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1 © 2008 Studer Groupwww.studergroup.com
An Introduction to Evidence-Based Leadership
Bob Murphy, R.N., Esq., FACHENational Speaker, Studer Group
What’s Right in Health CareSM | Evidence to Outcomes
Source: Medical Center Arlington, Arlington, TX, Total beds=270
7.807.60
6
7
8
Q1 Q2
Annualized Savings in First Year: $65,216 (30 bed unit)
Wo
rked
Ho
urs
p
er
pati
en
t D
ay
Return on Investment: Improved Productivity
Individualized Patient Care
Hourly Rounding
Nurse Leader Rounding on Patients
Tactic and Tool Implemented:
2 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Source: Southwest Washington M.C., Vancouver, WA, 360 beds
$494
$16,037$17,574
$0$2,000$4,000$6,000$8,000
$10,000$12,000$14,000$16,000$18,000
Month 1 Month 2 Month 3
Annualized Upfront Collections Increased: $136,420
Up
-fro
nt
co-p
ay
collect
ion
s
Return on Investment: Upfront Collections
AIDET
Tactic and Tool Implemented:
What’s Right in Health CareSM | Evidence to Outcomes
Return on Investment:ED Left Not Seen
8.4
5.74.8 4.5
0123456789
10
% LWS
Cal Y2006 May June July
Hourly Rounding/IPC implemented April 2007
Hourly RoundingIndividualized Patient Care
Tactic and Tool Implemented:
Annualized ROI: $969,000($500/patient x 1938 patients)
Source: Baptist Hospital of Miami, Miami, FL, Annual adult visits = 57,000
3 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Return On Investment: Reduction of Employee Turnover and ROI
24%
16%
22%
17%
21%
12%
31%
16%
25%
19%21%
19%
0%
5%
10%
15%
20%
25%
30%
35%
Tot BMC NCBH NEBH SLBH *SEBH
FY06 FY07
$923,832 $1,815,565 $410,058$3,086,810 $1,135,139
* All turnover onlySource: Baptist Health System, San Antonio, TX, Total Beds = 1673
Peer Interviewing
30/90 Day Meetings
Tactic and Tool Implemented:
What’s Right in Health CareSM | Evidence to Outcomes
Return on Investment: Reduction of Falls
18401651 1696
0
500
1000
1500
2000
Y2004 Y2005 Y2006
Hourly Rounding implemented 2005
Estimated Annualized Savings: $1.65 million
(150 falls x 11,000)
Hourly Rounding
Tactic and Tool Implemented:
Source: Montefiore Medical Center, Bronx, NY, Admissions: 60,632 , Total Beds = 1002, Estimated cost per fall = $11k, Hourly Rounding implemented in 2005
4 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
1. Dots are connected consistently to purpose, worthwhile work and making a difference
2. Balanced approach 3. Objective accountability
system4. Leaders have the training
to be successful 5. Sequenced approach to
introduction of new behaviors
6. Process in place to re-recruit the high and middle performers and address low performers (HML)
7. Process in place to take best practices and standardize across organization
8. Leaders “always” do desired behaviors
9. Good verification systems to hardwire behaviors
Why Organizations Attain/Sustain Excellence
Rev 12.07
What’s Right in Health CareSM | Evidence to Outcomes
Purpose, worthwhile work
and makinga difference
®
Healthcare Flywheel®
• Bottom Line Results
(Transparency and Accountability)
• Self-Motivation
• Prescriptive To Do’s
5 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
PrescriptivesPassion
Passion + Prescriptives = Results
What’s Right in Health CareSM | Evidence to Outcomes
Standardization AcceleratorsMust HavesSM
Performance Gap
