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Our Journey to Improved Service Excellence and Outcomes Michael Pulido Chief Human Resources Officer Overview • • • • Why we do what we do Our Journey to Quality - Baldrige Voice Of Customers (VOC) Connection to Purpose Workforce Engagement Customer Engagement Why We Do what we do Heartland Health, St. Joseph, Mo. Heartland is a fully integrated health-care delivery system, located in the heart of America and comprised of four entities: • • • • Heartland Regional Medical Center Heartland Clinic Heartland Foundation Community Health Improvement Solutions Heartland Health, St. Joseph, Mo. To make Heartland Health and our service area the best and safest place in America to receive health care and live a healthy and productive life. Heartland Health’s vision Obesity • 65 percent overweight or obese • School district reports an alarming increase in obesity • Direct connection between poverty and obesity Diabetes • Nine percent of people in St. Joseph live with diabetes • In the under $15,000 bracket, rate soars to nearly 21 percent Smoking 1 out of 4 people in St. Joseph smoke … Under $15,000 income bracket, the smoking rate doubles! Our community needs more than a hospital Social Responsibility Included in Strategic Planning Process • Community health needs assessment • Listen to the voice of the customer because we care Our Solution – Heartland’s Health Pyramid The Foundation of our Health Pyramid EmPower Plant 89 percent of students say they can make a difference The emPower Plant program provides a hands–on experience for students on the brink of adulthood Innovative Solutions Youth Health Partnership • Increase childhood immunizations and well–child exams • Reduce teen pregnancy • Improve oral health care The Health Express The Middle of our Health Pyramid Innovative Programs • Pound Plunge — 12–week, team approach, weight loss challenge • National model for community health improvement events Innovative Partnerships and Solutions Community Health Improvement Solutions’ Wellness Connections program creates health and wellness plans for individual businesses The Tip of our Health Pyramid Quality Care Innovation — putting the needs of the patient first Why Baldrige The First Step • Why we started the journey • How we took the second step Early Approach • • • • CEO support Few key leaders spearheaded efforts Small group assisted Criteria applied gradually Early Learnings • • • • Lack of structure Lagging results Growth focus Leadership change Engaging Others • Excellence in Missouri Foundation • Missouri Quality Award (MQA) • Consultation services • First integrated system application in 1999 • Team application in 2000 The First Wins • Turning point • Missouri Quality Award recipient as an integrated health system in 2000 • HealthGrades Distinguished Hospital Award for Clinical Excellence 2003-2006 • HealthGrades Distinguished Hospital Award for Patient Safety 2006-2009 • Solucient 100 Top Hospitals Cardiovascular 2000, 2004 Later Lessons Learned • Needed to enhance knowledge of the criteria • Trained eight employees as examiners • Learned to use feedback report to address opportunities for improvement • Success with performance improvement/ six sigma Staying the Course • Applied for Malcolm Baldrige National Quality Award in 2003 • Second Missouri Quality Award in 2005 • Small core team approach • 2007 — used the year to address feedback report A Fork in the Road • • • • Changed consultants in 2008 Shifted to more of a team approach Category leads and teams formed Focus on integration and learning Voice of our Customers Leadership System Heartland Health Organizational Architecture Core Competencies VISION (Cat. 1) MISSION (Cat.1) Voice of the Customer (VOC) Customers/Stakeholders (Cat 3) STRATEGY (Cat. 2) Strategies & Improvements (Cat. 2) · Leadership · Strategic Planning · Patient/Customer/ Market Focus · Information & Analysis · Human Resources · Process Management Process Model HC HRMC Service Service ·Manage Workforce Lines Lines ·Provide Exceptional Customer Service ·Enhance Growth ·Deliver Services Process ·Deliver Administrative Services ·Manage Financial Performance (Cat. 6) HC – Heartland Clinic HRMC – Heartland Regional Medical Center CHIS – Community Health Improvement Solutions, formerly Community Health Plan (CHP) HF – Heartland Foundation CHIS Product Lines Performance Scorecards Management Model Strategic Business Assessment (Cat. 2) HF Services Scorecards Balanced Scorecard September 2009 Performance Measurement System (Cat. 4) Performance Results Manage & Improve (Cat. 1 , Cat. 7) Health Pyramid Hospital and Clinic Inpatients Outpatients ER Clinics Community Health Improvement Solutions Members Community Heartland Foundation Community Region Strategic Planning Process 1 • Quality • Financial • Market • Satisfaction 8 2 Review • SWOT • Prioritization Leadership, CEO Leadership, CEO Jul. Aug. Deployment • Communication • LEM Process • Validation Employees and Medical Staff May Budget • Capital • Operating • Human Resources SL, Physicians Mar. 7 SBA Reviews Monthly Quarterly Annually 6 Initiatives SL, Physicians Feb. Strategic Planning Retreats • Vision/Mission/Values • Strategies • SWOT Exercise • Strategic Challenges • Prioritization BOD, Physicians, Leadership, Partners Oct. Long-Term 4 Strategic Plan • Plan Validation • BOD Approval SL, Physicians Dec. 3 Goal Setting • Seek Proposals • Prioritization SL, Physicians Jan. 5 Customer Relationship Model (CRM) Evaluation and Improvement (5) SPP Step 1 (2.1-1) Review customer inputs and analyze processes to refine feedback mechanisms, customer relationship strategies, and action plans (annual/ongoing). Voice of the Customer (2) Listening, Inputs and Methods (3.2-2) Analysis and Decision Making (3) SPP Steps 2-6 (2.1-1) Customer Groups Patients (1) Members Community - Region Deployment of Strategy and Actions Plans (4) SPP Step 8 (2.1-1) (6.1-2) Deploy improvement priorities through the BSC and LEM 90 3.1-1, Customer Relationship day action plans . Management Model Conduct reviews to determine customer requirements and assess if services, processes, and improvements are meeting customer needs. Translate results of analysis into priorities fo r improvement. Customer Groups CRM #1 If it’s important to them, it’s important to us. Voice of the Customer CRM #2 Obtain Services Seek Information • Heartland Clinic • Service Locations – Inpatient, Outpatient, Emergency Department, Urgent Care • Direct contact with staff, physicians and guest services patient representative • Patient orientation and guide to services Make Complaints/ Comments • Patient Advocate • In–person caregiver interaction • Complaint management Analysis and Decision Making CMR #3 • Collect, review and assess voice of the customer data and inputs • Performance improvement Listening to their concerns Deployment Strategy and Plans CRM #4 • 90-Day action plans, Balanced Scorecard (BSC) and goals • Requirements shared with the caregivers, medical staff, board Evaluation and Improvement CRM #5 • Opportunities for improvement • Cycles of improvement Connection to Purpose Workforce Engagement Heartland’s Workforce More than … • 3,300 caregivers • 120 employed physicians • 500 adult and student volunteers Our Aspiration … Creating an engaging workplace culture for our patients to receive care, for our caregivers to work, for our physicians to practice and for our community members to volunteer. Our Caregivers Employees Volunteers Physicians Everyone is a caregiver at Heartland Heartland’s People Plan: Workforce Alignment · · · · ENGAGEMENT OF: Leadership Caregivers Physicians Volunteers · · · · INTEGRATION OF: HRMC HC CHIS HF · · · · · · · ROLE CAPABILITIES Skills Competencies Education Certifications Licensures Essential Requirements Physical capacity · · · · · BEHAVIOR STANDARDS Respect Counts HEART Hear Excellence Appearance Responsibility Teamwork PEOPLE PLAN Aligned to 5 Strategic Priorities SELECTION · Attract workforce members with the “right” combination of capabilities and behaviors · · Orientation and preceptor practices reinforce capability and behavior expectations New workforce members feel engaged and proud · · · Align individual-unit/dept.