee Satisfaction 93rd percentile • Physician Satisfaction 99th percentile • Highest RN Satisfaction 2,000+ • Partners Quality Close (ex: not a single central line infection for past 18 months) • Unannounced Joint Commission survey eg. Clean, handwashing

Image Impact

100% 100% 2002 2003 2007 2002 2003 2007 80%

76.6% 72.3%

60%

61.3% 55.9% 47.5% 60.0%

40% 20% 0%

TOTAL Core Primary

Unaided Awareness of NWH by Area: 2002 2007 80%

73.5%

60%

49.9% 48.2%

40%

42.5% 52.1% 36.5% 42.4% 35.7% 36.3%

20%

18.8% 22.8% 11.5% 23.0% 22.8% 12.0% 24.3% 31.3% 21.7% 15.8% 22.9% 15.7% 10.8% 30.4% 12.2% 11.0% 15.0% 8.9% 19.5% 12.1% 10.1%

0%

TOTAL Core Primary Re mainde r

Proportion Identifying NWH as Having Best Overall Reputation: 2002-2007

Northe rn We s te rn Northe rn Southe rn

NWH is separated from MGH by a one 10 th of a percent in having the best overall reputation and is number 2 in our service area.

How We Did It

• Goals and Accountability (leader and support cards, session L) • Leadership Development • LI, Service Academy • S.O.C.

• Reward/Recognition • Bonuses, Celebrations, Team Awards • Transparency • Must Haves

What Did We Learn?

• Leadership from the top • Focus • Perseverance not brain surgery • Accountability • Start with people • Reward and recognition • Low performers

Current Focus • Hardwire Service and People • Process Improvement • Action OI • Growth “Get more efficient (current AOI is 18 work”

th

%ile), while maintaining course of making NWH a great place to get care and a great place to