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Presents…
Wednesday, December 8, 2010
The Critical Access & Rural Hospital of Choice Webinar
Presented byBrian Lee CSP
HealthCare's“Mr. Loyalty”
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As a Leader of a Smaller or Rural Hospital….
What keeps you awake at night?
The Critical Access & Rural Hospital of Choice Webinar - - PowerPoint PPT Presentation
The Critical Access & Rural Hospital of Choice Webinar - - PowerPoint PPT Presentation
Wednesday, December 8, 2010 Presents The Critical Access & Rural Hospital of Choice Webinar Presented by Brian Lee CSP HealthCare's Mr. Loyalty 1 As a Leader of a Smaller or Rural Hospital. What keeps you awake at night?
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It‟s difficult running a major hospital today,
But the challenges of successfully leading a Smaller or Rural hospital are monumental…
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Lets do a quick reality check…..
And see if these Issues are true for you?
Yes, No
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Community Image & Issues
- 1. Historic image as a “Band Aid”
station.
- 2. Critical local media.
- 3. Everybody knows
everybody.
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Competitiveness Issues
4. Ease and willingness of younger generation to drive to a nearby competitor. 5. Large competing hospitals with deep pockets seeking to gain market share. 6. Competitors who are also referral destinations. 7. Limited-growth market share.
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Emergency Department Issues
- 8. Missed marketing opportunities
due to poor Emergency Department service or reputation.
- 9. Poor quality Emergency
Department physician groups. 10.Difficulty signing quality Emergency Department physician groups.
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Management/ Leadership Issues
11.Working managers who multi-task 2-4 different job responsibilities. 12.Lack of consistent leadership training/development. 13.Limited to no systems for consistent policy execution/ accountability.
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Employee/Staffing Issues
- 14. Long-term employees with a sense of
entitlement and victimhood who stay at the hospital because “it‟s the only game in town”.
- 15. Unable to pay competitive
wages with larger competing hospitals.
- 16. Limited career options
for new graduates.
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Physician Recruitment & Retention Issues
17.Constant risk of loss of physicians/specialists. 18.High cost of physicians/specialist recruitment. 19.High maintenance physicians who understand their leverage.
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Board Trustee Issues
20.Board trustees who micro- manage rather than set policy. 21.One or two difficult trustees who play to the media.
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With all these unique challenges….
What‟s the one thing that Smaller or Rural hospitals can do to truly differentiate themselves, and create a long term sustainable competitive advantage?
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The Good News!
It‟s easier to transform the culture of a smaller Hospital, than a major one!
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“There is no Market for Mediocrity.”
- Brian Lee CSP
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=
a 2% Change In Customer Satisfaction a 1% Change In Employee Morale
- Press Ganey
Critical Link -
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Two Key Opportunities
# 1 EMPLOYER OF CHOICE™
= High employee morale & turnover 50% below state or national average.
# 2 PROVIDER OF CHOICE™
= Patient Satisfaction Scores at 90th %tile in 3 Years.
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“There is no single
silver Bullet.”
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“The Answer is to be firing on ALL Cylinders”
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AGENDA
1. HCAHPS at-a-Glance. 2. 7 Breakthrough Recommendations to succeed at HCAHPS. 3. Making a Business Case for Becoming an Employer & Provider
- f Choice.
4. The 3 Cornerstones of Culture Change. 5. Evaluation & Tool Kit Request
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Today‟s Mission
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In other words to become a
=
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“
Feedback is the breakfast
- f champions
Ken Blanchard”
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“93 % of what you learn in a classroom is forgotten within 14 days.”
- Dr. Tony Buzan,
The Brain Book
The Power of Coaching
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The Power of Coaching
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Post Seminar Coaching Call
- This “Hospital of Choice” seminar
includes a post classroom 1-hour private Coaching Call.
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Assignment
Be prepared to answer 3 questions at the end of the presentation:
- 1. What is the major barrier you have
encountered in your efforts to improve patient, employee, and physician satisfaction?
- 2. Clarify the best idea you discovered or
affirmed to overcome that barrier?
- 3. Think about which colleagues would
benefit from participating in a post seminar coaching call?
