Taking the LEM to Moon and Back!

1. Enhancing goals and optimizing the 90 day plan Taking the LEM to Moon and Back! Kelly Dickey, Accountability Coach Specialist June 2017

2. KELLY DICKEY • Accountability • Coach Specialist Lives in Pace FL 10th year with Studer Group Celebrated 10 years with my sweetheart We have two wonderful children – Kenny (8) and Kyleigh (3)

3. Session Objectives

4. Accountability Tools • Let’s review

5. Let’s do a quick Process Review… • As a table – complete the quiz. • The first table to complete the quiz and make 100% will win a prize!

6. LEM: Episode II • The Journey Continues Renee Fazendine & Rachel Kahn

7. Last year’s LEM – Does this sound familiar? There are so many goals! How do I know what to pick? Who’s entering this data? Where do I find my data? These goals don’t apply to me! Why did my goal get declined during the LEM audit?

8. Last year’s LEM – Does this sound familiar? You’re not alone! There are so many goals! How do I know what to pick? Who’s entering this data? Where do I find my data? These goals don’t apply to me! Why did my goal get declined during the LEM audit?

9. LEM: Episode II • The Journey Continues • LEM performance drives merit-based raises • LEM Goals may be different than the Market Living our Mission goals • LDI leaders are unlikely to carry the exact Market Living our Mission goals, but instead will carry LEM goals that support Living our Mission performance • 80% of LEM Goals will come from templates– Review of all custom goals by Conveners and CEO • As much as possible, LEM goals will align to Living our Mission. Exceptions will be allowed on a case-by-case basis Improve Focus  Increase Collaboration  Decrease Ambiguity

10. LEM: Episode II • The Journey Continues • No goal should be weighted above 30% • 30% = Urgency • 20% = Focus • 10% = Awareness • LEM Monthly Data Inputs: • Entity-level goals and above  Measurement Team experts input the data into LEM • Department-level goals or below  Dept leader inputs individual data into LEM Improve Focus  Increase Collaboration  Decrease Ambiguity

11. Developing LEM Goal “Parameters” FY18 Strategic Plan Focused Strategic Commitments per Pillar Developed by Convener LEM Goal Templates Alignment with Strategic Commitments LEM Goal “Rules of Thumb” Scope Weights Cascade to Leadership Groups Performance Bands

12. FY18 Living our Mission Goals & Strategic Commitments

13. FY18 Living our Mission Goals & Strategic Commitments

14. FY18 Living our Mission Goals & Strategic Commitments

15. FY18 LEM Goals – Rules of Thumb (EXAMPLE) Coworker Engagement • Two types of goals – Organizational Engagement (PCA) and Turnover • Organizational Engagement – Composite Score Only • Over 5 Employees - Required minimum 10% weight, Dept. goal • 5 or less Employees – Required minimum 5% weight, Facility goal • Turnover • Only applicable to departments with 10+ employees • If turnover rate is above a set threshold (TBD)  Required to carry a turnover goal Finalized FY18 Rules of Thumb will be provided in July

16. FY18 LEM Goals – Rules of Thumb (EXAMPLE) Quality • Creating more focus and increasing collaboration • CAUTI/CLABSI – Primary Quality goal for clinical leadership • Managers (where applicable) will carry facility-level goal • System leaders (where applicable) will carry Market goal • Majority of leaders will be measured by SIRs (no rates). Exceptions may be permitted for different outcome measures most relevant to your department which impact CAUTI/CLABSI • System Quality Composite • Expected to be carried only by select leaders Finalized FY18 Rules of Thumb will be provided in July

17. FY18 LEM Goals – Rules of Thumb (EXAMPLE) Growth • Caring for more patients through improved throughput and volume growth • Improved Throughput - Multiple goal options depending on role • Percent of Discharges Written by 11am – Facility-level goals • Left-Without Being Seen Rate – Facility-level goals • Volume Growth - Multiple goal options depending on role • Inpatient Admissions – Facility-level goals • Budgeted Volume – Primary/Specialty Care Visits, Ancillaries • IP Surgery Volume – Exceed prior year • New Consumers (Clinics Only) • System Year-over-Year Revenue Growth Goal – Executive Council only Finalized FY18 Rules of Thumb will be provided in July

18. FY18 LEM – Global View 200 Leaders in LEM – Approximate Distribution of FY18 Goals Coworker Engagement 200 Leaders Finance 200 Leaders Quality 100 Leaders Patient Experience 150 Leaders Growth 150 Leaders Phys Sat. 100 Leaders 5-10 Leaders Safety 50 Leaders 5-10 Leaders Transformation Service to Poor & Vulnerable

