covenant presentation Getting the Framework Right

www.studergroup.com ©2012 Studer Group1

CME Disclosure

Accreditation StatementStuder Group is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation of CreditStuder Group designates this educational event for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the educational event.

Disclosure PolicyJan McNally and Janice McKinley have disclosed that they do not have any relevant financial relationships with any commercial interests related to the content of this educational event.


Getting the Framework

RightHow Evidence-Based

Leadership Empowers 11,000 Professionals to

Improve in Unison

Presented By:Janice McKinley, RN, FACHE, NEA-BCSVP Quality & Nursing Jan McNally, BS, BSN, MSHSA, FACHECorporate Director - LeadershipCovenant Health – Knoxville, Tennessee

Journey to Excellence

A Journey, Not a Destination…


Objectives

Describe a Framework for Driving System-wide Performance

Discuss Lessons Learned

Share Tips and Takeaways for Other Organizations


We serve the community by improving the quality of life

through better health.

Mission

Covenant Health – First ChoiceCovenant Health’s clinical and service

excellence will make us the first and best choice for patients, employees, physicians, employers, volunteers and the community.

Vision


Journey Begins With…

Board of Directors and CEO:

– Board-Appointed Quality Committee

– Commitment to Quality Pledge 2002


Executive Leadership

Executive Leadership’s Commitment Drives:Patient Safety

Quality

Engaged Employees, Physicians, and Leaders

Partnership With Studer Group

Board and ELT’s Commitment to Seek Best Practices to Improve Patient Safety, Quality and Service

– Evidence Based Leadership

– Focused Coaching Plans

– Deployment


Timeline

2006 - Limited Partnership at Parkwest Medical Center

2007 - Expanded to Encompass All of Covenant Health System

2008 - Adoption of the LEM for Performance Management for all Covenant Leaders2009 / 2010 - Hardwired the “Must Haves”2011 – Focus on System Alignment2012 – Continue and Expand Focus on System Alignment

Timeline


Engaged Competent Leaders

Quarterly System-Wide and Facility LDIs– CEO Scorecard Reports and Market Updates

– Executive Leadership Reports on System Quality, Patient Safety / Value Based Purchasing, Employee Engagement

– Quarterly Facility Employee Forums - Connect the Dots for All Employees

Good Intentions to Results

Common, Aligned Goals


Goal Selection Process

Executive Leaders and Board of Directors Identify Goals for Upcoming Year

Pillar Framework for Balanced Approach and Focus

Executive Leadership Team (ELT) Communicates to Senior Leaders Across Health System

Do Your Goals Drive Performance?

Lessons Learned:– How to Use the LEM Team Effectively

– How to Use Effective, Equitable Weighting

– How to Drive a System Approach Using Goals and Weighting

– How to Cascade to the Right Leaders, i.e. Who Carries the Goal?


Provide Expertise and Recommendations to ELT– National and Regional Benchmarks for

Goal Targets

– Statistical Analysis of Current Data

– Facility Best Practices

– Coaching Leaders in Goal Development

System LEM and Measurement Teams

Weighting

Use to Drive Focus for Leaders

Tailor to Department, Unit, Service Based Upon Current Performance and Role in Contributing to Organization’s Goals

Incentivize System Alignment and Teamwork, Sharing Best Practices


Health System or System of Sovereign States?

Executive Direction

Common Goals

Lesson Learned: A Good Start

Best Practice

Goal Weighting to Share in a System Goal:

– 30% of Goal Target is Achieved by the Health System Meeting Its Goal for Patient Safety

– 20% of Goal Target is Achieved by System Finance Goal Being Met


Goal Cascading Process

Senior Leaders (System Vice-Presidents, CAOs) Communicate Goals to Entity-Level Leaders (VPs)

VPs Review with Managers and Directors and Propose Targets

Lesson Learned: Critical Step!

Senior Teams at Entity Review and Approve Goals and Targets for All Leaders to Insure Equity, Alignment and Entity-Level Success

Executive Leaders Review and Approve Senior Team Goals, Targets and Weighting


Covenant Health VisionFirst and Best Choice for Employees to Work– System Goal: Reduce or Maintain

Turnover to X% to Insure Stable Workforce• Entity Turnover Goal (ex. Hospital, IT Division)

• Departmental Turnover Goal (ex. ICU, ED)?

–When Does It Make Sense? What Weight?

Quality Commitment

First and Best Place for Patients to Receive Care

– Goal: Reduce Patient Safety Events by X%

Covenant Health Vision


Operationalizing the Journey

Aligned Goals / LEM

Comprehensive Scorecards

System Transparency

Accountability

Organizational Structure

President &CEO

ExecutiveVice President /

HospitalOperations

SeniorVice President

Quality, Safety & Nursing

Operations

Directors / Clinical

Effectiveness

NursingOperations /

Facility CNOs

Facility CAOs

ExecutiveVice President /

HumanResources

Corporate Director /

LeadershipDevelopment

Vice PresidentLearning & Leadership

Development


Transparency & Accountability


2012


A System Approach: Patient Safety BundlesSystem-Wide Deployment of Evidence Based

Bundles:– Hand Hygiene– Central Line Insertion / Maintenance– VAP Prevention– MRSA / MDRO Prevention– Decubitus Prevention– VTE Prevention– Catheter Related UTI Prevention– Falls Prevention– C-difficile

Patient Safety Events: Chasing Zero2010

System Goal of 25% in All Harm EventsHospital Specific Goals– CNO Scorecard Developed



System Goal of 25% in All Harm EventsHospital Specific Goals

2011System Goal of Additional Reduction of 20%– Patient Safety Scorecard– Shared Incentive with Senior Team

70% Hospital / 30% System


System Goal of 25% in All Harm EventsHospital Specific Goals

2011System Goal of Additional Reduction of 20%

2012System Goal of Additional Reduction of 10%


Patient Safety


Ventilator Associated Pneumonia

9358 9647 9232 9058 9220

11336 1086011801

55

30 39

18 20 105

02000

40006000

800010000

1200014000

2004 2005 2006 2007 2008 2009 2010 2011

# Ve

nt D

ays

051015202530354045

# VA

Ps

Vent Days # Cases

Untangling the Economics of QualityMean Cost per Incident

Sources: Beaver, Michelle, “CMS to Put Pressure on Providers for Decubitus Ulcer Prevention”, Infection Control Today, August 2008

Scott, R. Douglas, “The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention,” March 2009.