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Master H.C.A.H.P.S. and Pay for Reporting
The Hospital Consumer Assessment of Healthcare Providers and Systems Survey
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“
Or…
Or…
H.I.C.U.P.S!
Happy Campers at Hospitals Praise Staff.
Laura Stollard, St. Elizabeth‟s
”
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New HCAHPS Mandatory Survey
- 27 Questions
- 22 Performance
rated questions
- Adopted
May 12, 2005
- Rolled Out
Spring 2007
- Publicly Reported
March 2008
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HCAHPS Rating System
With HCAHPS, patients expectations shift from “Top Box” 5
- ut of 5 to
“Always” – 4 out of 4 or 9 and 10 out
- f 10
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Pain Control
13. How often was your pain well controlled? 14. How often did hospital staff do everything they could to help you with your pain?
1 – Never 2 – Sometimes 3 - Usually 4 - Always
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Overall Rating?
Hospital A Hospital B Hospital C
www.HospitalCompare.hhs.gov
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Maximize Reimbursement by Mastering Value Based Purchasing = Pay for Performance
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Premier Hospital Quality Incentive Pilot
- 250 Hospitals 2003 - 2006
- 3rd Year paid $24.5 million to 112
- Saved 2,500 lives from heart attacks
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Historic Date
Sunday, March 23,2010 - the Patient Protection and Affordable Care Act was signed into law
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The Patient Protection and Affordable Care Act (ACA)
- Transforming the
Health Care Delivery System
- Title III – Improving
The Quality And Efficiency of Health Care – Sections 3001 to 3015
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Caution…
This information is based on legislation approved to date, and proposed CMS implementation documentation. In the absence of final published regulations and procedures certain assumptions have been made based upon prevailing conventional wisdom.
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The Good News…
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There will be financial incentives for achievement and improvement of HCAHPS Scores
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The Bad News…
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There will be no money!
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Effective Oct 1, 2012 Hospital‟s base DRG payments will be reduced by 1% … to pay for VBP incentive payments
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Effective Oct 1, 2011 the baseline VBP measurement starts by comparing your hospital‟s current measure-score with its prior-period baseline.
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Which leaves you…
Months
Days
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and that‟s just the start of DRG payment reduction…
F2013: 1.0% F2014: 1.25% F2015: 1.5% F2016: 1.75% F2017: 2.0%
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How Hospitals Performance Scores will be Rated
VBP Dollars at Stake
Core Measures Patient Experience
- 1. Acute myocardial
infarction (AMI)
- 2. Heart Failure
- 3. Pneumonia
- 4. Surgeries
- 5. Healthcare-associated
infections
HCAHPS
30% 70%
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Current HCAHPS Themes
10 Themes – 7 in the Future?
1. Communication with Doctors 2. Communication with Nurses 3. Responsiveness of Hospital Staff 4. Pain Management 5. Communication about Medicines 6. Cleanliness of room 7. Quietness of room at night 8. Discharge Information 9. Overall Rating
- 10. Recommendation to others
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Translating Performance Score into Incentive Payment: (Example)
Attainment
Source: Centers for Medicare & Medicaid Services/May 2008 Thomas B. Valuck, MD. JD, Medical Officer & Senior AdviserPick Your Best
Or Improvement
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How to Earn Back Withheld DRG Payments
Earn Attainment Points based
- n your national HCAHPS
percentile rank. Earn Improvement Points based on national %tile rank Improvement over last year.
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Question: Who do you need to outrun?
?
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The Secretary is now The Decider
and will set Performance Standards 60 days prior to the start of the next fiscal year for each category, based on experience, improvement rates, and opportunity for continued improvement.
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Value Based Purchasing Update and Model Results
- CMS proposal required
- 2% to 5% of Medicare
IHPPS payments to be set aside & redistributed to “quality” hospital
- For now assume 4%
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Projected Threshold Scores
75%tile
National Ranking
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VBP Dollars at Stake At-Risk Patient-Experience VBP Dollars
$135,629 $58,127
At-risk VBP Patient Experience Dollars
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Expect a Bandwagon Effect
Blue Cross of Massachusetts Pays Atruis Health 10% Performance Incentive for Patient Experience (September 2009)
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Maine “Blue” Preferred Ribbon Rating for HCAHPS Patient Experience
Source: Maine Health Management Coalition
Hospitals receive a blue ribbon when they have a score equal or greater than 2.5. This
score is calculated by averaging the combined points received in the Overall Rating of Hospital and Likelihood of Recommending Hospital to Family or Friends measurement areas
.