-organization goals Review results regularly and mitigate issues Track engagement/satisfaction and mitigate issues · · · · · Reduce capability and behavior gaps Ready workforce for innovation and change Build skills for future needs Recognize, retain and grow best performers Provide stretch assignments · · · Reward individual and organization successes Incentivize and reward high performance Leadership and other role succession planning ONBOARDING MEASUREMENT DEVELOPMENT AND LEARNING RECOGNITION AND REWARDS Workforce Strategies Alignment PEOPLE PLAN Aligned to 5 Strategic Priorities SELECTION ONBOARDING Hire the “right” people: a servant’s heart combined with the skills and competencies to achieve our strategic priorities. Engagement begins day one. New caregivers are supported by their leader, colleagues, human resources, education and others Workforce Strategies Alignment PEOPLE PLAN Aligned to 5 Strategic Priorities SELECTION ONBOARDING MEASUREMENT Workforce Strategies Alignment PEOPLE PLAN Development and Learning Aligned to 5 Strategic Priorities SELECTION ONBOARDING • Aligned to Strategic Planning Process • Leadership effectiveness a clear differentiator MEASUREMENT • Formal Education/ Fellowship/LDI/SDI DEVELOPMENT AND LEARNING • Focused on our high performers Behaviors: “HOW You Do It” HEART behaviors lay a foundation for our culture: H – Hear: Voice of the Customer E – Excellence: Life long learning A – Appearance: Creating a positive impression R – Responsibility: Adhering to standards T – Teamwork: Collaborating with others Workforce Strategies Alignment Many ways to reward and recognize: • Competitive benefits/compensation • Sharing Success • Wellness programs (walking the talk) • Touchstone All designed to reinforce Heartland’s strategic priorities and align to Organizational Core Competencies PEOPLE PLAN Aligned to 5 Strategic Priorities SELECTION ONBOARDING MEASUREMENT DEVELOPMENT AND LEARNING RECOGNITION AND REWARDS • This Week At Heartland • Team Huddles • CEO lunches • Unit caregiver meetings • Results review Engagement Communication Methods to Engage Caregivers • Cross-Functional PI Teams • Educational sessions • Leadership meetings • Caregiver/volunteer rounding • Patient rounding Physician Engagement • • • • A key priority Selection of Physician CEO Leadership Structure: Dyads Quality Management Committee – leading quality, PI and capital expenditures • Heartland Clinic Board of Governors & Operational Council • Physician Leadership Development Volunteer Engagement • A critical extension of our workforce • HEART expectations aligned • Assignments based upon organizational “Fit” and interests • Involvement in operational value activities • Patient visitors • Guest Services • Discharge Transport These Linkages translate into these Results: Caregiver Satisfaction Results 90 83 80 70 Percentile 70 60 58 50 HH 40 30 20 10 0 2008 2009 2010 Caregiver Engagement Connection to Purpose – Customer Engagement Customer Engagement • Patient • Member • Community • Region Listening • Rounding • Satisfaction surveys • Community perception survey • Focus groups Voice of the Customer Community Engagement • Health improvement programs • Community forums–summits • Community Alliance • Corporate citizenship • Youth health • Senior health • Employee health Regional Engagement • Heartland Regional Medical Center regional development • Heartland Foundation regional development • Regional electronic medical record • Specialty clinics Customer Satisfaction Results mean score 100 90 80 70 60 50 FY06 FY07 Customer Satisfaction FY08 PG PG = Press Ganey FY09 FY10 YTD Jan PG Baldrige Index Willingness to Recommend 100 mean score 80 60 40 20 0 IP FY06 FY07 OP FY08 FY09 FY10 YTD Jan PG = Press Ganey HC PG PG Baldrige Index What People are Saying About Us “Engaged in the community” “Demonstrates performance excellence” “Provides patient safety” “Best in value” Foster McGaw Award Malcolm Baldrige National Quality Award Lessons Learned • Balance process and customer relationships • Long–term health improvement and illness prevention is the model for health-care reform • It takes a team • Lead with a servant’s heart • What is best for the patient Key Points • Transparency • Benchmark • Develop systems for key processes • Listen & Engage Heartland Health Sharing Days October 7 – 8, 2010 November 11 – 12, 2010 January 13 – 14, 2011 March 3 - 4, 2011 Register at www.heartland-health.com/baldrige