Modern Healthcare's Best Places to Work in Healthcare Conference and Awards Celebration 2014

Chris Van Gorder, CEO of Scripps Health

Opening Keynote Address –

Chris Van Gorder, FACHE, President & CEO, Scripps HealthPast Chairman, American College of Healthcare Executives

Managing Health Care Change Through Front-Line Leadership

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Miss Ellen Browning Scripps Scripps Memorial Hospital & Metabolic Clinic Founded in 1924

Mother Mary Michael Cummings & Sisters Of Mercy Founded St. Joseph’s Hospital, 1890 Named Mercy Hospital in 1924

HISTORICAL LEGACY

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About Scripps Health

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Scripps Coastal Medical Center

Scripps Clinic

Scripps Cardiovascular Institute (2015)

Scripps Hospice & Home Health

Scripps Hospital Campuses

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Not-for-Profit, Integrated Health Care System in San Diego, California

Operating Two of San Diego’s Six Trauma Centers

$2.6 BILLION IN REVENUE

13,500EMPLOYEES

2,600PHYSICIANS

2,000 IN INDEPENDENT PRACTICE

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Tell your stories.Openly share your experiences.

Forge those emotional connections.

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Caring for Miranda Klassen

MAJOR CHANGE INITIATIVES LAUNCHED• Budgets cut — End to employee “Scripps

Shares” — Move to align all physiciansRESULTS IN UNREST• Employees/physicians question leadership• Employee morale/culture at all time low• Quality scores fall; income drops; regular

news coverage; philanthropy suffers• Physicians & Board vote no confidence• May 2000: CEO resigns under pressure• May/June 2000: Van Gorder named CEO

• Long-term CEO retires after 25 years• New CEO named — physician/consultant

October 1999: Van Gorder hired as COO

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Scripps: At the Beginning1

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Fill the information gap.When people have the same information,

they reach similar conclusions.

Physician RelationshipsPHYSICIAN LEADERSHIP CABINET (PLC)

Established 2000 Precursor of co-management approach

100 percent adoption of recommendations

Elected physician leaders

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BUILD CULTURE FROM THE MIDDLE• Not Management 101• Small class sizes; mostly middle management• 12 monthly full-day sessions• Full participation from CEO• Team project/presentation• Behind the scenes – into the inner circle• Executive involvement• No question off-base; complete transparency

Scripps Leadership Academy

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Connect with your people.Share a piece of yourself.

You can’t be effective as a distant boss.

“One of the greatest benefits of all in connecting with the front line is the significance it brings to the work of leadership.

Every day we’re inspired to work even harder to earn their trust. Every day we feel that what we do has meaning.”

• Keep it casual; no entourage• On-site coffee chats• Department visits• Volunteering at events• Participate in staff training• Walk in employees’ shoes

Go to the Front-Line

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Be “situationally” aware.Actively seek to know and understand.

Empathize with others.

From 2001 to 2014, general GPTW score increased 30 points

• Measures primary satisfaction and trust factors: Fairness, Teamwork, Pride, Credibility

• Management accountability• Greater than 90 percent staff participation• Complemented by other surveys and focus groups • Provides base for continued investment in

employees/workplace

Great Place to Work Survey

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“Situational awareness directs your attention away from yourself and all that you are. Your executive

ego seems to evaporate as you put yourself right there with others, empathizing

with their concerns.”

• Ear to the ground• Get a feel for the mood of your organization• Body language• Emails / Open door policy• Influences timing of announcements,

policies, strategic changes

Stay in Touch

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Take care of the “me” first.Provide for your employees.

Give them the freedom to put others first.

Overall employee turnover down to 8.9 percent from more than

30 percent 11 years ago

• Changes driven by open feedback channels/survey and focus groups – investments even in tough times

• No layoff philosophy• Lifecycle approach to benefits• Wellness program• Innovative recruitment programs to attract the “best”• Twice-annual salary reviews • Staged retirement options

Accept Responsibility for Your People

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CENTER FOR LEARNING AND INNOVATION• Applied learning through in-person classes and an online

learning management center• Supports individual employee growth and development• Provides Annual Mandatory Training• Outside learning opportunities• Scholarship programs• Conducts new employee and manager orientations• Classes include:

• Crucial conversations• Project management• Business writing• Time management• Career development

Continuous Learning

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EMERGING LEADERS/MENTORSHIPS• One year, self paced opportunity for

non-management employees to explore leadership

• Paired with mentors for support/guidance• Final capstone project• Includes leadership development courses• First step on leadership ladder

Future Leaders

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EMPLOYEE 100• Engages non-management staff• Follows Leadership Academy model • Exposure to CEO and leadership• Behind-the-scenes explanations

and Q&A• Expected to feed Emerging Leaders

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It’s an all or nothing deal.Responsibility and authority must come

with accountability.

• Everyone has the same seat in your organization• Three legs – all necessary• No one asks for accountability• Be clear about expectations and consequences

Accountability is Worker Friendly

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“A front-line executive who cares about the average worker can’t afford to give a pass on poor managerial performance. If he or she does,

the organization suffers and people lose their jobs.”

RES

PON

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AC

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ILITY

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Leave no one behind.Protect and serve your people by being

their greatest advocate.

• Passport Community Discounts• Corporate Movie and Theatre Nights• Scripps Night at the Ballpark• Parenting, Financial and End of Life Conferences

Work/Life Balance

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“My kids now think I’m the coolest mom because they get to see advance screenings at Scripps movie nights before their friends do.

