Lee Memorial Health System Board of Directors Educational ... · Board of Directors Educational Workshop Thursday, August 29, 2013 ... Redesign orientation related to a culture of

Lee Memorial Health System Board of Directors

Educational Workshop Thursday, August 29, 2013

1:00 p.m.

BOARD OF DIRECTORS

OFFICE 239-343-1500

FAX: 239-343-1599

13685 DOCTORS WAY #190 FT MYERS, FLORIDA 33912

CAPE CORAL HOSPITAL

GULF COAST MEDICAL CENTER

HEALTHPARK MEDICAL CENTER

LEE MEMORIAL HOSPITAL

THE CHILDREN’S HOSPITAL

THE REHABILITATION HOSPITAL

LEE PHYSICIAN GROUP

LEE CONVENIENT CARE

BOARD OF DIRECTORS

DISTRICT ONE

Stephen R. Brown, M.D.

Marilyn Stout

DISTRICT TWO

Richard B. Akin

Nancy M. McGovern, RN, MSM

DISTRICT THREE

Sanford N. Cohen, M.D.

David Collins

DISTRICT FOUR

Diane Champion

Chris Hansen

DISTRICT FIVE

Jessica Carter

Stephanie Meyer, BSN, RN

AGENDA

BOARD EDUCATIONAL WORKSHOP

August 29, 2013 1:00 p.m.

Gulf Coast Medical Center – Boardroom (Medical Office Building) 13685 Doctors Way, Ft. Myers, FL 33912

082913 BOARD EDUCATIONAL WORKSHOP\AGENDA(TENTATIVE).doc

1. CALL TO ORDER (Richard Akin, Board Chairman)

2. TIME TOPIC WHO 1:00 PM �1:10 PM

Opening Comments Jim Nathan

1:10 PM �1:25 PM

Introduction to Strategic Plan Kevin Newingham

1:25 PM �1:50 PM

Service, Safety & Quality Chuck Krivenko, MD

1:50 PM �2:15 PM

Clinical Integration Larry Antonucci, MD

2:15 PM �2:40 PM

Aligned Multispecialty Group Scott Nygaard, MD

2:40 PM �3:05 PM

Workforce Jon Cecil Scott Nygaard, MD

3:05 PM �3:30 PM

Financial Viability Mike German

3:30 PM �3:40 PM

Closing Comments Jim Nathan

3. Date of the next Regular LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS MEETINGS: Thursday, September 26, 2013- 1:00 p.m. FINANCE BOARD & FULL BOARD OF DIRECTORS Gulf Coast Medical Center Medical Office Building, 13685 Doctors Way, Fort Myers, FL 33912

4. ADJOURN (Richard Akin, Board Chairman)

Lee Memorial Health SystemBoard of Directors

Strategic Planning Workshop

August 29, 2013

Opening Comments

Jim Nathan

5 Strategic Initiatives

Service, Safety & Quality

Clinical Integration

Aligned Multispecialty

Group

WorkforceFinancial Viability

Introduction to Strategic Plan

Kevin Newingham

Who We AreCaring People, Caring for People

MissionOur mission is to continue to meet the health

care needs and improve the health status of the people of Southwest Florida

VisionOur vision is to become the best patient‐ and family‐centered health care system by working collaboratively to deliver excellence in quality,

safety, efficiency and compassion.

Our View of the Future

Integrated Healthcare for Population Health Management

Seamless Care System across entire Continuum of Care

Maximized information technology with widely accessible electronic health records

Major shift to Value Based Payments

Do More with Fewer Resources

Tremendous Uncertainty and Unprecedented Intensity with the Pace of Change within Healthcare Landscape

Where We are Going:

5 Strategic InitiativesService, Safety

& QualityDeliver safe, highly reliable and exceptional patient centered care


Continue development of a clinically and technologically integrated provider network

FinancialViability Assure on‐going financial viability of LMHS


Group

Develop a culturally and strategically aligned multispecialty group

Workforce Ensure an optimal supply of quality physicians and workforce

Integrated Healthcare for Population Health ManagementSeamless Care System across entire Continuum of CareMaximized information technology with widely accessible electronic health recordsMajor shift to Value Based Payments

Do More with Fewer Resources

Tremendous Uncertainty and Unprecedented Intensity with the Pace of Change within Healthcare Landscape

View of the Future & Strategic InitiativesService, Safety & Quality



GroupWorkforce Financial

Viability





Viability





Viability





Viability





Viability





Viability


Chuck Krivenko, MD

Strategic Initiative:

Patient Safety is our Number 1 Core Value.

Patient outcomes are directly affected by Service, Safety, and Quality.

We will have a culture of performance excellence and accountability. We are committed to perform in the top decile of CMS measures.

