Bold, Innovative Leadership; Achieving Results, while igniting pride and passion in its people JUNE 3, 2014

CCHL BOLD LEADERSHIP CONFERENCE

BANFF, ALBERTA

Panelists Eric Hanna oPresident & Chief Executive Officer, Arnprior Regional Health

Ron Gagnon oPresident & Chief Executive Officer, Sault Area Hospital

Janice Skot oPresident & Chief Executive Officer, Royal Victoria Regional Health Centre

Gino Picciano o CCHL Board Member & Healthcare Consultant

What keeps you up at night? 1. Finances

2. Safe, Quality, Reliable Care

3. Staff Safety

4. Staff Engagement

5. Physician Engagement

6. Patient Experience

7. Alignment of Priorities

8. Management Strength/Consistency

9. All of the Above

10. Are there others?

Given these “stay awake” items…..

VIDEO TO INSERT HERE………………

Dryden Regional Dryden

Sault Area Hospital Sault St.Marie

Arnprior Regional Arnprior

Ottawa Hospital Ottawa

Montfort Hospital Ottawa

St. Joseph Health Care London London

Hanover and District Hanover

RVH Barrie

Headwaters Health Orangeville

Trillium Health Mississauga

Alexandria Marine and General Hospital Goderich

6

This is My Why….

7

SAH Overview

300 bed community hospital providing primary, secondary and limited tertiary care, oncology and renal services for district

First ever satellite radiation treatment suite

120,000 people in catchment area (Algoma district)

1,900 staff, 130 physicians and 450+ volunteers

$230 Million top line

Successful Foundation

Call to Action

CEO released Quality issues Morale is poor Staff safety is a

concern Patient and families

are not happy Confidence is down Reputation is ? Deficits are growing New hospital on the

horizon

Our Journey… 2007 Studer partnership began

Senior Leader, Board, MAC and Manager learning

Focused goals and alignment

Implementation and associated challenges

Ongoing monitoring, coaching and tools

Partnered with other Studer hospitals to learn, share and improve

Rebranding to “own” - Strategy

Seeing results

First Canadian Partner

Execution Framework Evidence-Based LeadershipSM

Standardization Accelerators Must

Haves®

Performance

Gap

Objective

Evaluation

System

Leader

Development

Foundation

STUDER GROUP®:

Agreed upon tactics and behaviours to achieve goals, such as:

Rounding for outcomes

Stop Light Reports

Huddles

Thank you notes

Monthly meeting model

AIDET®

Hourly Rounding®

Re-recruit high and middle performers

Move low performers up or out

Processes that are consistent and standardized

Standard meeting agendas

Process Improvement

CQI TQM LEAN

IT/IS

Continuum of Care

Care Redesign

Transformation

Aligned Goals Aligned Behaviour Aligned Process

Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results

Implement an organization-wide staff/ leadership evaluation system to hardwire objective accountability (Must Haves®)

Alignment and Focus

Inputs to 2013/14 Corporate Targets

Strategic PlanCurrent performance

HIP & PR+ +

Please do not edit or modify provided text in Columns A, B & C

AIM MEASURE CHANGE Quality

dimension Objective Outcome Measure/Indicator

Current

performance

Performance

goal 2011/12 Priority Improvement initiative

Methods and results

tracking Target for 2011/12 Target justification Comments

Safety 1)

2)

… N)

1)

2)

… N)

1)

2)

… N)

1)

2)

… N)

1)

2)

… N)

1)

2)

… N)

Space for additional

indicators

Effectiveness 1)

2)

… N)

1)

2)

… N)

1)

2)

… N)

Improve organizational

financial health

Total Margin (consolidated): Percent by which total corporate (consolidated) revenues exceed or fall short

of total corporate (consolidated) expense, excluding the impact of facility amortization, in a given year. Q3

2010/11, OHRSSpace for additional

indicators

Access 1)

2)

… N)

1)

2)

… N)

Space for additional

indicators

Patient-centred Please choose the question that is relevant to your hospital: 1)