Thank you Scripps!”

“A job becomes more than a job when people subscribe to an organization’s mission or values and when they feel protected and cared for. It’s not transcendent, soaring rhetoric that

matters, but transcendent acts of kindness, big and small.”

• EAP professionals• One-on-one family care in emergencies• Logistical, planning and financial assistance in crisis• Employee-to-employee help (HOPE)

Employee Assistance & Crisis Team

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INCENTIVES INSPIRE EMPLOYEES TO REACH GOALS• Management Incentive Compensation Program• Non-management

• Up to 8 days additional pay• Funded by achieving corporate financial goals• Distributed based on site patient satisfaction

and productivity goals

Success Shares

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In 2013, Scripps distributed $10.1 million in non-management success shares – $60 million in the past seven years

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Bring your mission to life.Genuine, heartfelt actions speak louder

than words.

“A complex organization can shine when people at all levels demonstrate genuine caring.”

• American Heart Association• Susan B. Komen• YMCA• Business organizations• First Responders

– Fire, Paramedics, Law Enforcement

Community Partnerships

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Corporate Citizenship

Your emails move me to tears, especially

the story about the two girls who were orphaned. The brief

moment they held your hand was probably the first time they

felt comforted after the earthquake. Thank you so much for

our Scripps presence in Haiti. It’s really humbling to see how

much the people have lost and how much we have, yet they

are still so appreciative and joyful.

—AMY ZAMORA, RN, OPERATIONS SUPERVISOR SCRIPPS GREEN

Provides Bonding Opportunities and Sense of Cultural Unity & Pride

SCRIPPS MEDICAL RESPONSE TEAMHurricane Katrina Relief | 2007 San Diego Wildfires | State Mobile Field Hospitals | Haiti Earthquake Relief

http://digital.virtualmarketingpartners.com/vmp/scripps-health/mission-Haiti/index.php#/0

http://www.scripps.org/about-us__scripps-in-the-community__disaster-relief



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Always ask, “What if?”Think long-term and big picture.

Be ready to fall up.

“If you don’t take time to imagine the future, you have no hope of proactively addressing possible threats.”

• Just like the Pentagon – always have a plan• Be ready – plan for the good as well as the bad• What problems might you face?• What opportunities may come your way?

Contingency Planning

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Lead courageously and decisively.Challenge your organization to move past

what’s comfortable.

ENCINITAS GREEN LA JOLLA MERCYMEDICAL

FOUNDATION

One Scripps: Four DivisionsCO

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NEW HORIZONTAL MANAGEMENT STRUCTUREReviews processes and practices across the system

Reduce NON-VALUE ADDED VARIATION

Improve QUALITY

Reduce COST

VALUE = Quality at the lowest cost and highest satisfaction

Create consistent and predictable outcomes and processes across all settings, times and providers to provide value for our patients and other customers

Develop our people to solve problems and improve performance

Engage staff expertise

PATIENT

Standard Work (consistent/reliable)

3636

An Evolution: Value by Design

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The rest of the story...

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Caring for Miranda Klassen

Chris Van Gorder, FACHE, President & CEO, Scripps HealthPast Chairman, American College of Healthcare Executives

Thank you.

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Morning Session - Consolidation to Integration

Maureen McKinney, (Moderator) Editorial Programs Manager, Modern Healthcare

Michael O. Ugwueke, DHA, FACHE, President/Chief Operating Officer, Methodist Le Bonheur Healthcare, President/Chief Executive Officer, Methodist Healthcare Memphis Hospitals

Dr. Lynn Mitchell, MD, MPH Chief Medical Officer and Associate Dean for Clinical Affairs

How Physician and Employee Engagement Lead

to Better Patient Experience Lynn Mitchell, MD, MPH

Chief Medical OfficerOU Physicians / OU Medicine

OU Physicians Overview

• 890 credentialed providers• 1100 employees• 66 clinic locations• 580k visits• $215M annual revenue• AAAHC Accreditation• NCQA PCMH Recognition

Employee Engagement RankingDimension 2014

Top Box Score Rank

Employee Engagement .52 93rd %

Rewarding Work .40 93rd %

Supervision .36 96th %

Growth Opportunities .26 96th %

Personal Relationships .31 96th %

Leaves .49 96th %

Physician Interactions .20 86th %

Workload .17 96th %

Pay .12 90th %

Health Benefits .36 96th %

Job Satisfaction 93rd %

Share a Mission

Pillar Goals

Give Me the Tools/Resources Needed to Succeed

Employee Engagement Toolkit

Contents:

Data interpretation Sharing results Action planning Engaging staff Best practices Staff Evaluation of the

Rollout Process

Employee Engagement Process

Physician Engagement

Physician CoachAIDET® training for

providersNew provider orientationTransparency in reporting

Communicate with Me

Standard CPR Meeting Reports

Reporting Transparency

Acknowledge My Contribution

OUP Employee Incentive Plan

Performance goals are closely aligned with organizational goals.