Case for Action:

National Integrated Accreditation for Healthcare Organizations (NIAHO)and ISO 9001

Quality Management System

CMS AccreditationNIAHO Accreditation

Consistent with CMS Conditions of ParticipationHospital Patient Care Processes and Supporting Operations

ISO 9001 Quality Management System

LMHS Quality Recognition

How We Achieve: Service, Safety & Quality

Improve Patient Experience

Improve Compliance

with Standardized Protocols and Pathways

Enhance Hospitalist Services

Align Medical Director

Payments and Hospital‐Based

Subsidies

What we are doing: Service, Safety & Quality

Improve Patient Experience

Layer Patient Experience on the Safety Cultural Transformation

Educate the Organization on Tools and Behaviors using facilitated instruction

Initiate "Top Two" Identification for all units for rapid improvement; assist poor performing units to improve

Develop a "Voice of the Patient" communication plan

Develop a Service Recovery Process and empower employees to act

Enhance employee selection process to incorporate patient service values

Redesign orientation related to a culture of patient service and safety

What we are doing: Service, Safety & Quality

Improve Compliance

with Standardized Protocols and Pathways

Evaluate sources of evidence‐based practice and continue to upgrade ordersets with new knowledge

Identify and implement clinical projects to standardize care

Standardize high risk medication administration

Standardize high risk clinical work processes

Assure compliance with Core Measures

Discussion


Larry Antonucci, MD


Right care at the right place at the right time. Healthcare is no longer episodic care for the

sick. It is comprehensive education, prevention, intervention, and rehabilitation, and then again re‐education cycle.

Value based reimbursement demands seamless interactions between caregivers.

As they move from one provider to another, patients expect seamless interactions and transitions by their caregivers.

Case for Action:

Seamless Care Systems

How We Achieve: Clinical Integration

Develop comprehensive managed care

strategy

Implement comprehensive Electronic Health Record and other

required/ supporting technologies

Develop disease

management programs

Pursue Federally Qualified

Health Center Look Alike Designation

Develop Continuum of

Care

Finalize and implement

master facility plan

What we are doing: Clinical Integration

Develop comprehensive managed care

strategy

Continue to work with payer community on products that support improving healthcare delivery systems

and reward performance and value

Evaluate opportunities to improve care delivery within LMHS self insured population

Create a network of physician, hospital, & ancillary healthcare providers who will be accountable for outcomes, safety, patient satisfaction and cost

effectiveness for the members it serves

Establish quality metrics to reward high performance within LMHS health plan


Implement comprehensive Electronic Health Record and other

required/ supporting technologies

Implement Epic in all LMHS Specialist Offices, Home Health, Long‐term Care

Implement Epic MyChart for Patients ‐ hospital departments, home health, etc.

Implement CareEverywhere to other Epic Providers around the state/country

Implement Epic Electronic Health Records to non‐Epic connectivity using Nationwide Health Information Network Direct, Continuity of Care Document

electronic standard ‐ Care AnywhereImplement Fuji Picture Archiving and Communication System at all campuses, including remote access of

imagesImplement replacement of Heartlab with Enterprise Cardiology Picture Archiving and Communication

System to include remote access of cardiology images


Develop Continuum of

Care

Consolidate Enterprise Care Continuum Management Functions

Establish Organizational Structure to Support Implementation

Strengthen LPG as Fulcrum in Care Management; Establish Affiliated Physician Provider Network

Expand LMHS Post Acute Services and Build Network Capacity to Support Patient Progression

Expand Service Line Planning and Programs Across Care Continuum to Target Seniors

Expand & Formalize Community Outreach and Partnerships for Long‐Term Medical & Supportive

Services (LTSS)

Discussion

Aligned Multispecialty Group

Scott Nygaard, MD


Only health systems that are tightly aligned with a critical mass of physicians will be able to organize their delivery systems to meet the demands for quality and efficiency.

Health systems are increasingly being held financially accountable on criteria that are clinical in nature and only very loosely under a executive team’s control (bundled payments, readmission penalties).

Reward all physicians who not only deliver exceptional patient care but also serve the health system as well.

Case for Action:

Building an Employed Physician Group

Grow the ScaleOrganize into Cohesive enterprise through governance, operating expectations, and financial rewards

Connectivity and communication across the group to better manage patients and population health

Aggregate Assimilate Integrate

Physician Alignment Pyramid

How We Achieve: Aligned Multispecialty Group

Become the Go To Group

Optimize Practice

Operations

Expand Number of Primary Care Physicians

Promote Referrals within

the Health System

What we are doing: Aligned Multispecialty Group

Become the Go To Group

Transition to new patient satisfaction survey; establish patient experience targets based on benchmark data

Implement advanced patient access program for all primary care locations

Adopt MyChart by actively promoting to patients

Expand Call Center and focus on performance improvement

What we are doing: Aligned Multispecialty Group

Expand Number of Primary Care Physicians

Finalize 5‐year physician growth plan

Review and update selection, orientation and retention process for providers

Develop and finalize facility, infrastructure and staffing plan to support future growth

Develop and implement a comprehensive marketing plan that secures a strong LPG brand while increasing

volumes

Discussion

Workforce

Jon CecilScott Nygaard, MD


Sustaining a positive culture will create workforce environment that attracts and retains talented physicians, providers, and administrators.

