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Alignment & Accountability: Creating Organizational Goals and Using An Objective Evaluation System Bob Murphy, R.N., JD Studer Group Senior Leader & Speaker

Slide 2

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Execution Framework Evidence-Based LeadershipSM

Rev 2.14 COPYRIGHT © STUDER GROUP Please do not quote or disseminate without Studer Group authorization

Example Organizational Results Using typical Leader Evaluation

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Example Distribution of Performance Using typical Leader Evaluation

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Same Organization’s Results After implementing Weighted and Objective Evaluation

Excellence Service Increase Patient Satisfaction (Inpatient)

People Reduce Annualized Turnover

Goal = 62nd Current =

Quality Decrease Mortality Index

Goal = .77 Current = .77

51st

Goal = 14.5%

Finance Operating Margin Goal = 5% Current = 5.6%

Growth Increase Inpatient Admissions

Goal = 2.7% Current = 7.6%

Current = 16.7% Increase Patient Satisfaction (Ambulatory)

Increase Employee Satisfaction

Reduce FTE per Adjusted Discharge

Increase Outpatient Visits

Goal = 1.15 Goal = 62nd Current = 65th

Current = 1.15

Goal = 5% Current = 8.0%

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Distribution of Performance After implementing Objective and Weighted Evaluation

Note: Percentages noted account for 93% of the leaders who have entered data as of 6.7.07.

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Example Hospital Inpatient Monthly Percentile Score Year 1 – Year 5 100%

95%

Goal = 90%

90% 80% 70% 60%

50% 40% 30%

Leader Evaluation Tool Implemented

20% 10%

Year 1

Year 2

Year 3

Year 4

Aug

Jun

Apr

Feb

Dec

Oct

Aug

Jun

Apr

Feb

Dec

Oct

Aug

Jun

Apr

Feb

Dec

Oct

Aug

Jun

Apr

Feb

Dec

Oct

Aug

Jun

Apr

Feb

0% Year 5

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Example Hospital Inpatient Monthly Percentile Score Year 5 – Year 7 100%

99%

90% 80%

Goal = 90%

70% 60% 50% 40%

30% 20%

Year 5

Year 6

May

Mar

Jan

Nov

Sep

Jul

May

Mar

Jan

Nov

Sep

Jul

May

Jan

0%

Mar

Leader Evaluation Tool Implemented

10%

Year 7

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Accountability Tools

Evaluation Report Card 90-Day Plan

Meeting Model COPYRIGHT © STUDER GROUP Please do not quote or disseminate without Studer Group authorization

Leader Evaluation Requirements Evaluation must be:

• Objective • Measurable • Weighted* • Contain metric ranges (1-5)

Right Leader Right Goal Right Weight

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Setting Weights

10%

20%

>30%

Awareness

Focus

Urgency

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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: Weight:

20.5%

16.2%

14%

30%

20%

10%

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Example: Senior Team Equity Review Pillar Finance

CEO (Org Goals) CNO

Entity's Goal Description Increase Net Operating Income to budget or higher. Increase Inpatient admissions compared to budget.

Growth

People

Quality

Service

15%

10%

10%

10%

Increase Outpatient Revenue compared to budget as measured by Finance Department records. Increase employee satisfaction to 90th percentile as measured by annual survey.

15%

10%

Reduce Average Length of Stay (ALOS) to 4.85 days or less.

10%

CMO

CFO

COO VP HR

10%

20%

20%

20%

10% 15%

15%

10%

10%

20%

10%

20%

15%

15%

10%

20%

20%

10%

Maintain overall Emergency Department patient satisfaction at 10% 90th percentile.

10% 10%

15%

10%

10%

20%

Achieve Value Based Purchasing Rollup measures.

Increase HCAHPS in 6/8 composites at 80th percentile. Increase 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%

15%

15%

30%

10% 20%

35%

100% 100% 100% 100% 100% 100%

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

Example: Cascading a goal to decrease LOS  Case Management / Discharge Planning / Social WorkIncrease % of patients discharged day the order is written

 Ancillary Department Leaders-Increase 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-Increase the % of discharge orders written by (fill in appropriate time)

 House Supervisors-Increase % of ED admissions to inpatient bed within XXX hours  EVS-Improve bed turnaround time after 3pm COPYRIGHT © STUDER GROUP Please do not quote or disseminate without Studer Group authorization

