Building A Healthy Work Environment

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Who Is HCA?

• Nation’s leading provider of healthcare services • 182 locally managed hospitals • 94 outpatient surgery centers • Imaging centers • Physician clinics and offices • 22 states, England & Switzerland • Revenues exceeding $24.5 Billion (2005) • Assets of more than $22 billion (2005) • 190,000 employees 2

What are we trying to achieve?



Patient Satisfaction

• Increased Quality & Service • Reduced claims risk 

Physician Satisfaction

• Expanded volumes • Higher revenue

HEALTHCARE PROVIDER OF CHOICE



Employee Engagement

• Stronger retention • Greater productivity • Better place to work

EMPLOYER OF CHOICE

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So How Do We Get There

• Establish High Performance Criteria – Balanced focus • Patient/Physician Satisfaction (Top Quartile) • Productivity/Retention • Financial Indicators (EBDITA, Operating Expense/Adjust Admit) • Employee Engagement Rankings – Consistent or Improving over multiple years • Identify High Performing Facilities Within The System • Research differentiating practices and behaviors 4

Much Lower Turnover 25 23.8

23.5

20 22.4

20.5

18.0

16.6

15 2002 2003 2004 Turnover at HPFs decreased 3.9% while increasing 1.4% at low performers

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Lower levels of risk Higher Patient Safety 45% 55% High Performers 21% 50% 29% Low Medium High Low Performers

Source: HCI – Issues in Review – 2004 & 2005. Risk level determined by and representative of actual

Financial Performance 20.9% 14.8% EBDITA as % of Net Revenue $15m more in average EBDITA per facility

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Higher Engagement Ratio 5.68

1.63

Engagement Ratio

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What We Learned

The basic leadership and workplace behaviors and practices we’ve said for years matter . . . really do impact a hospital’s success.

• External Consultants • Internal OE Team 9

Healthy Work Environment Doing well in these five areas is key to transforming good places to work into GREAT places to work

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Leadership Effectiveness

• • •

Senior Leadership Vision/Direction Distinct leadership styles practiced Leaders available and approachable Clear vision communicated and shared

• • •

Supervisor/Management Coach Work/Life Balance Skills/Career Development

LESSONS

Philosophy that drives decision making and communication Prototype for selection/cultural fit Balance Scorecard Accountability Effective visibility 11

Voice/Communication

• • • •

Two-way communication Willingness to share good and bad news Employee Advisory Groups exist HR is perceived to be employee advocate

LESSONS

Employee Advisory Groups Communication Toolkits No Employment At Will 12

Staffing and Workload

• • • •

Quality drives staffing decisions Resources/Technology support caregivers Selection based on behavioral fit Solid focus on learning and development

LESSONS

Role clarity Management Development Staffing Models 13

Compensation Practices

• • • •

Market competitive pay practices Flexibility is rewarded Understanding of total compensation Fair and equitable rewards

LESSONS

Articulated Philosophy to include market position/communication strategy Leveling Recognition Programs Variable pay practice guidelines 14

Recognition/Service Culture

• Recognition and appreciation occurs formally and informally at all levels • Regular and frequent activities to promote community  Strong standards put patients first, and include family, physicians and colleagues  Physicians take ownership for facility outcomes and accountability for behaviors

LESSONS

Diversity Management Medical Staff Leadership Consultation/Support Community Involvement Programs Longevity/Retention Programs 15

sustainable outcomes

High Performance The #s Culture People

balanced focus

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