An engaged workforce will lead to innovative solutions to complex problems.

We will invest in our workforce to fulfill professional potential.

We are only as good as our employees.

Case for Action:

Calculating Turnover Costs

LMHS Turnover Rates

LMHS Vacancy Rates

How We Achieve: Workforce

Ensure high performing culture

Develop a graduate medical education program

Develop physician leaders

Grow and develop current

and future workforce

Enhance leadership capabilities

What we are doing: Workforce

Ensure high performing culture

Enhance employee engagement

Develop pay for performance for staff

Enhance attracting and recruiting strategies

Enhance recognition and rewards programs

Promote healthy workforce

Promote diversity and inclusion


Enhance leadership capabilities

Develop current leaders

Develop future leaders

Physician Need

0

5

10

15

20

25

30

Pediactrics‐Gen

eral

Family M

edicine

Hematology/Oncology

Urology

Ortho

pedic Surgery

Internal M

edicine

OB/GYN

Pediactrics‐Specialty

Gen

eral Surgery

Neu

rology

Cardiology Interven

tional

Otolaryngology

Oncology Surgery

Cardio/Tho

racic Surgery

Cardiology ‐ Med

ical

Gastroe

nterology

Colon & Rectal Surgery

Pulm

onary

Rheu

matology

Urgen

t Care

Vascular Surgery

Nep

hrology

Infectious Dise

ase

Psychiatry

Neu

rosurgery

Oph

thalmology

Allergy & Im

mun

ology

Endo

crinology

Cardiology ‐ Electrop

hysio

logy

Plastic

Surgery

Derm

atology

Physical M

edicine & Reh

ab

Oral Surgery

Future Physician Need

Current Physician Need

Prim

ary Care

Prim

ary Care

Prim

ary Care

Prim

ary Care

Prim

ary Care

3d Health, Inc. Study 2011


Develop a graduate medical education program

Develop a family medicine residency program in partnership with the Florida State College of Medicine

Form the residency leadership team (program director, faculty, coordinator) from a national pool

Develop the Family Medicine Center for an 18‐resident program

Seek initial accreditation from Accreditation Council for Graduate Medical Education (ACGME) and recruit

residents to begin in July 2014

Develop a Graduate Medical Education Committee and Academic Council to oversee all programs

Build relationships with LPG and other community physicians who will teach residents

Discussion

Financial Viability

Mike German


Declining reimbursements demand improving efficiencies and controlling costs.

Payor Mix changes require astute focus on cost reduction and revenue enhancement.

Improved profitability needed to fund our capital requirements and new program development.

FinancialViability Assure on‐going financial viability of LMHS

Case for Action:

Declining Commercial Payors

Capital Spending - $70M per year

How We Achieve: Financial Viability

Enhance outpatient

market position

Rapid standardization across health

system

Develop solutions to maximize growth,

efficiency and capacity

What we are doing: Financial Viability

Enhance outpatient

market position

Assess Market Opportunities

Implement Outpatient Growth Initiatives

Joint Ventures, Partnership, and/or Acquisition Opportunities

Increase Market Share


Rapid standardization across health

system

Develop Value Stream Maps for acute and surgical patient flow

Improvement areas identified as system rapid improvement or “kaizen” opportunities

Resources from Lean Transformation Office partnered with operational leaders as lean facilitators

Internal Job Instruction and Job Relations training developed to teach foundation of standard work as

means to reduce unintended variationLean leadership competencies implemented through integration with annual learning and Organizational

Development plan

Implement Visual Management Metrics with Clinical Operations Group to trend progress of process &

outcomes

Simplify and operationalize Length of Stay tools with IT and Clinical Operations (Crimson, Truven, VHA)


Develop solutions to maximize growth,

efficiency and capacity

Identify Productivity Improvements and Expense Reductions

Low Income Clinics / Federally Qualified Health Center

Improve Clinical Documentation

Increase presence in South Lee County

Comprehensive Stroke Center

Ambulatory Pharmacy

Discussion

Closing Comments

ADJOURNMENT ___________________

L E E M E M O R I A L HEALTH SYSTEM BBBOOOAAARRRDDD OOOFFF DDDIIIRRREEECCCTTTOOORRRSSS

DATE OF THE NEXT REGULARLY SCHEDULED

MEETING:

FINANCE BOARD &

FULL BOARD OF DIRECTORS’ MEETINGS

Thursday, September 26, 2013

1:00pm

Gulf Coast Medical Center Boardroom 13685 Doctors Way, Ft. Myers, FL 33912

Documents

Lee Memorial Health System Board of Directors Educational ... · Board of Directors Educational Workshop Thursday, August 29, 2013 ... Redesign orientation related to a culture of