Post on 28-Dec-2015
Newton-Wellesley HospitalRising From the Ashes!
Pat JordanChief Operating Officer
Bentley CollegeJune 18, 2009
State of the Union – FY01
•$1M per month loss for 54 months
•Total clinical revenue $122M
•No capital, no training
•Limited patient satisfaction surveying•(39th percentile - Inpatient)
•Employee turnover 20+%•Low morale
-25,000
-20,000
-15,000
-10,000
-5,000
0
5,000
10,000
15,000
FY 1993 FY 1994 FY 1995 FY 1996 FY 1997 FY 1998 FY 1999 FY 2000
State of the Union – FY01
NWH Operating IncomeNWH Operating Income
FY01 – 02 Increase Volume
•Financial State-of-Emergency
•Capital investment
•Grow with Partners affiliation
•Consumer image campaign
•Maintain focus on quality
Clinical Collaborations
Mass General Hospital for Children
Breast Center/Breast & Ovarian Cancer Risk Assessment Program
Spine Center
Joint Center
Cardiology (EP and ECHO)
Vascular Surgery
Thoracic Surgery
Obstetrics
Maternal Fetal Medicine
Gyn Oncology
Radiation Oncology
Endocrinology
General Surgery
PET/CT
MIGS
Assisted Reproductive Medicine
Psychiatry
Teaching Collaborations:
Residency program in Surgery
Residency program in Pediatrics
Residency program in Medicine
Residency program in Anesthesia
Residency program in Psychiatry (MGH/McLean)
50+ MGH staff physicians on campus
50+ NWH medical staff training with MGH
Partners Collaborations
New Emergency Department
4 new Operating Rooms
Joint Center
Bariatric Center
Cancer Center/Radiation Oncology
Primary Care
Cardiology/Vascular Services
UCC
New Beds
ASC
NWH Growth
FY03 Create Loyalty
•Benchmark with Marriott, RMV, Greenwich
•Healthcare Advisory Board
•Baptist
•Management Team to Pensacola
•Connect with Quint
•Adopt pillar model/balanced scorecard
FY09 Operating Goals & Objectives
Top 5% in Patient
Satisfaction.
Voluntary annual turnover rate of 8% or less.
Employee Survey in Q2 FY09.
Plan for Physician Satisfaction
Survey FY10
Achieve margin of $12.7M for NWH
and Affiliates
Meet or exceed performance based contract targets: Achieve 100%
of withhold
Achieve $1.625M savings from
operations improvement
activities
Prepare for COMPASS system implementation in
Q1FY10
Achieve budgeted FY09 volume representing
4% growth in inpatient discharges,
and 9% growth in outpatient activity.
Recruit 10 PCP’s
Improve patient through-put to reduce
LOS by 4 hrs without a statistically significant
increase in re-admission rates
Build Cancer Center and 24 bed I/P unit to
increase bed capacity
Achieve a patient fall rate below the NDNQI 25th percentile
Implement EMAP for 75% of licensed inpatient beds by
Q1 FY10
Achieve 90% hand hygiene compliance before and after patient
contact
Achieve Influenza Vaccine Rates, Q2 FY09
80%- eligible employees80%- eligible inpatients
Ambulatory E-Prescribing of 80% by end of Q4 FY09
Maintain transfers due to lack of beds to 9 or less per month
CareFirstService
People Quality/ Safety
Finance Growth
CareFirst Service
Inpatient Satisfaction
0
10