6-month incentive periods All clinics share the same goals,

aligned with pillars Measurable and transparent

performance goals Monthly and quarterly “progress

reports”

FY 08 FY 09 FY 10 FY 11 FY 12 FY 13 FYTD 140

20

40

60

80

100

8

2834

7269 71

83

Nati

onal

Ran

king

Patient Experience Percentile Rank

* Based on Press Ganey’s National Facilities Database as of 5/30/14

• AIDET® • Rounding• EXCEL Incentive

• Pillar Goals & Alignment• Leader Evaluation Manager® • Monthly Meeting Model • Standards of Behavior

• IPC / Comment Cards• Clinic Visit Summary• Physician Coach

• Accountability Matrix • CPR Meetings• Visit Status Boards

• EE Toolkit• Access to Care -Referral

Tracking

• LEAN • MD

Engagement

Lessons Learned

• Not quick

• Multifactorial

• Common Mission

• Takes the “Team”

• Walk the Talk

Michael Ugwueke, President/COOOctober 23, 2014

Achieving Associate Engagement

Agenda

About Methodist Le Bonheur Healthcare

Associate Feedback Survey Results

How we Got There - the Culture of:• Power of One

• MLH

Nurturing Continual Improvement • Operational Efficiency

• AFS Action Planning

Questions & Discussion

Methodist UniversityBeds: 617

Methodist NorthBeds: 246

Methodist South

Beds: 156

Methodist Olive BranchBeds: 60

Le Bonheur Children’s Beds: 225

Methodist GermantownBed: 309

Methodist Fayette

Beds: 46

SNAPSHOT 2013 Stats

Licensed Beds 1,583

Average Daily Census 996.3

Discharges 63,195

Annual ED Visits 354,555

PSA/SSA Population 1,249,946

Net Revenue $1.5 billion

Active Physicians 1,626

Associates 12,165

Methodist Le Bonheur Healthcare Profile

2013 Payer Mix

2014 Associate Feedback Survey ResultsGoal: Top Decile Performance

Note – National Healthcare Average based on Morehead’s 6 commitment items.

6464

60th

95th 89th

81st

71st

Percentile ranking

Engagement Indicator Items

I would recommend MLH to family members and friends for their medical

care

I would like to be working at MLH three

years from now

I would stay with MLH if offered a similar job

elsewhere for slightly higher pay

I would recommend MLH as a good place to work

I am proud to tell people I work for MLH

Overall, I am a satisfied Associate

How we Got There:The Methodist Culture

ServiceBe of Service

QualityBe High Quality

IntegrityBe a Person of Integrity

TeamworkBe a Team Player

InnovationBe an Innovator

Make a Connection.Listen to Understand Needs.

Honor Commitments.

senn delaney

• Having Effective Conversations

• Be Here Now• Being at your Best• Showing Appreciation

• Levels of Listening• Assume Positive Intent• Understanding

Behavioral Styles

• Focus on “Blue Chips”• Accountability for

Achieving Results• Shadow of a Leader

Nurturing Continual Improvement

Ongoing Cycles of Learning

Seek Associate Feedback

Validate understanding

Develop/ implement solution

Verify satisfactio

n with solution

Communicate actions

taken to workforce

Associate Feedback Via:• 90-day Touch Point meetings

• Associate Feedback Survey

• Town Hall meetings

• Focus Groups

• Ad hoc work groups

• One-on-One meetings

• Open Door Policy

LISTEN to

LEARN

Levels of Associate Engagement

Tier IHighly Engaged

Tier 2Moderately Engaged

Tier 3Disengaged

Use Associate Feedback to Shift to High Engagement

Intensive Leader Coaching and Action Planning

Transition to High Engagement

Deploying Best Practices

Operational Efficiency: AFS ReadinessGoals Result Strengths Weaknesses

2014 AFS Goal:

4.31

Tier 1

4.33

I believe what my supervisor says.

MLH cares about its patients and/or customers.

I like the work I do.

MLH cares about quality improvement.

My supervisor cares about quality improvement.

The environment here makes me want to go beyond what’s expected of me in my job.

Members of my team work well together.

My department is adequately staffed.

My pay is fair compared to other employers.

The amount of job stress I feel is reasonable.

I am satisfied with my benefits

“I am involved in decisions that

affect my work”:

Goal: 3.83 4.02

Turnover Goal:

10.3%

Aug-YTD

9.2%

AFS Action PlanningItem Addressed Action Plan Status

Members of team work well together

- Scheduled quarterly ½ day Teambuilding sessions. - Support form Power of One coaching team.

Scheduled

Department adequately staffed

- Conduct analysis of staffing benchmarks- Share results with team during the November staff

meeting. - Be willing to request additional staff if warranted.

In Progress

Pay and Benefits are fair

- Requested market analysis from HR on pay compared to similar systems in the area.

- Invite HR to November staff meeting for Q&A.

In Progress

Amount of job stress I feel is reasonable

- Focus Group scheduled for December to brainstorm on departmental stressors

- Request Stress Management training from EAP.

Pending

Managing the Engagement Process Share AFS

Results with Team

Team-Driven Action Plan

Pulse Survey to Assess

Effectiveness

Questions

Morning Session - Consolidation to Integration


Michael O. Ugwueke, DHA, FACHE, President/Chief Operating Officer, Methodist Le Bonheur Healthcare, President/Chief Executive Officer, Methodist Healthcare Memphis Hospitals

Dr. Lynn Mitchell, MD, MPH Chief Medical Officer and Associate Dean for Clinical Affairs

12:20 p.m. – 1:20 p.m.: Lunch

Lunch is located in the Rouge Room on the lobby level.