Objective Evaluation
SystemLeader
Development
Foundation Breakthrough
STUDER GROUP:
Rev 12.07
RoundingThank You NotesEmployee SelectionPre and Post Phone CallsKey Words at Key TimesPrinciple 3, 5, 6, & 9
Re-recruit high and middle performersMove low performers up or out Principle 4
Agendas by pillar Peer interviewing30/90 day sessionsPillar goalsPrinciple 1 & 2
Leader Eval Mgr (LEM)Staff Eval Mgr (SEM)Discharge Call Manager (DCM)Rounding MgrIdea Express
Aligned Goals Aligned Behavior Aligned ProcessCreate process to assist leaders in developing skills and leadership competencies necessary to attain desired resultsPrinciple 4 & 8
Implement an organization-wide staff/leadership evaluation system to hardwire objective accountabilityPrinciple 2 & 7
Evidence-Based LeadershipSM
(EBL)
6 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Barriers to Change
• Denial• Rationalization• Blame• Uniqueness• Unwillingness• Not Skilled
What’s Right in Health CareSM | Evidence to Outcomes
Must Haves®
• Aligning Leader Evaluations with Desired Outcomes
• Rounding for Outcomes• Employee Thank You Notes• Employee Selection and the First 90 Days • Pre and Post Phone Calls• Key Words at Key Times
7 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Department MeetingsEmployee Conversations Employee R&RStaff Selection and OrientationStaff and Patient RetentionStaff PolicyPatient ConversationsPre Phone CallsPost Phone CallsStaff and Leader EvaluationOnly new item
Current Practice
Consistent AgendasRounding for OutcomesThank You NotesPeer interviewing and 30/90 Day MeetingsIndividual Employee MeetingsStandards of BehaviorKey Word at Key TimesPre Phone CallsPost Phone CallsStaff and Leader EvaluationLeadership Training
Effective Approach
Not New - Better
What’s Right in Health CareSM | Evidence to Outcomes
Aligned Goals
Objective Evaluation
System
* Principle 2 and 7
Must HavesSM
Performance Gap
Aligned Behavior
Standardization Accelerators
Aligned Process
Leader Development
Aligned Goals
Objective Evaluation
System
8 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Leader and Staff Evaluation
Accountability and Prioritization
What’s Right in Health CareSM | Evidence to Outcomes
Leader Evaluation Requirements
Evaluation must be:• Objective• Measurable• Weighted• Contain metric ranges (1-5)
9 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
• Clearly connects the goals of the organization to individual leader
• Provides prioritization roadmap for leader
• Keeps leaders focused on what is really important
• Allows senior leader to continuously monitor leader performance
• Provides for organizational agility
Why Have Leader Evaluations Based on Objective Goals?
What’s Right in Health CareSM | Evidence to Outcomes
“Ask yourself, can leaders or staff under-perform and still get a good
evaluation?”
Bob Murphy, R.N., Esq., FACHENational Speaker/CoachStuder Group
10 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Leader Development
* Principle 4 and 8
Must HavesSM Performance
Gap
Aligned Behavior
Standardization Accelerators
Aligned ProcessAligned Goals
Objective Evaluation
System
Leader Development
Aligned Goals
What’s Right in Health CareSM | Evidence to Outcomes
“The pace of change in healthcare is accelerating, we need new skills to
be ready for the future.”