20
30
40
50
60
70
80
90
100
Jan
05 R
pt
July
05
Rpt
Jan
06 R
pt
July
06
Rpt
Jan
07 R
pt
Apr
07
Rpt
Jul 0
7 R
pt
Oct
07
Rpt
Dec
07
Rpt
Mar
08
Rpt
Jun
08 R
pt
Sep
-08
Rpt
Dec
08
Rpt
Mar
09
Rpt
Apr
-09
May
-09
Jun-
09
Press Ganey Quarterly Results
* Compared to MA Peer Group
Quarter To Date Press Ganey Results
87.1
85.8
CareFirst Service
ED Patient Satisfaction
0
10
20
30
40
50
60
70
80
90
100
Apr
il-05
Rpt
Oct
05
Rpt
Apr
il-06
Rpt
Oct
06
Rpt
Jan
07 R
pt
Apr
07
Rpt
Jul 0
7 R
pt
Oct
07
Rpt
Dec
07
Rpt
Mar
08
Rpt
Jun
08 R
pt
Sep
-08
Rpt
Dec
08
Rpt
Mar
09
Rpt
Apr
-09
May
-09
Jun-
09
Per
cent
ile
* Compared to MA Peer Group
Press Ganey Quarterly Results Quarter To Date Press Ganey Results
87.3
86.3
CareFirst Service
Outpatient Satisfaction
0
10
20
30
40
50
60
70
80
90
100
Jan
05 R
pt
July
05
Rpt
Jan
06 R
pt
July
06
Rpt
Jan
07 R
pt
Apr
07
Rpt
Jul 0
7 R
pt
Oct
07
Rpt
Dec
07
Rpt
Mar
08
Rpt
Jun
08 R
pt
Sep
-08
Rpt
Dec
08
Rpt
Mar
09
Rpt
Apr
-09
May
-09
Jun-
09
Per
cent
ile
* Compared to AHA Region 1
Press Ganey Quarterly Results Quarter To Date Press Ganey Results
93.1
92.1
CareFirst Service
Ambulatory Surgery Patient Satisfaction
0
10
20
30
40
50
60
70
80
90
100
Jan
05 R
pt
July
05
Rpt
Jan
06 R
pt
July
06
Rpt
Jan
07 R
pt
Apr
07
Rpt
Jul 0
7 R
pt
Oct
07
Rpt
Dec
07
Rpt
Mar
08
Rpt
Jun
08 R
pt
Sep
-08
Rpt
Dec
08
Rpt
Mar
09
Rpt
Apr
-09
May
-09
Jun-
09
Per
cent
ile
* Compared to AHA Region 1
Press Ganey Quarterly Results Quarter To Date Press Ganey Results
93.9
93.2
CareFirst Service
Urgent Care Center Patient Satisfaction
0
10
20
30
40
50
60
70
80
90
100
Apr
il-06
Rpt
Oct
06
Rpt
Jan
07 R
pt
Apr
07
Rpt
Jul 0
7 R
pt
Oct
07
Rpt
Dec
07
Rpt
Mar
08
Rpt
Jun
08 R
pt
Sep
-08
Rpt
Dec
08
Rpt
Mar
09
Rpt
Apr
-09
May
-09
Jun-
09
* Compared to All Facility DB
Press Ganey Quarterly Results Quarter To Date Press Ganey Results
87.987.1
Service Tactics
Greeter Program
Tools & Equipment
Scripting in Key Areas
Support Cards
Service Recovery
Discharge Phone Calls
Service Operations Committee
Service Academy
Support CardsSupport Card UnitGina Kline, and Kristy Boyd Date:
Please rate each department on a scale of 1(very poor), 2 (poor), 3 (fair), 4 (good), 5 (very good), or N/A (not applicable)
Standard:
SHIFT Day Eve Noc Day Eve Noc Day Eve Noc Day Eve Noc Day Eve
FOOD SERVICESKevin O'Connor #57794
5 4 N/A 5 3 N/A 5 5 N/A 4 4 N/A 5 5
SUPPLIESCharlie Miceli #56584
4 4 4 4 4 4 5 5 N/A 5 5 N/A 5 5
ENVIRONMENTAL SERVICESRudy Viscomi #51460
5 4 3 4 4 3 5 5 N/A 5 5 5 4 4
TRANSPORTRudy Viscomi #51460
4 4 4 3 4 4 3 4 4 4 4 4 4 4
EQUIPMENTRudy Viscomi #51460
4 4 4 4 4 4 4 4 4 4 4 4 4 4
BIO-MED ENGINEERINGCharlie Miceli #56584
5 N/A N/A 5 N/A N/A 5 N/A N/A 5 N/A N/A 5 N/A
LINENRudy Viscomi #51460
5 5 N/A 5 5 N/A 5 5 N/A 5 5 N/A 5 5
PHARMACYSteve Clark #51308
5 5 N/A 4 5 N/A 5 5 N/A 5 5 N/A 5 5
ENGINEERING/MAINTENANCEBill Sullivan #57645
5 5 N/A 5 5 N/A 5 5 N/A 5 5 N/A 5 5
Comments:Any score of 1 or 2 should always contain a comment for follow up.
