Hardwiring Leader Evaluations Flagler Hospital

1. Hardwiring Leader EvaluationsFlagler Hospital Bill Bielenda

2. What you will learn today… • Importance of leader accountability and goal alignment • How to develop effective goals • The basics on accountability tools

3. Healthcare Flywheel® Bottom Line Results (Transparency and Accountability) • Prescriptive To Do’s Purpose, worthwhile work and makinga difference ® • Self-Motivation

4. Rev 4.8.11 Execution FrameworkEvidence-Based LeadershipSM Breakthrough Foundation STUDER GROUP®: Objective Evaluation System Leader Development Must Haves® Performance Gap Standardization Accelerators Aligned Goals Aligned Behavior Aligned Process Re-recruit high and middle/solid performers Move low performers up or out • Processes that are consistent and standardized • Process Improvement • PDCA • Lean • Six Sigma • Baldrige Framework Implement an organization-wide staff/leadership evaluation system to hardwire objective accountability (Must Haves®) Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results Agreed upon tactics and behaviors to achieve goals Software

5. 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.

6. Year 1 – Goals

7. Leader Evaluation Results – Year 1

8. Year 2 – Goals Excellence Service People Quality Finance Growth Increase Patient Satisfaction (Inpatient) Goal = 62nd Current = 51st Decrease Mortality Index Goal = .77 Current = .77 Operating MarginGoal = 5% Current = 5.6% Reduce Annualized Turnover Goal = 14.5% Current = 16.7% Increase Inpatient Admissions Goal = 2.7% Current = 7.6% Reduce FTE per Adjusted Discharge Goal = 1.15 Current = 1.15 Increase Outpatient Visits Goal = 5% Current = 8.0% Increase Patient Satisfaction (Ambulatory) Goal = 62nd Current = 65th Increase Employee Satisfaction

9. Leader Evaluation Results – Year 2 Note: Percentages noted account for 93% of the leaders who have entered data as of 6.7.07.

10. Financial Impact: Hospital Acquired Infections Percent of HAI Over Admissions 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

11. Why Have Leader Evaluations Based on Objective Goals? • Clearly connects the goals of the organization to individual leader • Provides prioritization roadmap for leader • Reduces unnecessary work and duplication of efforts because clear expectations are set • Keeps leaders focused on what is really important • Allows senior leader to continuously monitor leader performance • Provides for organizational agility • Competencies do not guarantee desired outcomes

12. Goal Alignment & Balance

13. What is goal alignment? Insuring that individual leader activities are consistent with the goals of the organization.

14. Vertical Alignment ORGANIZATION GOALS DIVISION GOALS DEPARTMENT GOALS LEADER / UNIT GOALS

15. Horizontal Alignment ORGANIZATION GOALS DIVISION GOALS DEPARTMENT GOALS

16. How Organizational Balance is Defined MISSION Integrating and connecting the vision, value and goals of the organization into daily decisions, behaviors and actions Innovation Service Community Quality Finance

17. Goal Development Process • Senior leaders set organizational goals • Organizational goals are shared with all leaders • Each leader determines their goals and preliminary weights • Goals are reviewed by each leader’s reporting senior • Goals are shared within leadership team to insure everyone's needs are addressed • Goals are audited for continuity • Leaders finalize their goals

18. Goal Development

19. Goal Development Tips Develop quantifiable goals.

20. Goal Scales 5 = Stretch 4 = Partial Stretch 3 = Goal 2 = Partial Accomplishment 1 = No Accomplishment

21. Example Goal with Rating Scale Goal Increase the number of visits to 200 Rating Scale 5 is ≥ 250 4 is 225 to 249 3 is 200 to 224 2 is 150 to 199 1 is ≤ 149

22. LEM Score Distribution 3 3 2 3 4 1 2 3 4 5 Target Opportunity Excellent

23. Example LEM Results Average Score = 3.07 0 1 2 3 4 5

24. Goal Development Tips Develop quantifiable goals. Use language that everyone understands. Connect goals to purpose. Fewer, rather than more goals, are better.

25. 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.

26. Goal or Tactic? • Conduct employee evals on time • Improve staff productivity • Round on 100% of inpatients • Attend all leadership development sessions • Pass OSHA inspection

27. 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

28. SMART Goals are • Specific • Measurable • Attainable • Realistic • Time-bound

29. What might not fit as goals: • Standards of performance • Subjective and vague statements • Tactics to achieve goals • Maintaining regulatory compliance • Routine job activities

30. Middle Management Common Goals(Examples) • Budget • Patient Perception of Care • Interdepartmental Satisfaction • Employee Engagement • Core Measures • Patient Fall Rate

41. Tools of Accountability • Leader Performance Evaluation • Leader Report Card • 90 Day Plan

50. No Surprises MONTHLY QUARTERLY YEAR END