Chief Executive Officer (CEO) Goals Service 30%

People 20%

Quality 20%

Finance 10%

Growth 20%

Increase HCAHPS to 70th percentile in 6/8 composites Weight = 10%

Increase Employee Satisfaction to 85th percentile Weight = 10%

Decrease 30 Day All-Cause Readmissions to 5% or less Weight = 10%

Operating Margin of 3.5% Weight = 10%

Increase Adjusted Admissions by 2.5% (18,260) Weight = 10%

Increase ED Patient Satisfaction to 80th percentile Weight = 10%

Increase Physician Satisfaction to 70th percentile Weight = 10%

Decrease CMS Never Events to 2 or less

Increase CGCAHPS to 80th percentile Weight = 10%

Weight = 10%

Increase Outpatient billable encounters to 37,000 Weight = 10%

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Chief Nursing Officer (CNO) Goals Service 35%

People 10%

Quality 35%

Finance 20%

Increase HCAHPS to 70th percentile in 6/8 composites

Increase Employee Satisfaction to 85th percentile

Decrease 30 Day All-Cause Readmissions to 5% or less

Decrease LOS to less than 3.4 days

Weight = 25%

Weight =10%

Weight = 15%

Increase ED Patient Satisfaction to 80th percentile

Growth 0%

Weight = 10%

Decrease CMS Never Events to 2 or less

Achieve Operating Budget

Weight = 20%

Weight = 10%

Weight = 10%

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Med Surg Nurse Manager Goals Service 30%

People 20%

Quality 40%

Finance 10%

Increase Med/Surg HCAHPS to 70th percentile in 6/8 composites

Increase Med/Surg Employee Satisfaction to 85th percentile

Decrease CHF Readmissions to 5% or less

Achieve 100% Variance to Budget

Weight = 20%

Weight = 10%

Weight = 30%

Weight = 10%

Growth 0%

Decrease fall rate (never event) to 2.5 or less Weight = 20%

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Chief Medical Officer (CMO) Goals Service 25%

People 15%

Quality 20%

Finance 10%

Growth 30%

Increase CGCAHPS to 80th percentile

Increase Physician Satisfaction to 70th percentile

Decrease CHF Readmissions to 5% or less

Reduce average Clinic no-show rate to 10% or less

Increase Outpatient billable encounters to 37,000

Weight = 10%

Weight = 10%

Weight = 15%

Weight = 10%

Weight = 30% Increase HCAHPS Physician Composite to 70th %tile Weight = 15%

A1C score greater than 7 will decrease to 25% or less Weight = 10%

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Physician Practice Manager Goals Service 25%

People 20%

Quality 15%

Finance 15%

Growth 25%

Increase CGCAHPS to 80th percentile

Increase Physician Satisfaction to 70th percentile

A1C score greater than 7 will decrease to 25% or less

Reduce average Clinic no-show rate to 10% or less

Weight = 10%

Weight = 15%

Weight = 10%

Increase number of billable patient encounters to 9,000

Weight = 15%

Weight = 25% Increase inNetwork Referral Rate to 85%

Increase Employee Satisfaction to 85th percentile

Weight = 10%

Weight = 10%

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Primary Care Physician Example Service 15%

People 10%

Quality 35%

Finance 10%

Growth 30%

Increase CGCAHPS to 80th percentile Weight = 15%

Increase Employee Satisfaction with Providers to 70th percentile Weight = 10%

Increase elderly annual flu show vaccine rate to 85% Weight = 10%

Generate 4,600 median work RVUs Weight = 10%

Increase innetwork referral rate to 85% Weight = 10%

Increase % of diabetics, ages 18-75, whose HbA1c was less than 7% (well controlled) to 70% Weight = 15% Increase percent of women, ages 42-69, who had a mammogram in the last two years to 85% Weight = 10%

Increase number of billable patient encounters to 3,400 Weight = 20%

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What is a 90-Day Plan? Plate Manager

Prioritization Tool

 Helps define most  Clearly defines important use of priorities for leader leader’s time and leader’s  Allows leaders to set supervisor interim goals in 90  Identifies key action day period to steps necessary to achieve annual goals achieve 90 day goals across all pillars  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

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90-Day Plan Example Goal

Action Steps

Manage Up Level

Results

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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

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Monthly Meeting Model Agenda Four Key Components 1. Review of performance (via report card and 90day 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 COPYRIGHT © STUDER GROUP Please do not quote or disseminate without Studer Group authorization

Thank You!

Bob Murphy, R.N., JD 850-393-4481 [email protected] www.studergroup.com

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