Attitude Operations
Day to day operations are run effectively and
efficiently?
Tanger 4 West11-Oct-02
Did we receive the right product or was a
variation communicated?
Accuracy
Was it a nice experience? Did you receive service with a
smile?
Can we reach a live person or use an electronic systems tool for reach out?
Accessibility
Response time and delivery when
promised
Timeliness
Purpose: Timely review of patient
positive/negative comments by all leaders will lead to investigation, service recovery and ultimately service improvement and an increase in patient satisfaction scores
Scope: All leaders of clinical and
support departments Chaired by President of the
Hospital Leaders investigate, comment,
follow-up with patient and staff as appropriate and provide a summary of their investigation, outcome and follow-up on every complaint
SOC
Service RecoverySOC
NAME PHONE SURVEY COMMENT UNIT
(401)780-XXXX 280520709
I found *Dr. Keith Isaacson to be very honest and very compassionate. He explained everything - very thoroughly. I am pleased that I chose him and MIGS. MIGS/ART
(781)237-1648 289316175
Everything was like "clockwork." *DR. CURTIS AND HIS TEAM were EXCEPTIONAL - efficient, caring and professional. Adult Gi
(508)872-XXXX 289317702
Everyone I came in contact with was very professional, kind, courteous and knowledgeable ESPECIALLY Reno and Lyn in the radiology dept. Reno stayed by my side the entire time and was there when I woke up. She was such a comfort to me at a very trying time. She made a BIG difference in my visit. Your entire nursing and volunteer staff is outstanding. Carol in the main Lab was most helpful to me when my scheduling went off track. She made it happen. CT SCAN
(508)533-XXXX 289317317
I can't say enough about how wonderful Dr. Robinson & his staff are! Dr. Robinson is caring & concerned & I felt confident that he was looking on for both me & my baby. MFM
POSITIVE COMMENTS
SOC
SOC
NAMEPHON
E SURVEY COMMENTS UNITASSIGNE
D TO
NEGATIVE COMMENTS
292171147
The food was not of good quality. It was not very tasty and temperatures were not great. Everything was warm. Usen 6
Kevin O’Connor
17051051
1
Please note, upon entering hospital registration area (8:30 p.m.) I was totally alone found no one for 10 minutes. Person then told me wrong directions & wrong floor to go to: Went back to registration area & had to wait 10 more minutes until someone else finally came & directed me to sleep unit. This should never, ever happen.
NEURO/ ASL Mary Murray
(617)308-XXXX
150401752
Bed & furniture were very uncomfortable. Room noise level was constantly high. Impossible to get rest or sound sleep. Usen 4
Judy Thorpe/ Bill Sullivan
(617)969-XXXX
256928543
The doctors whom stood in for my main doctor, need to rethink there bedside manors. I glad to say that they aren't my doctors & they happen to be women doctors. Usen 6
Fred Millham/ Priscilla Velardo
(508)234-XXXX
259349241
One nurses' assistant was HORRIBLE - rude, mean-spirited, insensitive - after mentioning it to the regular nurse, she dismissed it as "just being her way." Very unpleasant. Usen 6
Priscilla Velardo
(978)451-XXXX
230422821
Would've been nice if someone explained how the bed worked & showed me where all the lights were. In the morning I discovered the subtle over-the bed lights that I would've liked to have used the previous night. 5 West
Mary Ellen Olson
(978)725-3855
264089872
Metal staples were used even though I told the doctor of METAL ALLERGY. Got a BAD INFECTION!! 3 West Fred Millham
SOC
SOC
People
Annualized Employee Turnover Rate
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09
Tu
rno
ver
Rat
e
Annulized Turnover Rate FY09 FY09 Turnover Goal
People Tactics
Thank You Cards
45 & 90 Day Interviews
180 Day President’s Lunch
Reward & Recognize
Fitness Center
Cambridge College
EFAP
Enhance Employee Orientation