Maine Health Management Coalition
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Expect a Bandwagon Effect
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Do all of your current patient satisfaction scores adequately reflect your clinical excellence? HCAHPS Data – Inpatient Facilities ?
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Critical Access demonstration begins 2012- 2015, across a representative spectrum
Critical Access is Next…
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“Act as if HCAHP Is mandatory!”
- Brian Lee, CSP
Recommendation For Critical Access Hospitals & Rural Health Clinics
Why?
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What a great excuse to become great!
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Recommendation
Do a financial „dry run‟ and estimate the potential cost to your bottom line now
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Understanding & Managing VBP
1. Calculate Medicare reimbursement related to Inpatient business 2. Enter HCAHPS scores as a percentile 3. Enter Benchmark group HCAHPS scores as a percentile
- Attainment Thresholds
calculated
- HCAHPS „performance
points‟ assigned
- Cost of performance by
HCAHPS dimension calculated
- Due/Earned calculated
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Recommendations
Make HCAHPS improvement a top priority by setting goals to:
- Goal #1 - Engage absolutely everyone.
NOW!
- Goal #2 – to be well above the national
average in every domain by Oct. 1, 2011
- Goal #3 – to be in the top quartile by
- Oct. 1, 2012
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My challenge to you- Make a commitment to be the BEST YOU CAN BE
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What is the alternative to being the best you can be?
It‟s being…….
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ACME Hospital
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Recommended Tool “E” Seminar PowerPoint
P.S. Use a PowerPoint of this seminar to educate leaders not in attendance here today
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Recommended Tool F Value Based Purchasing Risk Assessment
Please Note your Evaluation Form
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Breakthrough Recommendation #1:
- Prepare an Economic
Impact Statement, a cost/benefit analysis of becoming a Hospital of Choice
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Making a Clinical Case for Improved Patient Satisfaction Payoffs for the Patient*
(verified by 47 studies)
↑ Chronic Disease Control ↑ Clinical Quality ↑ Compliance ↓ Drug Complications ↑ Emotional Health Status ↑ Quality of Life ↑ Physical Functioning ↑ Physical Health Status ↓ Post-Surgery Complications ↑ Post-Surgery Recovery Time ↓ Risk-Adjusted Mortality ↓ Unexpected Mortality ↑ Work Effectiveness
*Source – Press Ganey - The ROI of Satisfaction
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PERFORMANCE IMPROVES Profit Improves Market share increases Revenues go up Productivity improves Customers sing our praises Costs go down Processes improve
Economic Impact of Improving Patient Satisfaction*
* Source Fred Lee
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The Cost of Nurse Turnover
Fact – The cost of replacing a valued nurse is 1.5 times their annual compensation
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Estimated Annual Cost of Nurse Turnover
Average Annual Nurse Compensation $42,316.80 Estimated Number of Nurses to be hired this year x 5 Gross Compensation of new hires $211,584.00 Replacement Cost x 1.5 Estimated Annual Nurse Turnover Replacement Cost $317,376.00
Ex.
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6.A- Keep Your Nurses for Life Book
- Please Note
your Evaluation Form
http://www.customlearning.com/HospitalofChoice
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Making a Business Case for Becoming a Provider of Choice
+$58
- $55
Earnings per Adjusted Patient Day
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Cost of Poor Patient Satisfaction
Earning per adjusted patient day $113.00 Number of patient days (this fiscal year) x 17,828 Reduced cost / enhanced revenue $2,014,564.00 % change to move to top quartile:
Move Inpatient from 13th %tile to 90th %tile
100% Total Reduced Cost/Enhanced Revenue per year $2,014,564.00 3-year SEI Process x 3 Total Reduced Cost/Enhanced Revenue for 3 years $6,043,692.00
Ex.
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Revenue Growth Related to Market Share Growth
Current Market Share 42 Market Share Goal 46 Change in Market Share 4% Value of Growth in Market Share $600,000.00
Ex.