Bill Wooten, Ph.D., Executive Director,

Office of Business Transformation University of Texas MD Anderson Cancer Center

Afternoon Session 1 - Managing the Multi-

Generational Workforce

CONFIDENTIAL

Managing the Multi-Generational Workforce in Complex Healthcare Organizations

Presented by Bill M Wooten, PhD

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The 2020 Workforce

“The Future Isn’t What It Used To Be” – Yogi Berra

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In 2000, A Fairly “Young” World . . .

Under 5% 5% to 12.4% 12.5% to 20% Above 20%

Source: U.S. Census Bureau

Percent of Population Age 60+ 2000

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. . . Rapidly Aging by 2025


Under 5% 5% to 12.4% 12.5% to 20% Above 20%

Percent of Population Age 60+ 2025

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Screeching to a Halt:Growth in the Working-Age Population

Deloitte Research/UN Population Division It’s 2008: Do You Know Where Your Talent Is? Why Acquisition and Retention Strategies Don’t Work

-50%

0%

50%

100%

150%

200%

Mexico Brazil India China South Australia Canada US Netherlands Spain France UK Russia Italy Japan GermanyKorea

1970-2010

2010-2050

91

5% 5%

-9%

18%

48%

15%

-20%

0%

20%

40%

60%

80%

16-24 25-34 35-44 45-54 55-64 65+

Age of Workers

Percent Growth in U.S. Population by Age: 2000-2010

Dramatically Different Patterns of Growth by Age

1. Declining number of mid-career workers

2. Few younger workers entering

3. Rapid growth in the over-55 workforce


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. . . Continuing for Our Working Lives!

Age of Workers

Percent Growth in U.S. Workforce by Age: 2000-2020

7% 8% 7%

-10%

3%

73%

54%

-20%

0%

20%

40%

60%

80%

under 14 15-24 25-34 35-44 45-55 55-64 65+


The Healthcare Workforce of Today and Tomorrow

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http://youtu.be/HPedKi-5k6o

://youtu.be/totMfYaq8O8

What Does the Workplace of the Future Look Like ?



http://youtu.be/totMfYaq8O8

Slow Growth in the Supply of Talent in Key Disciplines

Source: Based on McKinsey Global Institute Labor Supply Database

Growth in the Number of

Life Science Researchers

Boding Critical Shortages in Physicians . . .


Growth in the Number of

Doctors

. . . And Nursing Talent


Growth in the Number

of Nurses

9898

A Serious Skill Mismatch: What’s Ahead in the U.S.?• Over the next decade

– Only 30% of the twenty-year-olds in the U.S. will obtain a college degree

– Over two-thirds of the new jobs created in the U.S. will require a college degree

• Key skill sets will be in critically short supply– The number of students that declared their major in computer

science has declined for the past four years and is now 39% lower than in the fall of 2000

– Other shortages: engineering, sciences, healthcare• A growing number of high school dropouts

– And few high school graduates with solid vocational trainingThe Seventh-Annual Workplace Report, Challenges Facing the American Workplace

Workforce Crisis: Acute in Health Care More than 1 million new and replacement nurses will be needed by 2020, 36 percent below

requirements

Thirty states had shortages of registered nurses (RNs) in the year 2000; by 2020, 44 states and D.C. will have shortages

The RN workforce is expected to grow from 2.71 million in 2012 to 3.24 million in 2022, an increase of 526,800 or 19%

• Though AACN reported a 2.6% enrollment increase in entry-level baccalaureate programs in nursing in 2013, this increase is not sufficient to meet the projected demand for nursing services.

Overall source: American Association of Colleges of Nursing (AACN) Fact Sheet; April 24, 2014

The Coming Crisis: This Century’s Workforce Challenge

Limited availability

Chronologically older

Lacking key skills

Global and virtual

Less interested in “responsibility”

as well as . . .

Highly diverse

Source: U.S. Senate Committee on Health, Education, Labor and Pensions, May 2005

Generational Differences in the Workplace• Today’s workforce is primarily composed of four distinct

generations (with one more that will be in the workplace in the next five years)

• Traditionalists (working past retirement)• Baby Boomers (also working past retirement)• Generation X • Millennials• Gen C (2020)

American Hospital Association Environmental Scan 2011

Source: Based in part on “Meeting the Challenges of Tomorrow's Workplace,” CEO Magazine, 2005

Four generations not only being asked to coexist but to succeed together

The Emerging Workforce Has Different Values

Traditionalist Boomer Generation X

Generation Y

Born 1928-1945Born 1946-1964/5Born 1965/6-1976-80 Born 1980-2000

Workplace Traits Most Attributed to Generations• Traditionalist

• Plan to stay with the organization over the long term

• Respectful of organizational hierarchy• Like structure• Accepting of authority figures in the workplace• Give maximum effort

• Baby Boomers• Give maximum effort• Accepting of authority figures in the workplace• Results driven• Plan to stay with the organization over the

long term• Retain what they learn

Gen Xers• Technologically savvy• Like informality• Learn quickly• Seek work-life balance• Embrace diversity

Gen Yers• Technologically savvy• Like informality• Embrace diversity• Learn quickly• Need supervision

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Generation Nickname Born DuringStereotypically

Known For:Est. % in 2020

Workforce

Traditionalists

The Silent Generation

The Greatest Generation

1925 to 1945

Loyalty, respect for authority, discipline, adherence to rules

1%

Baby BoomersThe Post-War Generation

1946 to 1964

Optimism, innovation, achievement, individualism

22%

Generation X Gen X 1965 to 1980

Autonomy, productivity, recognition, adaptability

20%

Generation Y Millennials 1981 to 2000

Self-expression, comfort w/ change, resilience, global awareness, connected

50%

Generation ZNet GenerationDigital Natives

2000 & after

Technologically savvy, fast-paced, socially connected, creative, collaboration

7%

Myths and Reality• Negative stereotypes and

outdated notions abound for all generations.

