Indiana Rural Health Association

1. Indiana Rural Health Association Quint Studer August 13, 2010

2. Outcomes for Today: • Learn how to lead and identify gaps in your organizational alignment, action and accountability.

3. Strategy Results Structure Execution

4. Four Phases of Competency

5. “People wish to be settled; but only as far as they are unsettled, is there any hope for them.” Ralph Waldo Emerson

6. Dots are not connected consistently to purpose, worthwhile work and making a difference Do not achieve critical mass - Lack of balanced approach Absence of an objective accountability system Leaders do not have the training to be successful Too many new behaviors introduced at once – need of sequenced approach No process in place to re-recruit the high and middle performers and address low performers (highmiddlelow®) Inability to take best practices and standardize across organization Failure to have leaders “always” do desired behaviors (lack of verification systems) Rev 8.09 Why Organizations Do Not Attain and Sustain Excellence

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

8. Rev 8.9.10 Evidence-Based LeadershipSM Breakthrough Foundation STUDER GROUP®: Objective Evaluation System Leader Development Must Haves® Performance Gap Standardization Accelerators Aligned Goals Aligned Behavior Aligned Process 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 Re-recruit high and middle performers Move low performers up or out Processes that are consistent and standardized throughout the company Leader Eval ManagerTM Patient Care ManagerTM

9. Three Elements to Execution

10. Alignment Action and Accountability Assessment Case Study: Ohio Critical Access Hospital; Bed Size = 25; Average Daily Census = 10; Admissions = 857; ED Visits = 8,200; Outpatient Visits= 32,500; Employees = 256

11. Alignment Action and Accountability Assessment If your organization would like Studer Group to conduct a complimentary Straight-A-Leadership Organizational Assessment go to: www.studergroup.com/indianarural

12. Pillar Result - Example Ohio Critical Access Hospital; Bed Size = 25; Average Daily Census = 10; Admissions = 857; ED Visits = 8,200; Outpatient Visits= 32,500; Employees = 256

13. Pillar Results Ohio Critical Access Hospital; Bed Size = 25; Average Daily Census = 10; Admissions = 857; ED Visits = 8,200; Outpatient Visits= 32,500; Employees = 256

14. Organizational Assessment What is your role?

15. Organizational Assessment Please list the top 3 things your organization does well and should continue to do.

16. Organizational Assessment Please list the top three opportunities for improvement at your organization?

17. Organizational Assessment What are the top 3 barriers/challenges you face that keep you from achieving your results in your area of responsibility at our organization?

18. Organizational Assessment 12 or 44% of the 27 leaders who took the survey feel the external healthcare environment over the PAST FIVE YEARS at your organization has been very easy, easy or normal. Over the past 5 years, the external healthcare market in your area has been: * Calculation: 1=0, 2=25, 3=50, 4=75, 5=100

19. Organizational Assessment 1 or 3% of the 27 leaders who took the survey feel the external healthcare environment over the NEXT FIVE YEARS will be very easy, easy or normal. *SG Norm = 30% Over the next 5 years, the external healthcare market in your area will be: * Calculation: 1=0, 2=25, 3=50, 4=75, 5=100

20. Organizational Assessment 12 or 44% of the 27 leaders who took the survey feel if they stay the same, results will be the same, better or much better. If your organization continues to perform exactly as they do today (with the same processes, cost structure, efficiencies, patient care volume, productivity, techniques), the results over the next five years will be? * Calculation: 1=0, 2=25, 3=50, 4=75, 5=100

21. Recommendation Plan • Education of all staff to see the external environment the same way. External Environment Tools: • Senior Leader Visibility • Tough Questions • Financial Impact Grid • Supervisory Meeting Model • Rounding with Staff • Employee Forums • Communication Boards Source: Straight A Leadership Section Two: External Environment Communication Tools

22. Organizational Assessment How well did your leader performance evaluation hold people accountable (prior to the initiative)? * Calculation: 1=0, 2=25, 3=50, 4=75, 5=100