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Executive Summary – 3 Year Economic Impact Statement
I Retention & Recruitment $ 2,337,159 II Staff Morale/Productivity $ 1,320,000 III Poor Patient Satisfaction $ 6,043,692 IV Market Growth Opportunity $ 600,000
GRAND TOTAL $10,300,851
ANALYSIS Assume only 50% $ 5,150,426 Assume only 20% $ 2,060,170
Assume only 5% $ 515,042
Ex.
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Cost Base Allowance Recovery
CMS Medicare Total Income ($)
Consulting fees allowable for Improving Patient & Employee Satisfaction
Training, Implementation, and Consulting Fees – CMS (Cost Based Recoverable) = Actual Fees
Ex.
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Admit 1 more inpatient a day for 1 year at an average of $4,242 for a 3.8-day stay
= $1,548,418
Ex.
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6.B - Economic Impact Statement Forms
- Please Note
your Evaluation
http://www.customlearning.com/HospitalofChoice
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Breakthrough Recommendation #2:
Make a formal/Board commitment to become an Employer and Provider of Choice™
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Understanding the Value of a Satisfied Loyal Customer
Adapted from: Jones, T, and Sasser, E. Why Satisfied Customers Defect. Harvard Business Review, Nov. – Dec. 1995.
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Breakthrough Recommendation # 3:
Appoint a representative Service Excellence Council
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7 A.- Service Excellence Council Charter
Please Note your Evaluation
http://www.customlearning.com/HospitalofChoice
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Breakthrough Recommendation # 4:
Focus on Culture Change
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Culture:
“An organization‟s way of life.” “The way we do things around here.” “Unwritten rules.”
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Question:
What unwritten rules does your
- rganization have that are not
good rules?
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Examples of Unwritten Rules that are Not Good Rules
- “I‟ll get the call light when I can.‟
- “Night shift can only call a doctor if
the patient is coding.”
- “That patient is a complainer”
- Smokers get longer breaks”
- “That‟s not my job.”
- “That‟s just the way they are.”
- “It‟s OK for physicians to be rude.”
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“Flavor of the month campaigns leave a bad taste and are such a waste!”
Brian Lee CSP
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The 3 Cornerstones
- f a Culture of
Engagement
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Engage
Transform
Empower
The 3 Cornerstones
- f a Culture of
Engagement
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Cornerstone #1
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Breakthrough Recommendation # 5
“Hardwire” for Performance Accountability by linking:
Job descriptions & performance
incentives
through an annually negotiated
Accountability Agreement for patient and employee loyalty.
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Accountability Agreement
Linking Patient Scores & Staff Turnover rates to Success.
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Sample Agreements
Admitting Nursing Dietary
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Internal Support Service Scorecard
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6.C- Accountability Agreement Forms
http://www.customlearning.com/HospitalofChoice
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Breakthrough Recommendation # 6
“Train and engage your entire management team to serve on cross functional, Best Practice Performance improvement teams.”
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Best Practice Gap Analysis- Prioritized Recommendations
Critical Access
6 Priority
Proven Best Practices per year x 3 years
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Consider the Strategy of OASIS Best Practice Projects:
Operationally Advanced Service Improvement Systems
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Recommendation- Implement Strategic Best Practices by Way
- f OASIS Teams
6-8 managers Cross Functional
Membership
Hardwire 1
strategic best practice per year
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HCAHPS Questions - Nursing Care & Hourly Rounding
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How It Works:
3 Ps
- Pain – Evaluate the pain
level
- Position – Help the
patient get comfortable
- Potty – Offer help using
the toilet
4 Rs
- Rx – Provide any needed
medication (RN visits
- nly)
- Reach – Are all the
patient‟s needs (call light, phone, reading materials, etc.) within easy reach
- Respond to questions.
Ask is there anything else the patient needs.
- Reassure – Express care
and concern. Let the patient know at what time the next rounding visit will occur.
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What Evidence Shows that Hourly Rounding Works?
