Welcome to St. David’s South Austin Medical Center

1. Welcome to St. David’s South Austin Medical Center New Physician Orientation

2. Mission • To provide exceptional care to every patient every day with a spirit of warmth, friendliness and personal pride

3. Values • ICARE Values: • Integrity • Compassion • Accountability • Respect • Excellence

4. Goals • Exceptional Care • Customer Loyalty • Financial Strength

5. Comprehensive, acute care hospital including emergency, heart, and women’s services • Established in 1982 • Member of St. David’s HealthCare and Hospital Corporation of America (HCA) 5

6. South Austin Medical Center was built in 1982 • Many people did not see the need for a hospital “south of the river” • Original planning meetings held at Hill’s Café • The Goodnight family, local business owners, were very supportive and instrumental in the construction of the hospital 6

7. Hospital Services • Blood Cancer Treatment &Bone Marrow Transplant • Robotic Surgery • Freestanding Emergency Departments • Urgent Care Clinics • Wound Care/Hyperbaric Services • Sleep Lab • Transfer Center 7

8. Currently has approximately 40 beds • Observation area (called Fast Track) • In 2008, a helipad was constructed immediately adjacent to the ED to receive critically ill and/or injured patients 8

9. In 2010, SAMC had the busiest ED in Austin, with over 73,000 visits annually • Patients receive care based on a triage system • The majority of hospital admissions come through the ED • Major SAMC goal is to reduce wait times in ED and the time to release or admit patients 9

11. Triage station Walk-in and ambulance entrances

12. Several areas dedicated to surgical patients • Orthopedic patients • Post surgery patients • Oncology patients • Patients with illnesses • All floors have telemetry or heart monitor capability if required by patients (except L&D) 12

14. Levels of care • ICU – Intensive care unit (2nd floor) • IMC – Intermediate care unit (7th floor) • Full telemetry monitoring is done on these patients, according to their needs 14

15. Patient room with telemetry equipment

16. Nurses station Family waiting area

17. Heart–related areas include • Cardiac cath labs and Outpatient Heart Center • Special procedures area and EP Lab • CVRU (Heart-related ICU) on 4th floor • Two open-heart operating rooms • This unit has 8 beds 17

19. Procedure room & telemetry

22. Postpartum/2Central

23. X-Ray Machine Digital Mammography Suite

24. Nuclear X-ray Cat-Scan

27. Medical Staff Leadership Chief Medical Officer: Al Gros, MD Chief of Staff: Robert Northway, MD Chief of Staff-Elect: Alex Esquivel, MD Secretary: David Savage, MD • Dr. Al Gros CMO, South Austin Medical Center • Office: (512) 816-6112 • Mobile: (512) 294-7064 • Fax: (512) 816-7278 • Email: Albert.Gros@stdavids.com

28. Senior Leadership Todd Steward CEO Brett Matens COO/ECO Dan Huffine CFO Nikki Sikes Associate Administrator Sally Gillam CNO

29. Governance & Peer Review

30. BOT MEC(Chief of Staff) Action MCEC (Chief Medical Officer) Rapid Review Team Egregious Event:(incl. Sentinel Events, In-House Physician Quality Issues) Medical Director / Vice Chief of Staff Department Triage(Med Dir & PIC) Clinical Issue: Competence,Core Measures, OutcomesIndicator 'Fall-outs' Compliance / Social Issue:(i.e., Complaints, Non-compliance,Behavior) Variance Reports Physician PI Coordinator Prof. Liability Actions Patient Complaints Sentinel Events Failed Measures Employee Complaints Fall-out from Screens Compliance Issues Approved by MEC 2/08

31. OPPE & FPPE Review

32. Core Measures • AMI (Acute Myocardial Infarction) • HF (Heart Failure) • PN (Pneumonia) • SCIP (Surgical Care Improvement Project)

33. SCIP Core Measures SCIP INFECTION QUALITY INDICATORS • Prophylactic Antibiotic Received within 1 Hour of Incision (2 hrs for Vancomycin or fluoroquinolones) • Recommended Prophylactic Antibiotic Selection for Surgical Patients • Prophylactic Antibiotics Discontinued within 24 Hours After Surgery End Time (48 hrs for Cardiac Surgery) • Cardiac Surgery Patients with Controlled 6 A.M. Post-op Serum Glucose (<200 mg/dL) post-op day 1 & 2 • Surgery Patients with Appropriate Hair Removal (no razors) • Urinary Catheter Removed on Post-op Day 1 or 2 • Surgery Patients with Perioperative Temperature Management (active warming intraoperatively or one body temp. > 96.8o within 30 min. prior to 15 min. after Anesthesia End Time)