• These need to be addressed at all levels in order to create a productive intergenerational organization

Myth: “Millennials are only in it for themselves.”

Reality: The Higher Education Research Institute has surveyed college freshmen and found the highest levels of social concern and responsibility since 1966. In 2006 “the importance of helping others” was the third highest

Myth: “Millennials have a sense of entitlement and want opportunities handed to them.”

Reality: A major survey of U.S. employees revealed that Millennials have an entrepreneurial spirit that makes them self-reliant.

Millennials

Baby BoomersMyth: “Baby Boomers are a selfish “me generation.”

Reality: Baby Boomers want to make contributions to their clients, employers and community. A 2005 study found that 58% of those 50 to 59 are interested in finding work that contributes to the greater good, naming education and social services among their top choices

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Older workers

• Myth: Older workers can’t learn technology.

• Reality: Older adults are willing students when training is done respectfully and in an environment with low stress. A 2005 study found that mature workers were more willing than their younger counterparts to learn new technology.

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Why Focus on Generational Diversity?

• The health care industry will face: • Workforce shortages due to aging employees • More patients living longer due to new treatments and

technology

• This patient and workforce population shift will create a generational gap between older patients and younger health care providers, impacting the care delivered in hospitals.

So what does that mean?

• Continuing presence of Baby Boomers

• Growing presence of Generation X and Millennial workers with different work interests and expectations

• All require more flexibility on the part of the employer


Mixing Generations in the Workplace• We need to attract and retain a younger workforce to work with

and/or be supervised by “older” workers“Need for speed” vs. cautious and measured

“Live and breathe technology” vs. avoidance of technology

“I want you to help me have fun and tell me I’m doing a good job.” vs.

“Just put your head down and do your work!”

“The Generations @ Work” Global Survey Results• Key Findings

• Traditionalists and Boomers are Likely to Be Web Contributors as Millennials Are.

• Boomers and Generation X look for work life/home life balance, while millennials see work as “part of life”

• Millennials and Generation X place a high importance on working for a company that develops both their career and life skills.

• Millennials are likely to select an employer based on the ability to access the latest tools and technologies at work.

• Both Traditionalists and Boomers place high importance on a manager who understands age diversity in the workplace.

Source: “The 2020 Workplace” – Meister & Willyerd, 2010

What’s Driving Change?

Examples• Aging population requires ongoing care for chronic conditions – higher

volume, longer care

• Increased demand for out-patient and at-home services

• Goal = hospitalization as last resort

• Payments will include incentives to achieve defined thresholds of quality

• Penalties for unintended complications, poor outcomes, and/or excessive variation from clinical guidelines


Workforce Skills of

The Future

Basic Skills for Tomorrow’s Health Care Workforce

Same as today…

• Customer Service• Problem-Solving• Teamwork• Critical Thinking• Math and Science• Reading Comprehension• Writing Skills• Interpersonal Communication


New Skills for Tomorrow’s Workforce• Business Acumen

• Ability to manage resources (time, money, people)• Lean / Six Sigma

• Innovation: willingness and capacity for rapid and continuing change

• Ability to work across generations

New Skills for Tomorrow’s Workforce

• Cultural competency

• Patient- and family-focused

• Service orientation

• Proficient in technology

• Comfortable practicing health care outside of acute care setting

Workforce Needs of the Future

• Heavy emphasis on Bachelor level and above:• Nurses• Medical Technologists• Physical Therapists• Occupational Therapists• Health Information Technology

professionals

Cost and Benefit of Managing Generational Diversity• A generationally diverse workforce can influence organizational

culture and ultimately affect the care delivered in hospitals. • Organizations that effectively manage a diverse

workforce will: • Thrive with a steady and able labor force • Perform optimally in clinical outcomes and patient experience

• Organizations that fail to effectively manage a diverse workforce will: • Experience high employee turnover • Pay higher costs for recruitment, training and retention • Have lower patient satisfaction scores and worse clinical

outcomes.

Establishing Effective Generational Management Practices• Customize management and communication styles

• A “one-size-fits-all” approach to managing and communicating is not effective with four generations in the workforce.

• Leverage employee strengths • Understanding the different skills and strengths of each generation can help

managers and supervisors create effective teams. • Tailor recognition and rewards

• Each generation expects to be rewarded differently, not just in terms of compensation, but also in terms of recognition at the end of a successful project or acknowledgment of ideas.

• Encourage collaboration • Social interaction increases collaboration in the workplace.