- Research on hourly rounding in 14 hospitals*
showed:
- 9 point sustained increase in patient
satisfaction overall score
- 52% reduction in patient falls
- 37% reduction in call light use
- 14% decline in skin breakdowns
- In addition, one hospital measured a 20%
reduction in the distance walked each day by the nursing staff
Source: Leighty, John. “Hourly Rounding Dims Call Lights” www.Nurse.com December 4, 2006 Meade, Christine M. et al “Effects of Nursing Rounds on Patients‟ Call Light Use, Satisfaction and Safety” American Journal of Nursing September 2006
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HCAHPS Questions - Pain Control/Medication
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HCAHPS Questions - Physician Care
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Service Recovery System
“Mess Up, Fess Up, and Dress Up.”
- Brian Lee CSP
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Awards and Recognition Process
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Service Standards & Service Scripting, “Key Words at Key Times”
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6.D Best Practice Gap Analysis & Report
Please Note your Evaluation
http://www.customlearning.com/CriticalAccess
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VBP Bootcamp
http://www.customlearning.com/HospitalofChoice
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6.D Best Practice Gap Analysis & Report
Please Note your Evaluation
http://www.customlearning.com/CriticalAccess
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Quality & Patient Safety
Provider
- f Choice
Empower
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Breakthrough Recommendation # 7
“Engage and train a representative group of the best of your best frontline staff to teach an annual Service Excellence Workshop and serve as a positive role model.”
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“For culture change to work just fine… it must be led from the top and the frontline!”
- Brian Lee, CSP
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- 1. Frontline/Non-Management
- 2. Terrific Attitude
- 3. Demonstrated Commitment
to Patient Satisfaction
Recommendation, consider utilizing the
The Service Excellence Advisor
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Cornerstone #2
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- 1. Frontline/Non-Management
- 2. Terrific Attitude
- 3. Demonstrated Commitment
to Patient Satisfaction
Recommendation, consider utilizing the
The Service Excellence Advisor
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Girard Medical Center SEAs
Appointed for one-year term
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SEAs teach in teams of 4
Phelps Memorial SEA Team
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+
SEAs participate in a
2 day Train-the-Trainer Course
First Half Day 3 hour Service Excellence Workshop Remaining Day + Half Teach them how to teach
Waverly Health SEAs
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The Service Excellence Advisor Train-the-Trainer Course Graduation Celebration
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...SEAs experience a rocket ship ride of personal and professional growth
Unity Health SEAs
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Letter from Tom Wilkinson
“Being a Service Excellence Advisor at Hoag Hospital 10 years ago was the highlight of my life.”
- Tom Wilkinson
former HOAG SEA
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Based upon 240 Employees as well as Volunteers and Physician Office Staff you would have 20 Service Excellence Advisors in Year 1
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and
60
Service Excellence Advisors by Year 3!
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What would it mean to you if your staff „owned‟ and felt accountable for your HCAHPS outcomes?
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What would you see is the value of frontline ownership?
Question
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Benefits of Frontline Leadership
- 1. Improve morale
- 2. Create pride
- 3. Gain commitment
- 4. Keep staff out of my office,
thinking on their feet, and solving their own problems
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Benefits of Frontline Leadership
- 5. Improved patient satisfaction
- 6. Create teamwork
- 7. Staff will really want to bring
family and friends
- 8. Reduce sick days
- 9. Increase trust – due to
enhanced peer to peer relationships
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Benefits of Frontline Leadership
10.Peers trust peers more than senior leadership 11.More staff will get the message 12.Breeds more trust in the community 13.Reduce the blame game
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Benefits of Frontline Leadership
14.Create accountability and honesty at every level 15.Breaks down the “us versus them” relationship between management and the frontline 16.Work becomes fun 17.Better communication
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You Just Can‟t Do It Your Way
- Brian Lee CSP
You cannot force someone to care. You cannot drive lasting change by telling people what to do… Or by issuing a memo and expect people to conform or change by decree. You cannot order someone to go the extra mile because they will not go that extra mile unless they really want to. You cannot cause people to alter their attitude
- r behavior or beliefs just because you are
the boss and you issue their paycheck.
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You Just Can‟t Do It Your Way
While vision and accountability must begin at the top, change will only really take place when there is buy-in and
- wnership and commitment and passion
from those people who must deliver on your promises. For culture change to work just fine, it must be led from the top and the frontline.