Bob Murphy, R.N., Esq., FACHENational Speaker/CoachStuder Group
11 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Basic Leadership Skills: The Foundation
Leaders must be skilled in:• Running effective meetings• Managing financial resources• Answering tough questions so as to not create a
“we/they” culture (compensation including salaries)
• Selection of talent• Development of talent• Critical thinking• De-selection• Understanding the external environment
What’s Right in Health CareSM | Evidence to Outcomes
Must HavesSM
* Principle 3, 5, 6 and 9
Performance Gap
Aligned Behavior
Standardization Accelerators
Aligned ProcessAligned Goals
Objective Evaluation
System
Leader Development
Must HavesSM
Aligned Behavior
12 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Key Must HavesSM
• Got Chart• Physician
Preference Card • Physician Code• Rounding for
Outcomes
• Leader Rounding on Patients
• Post Visit Calls• Hourly Rounding• Individualized
Patient Care• Bedside Shift
Report• AIDET• Pre Visit Calls
• Rounding with Employees
• Employee Thank You Notes
• Peer Interviewing • 30 and 90 Day
Meetings (Input)• Employee
Attitude Survey • Employee Forums • Bright Ideas
Patient• Standards
PhysiciansPatientsEmployees
What’s Right in Health CareSM | Evidence to Outcomes
Employee Strategies
• Rounding for Outcomes (Input)
• Employee Thank You Notes (Reward Desired Performance)
• Peer Interviewing (Select)
• 30 and 90 Day Meetings (Input)
• Employee Attitude Survey (Diagnostic)
• Employee Forums (Alignment / Recognition)
• Bright Ideas (Innovation/process improvement and input)
• Managing up (Communication)
• Service Teams (Involvement)
13 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Rounding for
Outcomes
Employee - Input
What’s Right in Health CareSM | Evidence to Outcomes
Rounding for Outcomes - Staff
Follow-up
Tools and Equipment
Systems to Improve
People to Recognize
What is Working Well
Concern and Care
Rounding with Staff
14 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Verification: Rounding Log
Safety
What’s Right in Health CareSM | Evidence to Outcomes
Study conducted by Dr. Gerald Graham, Management Professor at Wichita State UniversityMotivating Today’s Employees, Bob NelsonTalent+, 1998
Top 5 Workplace Incentives
1. Written Thanks From Manager/Executive Team Leader
2. Personal Thanks From Manager
3. Promotion for Performance
4. Public Praise5. Morale-Building
Meetings
15 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Thank You Notes
Reward Desired Performance
What’s Right in Health CareSM | Evidence to Outcomes
Recognize and Reward Behavior
• Reinforces positive behavior • Creates role models for other staff• Shows staff how they can make a
difference• Creates improved results across
organization
16 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Verification: Thank You Grid
What’s Right in Health CareSM | Evidence to Outcomes
Compliment to Criticism Ratio
1 compliment 1 criticism
2 compliments1 criticism
3 compliments1 criticism
Negative1 to 1
Neutral2 to 1
Positive!3 to 1
Source: Tom Connellan, “Inside the Magic Kingdom”, pgs 91-95
17 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
January 7, 2008Dear Susan,John Smith wrote me the nicest note about the number of positive comments you have been getting on the patient satisfaction surveys. Your patients notice how you check on them every hour and are available to meet their needs. John also told me you are helping interview staff for the unit. This is very important. Thank you for being at our organization!Sincerely,Bob
Employee Thank You Note Sample
What’s Right in Health CareSM | Evidence to Outcomes
Selection
Select
18 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Impact on Turnover
17.9%
14.2% 15.1%
11.9%
0%2%4%6%8%
10%12%14%16%18%20%
Overall Turnover Nursing Turnover2006 2007 2006 2007Jewish Hospital St. Mary’s Healthcare – Louisville Kentucky, 42,000 discharges, Total beds = 1,900 beds
268 positions retained 75 positions
retained
Total Estimated ROI: $9 million Overall
Tactic and Tool Implemented:
Behavioral and Peer Interviewing
30 and 90 Day Meetings
What’s Right in Health CareSM | Evidence to Outcomes
PERFORMANCE STANDARDS
A set of performance standards has been developed by the employees of ______________________ to establish specific behaviors that all employees are expected to practice while on duty.
By incorporating these standards as a measure of overall work performance, ______________________ makes it clear that employees are expected to adhere to and practice the standards of performance outlining the Standards of Performance handbook.
I have read and understand the Standards of Performance handbook and I agree to comply with and practice the standards outlined within.
______________________ _____________________Signature of Applicant Date
…includes a signed agreement and
commitment to the standards and values of
the organization
Application Process: Signing the Standards (Early On)
19 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
InitiativeWhat processes or techniques have you learned to make a
job easier or more effective? What was your discovery process and how did you implement your idea?