Physician & Employee Satisfaction Survey
People Tactics-Employee Survey
- Surveyed in October 2005 (Sperduto)
1205 employees participated in the survey (56% response rate)
73% of employees surveyed showed positive morale – 93d percentile New England - Key areas of strength: NWH image, goals/mission, meaningful work, pride in working at NWH, would recommend NWH as place to get care, value in Partners affiliation
People Tactics-Physician Satisfaction
- Surveyed in June 2006 (Press Ganey)
- “Overall facility” scored in the 99th percentile of All Facility grouping & 99th in the Community Hospital grouping
- “Quality of patient care” scored in the 99th percentile for both grouping
- “Quality of the nursing staff” scored in the 99th percentile in both benchmark groups
- “Likelihood of recommending to family & friends” scored in the 99th percentile
Mean Mean Mean NAME TITLE DOH Feb-03 Nov-03 Jan-05
1 Dept. 1 02/11/85 2.4 2.8 2.82 Dept. 2 02/25/02 3.0 2.9 2.73 Dept. 3 07/16/01 2.6 2.3 2.74 Dept. 4 02/10/03 2.5 2.3 2.65 Dept. 5 11/25/85 2.0 1.8 2.66 Dept. 6 06/28/76 2.8 2.7 2.67 Dept. 7 02/11/03 2.5 2.68 Dept. 8 08/01/99 2.9 2.7 2.59 Dept. 9 12/03/01 2.5 2.3 2.510 Dept. 10 05/13/02 1.9 1.2 2.511 Dept. 11 04/22/02 2.5 2.0 2.412 Dept. 12 04/24/00 2.5 2.6 2.313 Dept. 13 10/21/02 2.1 1.8 2.314 Dept. 14 02/16/98 2.5 2.3 2.315 Dept. 15 09/09/96 2.1 1.5 2.316 Dept. 16 07/05/01 2.8 2.8 2.317 Dept. 17 03/26/01 2.3 1.7 2.318 Dept. 18 9/20/2004 2.319 Dept. 19 9/9/2002 1.8 2.020 Dept. 20 03/25/96 2.1 1.3 1.921 Dept. 21 07/18/88 2.7 2.5 1.922 Dept. 22 10/16/95 2.1 1.7 1.823 Dept. 23 11/17/97 2.6 1.3 1.824 Dept. 24 06/03/91 2.1 1.0 1.725 Dept. 25 05/27/86 2.3 1.3 1.626 Dept. 26 04/05/93 1.6 1.3 1.127 Dept. 27 01/03/01 2.1 RIF28 Dept. 2829 Dept. 29 07/09/01 1.5 RIF30 Dept. 30 08/27/01 2.0 1.431 Dept. 3132 Dept. 3233 Dept. 33 08/31/98 1.9 PIP34 Dept. 34 06/13/01 2.8 2.435 Dept. 35 07/26/99 2.7 2.336 Dept. 36 05/29/01 2.0 RIF37 Dept. 3738 Dept. 38 12/09/72 1.7 RIF
Management Relative Performance Rankings
Low(Rarely meets standards) Points out problems in a
negative way Positions leadership poorly Thinks they will outlast
you
Medium(Sometimes meets standards) Loyal most of the time Influenced by low and
high performers Could just need more
experience
High(Consistently meets standards) You relax when you know
they are scheduled Good influence on others Strong sense of ownership
Attitude
Appearance
Commitment to Customer Needs
Customer Waiting
Privacy
Safety Awareness
Sense of Ownership
High, Medium, and Low
Leader Evaluation
CAREfirst Standards
Compassion
Attitude
Responsibility
Excellent & Quality
Accomplishment of Goals & Objectives
Service
People
Quality, Regulatory, and Safety
Finance
Growth
Leadership & Management Competencies
Practices & promotes ethical behavior
Problem solving/Decision-making
Leadership
Communications & Interpersonal Skills
Accountability
Vision & Strategic Planning
•26 LI’s conducted
•Invitees include 180 leaders (supervisors and above, including Chief s and Chairs)
•Quarterly for two day’s and off site
•Largely in house trainers with key note speakers
October 2002
Creating a Culture of Service Excellence
Roger Dow, Sr. V.P. Marriott CorporationDan Grabouskas, MA Registrar of MV January 2003The Goal of ChampionsJeff Taylor, Founder, Monster.ComRobin Brown, G.M. Four Seasons Hotel (
May 2003Balancing Dollars and SenseBarry & Eliot Tatelman, Jordan’s FurnitureKate Walsh, COO, Novartis
Leadership Institutes
External Leader Development
•Studer Group
•Pensacola Baptist Hospital
•Greenwich Hospital
•Multidisciplinary teams with executive management•Typically 3 days away
•Goal is to train in Service Excellence and re-recruit good employees
•Since 2003 we have sent nearly 1,400 trainees to training in places like Pensacola, San Diego, LA, Dallas, Las Vegas, Orlando, etc..