Regional Care SystemOrganization Charts

Regional Oncology Network MapSugarland

Katy

Woodlands

Bay AreaMain Campus

Getting things Done Often Depends Less on Formal Structure than on an Informal Network of Colleagues

RCS Formal Structure Informal Structure

Success depends less on reporting structure and more on an information web of contacts

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Generational Differences

All Generations

2000/2001-New Silent Generation or Generation Z1980-2000 - Millennials or Generation Y1965-1979 - Generation X1946-1964 - Baby Boom1925-1945 – Traditionalist/Silent Generation

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Boomers & Gen X

2000/2001- New Silent Generation or Generation Z1980-2000 - Millennials or Generation Y1965-1979 - Generation X1946-1964 - Baby Boomer1925-1945 – Traditionalist/Silent Generation

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Boomer

2000/2001- New Silent Generation or Generation Z or C1980-2000 - Millennials or Generation Y1965-1979 - Generation X1946-1964 - Baby Boomer1925-1945 – Traditionalist/Silent Generation

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Gen X

2000/2001- New Silent Generation or Generation Z1980-2000 - Millennials or Generation Y1965-1979 - Generation X1946-1964 - Baby Boom1925-1945 – Traditionalist/Silent Generation

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Gen Y

2000/2001- New Silent Generation or Generation Z1980-2000 - Millennials or Generation Y1965-1979 - Generation X1946-1964 - Baby Boom1925-1945 – Traditionalist/Silent Generation

Attract, Retain, and Engage the Future Workforce: Prepare to Turn Every Stone

Retire “retirement”

Create bell-shaped career paths

Design cyclic work

Accommodate blended lives

Recruit at multiple entry points

Invest in development

Offer lateral career opportunities

Engage hearts and minds

In closing• All generations have similar values. The most striking result of the research is how similar the

generations are in the values that matter most• Family is listed as the top priority for all of the generations• Everyone wants respect. All workers want respect, but the generations don’t define it in the same

way. In the study, older individuals talked about respect in terms of “giving my opinions the weight I believe they deserve,” while younger respondents characterized respect as “listen to me; pay attention to what I have to say.”

• Leaders must be trustworthy. All workers want leaders they can trust.• No one really likes change. People of all generations are uncomfortable with change. It has less to

do with age but rather how much people stand to gain or lose as a result of the change.• Everyone wants to learn. Learning and development opportunities were important for all

generations.• Everyone likes feedback. Everyone want to know how they are doing and how to improve through

learning and training opportunities.• Finally, generations adjacent to one another may share more similarities than those that are two or

more generations removed.

http://youtu.be/C4LbAUa4ZwY

Are we ready for delivering healthcare in 2025

http://youtu.be/C4LbAUa4ZwY

CONFIDENTIAL

Managing the Multi-Generational Workforce in Complex Healthcare Organizations

Presented by Bill M Wooten, PhD

Thank You!

Afternoon Session 2 –Where Does Employee Wellness Fit In?


Daniel Timblin, President and Chief Executive Officer Onlife Health, wellness unit of BlueCross BlueShield of Tennessee

Gerald Barbini, President and Chief Executive Officer, Allegan General Hospital

Ray Kendrick, Senior V.P. Human Resources and Chief Diversity Officer, Memorial Healthcare System

The Role of Employee WellnessOCTOBER 23, 2014

The Role of Employee Wellness

Gerald J. Barbini, MSW, MBA,President and CEOAllegan General Hospital, Allegan, Mich.


Ray KendrickSenior Vice President of Human Resources and Chief Diversity OfficerMemorial Healthcare, Hollywood, Fla.


Daniel TimblinPresident and Chief Executive OfficerOnlife Health, wellness unit of BlueCross BlueShield of Tennessee


Financial incentives Promoting a culture of wellness Measurement Link to higher productivity and improved morale Targeting high-risk employees Flexible approach Link to better care for patients? Reduced costs

Afternoon Session 2 –Where Does Employee Wellness Fit In?


Daniel Timblin, President and Chief Executive Officer Onlife Health, wellness unit of BlueCross BlueShield of Tennessee

Gerald Barbini, President and Chief Executive Officer, Allegan General Hospital

Ray Kendrick, Senior V.P. Human Resources and Chief Diversity Officer, Memorial Healthcare System

Dr. Gerald HicksonSenior Vice President for Quality,

Safety and Risk Prevention, and Assistant Vice Chancellor for Health Affairs

Vanderbilt University Medical Center

Organization Culture – Promoting Professional

Behavior

Addressing Behaviors that Undermine a Culture of Safety

Gerald B. Hickson, MDSr. Vice President for Quality, Safety and Risk Prevention

Assistant Vice Chancellor for Health AffairsJoseph C. Ross Chair in Medical Education & Administration

Vanderbilt University Medical Center

Bullying and Intimidation in the Healthcare Workplace - a Patient Safety Issue

An environment of mutual respect and teamwork.

A workforce that feels valued, safe from harm, and part of solutions for change.

Lucian Leape Institute 2013; Through the Eyes of the Workforce – Creating Joy, Meaning, and Safer Health Care

And safe to speak about and report errors, mistakes, and hazards that threaten safety.

Essential Elements

Joy, Meaning and Safety

Definition: “Failure free operation over time… effective, efficient, timely, pt-centered, equitable”

Requires: Vision/goals/core values Leadership/authority (modeled) A safety culture = willingness to report and address

• Psychological safety• Trust

Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001; Nolan et al. Improving the Reliability of Health Care. IHI Innovation Series. Boston: Institute for Healthcare Improvement; 2004; Hickson et al. Chapter 1: Balancing systems and individual accountability in a safety culture. In: Berman S., ed. From Front Office to Front Line. 2nd ed. Oakbrook Terrace, IL: Joint Commission Resources;2012:1-36.