NRC Picker / HCAPHS: "Would you recommend this hospital to your friends and family?" (add together

percent of those who responded "Definitely Yes")

2)

In-house survey (if available): provide the percent response to a summary question such as the "Willingness

of patients to recommend the hospital to friends or family" (Please list the question and the range of

possible responses when you return the QIP)

… N)

Space for additional

indicators

Improve patient satisfaction

Reduce clostridium difficile

associated diseases (CDI)

Reduce unnecessary hospital

readmission

Reduce unnecessary deaths in

hospitals

Reduce unecessary time spent

in acute care

Reduce incidence of Ventilator

Associated Pnemonia (VAP)

HSMR: number of observed deaths/number of expected deaths x 100 - FY 2009/10, CIHI

Improve provider hand

hygiene compliance

Hand hygiene compliance before patient contact: The number of times that hand hygiene was performed

before initial patient contact divided by the number of observed hand hygiene indications for before initial

patient contact multiplied by 100 - 2009/10, consistent with publicly reportable patient safety data

Avoid falls Falls: Percent of complex continuing care residents who do not have a recent prior history of falling, but fell

in the last 90 days - FY 2009/10, CCRS

Reduce rate of central line

blood stream infections

Rate of central line blood stream infections per 1,000 central line days: total number of newly diagnosed

CLI cases in the ICU after at least 48 hours of being placed on a central line, divided by the number of

central line days in that reporting period, multiplied by 1,000 - Average for Jan-Dec. 2010, consistent with

publicly reportable patient safety data

Avoid new pressure ulcers

ER Wait times: 90th Percentile ER length of stay for Admitted patients. Q3 2010/11, NACRS, CIHI

Readmission within 30 days for selected CMGs to any facility: The number of patients with specified CMGs

readmitted to any facility for non-elective inpatient care within 30 days of discharge, compared to the

number of expected non-elective readmissions - Q1 2010/11, DAD, CIHI

Percentage ALC days: Total number of inpatient days designated as ALC, divided by the total number of

inpatient days. Q2 2010/11, DAD, CIHI

CDI rate per 1,000 patient days: Number of patients newly diagnosed with hospital-acquired CDI, divided by

the number of patient days in that month, multiplied by 1,000 - Average for Jan-Dec. 2010, consistent with

publicly reportable patient safety data

Reduce wait times in the ED

ER Wait times: 90th percentile ER Length of Stay for Complex conditions. Q3 2010/11, NACRS, CIHI

Pressure Ulcers: Percent of complex continuing care residents with new pressure ulcer in the last three

months (stage 2 or higher) - FY 2009/10, CCRS

VAP rate per 1,000 ventilator days: the total number of newly diagnosed VAP cases in the ICU after at least

48 hours of mechanical ventilation, divided by the number of ventilator days in that reporting period,

multiplied by 1,000 - Average for Jan-Dec. 2010, consistent with publicly reportable patient safety data

QIP

+ Provincial &

LHIN context=

2013/14 Goals

• Reduce Total conservable days by

12% to 16,476 days (20%)

• Hand Hygiene compliance (all

moments) of 100% by March 31,

2013 and 80% for entire year (10%)

• Reduce Severe and Critical events

by 26% to 22 or less (5%)

•HSMR <= 94 for last 4 quarters

• Unplanned readmits <= 14%

• Increase Employee

Engagement by 10% to

66.2% (10%)

• Increase Physician

Engagement by 10% to

65.7% (10%)

•Reduce New Lost time

days to 282 or less

•Improve Patient satisfaction to

94% (5%)

•Meet provincial target for

wait times x% of the time:

- ED 90% (10%)

- Surgical 82% (5%)

- DI 88% (5%)

• Total Margin >= 0.8%

($1.5 M) (20%)

•LEAN projects and ROI

Quality

35%

People

20%

Service

25%

Partnerships

Operational

Efficiency

20%

2013/14 Goals (Draft)

