Hardwiring Leader Evaluations

Bill Bielenda

What you will learn today…

Importance of leader accountability and goal alignment

How to develop effective goals

The basics on accountability tools

Purpose, worthwhile work

and makinga difference

®

Healthcare Flywheel®

Bottom Line Results

(Transparency and Accountability)

Self-Motivation

Prescriptive To Do’s

Aligned Goals Aligned Behavior Aligned Process

Evidence-Based LeadershipSM (EBL)

Sequence tools and techniques

Retain High Performers, Coach Mid Performers, Help deal with low performers

Better align training to outcomes

Implement objective accountability system

Hardwire consistency

Objective Evaluation

System

Leader Development

Must HavesSM

Performance Gap

Standardization

Accelerators

Healthcare is trying to build world class performance on

prehistoric evaluation systems.

Quint Studer

Leader Evaluation: Comparison of those organizations that have the leader evaluation process hardwired and those that do not

Source: Studer Group® October 2008 Measurement Spreadsheet; Organizations that hardwire the leader evaluation process in their organization, show patient perception of care ratings that are significantly higher than those that do not. Patient perception of care mean score average includes all partner selected vendors including Arbor, Avatar, Gallup, HCAHPS, Healthstream, Jackson, NRC, PRC Picker, Press Ganey, RPM, and Statisquest.

Year 1 – Goals

IssueReduce Costs /

Improve Financial Performance

Provider of Choice (patient

satisfaction)

Employer of Choice (employee

satisfaction)

Improve Care (Quality, Safety, Effectiveness)

Information Management

Goals

Achieve financial margins of:

– 4.0% in FY ’06

– YTD 4.6%more detail>

–5.0% in FY ‘07

Achieve organization-wide average patient satisfaction scores of:

– 93.7 for “Overall quality of care/services”

– YTD 93.5

– 76.1 for “Would you recommend”

– YTD 73.5

Reduce overall turnover of:

– “permanent” positions to11%

– YTD 14%more detail>

– “permanent” core RN positions to 13%

– YTD 16%

Achieve 90% compliance with CMS measures:

Community Acquired Pneumonia 3>90% - 5<90%

Surgical Infection Prevention

1 >90% - 2<90%

Heart Failure 2>90% - 2<90%

Acute Myocardial Infarction

5>90% - 2<90%

Achieve 90% compliance with evidence-based practice for prophylaxis of the following: DVT/PE, Post-op UTI, Post-op Pneumonia, Post-op AMI, Pressure Sores, Post-op Sepsis

– Implement Employee Satisfaction Assessment process during 2005

– Create projected timeline for the implementation of the Advanced Point of Care (APOC) clinical system

Leader Evaluation Results – Year 1

Service

Increase Patient Satisfaction (Inpatient)

Goal = 62nd

Current = 51st

Reduce Annualized Turnover

Goal = 14.5%

Current = 16.7%

Increase Employee Satisfaction

Decrease Mortality Index

Goal = .77

Current = .77

Operating Margin

Goal = 5%

Current = 5.6%

Reduce FTE per Adjusted Discharge

Goal = 1.15

Current = 1.15

Increase Inpatient Admissions

Goal = 2.7%

Current = 7.6%

Increase Outpatient Visits

Goal = 5%

Current = 8.0%

People Quality

Finance

Growth

Excellence

Increase Patient Satisfaction (Ambulatory)

Goal = 62nd

Current = 65th

Year 2 – Goals

Leader Evaluation Results – Year 2

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

Financial Impact: Hospital Acquired Infections

Perc

en

t of

HA

I O

ver

Ad

mis

sio

ns

Tactic and Tool Implemented:

Objective Evaluation System

Metric Reduction

Hospital Acquired Infections

156

Incremental Costs $1.93 million

Bed Days Avoided 984

Source: Arizona Hospital, Total beds = 355, Employees = 4,000, Admissions = 10, 188

HFMA article, “When Hospital Infections Go Down, Pay Raises and Bonuses Go Up at UMC”, July 2009

Clearly connects the goals of the organization to individual leaderProvides prioritization roadmap for leaderReduces unnecessary work and duplication of efforts because clear expectations are setKeeps leaders focused on what is really importantAllows senior leader to continuously monitor leader performanceProvides for organizational agilityCompetencies do not guarantee desired outcomes

Why Have Leader Evaluations Based on Objective Goals?