Service Discharge Phone Calls in Surgery
Purposeful Rounding, Expand PG to Outpatient Arena, Support Cards, Service Recovery Program, Discharge Phone Calls in Inpatient, Greeter Program Service Hotline
Standards of Excellence
SOC, Enhanced Leader Rounding, MHQP Satisfaction Survey in Primary Care, Roll-out Discharge Phone Calls to Additional Patient Care Areas, Enhancements to Service Recovery
Concierge Service for Patients, Visitors, EE Bonus Program
InfrastructureCare First, EMT RPR G&O, LI
Leader Report Card, Communication Boards Leader Eval
ST RPR, Empl. Eval, & HML
PeopleCF Awards, NEO, Cambridge College Masters Program, EFAP
Thank You Cards 45 & 90 Day Interviews, Presidential Lunch Care Teams, OE Team Awards Peer Interviewing
EE Sat. Survey, Bright Idea's, Tool Time, Six Sigma 1
MD Sat Survey, Six Sigma 2, Shipley Fitness Center
EE Sat Survey, Outlook Mtg Request
MD Sat. Survey, CF Service Academy, Lean
Pre FY03 FY04 FY05 FY06 FY07
NWH Time-Line
What Have we Learned?
•Leadership from the top
•Focus
•Perseverance not brain surgery
•Accountability
•Start with people
•Reward and recognition
•Low performers
Finance - Operating Income(000’s omitted)
FY99 FY00 FY01 FY02 FY03 FY04 FY04 FY06 FY07 FY08 FY09($15.0)
($10.0)
($5.0)
$0.0
$5.0
$10.0
$15.0
Financial Results
• Double digit growth-410M in revenue• Gross revenues tripled since FY01• Market share growth of 6 points • Top 100 Hospital 5 of past 7 years• Consumers Digest Top 50 hospitals for Patient Safety 2005• BBJ Best Places to Work 2007, 2008
Outcomes
• Patient satisfaction 80th – 95th percentile• Employee Turnover 8%• Employee Satisfaction 93rd percentile• Physician Satisfaction 99th percentile• Highest RN Satisfaction 2,000+• Partners Quality Close(ex: not a single central line infection for past 18 months)• Unannounced Joint Commission survey eg. Clean, handwashing
Outcomes
Unaided Awareness of NWH by Area: 2002-2007
47.5%
60.0%55.9%
61.3%
0%
20%
40%
60%
80%
100%
TOTAL Core Primary RemainderPrimary
Western Northern SouthernProportion Identifying NWH as Having Best Overall Reputation: 2002-2007
Proportion Identifying NWH as Having Best Overall Reputation: 2002-2007
11.5%
18.8%22.8%
0%
20%
40%
60%
80%
100%
TOTAL Core Primary RemainderPrimary
Western Northern Southern
NWH is separated from MGH by a one 10th of a percent in having the best overall reputation and is number 2 in our service area.
Image Impact
• Goals and Accountability (leader and support cards, session L)
• Leadership Development
• LI, Service Academy
• S.O.C.
• Reward/Recognition
• Bonuses, Celebrations, Team Awards
• Transparency
• Must Haves
How We Did It
• Leadership from the top• Focus• Perseverance not brain surgery• Accountability• Start with people
• Reward and recognition• Low performers
What Did We Learn?