Work EnvironmentTell me about a time when your unit was full and you had to care for multiple patients. How did you prioritize your work?
CommunicationDescribe a time when you had a miscommunication with a patient or family member. What did you do and what was
the outcome?
Behavioral Based Questions
What’s Right in Health CareSM | Evidence to Outcomes
Supervisor asks the following:• How do we compare with what we said?• What’s working well? Have there been any
individuals who have been helpful to you?• Based on your prior work, what ideas for
improvement do you have?• Is there any reason that you feel this is not
the right place for you?• Do you know of anyone who would be a
good fit for our organization?• As your supervisor, how can I help you?
90-Day Meetings
20 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Patient and Families
Performance Gap
Aligned Behavior
Standardization Accelerators
Aligned ProcessAligned Goals
Objective Evaluation
System
Leader Development
Must HavesSM
What’s Right in Health CareSM | Evidence to Outcomes
Sample distribution of inpatient satisfaction scoreresponses to achieve excellence
99thPercentileHospital
64thPercentileHospital
1’s 2’s 3’s 4’s 5’s
1% 2% 7% 24% 66%
1% 2% 8% 34% 55%
2% 2% 8% 36% 52%35thPercentile
Reference: Press Ganey and Associates, March 2007
Let’s look at Service – 4 vs 5
21 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Patient Prescriptives
• Leader Rounding on Patients• Post Visit Calls• Hourly Rounding• Individualized Patient Care• Bedside Shift Report• AIDET• Pre Visit Calls
What’s Right in Health CareSM | Evidence to Outcomes
What is HCAHPS?
Hospital Consumer Assessment of Healthcare Providers and Systems
• A standardized national patient survey, allowing public sharing of comparable data across all acute care hospitals
22 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Leader Rounding on Patients
What’s Right in Health CareSM | Evidence to Outcomes
Leader Rounding on Patient -Outcomes
Per
cent
ile Percent
14
4
38
20 1626
95
34
63
74 76
53
98%90%
81%
100%99%92%
0
20
40
60
80
100
PCU SSC MBC MSC WCU BH0%
20%
40%
60%
80%
100%
2005 4Q 2006 % Patient Rounded OnSource: Presbyterian Hospital, Albuquerque, NM, Beds = 375
Leader Rounding on Patient
Tactic and Tool Implemented:
23 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Rounding for Patient Outcomes
Set Expectations
Identify Patient and Family Needs
Give instructions on what to do if they do not get the care they expect
Explain the feedback system
Document NeedsRounding with Patients and
Families
What’s Right in Health CareSM | Evidence to Outcomes
Verification: Leader Rounding on Patient Log
24 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Outcomes: Rounding on Patients“Did a Nurse Manager Visit You During Your Stay?”