Goal Alignment & Balance

What is goal alignment?

Insuring that individual leader activities are consistent with the goals of the organization.

Vertical Alignment

ORGANIZATIONGOALS

DIVISIONGOALS

DEPARTMENTGOALS

LEADER / UNIT GOALS

Horizontal Alignment

DEPT X

GOALS

DEPT Y

GOALS

ORGANIZATIONGOALS

DIVISIONGOALS

DEPARTMENTGOALS

How Organizational Balance is Defined

MISSIONS

ervi

ce

Peo

ple

Qu

alit

y

Fin

ance

Integrating and

connecting the vision, value and

goals of the organization

into daily decisions,

behaviors and actionsG

row

th

Ed

uca

tio

n

Res

earc

h

Goal Development Process

1. Senior leaders set organizational goals

2. Organizational goals are shared with all leaders

3. Each leader determines their goals and preliminary weights

4. Goals are reviewed by each leader’s reporting senior

5. Goals are shared within leadership team to insure everyone's needs are addressed

6. Goals are audited for continuity

7. Leaders finalize their goals

Goal Development

Goal Development Tips

Develop quantitative goals.

Goal Scales

5 = Stretch

4 = Partial Stretch

3 = Goal

2 = Partial Accomplishment

1 = No Accomplishment

Example Goal with Rating Scale

Growth

Increase the number of procedures to 200.

Rating Scale

5 is ≥ 250

4 is 225 to 249

3 is 200 to 224

2 is 175 to 199

1 is ≤ 174

LEM Score Distribution

3

3

3

3

2

42

1 4 5

Target ExcellentOpportunity

Example LEM Results

0 1 2 3 4 5

Average Score = 3.07

Goal Development Tips

Develop quantitative goals.

Use language that everyone understands.

Connect goals to purpose.

Fewer, rather than more goals, are better.

Goal Development Tips – Cont.

It is not always practical to have a goal under each pillar.

Goals should be aggressive yet realistic.

Focus on results, not tactics or projects.

Goal or Tactic?

Conduct employee evals on time

Improve staff productivity

Round on 100% of inpatients

Attend all leadership development sessions

Pass OSHA inspection

Define how much time goal must be sustained

For fiscal year-to-date (FYTD)

For the month of December

For the 4th quarter

For last 6 months of the year

SMART Goals are

Specific

Measurable

Attainable

Realistic

Time-bound

What might not fit as goals:

Standards of performance

Subjective and vague statements

Tactics to achieve goals

Maintaining regulatory compliance

Routine job activities

Middle Manager Common Goals

Examples:

•Budget

•Patient satisfaction

•Employee satisfaction

•Patient Falls

Example Goals

Laboratory - Example

Pillar Weight Laboratory Goal

Service 25% Achieve a percentile rank of 99 for test and treatments for the fiscal year.

People 20% Reduce turnover to 15% annualized for entire fourth quarter.

Finance 20% Meet expense budget of $2.10 per test for fiscal year.

Quality 10% Reduce repeat test below 2% for last 6 months of fiscal year.

Growth 25% Increase lab outreach tests by 5% for fiscal year.

Patient Care Unit - Example

Pillar Weight Med/Surg Unit Goal

Service 30% Achieve a percentile rank of 99 for nursing care for the fiscal year.

People 30% Reduce turnover to 25% annualized for fiscal year.

Finance 25% Meet productivity target of 6.5 hours per patient day for fiscal year.

Quality 15% Decubiti rate of 0% achieved by last 6 months of fiscal year.

Growth 0% N/A

Medical Records - Example

Pillar Weight Medical Records Goal

Service 20% Achieve an average 4.8 on support services evaluation for fiscal year.

People 20% Maintain turnover level at or below 5% annualized for fiscal year.

Finance 30% Achieve A/R days of 65 by year-end.

Quality 20% Reduce inpatient denials by 20% for fourth quarter.

Growth 10% In-house transcription revenue to increase 10% for fiscal year.

Tools of Accountability

Leader Performance Evaluation

Leader Report Card

90 Day Work Plan

MONTHLY

QUARTERLY

YEAR END

No SurprisesNo Surprises

For valuable tips on creating a culture of organizational excellence, visit our web site at

www.studergroup.com

Bill Bielenda

850-934-1099

Thank You!