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1 Slide 1 COPYRIGHT STUDER GROUP Please do not quote or disseminate without Studer Group authorization

2 Alignment & Accountability: Creating Organizational Goals and Using An Objective Evaluation System Bob Murphy, R.N., JD Studer Group Senior Leader & Speaker Slide 2 COPYRIGHT STUDER GROUP Please do not quote or disseminate without Studer Group authorization

3 Execution Framework Evidence-Based Leadership SM Rev 2.14

4 Example Organizational Results Using typical Leader Evaluation

5 Example Distribution of Performance Using typical Leader Evaluation

6 Same Organization s Results After implementing Weighted and Objective Evaluation Excellence Service People Quality Finance Growth Patient Satisfaction (Inpatient) Goal = 62 nd Current = 51 st Patient Satisfaction (Ambulatory) Reduce Annualized Turnover Goal = 14.5% Current = 16.7% Employee Satisfaction Decrease Mortality Index Goal =.77 Current =.77 Operating Margin Goal = 5% Current = 5.6% Reduce FTE per Adjusted Discharge Inpatient Admissions Goal = 2.7% Current = 7.6% Outpatient Visits Goal = 62 nd Current = 65th Goal = 1.15 Current = 1.15 Goal = 5% Current = 8.0%

7 Distribution of Performance After implementing Objective and Weighted Evaluation Note: Percentages noted account for 93% of the leaders who have entered data as of

8 Feb Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun Aug Example Hospital 100% 90% Goal = 90% Inpatient Monthly Percentile Score Year 1 Year 5 95% 80% 70% 60% 50% 40% 30% 20% 10% Leader Evaluation Tool Implemented 0% Year 1 Year 2 Year 3 Year 4 Year 5

9 Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Example Hospital 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Goal = 90% Leader Evaluation Tool Implemented Inpatient Monthly Percentile Score Year 5 Year 7 99% Year 5 Year 6 Year 7

10 Accountability Tools Evaluation Report Card 90-Day Plan Meeting Model

11 Leader Evaluation Requirements Evaluation must be: Objective Measurable Weighted* Contain metric ranges (1-5) Right Leader Right Goal Right Weight

12 Setting Weights 10% 20% >30% Awareness Focus Urgency

13 Setting Weight Example: Turnover Leader A Leader B Leader C Goal: Decrease organization turnover from 18% to 14% as measured by HR Report by FY end. Current Turnover: 20.5% 16.2% 14% Weight: 30% 20% 10%

14 Example: Senior Team Equity Review Pillar Finance Growth People Entity's Goal Description Net Operating Income to budget or higher. Inpatient admissions compared to budget. CEO (Org Goals) CNO CMO CFO COO VP HR 15% 10% 10% 20% 20% 20% 10% 10% 10% Outpatient Revenue compared to budget as measured by Finance Department records. 15% 15% employee satisfaction to 90th percentile as measured by annual survey. 15% 10% 10% 10% 20% 20% Quality Reduce Average Length of Stay (ALOS) to 4.85 days or less. Achieve Value Based Purchasing Rollup measures. 10% 10% 20% 15% 15% 10% 20% 20% 10% Service Maintain overall Emergency Department patient satisfaction at 90th percentile. 10% 10% HCAHPS in 6/8 composites at 80th percentile. physician satisfaction to 85th percentile as measured by annual survey. Other department/cascading metrics. Examples: AR Days, Door to Doctor, Productivity, Patient Safety Measures, Physician Satisfaction 15% 15% 10% 10% 15% 15% 15% 30% 10% 10% 10% 20% 35% 100% 100% 100% 100% 100% 100%

15 Cascading Goal Examples Chief Executive Officer Chief Nursing Officer Med/Surg Nurse Manager Chief Medical Officer Physician Practice Manager Primary Care Physician Chapter Six: Objective Leader Evaluation System: The Birthplace of Accountability

16 Example: Cascading a goal to decrease LOS Case Management / Discharge Planning / Social Work- % of patients discharged day the order is written Ancillary Department Leaders- the number of inpatient procedures completed the day the order is written Inpatient Nurse Managers-X% of patients discharged by (fill in appropriate time) Medical Staff Leaders- the % of discharge orders written by (fill in appropriate time) House Supervisors- % of ED admissions to inpatient bed within XXX hours EVS-Improve bed turnaround time after 3pm