Pursuing Reliability

The following event was reported to you (responsible party) through an event reporting system.

A patient is scheduled for a procedure. Nurse notes a hole in an instrument wrapper, deems the contents potentially contaminated and requests another scope.

Case: Contaminated Scope

All scope trays are in use. A greater search finds another scope. It appears to have been removed from processor.

Brought to room and used.

Chemical indicator is unchanged. Scope had been decontaminated but not placed in processor. Scope was potentially contaminated.

Infectious Disease…a low risk of transmittable disease.


Time Pressures: Case was in progress and waiting on the availability of a scope.

Human Error: Leader provided the tray= automatic trust, versus standard verification process.

Environmental: Work area with increased clinical volume of patients.

Equipment: Key component of (scope) tray limited, which adds production pressure.

Event Analysis Conducted


It turns out the same nursing professional was involved in a similar slip 3 months ago…

So within the concept of a just culture, what is our duty to the health system and those it serves and to the nursing professional?


Reason, J., Managing the Risks of Organizational Accidents

Decision Tree for Determining Culpability of Unsafe Acts

1. No action needed 2. Ask to reflect on

performance3. Be assigned training4. Assigned training and a

reprimand for file5. Dismiss6. Something else

1. 2. 3. 4. 5. 6.

0% 0% 0%0%0%0%

What consequences for the nursing professional?

Let’s consider another event.

Dr. XX was performing a transverse colon resection. At the appropriate point in surgery, circulating nurse stated, “Dr. XX you need to re-gown and glove per our colo-rectal bundle”.

Dr. XX stopped, stared at the nurse, then continued the procedure without a new gown and gloves.

Case: Disapproving Stare

1. Strongly Agree2. Agree3. Uncertain4. Disagree5. Strongly Disagree

1. 2. 3. 4. 5.

0% 0% 0%0%0%

Represents a threat to safety?

1. 0%-20%2. 20%-40%3. 40%-60%4. 60%-80%5. 80%-100%

1. 2. 3. 4. 5.

0% 0% 0%0%0%

What % of the time would someone report the event to a responsible party or through an established event reporting system?

1. 0%-20%2. 20%-40%3. 40%-60%4. 60%-80%5. 80%-100%

1. 2. 3. 4. 5.

0% 0% 0%0%0%

If reported, what % of the time would a medical leader have a conversation with Dr. X?

What arebehaviors that undermine

a culture of safety?


Interfere with abilityto achieve intended outcomes

Excerpts from Vanderbilt University and Medical Center Policy #HR-027, 2010

Create intimidating, hostile, offensive (unsafe) work environment

Threaten safety (aggressive or violent physical actions)

Violate policies (including conflicts of interest and compliance)

It’s About Safety

Definition of Behaviors That Undermine a Culture of Safety

What barriers exist?vs.

Why bother acting?

Why are we so hesitant to act?

LawsuitsNon adherence/ noncompliance

Consequences of Unsafe Behavior: Patient Perspective

Drop out

(tip of the iceberg)

Infections/ Errors

Bad-mouthing the hospital/ practice to others

Costs

Felps W, et al. How, when, and why bad apples spoil the barrel: negative group members and dysfunctional groups., Research and Organizational Behavior. 2006; 27:175-222.

SurgicalComplication

Consequences of Unsafe Behavior: Healthcare Professional Perspective

Felps W, et al. How, when, and why bad apples spoil the barrel: negative group members and dysfunctional groups., Research and Organizational Behavior. 2006; 27:175-222.

Harassment suits

Jousting

Burnout

(tip of the iceberg)Lack of retention

Infections/ Errors

Costs

Bad-mouthing the organization in the community

According to AONE, the real cost of replacing a medical/surgical nurse is $42,000 and $64,000 for a specialty nurse.

In the United States it is estimated that employers spend in excess of $300,00 per year in nurse turnover costs for every 1% increase in turnover rates

Pricewaterhouse Coopers Health Research Institute. What works: healing the healthcare staffing shortage. Updated 2007.

What is the yearly cost of replacing nursing professionals due to behavior?

Respect, trust and team performance

Our latest work: Patient Complaints & Surgical

Outcomes

Dr. __ did a very poor job of communicating. He raced through an explanation of what we should expect, then left without giving us a chance to get clarification.

RespectfulDr. __ didn’t listen to me. Dr. __ interrupted me while I was explaining my symptoms and said, “I got it. I already know all about patients like you…”

Clear and Effective Communication

Patient Complaints

Question: Do Periop Risk Factors moderate the relationship between Patient Complaints and Surgical Outcomes?