• Patient Experience as measured by

% Excellent (20%)

• Conservable Days (10%)

• ED Throughput Times (10%)

• Overall rating of care

• HSMR ≤ 94 for last 4 quarters

• Unplanned readmits ≤ 14%

• Employee Experience

(15%)

• Physician Experience

(15%)

• Partner/community

engagement measure (15%)

• Total Margin ≥ 0.8%

($1.5 M) (15%)

• LEAN Projects and ROI

Quality &

Service

40%

People

30%

Partnerships

15%

Patients & Families

Operational

Efficiency

15%

2013/14 Targets

• Improve Patient Experience as

measured by % Excellent Score by

9.5% to a rate of 45% (20%)

• Reduce Conservable Days by 4%

to 18,630 days (10%)

• Improve ED Throughput Times by

6% to meet Provincial Targets 93%

of the time (10%)

• Overall rating of care by patients of

> 94%

• HSMR ≤ 89 for last 4 quarters

• Improve Employee

Experience by 5 to 10

points (15%)

• Physician Experience

by 5 to 10 points (15%)

• Reduce unplanned

readmission rate for selected

CMGs by 15% to a rate of

15.40% (15%)

• Total Operating Margin

≥ 0.8% ($1.5 M) (15%)

• LEAN Projects and ROI

Quality &

Service

40%

People

30%

Partnerships

15%

Patients & Families

Operational

Efficiency

15%

From Board to front line

Other tools and behaviour

Leader Evaluation Manager®

Rounding with purpose

AIDET/Key Words at Key Times

PDCA

Values based (Ownership)

Vision

To be recognized as the best hospital in Canada and an active partner in the best community health care system in the country

16

Mission

Exceptional people working together to provide outstanding care in Algoma

For Our Patients… Patient satisfaction – now focused on % Excellent!

84.0

85.0

86.0

87.0

88.0

89.0

90.0

91.0

92.0

93.0

94.0

95.0

Baseline 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14*

1

1.5

2

2.5

3

3.5

4

4.5

5

5.5

6

2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14*

For Our Patients…

MRI wait times among SHORTEST in the Province!

ED throughput times reduced 54%!

For Our Patients… HSMR - continual improvement in Quality

60

70

80

90

100

110

120

130

2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

For Our Patients…reduced infections

HAI down 68% from baseline

C. Diff down 89% Cost avoided/saved

$7.2 MILLION*

* Public Health Agency of Canada website. $13,973 per HAI (1999/2000)

For Our Patients…High Quality Hospital

Accreditation With Commendation in 2013

98.2% achievement on over 2,000 standards

Ontario Lab Accreditation in October 2013

97% compliance, including 100% Point of Care Testing

20

25

30

35

40

45

50

55

60

Baseline Now

20

30

40

50

60

70

80

Baseline Now

For Our People… Employee – overall satisfaction

with organization.

Up 46%

Physician – overall satisfaction as a place to practice.

Up 67%!

0

10

20

30

40

50

60

70

2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14

For Our People… Lost time injuries reduced by 81%! First ever NEER Rebate.

$7.9 MILLION+

saved*

*$24K/incident per WSIB + NEER savings

For Our People and Operating Efficiency… Annual overtime and sick-time reduced by 22%.

-

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14*

$8 MILLION saved!

For the Health of Our Organization…

Operating deficits to sustainable SURPLUSES! Balance sheet strengthened INVESTING in health care through Innovation

(15,000)

(10,000)

(5,000)

-

5,000

10,000

15,000

20,000

25,000

2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14*

For Our Community - New Hospital Celebrated our 3rd anniversary on March 6, 2014

On budget and ahead of schedule

Beyond all expectations and getting better!

Largest fundraising per capita

Back to the “why” We have much of which to be proud

It all starts with our people and is for our patients

$-

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000

Investments Return

Return On Investment

Conservative

Part of the solution

Great people are key!

Plus $45 MILLION of working capital relief funding!

820% ROI!