Spetz, Joanne, PhD, “Cost Effectiveness of a Medical Vigilance System to Reduce Patient Falls, Nursing Economics, January 2008

$43,180

$18,222

$24,070 $26,000

$934

$4,233

$23,272

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

$45,000

Pressure Ulcer BloodstreamInfection

VentilatorAssociatedPneumonia

MRSA Urinary TractInfection

Patient Fall Surgical SiteInfection


Business Case for Quality Efforts

Pressure Ulcers: Stage III, IV & Unstageables

Patient Falls: F - I

Total Estimated Cost Avoidance = $3,887,182

Total Estimated Cost in 2009 = $9,775,351Total Estimated Cost in 2010 = $7,031,165Total Estimated Cost in 2011 = $7,938,455

System Goal for Core Measures

Examples of Goals at Each Level:– System

• 98% Composite• 75% at 100%

– Hospital– Service Line: ED– Unit or Work Area: Nursing Unit


Core Measure Compliance

91.5%

95.2%

98.7%98.0%97.4%

90%

95%

100%

2007 2008 2009 2010 2011

MHHS Core Measure Compliance

99.9%

89.7%

85%

90%

95%

100%

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2nd Q

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3rd Q

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4th Q

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1st Q

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2nd Q

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3rd Q

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4th Q

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3rd Q

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HCAHPS Goal Example

SystemAchieve Threshold on all Measures

HospitalsShared by Senior TeamDirectors and Managers

HCAHPS – Overall Hospital

73.4%72.9%71.8%71.1%70.0%72.7%

50%

60%

70%

80%

90%

100%

2006 2007 2008 2009 2010 2011

Overall Rating Benchmark Threshold


Value Based Purchasing

Developed IndexDeployed Monthly Analysis on All Elements of VBP

Action Plans Developed & Communicated to ELT

Working with VHA to Predict Payment Model

System Turnover Goal

Hospital Turnover Goal– Unit Specific Turnover Goal

– Describe How Weighting is Used to Focus Areas With High Turnover, Lower Weighting For Areas to Maintain Current Turnover


Voluntary TurnoverSystem Overall

11.37% 11.57%

10.86%

8.61% 9.24% 9.44%

6%

7%

8%

9%

10%

11%

12%

2006 2007 2008 2009 2010 2011

Vol Turnover Linear (Vol Turnover)

Voluntary Turnover - RNs System Overall

11.1%9.7%

10.4%10.5%11.8%11.5%

6%8%

10%12%14%16%18%20%22%

2006 2007 2008 2009 2010 2011

Vol Turnover National Avg


Ongoing Journey

The Journey Continues

Performance Excellence Awards

External Recognition

Buscetta Leadership Award


Annual Performance Excellence Awards Ceremony

Recent External Recognition2011 President’s Award of Honor– VHA, Inc.

VHA Leadership Award / Sustainability Excellence Award: Best in Class – Comprehensive Program– VHA, Inc. (Parkwest Medical Center)

VHA Leadership Award for Supply Chain Management Excellence– VHA, Inc.

VHA Leadership Award for Clinical Excellence– VHA, Inc. (Parkwest Medical Center)

VHA Leadership Award for Clinical Excellence– VHA, Inc. (Methodist Medical Center)

Reduction in MRSA – Silver Award– VHA, Inc. (Parkwest Medical Center)


Recent External Recognition#1 Hospital in Knoxville Metro Area – US News & World Report (Methodist Medical Center)

Best Performing Health Systems in US– Thomson Reuters

Top 100 Integrated Health Networks– SDI

Pinnacle Business Award – Impact Award for Improving Quality of Life in East Tennessee– Knoxville Chamber of Commerce

2011 Top 100 Hospital Designation– Thomson Reuters (LeConte Medical Center)

Covenant Health Market ShareInpatient Discharges:16-County Service Area

41.2%40.8%

35.5%

34.1%

31.3%31.2%

31.0%

30.3%

30.9%31.3%31.5%

32.8%33.6% 34.5%

35.4%

34.0%

32.4%

29.0%

31.0%

33.0%

35.0%

37.0%

39.0%

41.0%

43.0%

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Jan-Sep2011


Summary

Balanced ApproachExecutive and Board CommitmentEstablished Framework for DeploymentPositive Results for Each Pillar

Journey - Not a Destination

Objectives

Describe a Framework for Driving System-wide Performance

Discuss Lessons Learned

Share Tips and Takeaways for Other Organizations


Contact Information

Jan McNally, BS, BSN, MSHSA, FACHE– [email protected]– (865)531-5274

Janice McKinley, RN, FACHE, NEA-BC– [email protected]– (865)531-5326

How To Acquire CME Certificate

You must take the entire survey to receive your CME Certificate.To take the survey, visit www.studergroup.com/webinar15To receive CME credit for this webinar you must take the survey prior to June 26, 2012. After June 29th you will receive an email with instructions on how to download your certificate.

The Studer Group is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Studer Group designates this educational activity for a maximum of 1AMA PRA Category 1CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity


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Documents

covenant presentation Getting the Framework Right