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6.E – Frontline Leader Recruitment & Selection Guide
- Please Note
your Evaluation
http://www.customlearning.com/HospitalofChoice
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” “
I‟m not asking you to TRY to do it, I‟m asking you to DO IT!
- Tony Stark, Ironman
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6.F - Digital PowerPoint
- f this Tele-seminar
P.S. Use a PowerPoint of this seminar to educate leaders not in attendance here today
http://www.customlearning.com/HospitalofChoice
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Pop Quiz!
1. Invite everyone to stand. 2. Remain standing if you can answer yes to these 5 questions 3. Sit down if you can‟t.
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Informal Frontline Survey Understanding Validation Survey *
1.
Do you know your department‟s latest Patient Satisfaction scores? What are they?
*source: Custom Learning Systems Group Ltd
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Informal Frontline Survey Understanding Validation Survey *
2. Do you know how the scores have changed since the previous report? How?
*source: Custom Learning Systems Group Ltd
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Informal Frontline Survey Understanding Validation Survey *
3. Can you identify two of the top 10 things your Patients say that you and your peers do best? What are they?
*source: Custom Learning Systems Group Ltd
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Informal Frontline Survey Understanding Validation Survey *
4. Can you identify two of the top 10 things your Patients say that you and your peers can improve upon? What are they?
*source: Custom Learning Systems Group Ltd
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Informal Frontline Survey Understanding Validation Survey *
5. Can you name your work groups current Service Improvement Project (projects)? What is it?
*source: Custom Learning Systems Group Ltd
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“Here‟s How You Get Firing
- n ALL Cylinders”
To Summarize:
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1. Prepare an Economic Impact Statement 2. Commit to Hospital of Choice 3. Appoint a Service Excellence Council 4. Focus on Culture Change 5. Negotiate Accountability Agreements 6. Train and Engage all your Leadership 7. Train and Engage your Frontline Leaders – “SEA‟s”
7 Steps to Excellence
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CEO‟s Service Excellence Initiative™
- 2 Days on site
- Comprehensive Assessment
- Dynamic 4 hour Seminar
“The Rural Hospital of Choice”
- No Charge, Travel honorarium only
Contact: Brian 403-270-5804
- r James 403-270-5819
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Questions?
1 800 667 7325 Cell 403 607 7444 Fax 403 228 6776 brian@customlearning.com
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The Benefit of Expert Coaching
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Post Seminar Coaching Call
- This “Hospital of Choice” seminar
includes a post classroom 1-hour private Coaching Call.
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Post Webinar Implementation Private Coaching Session
Barry/James will be in contact later today to schedule one hour coaching
- ption:
- 1 on 1
- Executive Team
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“Feedback is the breakfast
- f champions."
Ken Blanchard
http://www.customlearning.com/HospitalofChoice
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Evaluation Request
- 1. For me, the most valuable idea I
learned and intend to use is:
- 2. What I would tell others about
the quality of the speaker and value of the content:
- 3. Presentation improvements I
would suggest
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Evaluation
4. On a scale of 1-5 this presentation:
(Met my expectations) 5-4-3-2-1 (did Not)
5. Current Patient Satisfaction Scores
Now ________ %tile Goal _________%tile
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- 6. Free Tools - Critical
Access Hospital of Choice
- Yes A) Keep Your Nurses for Life Book
- Yes B) Economic Impact Statement -Analysis
Forms
- Yes C) Accountability Agreement Forms
- Yes D) Best Practice Gap Analysis
- Yes E) Front Line Leader Selection guide
- Yes F) Digital Power Point of this
presentation
- Yes I) CEO‟s Service Leadership Initiative
- Yes J) Private Coaching Session
- Yes k) Value Based Purchasing – Excel Form
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Recommendation If you‟re going to act,
Act With Urgency!
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Utilize the website or forward Your Tool Kit Request to
Be sure to
Fax: 1-403-228-6776
Phone: 1-800-667-7325 – James Simone Email: james@customlearning.com
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A Special Thanks to you for your:
interest, time and commitment to
“making a difference”
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…. and before we adjourn, Let me leave you with
- ne final thought…
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Today‟s Mission
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…So who is accountable to put these ideas to work for your hospital?
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Why not start TODAY!
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