34. SCIP Core Measures SCIP VTE QUALITY INDICATORS • Recommended Venous Thromboembolism Prophylaxis Ordered anytime from hospital arrival to 24 hrs after Anesthesia End Time • Recommended Venous Thromboembolism Prophylaxis within 24 Hours Prior to Anesthesia Start Time to 24 Hours After Anesthesia End Time SCIP CARDIAC QUALITY INDICATOR • Surgery Patients on Beta Blocker Therapy Prior to Admission Who Received a Beta Blocker During the Perioperative Period SCIP HEART FAILURE QUALITY INDICATOR • ACEI or ARB Prescribed at Discharge for Patients with <40% LVEF

35. Physician and Patient Communication

36. Why Should You Care? • A 2004 Harris Interactive poll of 2,267 U.S. adults showed that “patients place more importance on doctors’ interpersonal skills than their medical judgment or experience, and doctors’ failings in these areas are the overwhelming factor that drives patients to switch doctors.” • Physician conduct and communication, not necessarily clinical outcomes, appear to be the principle predictors of malpractice risk.

37. HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems

38. HCAHP Survey Questions

39. Key Stakeholders • The physician/patient interaction influences the patient’s experience and perception of care • CMS surveys patient on physicians: • Treating with courtesy and respect • Listening carefully • Explaining things in a way patients can understand

40. Management Best Practices • AIDET and Key Words • Consistent approach to communication • Acknowledge • Introduce • Duration • Explanation • Thank You • Employee Forums • Global communication and education • Senior Leader visibility

41. Case for Service • Communication skills can heavily influence patient compliance and will impact clinical outcomes • Studies have demonstrated that when a physician is approachable, gives serious consideration to the patient’s concerns, and communicates well, better patient compliance is likely.

42. Case for Service • Exceeding expectations with exceptional service keeps patients coming back. • Loyal patients are greater revenue producers than acquiring new patients

43. Case for Service • Physicians can improve staff morale, performance, and retention through: • Investing in relationships • Clear, constructive, respectful communication • Specific reward and recognition • Modeling behaviors consistent with the mission

44. RX Tool #1 – First Impressions • Knock, then pause two seconds prior to entry • Smile, shake hands, and introduce yourself to the patient and everyone in the room • Sit and sustain eye contact • LOOK as though you ENJOY what you do! • Use a consistent opening dialogue for established and new patients that creates comfort and approachability with you. • Tell patients about your training, your experience, and your personal approach to patient care.

45. RX Tool #2 – Exam Room Preparedness • What you know and don’t know when you enter the exam room creates or undermines the confidence patients will have in you. • Review interval events, consults, and what you did last prior to entering the exam room. • Specifically reference your “plan” that was established during the prior visit. • Communicate your awareness of interval medical events. • Leverage the information available to convey you are attentive and aware of every element of their care.

46. RX Tool #3 – The Physician Exam • Providing information on physician exam findings conveys thoroughness and a diligent effort to find the cause of a problem. • Review your physical exam findings as you perform the exam. • The more information you provide to patients about themselves, the greater value for the visit in the eyes of patients.

47. RX Tool #4 – Providing Patient Information • Explanation of diagnosis and treatment is the most important element of the patient visit • Effective communication improves recall of directions, compliance, and patient satisfaction. • Every condition and plan must include a simple explanation. • All explanations must be followed by query of the patients for their understanding. • Ask patients to repeat the plan as they understand it to ensure their understanding and identify areas needing further explanation.

48. RX Tool #5 – Collaboration with Patients • Establishing collaboration with patients improves compliance, outcomes, and patient satisfaction. • Collaboration can be established by asking patients if they have any reservations or concerns in regard to a treatment plan. • Collaboration is about specifically soliciting patient input regarding the treatment plan going forward.

49. RX Tool #6 – Patient Follow-Up • All patients must leave a visit understanding exactly what it is that will happen next. • Provide clear follow-up on the timing and purpose of patients’ upcoming visits. • Provide information regarding the timing of laboratory and radiographic tests and how the results will get to the patient. • Explain the purpose and timing for specialty consultation in terms of when, why, and who. • Position specialty physician colleagues well.

50. Steps in Effective Service Recovery • Apologize • Let the patient speak • Validate • Correct the issue • Take action • Follow up with the patient