96th96th89th
96th
45th
8th14th
44th
0
10
20
30
40
50
60
70
80
90
100
Overall Nurses Section Response toConcerns/Complaints
Likelihood toRecommend
Nat
iona
l Per
cent
ile R
anki
ng
Yes
No
Source: Inpatient surveys received April 22-June 4, 2007n=361 surveys (55%=YES; 44%=NO)
What’s Right in Health CareSM | Evidence to Outcomes
Post Visit Phone Calls
Saves Lives
25 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Reality of Adverse Events Post Discharge
Type of Adverse Events
66%17%
5%
8%
4%
Adverse Drug Event
Procedure Related
Nosocomial Infection
Fall
Other
* 81 events occurred in 76 patients
“Nearly 1 in 5 patients”*
400 patients surveyed
76 (19%) had adverse events after discharge
* “Adverse Events After Discharge from Hospital”, Annals of Internal Medicine, February 2003
What’s Right in Health CareSM | Evidence to Outcomes
Post Visit Calls: Patient Perception of Care - Inpatient
75
98
76
98
60
99
56
98
59
98
0
10
20
30
40
50
60
70
80
90
100
3Q06 4Q06 1Q07 2Q07 3Q07
No Call Call
“Likelihood of Recommending”
Source: Hackensack University Medical Center, Inpatient admissions=75,297, Total beds = 781
Post Visit Calls - Discharge Call Manager
Tactic and Tool Implemented:
Perc
en
tile
Ran
k
Inpatient Admissions
= 75,297
26 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Post Visit Calls:Patient Perception of Care - ED
27
76
47
88
32
87
62
95
63
93
47
77
25
76
0
10
20
30
40
50
60
70
80
90
100
1Q 06 2Q06 3Q06 4Q06 1Q07 2Q07 3Q07
No Call Call
“Likelihood of Recommending”
Perc
en
tile
Ran
k
Source: Emergency Department, Hackensack University Medical Center, Hackensack, NJ, ED Visits: 85,034
Post Visit Calls - Discharge Call Manager
Tactic and Tool Implemented:
85,034 ED Visits
What’s Right in Health CareSM | Evidence to Outcomes
Hourly Rounding
Preventing Falls, Decubuti and Restraints
27 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
13,216
9,3168,315
0
3,000
6,000
9,000
12,000
15,000
Pre-Rounding Weeks 1-2 Weeks 3-4
One Hour
1 Hour Rounding/29 beds
37.8% reduction
* Reduction for one-hour was statistically significant (p=.000)
Call L
igh
t R
ing
s
Call Light Reductions After Implementing Rounds
What’s Right in Health CareSM | Evidence to Outcomes
One Hour: n=18 units
79.991.9
0
20
40
60
80
100
Pre One Hour Rounding During One Hour Rounding
1 Hour Rounding +12.0 point
mean increase
Overa
ll N
urs
ing
Service: Patient Satisfaction Increased
28 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
25
12
0
5
10
15
20
25
30
Pre One-Hour During One hour
1 Hour Rounding 50% reduction
Pati
en
t Falls
(n=18 units)
Quality: Patient Falls Reduced
What’s Right in Health CareSM | Evidence to Outcomes
7
5
0
2
4
6
8
10
Pre One-Hour During One hour
1 Hour Rounding 14% reduction
No
soco
mia
l D
ecu
bit
i
(n=9 units)
Quality: Skin Breakdown Reduced
29 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Hourly Rounding Steps
8. Document the round on chart.
7. Tell each patient when you will be back.
6. Close the conversation.
5. Conduct an environmental assessment.
4. Assess additional comfort needs.
3. Address the 3 P’s of pain, position and potty.
2. Perform scheduled tasks. (Explain and Duration)
1. Use opening key words to reduce anxiety.
Hourly Rounding
What’s Right in Health CareSM | Evidence to Outcomes
Key Words at Key Times
Reducing Anxiety
30 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Things said and done to “connect
the dots” and help patients,
staff and physicians
understand why we do things and what is going on.
Key Words at Key Times
What’s Right in Health CareSM | Evidence to Outcomes
Studer Group Five Fundamentals
A
I
D
E
T
Acknowledge
Introduce
Duration
Explanation
Thank You
31 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Outcome - Outpatient Satisfaction
0
10
20
30
40
50
60
70
80
90
100
July
-04
Sep
t-04
Nov
-04
Jan-
05
Mar
ch-0
5
May
-05
July
-05
Sep
t-05
Nov
-05
Jan-
06
Mar
ch-0
6
May
-06
July
-06
Sep
t-06
Nov
-06
Jan-
07
Mar
ch-0
7
May
-07
July
-07
Sep
t-07
AIDET Training Began
Source: Advocate Good Samaritan Hospital, Downers Grove, IL, Beds = 303, Admissions = 17,486, measured by Press Ganey Associates, Inc.