23. Organizational Assessment How well does your current leader performance evaluation (LEMTM) hold people accountable today? * Calculation: 1=0, 2=25, 3=50, 4=75, 5=100

24. Treatment Plan • We find that one consistent attribute of a high performing organization is a solid evaluation tool for leaders that is objective and weighted. High Performing Organization Study 2004 Measures

25. Organizational Assessment How well did your leadership training prepare you for your leadership role (prior to initiative)? • Calculation: 1=0, 2=25, 3=50, 4=75, 5=100

26. Organizational Assessment How well does your current leadership training prepare you for your leadership role today? * Calculation: 1=0, 2=25, 3=50, 4=75, 5=100

27. Passion = Will Ability = Skill Processes = Tools and Techniques Three Components for Success

28. 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 • Manage up the positive, the solution and the decision • Improving Processes • Communication

29. Organizational Assessment From a patient/family perspective and point of view, how would a patient/family have rated your organization (prior to initiative)?   (1=Worst to 10=Best in Class)

30. Organizational Assessment From a patient/family perspective and point of view, how would a patient/family rate your organization today?   (1=Worst to 10=Best in Class)

31. Organizational Assessment Rate your perception of the ease of practicing medicine for physicians at your organization (prior to initiative). (1=Worst to 10=Best in Class)

32. Organizational Assessment Rate your perception of the ease of practicing medicine for physicians at your organization today. (1=Worst to 10=Best in Class)

33. Organizational Assessment Rate your perception of the consistency in leadership throughout the organization (prior to initiative). (1=Worst  to 10=Best in Class)

34. Organizational Assessment Rate your perception of the consistency in leadership throughout the organization today. (1=Worst  to 10=Best in Class)

35. Organizational Assessment Rate the skill set at your organization in implementing and standardizing best practices throughout the organization (prior to the initiative). (1=Worst to 10=Best in Class)

36. Organizational Assessment Rate the skill set at your organization in implementing and standardizing best practices throughout the organization today. (1=Worst to 10=Best in Class)

37. Best Practice Inpatient, Outpatient, ED and Support Departments • Inpatient is driven by Leader Rounding, Staff Rounding, Key Words and Post Phone Calls. • Outpatient is driven by Leader Rounding, Key Words and selected Post Phone Calls • ED is driven by Rounding, Key Words and Post Calls • Support Department is driven by Measurement, Expectations, Key Words and Follow-up.

38. Organizational Assessment How many employees do you directly supervise (complete their annual evaluation)? The average leader supervises 9.5 individuals * 27 leaders / 256 employees

39. Organizational Assessment How many of those employees that you supervise are not meeting performance expectations? Out of 256 employees identified, approximately 50 or 19.5% are identified as not meeting expectations.

40. Organizational Assessment How many employees do you have currently working for you who are in formal corrective/disciplinary action? 18 employees of the 50 employees not meeting expectations (36%) were identified as in formal corrective/disciplinary action.

41. highmiddlelow® Conversations & Organizational Results Source: highmiddlelow Research Study 8/08 Before HML, N=26; After HML, N=25 for Retaining High Performers Before HML, N=25; After HML, N=25 for Further Developing Middle Performers Before HML, N=25, After HML, N=25 for Moving Out Low Performers

42. On a scale of 1-10 … 1 2 3 4 5 6 7 8 9 10 • Where would you rank in how value driven you are as an organization? • Where would you rank in dealing with performance issues?

43. Results Decline H The Wall M M H H Gap is intolerable M M H Gap is uncomfortable Results Decline M L L L L

44. Over the Wall H M H The Wall M H Gap is intolerable M H Gap is uncomfortable M L L L

45. Improved Operational Performance Across the Board NEW OLD Performance

46. “Always bring it back to values . . .” Quint Studer

47. “It always seems impossible until it is done.” Nelson Mandela

48. Alignment Action and Accountability Assessment If your organization would like Studer Group to conduct a complimentary Straight-A-Leadership Organizational Assessment go to: www.studergroup.com/indianarural