17 Chief Executive Officer (CEO) Goals Service 30% People 20% Quality 20% Finance 10% Growth 20% HCAHPS to 70 th percentile in 6/8 composites Employee Satisfaction to 85 th percentile Decrease 30 Day All-Cause Readmissions to 5% or less Operating Margin of 3.5% Adjusted Admissions by 2.5% (18,260) ED Patient Satisfaction to 80 th percentile CGCAHPS to 80 th percentile Physician Satisfaction to 70 th percentile Decrease CMS Never Events to 2 or less Outpatient billable encounters to 37,000

18 Chief Nursing Officer (CNO) Goals Service 35% People 10% Quality 35% Finance 20% Growth 0% HCAHPS to 70 th percentile in 6/8 composites Weight = 25% Employee Satisfaction to 85 th percentile Weight =10% Decrease 30 Day All-Cause Readmissions to 5% or less Weight = 15% Decrease LOS to less than 3.4 days ED Patient Satisfaction to 80 th percentile Decrease CMS Never Events to 2 or less Weight = 20% Achieve Operating Budget

19 Med Surg Nurse Manager Goals Service 30% People 20% Quality 40% Finance 10% Growth 0% Med/Surg HCAHPS to 70 th percentile in 6/8 composites Med/Surg Employee Satisfaction to 85 th percentile Decrease CHF Readmissions to 5% or less Weight = 20% Achieve 100% Variance to Budget Weight = 30% Decrease fall rate (never event) to 2.5 or less Weight = 20%

20 Chief Medical Officer (CMO) Goals Service 25% People 15% Quality 20% Finance 10% Growth 30% CGCAHPS to 80 th percentile Physician Satisfaction to 70 th percentile Weight = 15% Decrease CHF Readmissions to 5% or less Reduce average Clinic no-show rate to 10% or less Outpatient billable encounters to 37,000 Weight = 30% HCAHPS Physician Composite to 70 th %tile Weight = 15% A1C score greater than 7 will decrease to 25% or less

21 Physician Practice Manager Goals Service 25% People 20% Quality 15% Finance 15% Growth 25% CGCAHPS to 80 th percentile Weight = 15% Physician Satisfaction to 70 th percentile A1C score greater than 7 will decrease to 25% or less Weight = 15% Reduce average Clinic no-show rate to 10% or less number of billable patient encounters to 9,000 Weight = 25% in- Network Referral Rate to 85% Employee Satisfaction to 85 th percentile

22 Primary Care Physician Example Service 15% CGCAHPS to 80 th percentile Weight = 15% People 10% Employee Satisfaction with Providers to 70 th percentile Quality 35% elderly annual flu show vaccine rate to 85% % of diabetics, ages 18-75, whose HbA1c was less than 7% (well controlled) to 70% Weight = 15% percent of women, ages 42-69, who had a mammogram in the last two years to 85% Finance 10% Generate 4,600 median work RVUs Growth 30% innetwork referral rate to 85% number of billable patient encounters to 3,400 Weight = 20%

23 What is a 90-Day Plan? Plate Manager Helps define most important use of leader s time Allows leaders to set interim goals in 90 day period to achieve annual goals across all pillars Prioritization Tool Clearly defines priorities for leader and leader s supervisor Identifies key action steps necessary to achieve 90 day goals Helps get less important items off the plate Tactics that drive outcomes Communication Tool Creates necessary conversations in both directions Allows high performing employees to know the organizations plan Allows leaders to present plan of action to supervisor and employees Discuss any resources required, hurdles, or competing priorities

24 90-Day Plan Example Goal Action Steps Manage Up Level Results

25 Tips for creating action steps Involve staff Identify 1-2 key tactics to achieve the 90 day goal Clearly define each step to achieve the outcome Set a realistic date to accomplish each step Assess effectiveness of previous action steps

26 Monthly Meeting Model Agenda Four Key Components 1. Review of performance (via report card and 90- day plan) 2. Verification of key behaviors that are being used to achieve results 3. Review of LDI Linkage grid to confirm status of completing linkage assignment 4. Professional development NOTE: Senior leader may begin the Supervisory Meeting with Rounding on their direct report

27 Thank You! Bob Murphy, R.N., JD