AIDET
Tactic and Tool Implemented:
What’s Right in Health CareSM | Evidence to Outcomes
Improved clinical
outcomes and increased
patient and physician
satisfaction
Advantages of AIDETSM
DecreasedAnxiety
IncreasedCompliance+ =
Decrease anxiety with increased compliance
32 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Performance Gap
* Principle 4
Must HavesSM
Aligned Behavior
Standardization Accelerators
Aligned ProcessAligned Goals
Objective Evaluation
System
Leader Development
Performance Gap
Aligned Behavior
What’s Right in Health CareSM | Evidence to Outcomes
“We get more quality, productivity and service by focusing on our high
performers rather than low performers.”
Bob Murphy, R.N., Esq., FACHENational Speaker/CoachStuder Group
33 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Definition
Professionalism
Teamwork
Knowledge & Competence
Communication
Comes to work on timeGood attitudeProblem solvesYou relax when they are scheduledGood influenceUse of peer interviewsPillar ownershipBrings solutions
Safety Awareness
Adheres to policies concerning breaks, personal phone calls, leaving the work area, and other absences from work.
Demonstrates high commitment to making things better for their team and organization as a whole.
Eager to change for the good of the organization. Strives for continuous professional development.Consistently communicates organizational. Does not create we/they. Provides frequent feedback to staff.Demonstrates the behaviors of safety awareness in all aspects of work.
H
Definition of High Performer
What’s Right in Health CareSM | Evidence to Outcomes
Definition
Professionalism
Teamwork
Knowledge & Competence
Communication
Good attendanceLoyal most of timeInfluenced by high and low performerWants to do a good jobCould just need more experienceHelps manager be aware of problems
Safety Awareness
Usually adheres to policies concerning breaks, personal phone calls, leaving the work area, and other absences from work.
Committed to improving performance of their team and organization. May require coaching to fully execute.
Invested in own professional developments. May require some coaching to fully execute.
Usually communicates organizational information. Occasionally uses we/they language. Provides some feedback to staff.
Demonstrates the behaviors of safety awareness in all aspects of work.
M
Definition of Middle Performer
34 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Definition
Professionalism
Teamwork
Knowledge & Competence
Communication
Points out problems in a negative wayPositions leadership poorlyMaster of “We/They”Passive aggressiveThinks they will outlast the leaderSays manager is the problem
Safety Awareness
Does not communicate effectively about absences from work. Handles personal phone calls in a manner that interferes with work. Breaks last longer than allowed.
Demonstrates little commitment to their team and the organization.
Shows little interest in improving own performance or the performance of the organization. Develops professional skills only when asked.
Does not communicate organizational information. Uses language to create we/they culture. Does not provide feedback.
Performs work with little regard to the behaviors of safety awareness.
L
Definition of Low Performer
What’s Right in Health CareSM | Evidence to Outcomes
Moving the High Performers
• Tell them where the organization is going• Thank them for their work• Outline why they are so important• Ask if there is anything you can do for
them
35 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Person with Middle Performance Conversation
Reassure individual goal is to retain• S : Support
– Describe good qualities – calm down their anxiety
• C : Coach– Cover development opportunity
• S : Support– Reaffirm good qualities
What’s Right in Health CareSM | Evidence to Outcomes
Person with Low Performance Conversation
Does not start meeting on a positive note• D : Describe
– Describe what has been observed.• E : Evaluate
– Evaluate how you feel.• S : Show
– Show what needs to be done.• K : Know
– Know consequences of continued same performance.
• Follow up
36 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
What Has Been Accomplished?
• Leader demonstrates concern and care for team member
• Leader demonstrates commitment to team member professional development
• Leader affirms and shows appreciation for high and middle
• Leader lets people with sub-par performance know exactly where they stand and next steps for their performance
• Leader role models value driven leadership
What’s Right in Health CareSM | Evidence to Outcomes
Frequently Asked Questions
• What if a person is good clinically and good with the patient but cannot work with co-workers?
• What about the high performer who has an attendance problem?
• What if the sub-par performer has been in organization a long time?
• What if my leader is a sub-par performer?
• If I deal with staff with performance issues and other leaders do not, will people think I am a mean leader?