19. Pillar Goal Decision Matrix * Repeat this process for each Pillar goal on the organizational scorecard If “Yes”: Assume the goal or sculpt a goal that reflects the portion of the goal you have influence over If “Yes”: Sculpt a goal that reflects the area of influence. “Do you have direct control or influence over the organizational goal?” If “Yes”: Sculpt a goal that reflects this work If “No”: Ask, “Do you have any other departmental goal that is important to track that represents an important part of the work of your unit? “ If “No”: Ask, “Do you have indirect control or influence over the organizational goal?” If “No”: It may be appropriate not to a have a goal under that pillar

20. Cascading/Aligning to Improve ED Flow • ED Leader: Admit Decision Time to ED Departure for Admitted Patients - 20% • MedSurg Leader: Admit Decision Time to ED Departure for Admitted Patients - 12% • EVS Leader: Admit Decision Time to ED Departure for Admitted Patients - 10%

21. Cascading a goal to decrease LOS • Sample: • Case Management / Discharge Planning / Social Work-Increase % 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

22. HCAHPS Sample Cascade

23. OASCAHPS Sample Cascade

24. CGCAHPS Sample Cascade

25. Getting to the moon - • On each table, please find your worksheet and the LOM measure assigned to your table. This is your ticket to the moon. • In order to get to the moon – all leaders must have a goal that aligns to the LOM measure and all goals must be outcomes. • If a goal is deemed not appropriate or aligned to the leader, specify why.

26. Accountability tools • Let’s review

27. Steps to creating a 90-day plan

28. Identify Specific Action Steps • Focus on 2–3 priority actions that will drive multiple outcomes (practices that get results) • Clearly define actions you are committing to in each step • Don’t set yourself up to fail; set a realistic date to accomplish each step • Define when within the quarter would you will accomplish a task. • Tip: Engage your staff and other stakeholders in the 90-day goal when creating action items

29. Moving results • If the action item cannot move results; remove it! Verbs that do not indicate action: • Review • Continue / ongoing • Start • Attend Verbs indicating actions that move results: • Validate • Train • Observe • Recognize • Coach • Diagnose

30. Strong or Weak Action Items?

31. Co-Worker Engagement Action Plans: • 90 day goal: Increase Co-worker Engagement from X to Y… • Action Steps: • Round on co-workers (< 30 = monthly, 31-60 = e/o month, > 61 quarterly) • Communicate with co-workers actions from rounding by posting stoplight reports on communication boards and reviewing progress during huddles. • Send 4 thank you notes per month to co-workers who demonstrate standards of performance. • Increase attendance at department meetings by offering multiple opportunities for night and weekend shifts to attend.

32. Expense Budget Action Plans: • 90 day goal: Maintain budget to 100% or better… • Action Steps: • Review staffing matrix to ensure peak hours are staffed • In the department meeting on 4/1 conduct an exercise with co-workers to harvest ideas from them on how we can reduce cost in the department

33. Patient Experience Action Plans: • 90 day goal: Increase Patients Perception of Care from X to Y… • Action Steps: • Round on 100% of patients prior to discharge (non-clinical) or Round on 100% of patients daily (IP RN Manager) • 100% of co-workers trained on hourly rounding • 100% of co-workers trained on AIDET • Observe and validate 100% of co-workers using AIDET in encounters with internal or external customers (patients or co-workers).

34. GOOD • Improve “Courtesy and Respect” question from 55% top box to 60% top box. Improve Nurse Communication Composite to 75%ile

35. BETTER • Improve “Courtesy and Respect” question from 55% top box to 60% top box. Improve Nurse Communication Composite to 75%ile

36. BEST • Improve “Courtesy and Respect” question from 55% top box to 60% top box. Improve Nurse Communication Composite to 75%ile

37. OH NO – Now we are stuck… Your mission, should you choose to accept it. Using the blank 90 day plan worksheet, develop an action plan that will help you and your colleagues get back to earth before your 90 day supply of food is gone!

38. Deliverable Grid - • Expectations from today’s learning: Review your goals for FY17 with your 1-up leader and identify ways you can further refine your goals for FY18. Review the rules of thumb and populate your FY18 goals in LEM by June 30, 2017. Develop your 1Q action plan in LEM. Review this plan during your June or July Monthly Meeting. Mark your 90 day plan approved by July 31, 2017.

39. Thank you! • Kelly Dickey: Kelly.dickey@studergroup.com • 850-898-3862