NSQIP and Patient Complaints

• 66 surgeons; 10,536 procedures• Correlations between pt complaints and occurrences:

Occurrences Correlation with Patient Complaints

Intraoperative 0.58, p<.001Wound 0.60, p<.001Urinary 0.61, p<.001

Respiratory 0.59, p<.001Other 0.55, p<.001

The relationship is moderated by perioperative risk

Results: Significant relationships between Occurrences & Complaints

*Wound depicted, same pattern for Urinary, Intraoperative, and Respiratory Occurrences Analysis controls for # cases sampled. Catron, Guillamondegui et al. Submitted, 2014

Patient Complaints Moderate the Relationship Between Risk Factors and Surgical Outcomes *

Fewer # Pt Complaints Greater # Pt Complaints

Do nothing Do something

Staff satisfaction and retention

Reputation

Patient safety, clinical outcomes

Liability, risk mgmt costsFear of antagonizing

Leaders “blink”

Not sure how lack tools, training

Competing priorities

“Can’t change…”

Studer Group and Vanderbilt Center for Patient and Professional Advocacy, Unprofessional Behavior in Healthcare Study, June 2009; Hickson GB, Pichert JW. Disclosure and apology. In: National Patient Safety Foundation Stand Up for Patient Safety Resource Guide, 2008; Pichert JW, Hickson GB, Vincent C: Communicating about unexpected outcomes and errors. In: Carayon P, ed. Handbook of Human Factors and Ergonomics in Healthcare and Patient Safety, 2007.

The Balance Beam

To “do something” requires more than a commitment to professionalism and personal

courage.

It requires a plan(people, process and technology).


Key Factors Domains

People

Committed leadership, modeled authority

Dedicated project champions

Engaged implementation team(s)

Policies and Procedures

Clearly articulated organizational values, aligned goals

Enforceable policies, procedures tied to expectations

Sufficient and right resources to achieve goals

Model for interventions

Performance Data & Reviews

Robust measurement, surveillance tools, data

Processes for thoughtful, reliable data reviews

Multi-level training about philosophy, skills, accountability

Critical Elements

Policies will not work if behaviors that undermine a culture of

safety go unobserved, unreported and unaddressed


Hand Hygiene

Performance

Hickson GB, Moore IN, Pichert JW, Benegas Jr M. Chapter 1: Balancing systems and individual accountability in a safety culture. In: Berman S, ed. From Front Office to Front Line. 2nd ed. Oakbrook Terrace, IL: Joint Commission Resources;2012:1-36.

Staff Concerns

Risk Event Reporting

System

Patient Relations

Department

What Are “Surveillance Tools”?

Confidential and privileged information under the provisions set forth in T.C.A. §§ 63-1-150 and 68-11-272; not be disclosed to unauthorized persons.

Called Dr. __ re: patient status change …came 25 min later, glanced at patient, yelled publicly, “You lied… patient is okay… don’t call again.”…patient suffered…I felt threatened.

MD refused to do a time out before surgery, …. said, “We’re all on the same page here.”

Dr. __ was making personal calls (appt for massage) …had sick pts…needed orders…I asked for Dr. __’s help… “They can wait…,” …families overheard.

Staff Professionalism Concerns

Co-Worker Observation Reporting System:VUMC Physicians – 3 years


Promoting Professionalism Pyramid

Adapted from Hickson, Pichert, Webb, Gabbe. Acad Med. 2007.©2014 Vanderbilt Center for Patient and Professional Advocacy

Improves physicians’ prescribing, clinical decision making1

Reducing malpractice claims and expenses: By greater than 70%2

Improving hand hygiene practices:From 50% to greater than 95% compliance3

Addressing behaviors that undermine a culture of safety4

1Schaffner W, et al. JAMA 1983;250:1728-1732; Ray WA, et al. Am J Public Health 1987;77:1448-1450; Greco PJ, Eisenberg JM. New Engl J Med 1993;329:1271-12732Hickson et al. JAMA. 2002;287(22):2951-57; Hickson et al. South Med J. 2007;100(8):791-6; Pichert et al. In: Henriksen et al, editors. AHRQ; 2008: 421-30; Hickson & Pichert. In: Youngberg, editor. Jones and Bartlett Publishers; 2012: 347-68; Pichert et al. Jt Comm J Qual Patient Saf. 2013;39(10):435-46. 3Talbot et al. Infect Control Hosp Epidemiol. 2013; 34: 1129-364Dmochowski et al. Manuscript in preparation, 2014

Does any of this really work?

Now back to our Nursing Colleague…

The following event was reported to you (responsible party) through an event reporting system.

The same nursing professional is involved in a third incident, this time involving a misplaced instrument in the operating room.

Case: A Third Report

1. 2. 3. 4. 5. 6.

0% 0% 0%0%0%0%

What consequences for the nursing professional?

1. No action needed 2. Ask to reflect on

performance3. Be assigned training4. Assigned training and a

reprimand for file5. Dismiss6. Something else

So what if Dr. Surgeon was working with Nurse X every

time a slip occurred?

Co-Worker Observation Reporting System:VUMC Physicians – 3 years


Do you want to reconsider your response to Nurse X’s third slip?

You can’t pursue joy and meaning, safety and reliability or a just

culture without a commitment to address behaviors that undermine

a culture of safety…

and that pursuit means holding all professionals accountable

regardless of rank or status

Professionals commit to:• Technical and cognitive competence

Professionals also commit to:• Clear and effective communication• Modeling respect• Being available• “Self awareness”

Professionalism promotes teamwork Professionalism demands self and group regulation You have a critical role

Hickson GB, Moore IN, Pichert JW, Benegas Jr M. Balancing systems and individual accountability in a safety culture. In: Berman S, ed. From Front Office to Front Line. 2nd ed. Oakbrook Terrace, IL: Joint Commission Resources;2012:1-36.

Professionalism and Self-Regulation

Now or Later

www.mc.vanderbilt.edu/cppa

Let Us Hear Your Comments and Questions