• What if all past evaluations are good?
• What if I have not documented well?
• What if HR protects people?
37 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Standardization
* Principle 1 & 2
Must HavesSM Performance
Gap
Aligned Behavior Aligned ProcessAligned Goals
Objective Evaluation
System
Leader Development AcceleratorsStandardization
Aligned Processes
What’s Right in Health CareSM | Evidence to Outcomes
What hospitals might standardize
• Agendas• Supervisory Meeting Model• Staff Selection and the First 90 Days• Employee Forums• Communication Boards• Verification• Rounding Times
38 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Board Agenda Sample
• Community Needs Assessment Status
• % of employee volunteers
• New Patient Volume Growth
• Surgical Growth
• No-shows
• Operating Margin (MTD / YTD)
• Turnover
• Turnover –First 90 Days
• Employee Satisfaction and Retention
• Agency Costs
• Vacancies
• Key Clinical Indicator Review
• Medication Errors
• Reduction of Patient Falls
• Patient Satisfaction
• Physician Satisfaction
CommunityGrowthFinancePeopleQualityService
What’s Right in Health CareSM | Evidence to Outcomes
Department Head Agenda Sample
• Upcoming Safety Fairs and Community Events
• Volume compared to budget
• Specific Service line growth
• No-shows
• ED Diversion
• LWBS
• Operating Margin
• Cash Collections
• AR days
• Turnover
• Upcoming hospital celebrations
• Upcoming Peer Interview training
• Standard of the Month
• Key Clinical Indictors –results for the organization
• LOS
• Patient Satisfaction all service lines
• Patient letter
CommunityGrowthFinancePeopleQualityService
39 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Department Specific Agenda Sample
• Upcoming safety fair
• Department employee recognition for volunteer hours
• Dept admissions
• Community events
• Hospital growth YTD
• Dept productivity
• Dept supply costs
• Key actions for staff to take next 30 days
• Hospital financial perform-ance YTD
• Introduce new employee
• Dept turnover
• Peer interview update
• Upcoming training activities
• Reward and recognition
• Dept quality indicators
• Dept LOS• Key action
steps for staff to take next 30 days
• New tools and equipment
• Dept patient satisfaction
• Patient comments
• What we have improved
• Where we need to focus
• Ideas from staff
• Post visit phone calls
CommunityGrowthFinancePeopleQualityService
What’s Right in Health CareSM | Evidence to Outcomes
Studer Group Supervisory Meeting ModelLeaders bring the following items and results to
their immediate supervisor:• Leader Evaluation • Monthly Report Card• 90-Day Plan-Professional Development• Linkage Grid from Leadership Development
Institute (LDI)• Rounding Logs • Thank you notes • People Trends and Issues-Standards of
Behavior
40 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Verification Tools - Samples
Employee:• Leader Rounding on
Employee Log• 30 and 90 Day New
Employee Meeting Report
• Thank you Note Grid
Patient:• Leader Rounding on
Patient Log• Hourly Rounding Log• IPC Rounding Log• Bedside Shift Report
Rounding Log• AIDET Interaction
Assessment
What’s Right in Health CareSM | Evidence to Outcomes
Accelerators
Must HavesSM
Performance Gap
Aligned Behavior
Standardization
Aligned ProcessAligned Goals
Objective Evaluation
System
Leader Development Accelerators
Aligned Processes
41 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Accelerators
• Leader Evaluation Manager (LEM)• Staff Evaluation Manager (SEM)• Discharge Call Manager (DCM)• Rounding Manager• Idea Express
What’s Right in Health CareSM | Evidence to Outcomes
It is not about 4’s and 5’s …. but
saving lives
42 © 2008 Studer Groupwww.studergroup.com
What’s Right in Health CareSM | Evidence to Outcomes
Purpose, Worthwhile Work
and Making a Difference
Thank You!
Bob Murphy, RN, Esq., FACHECell (850) 393-4481