Newton-Wellesley Hospital Rising From the Ashes! Pat Jordan Chief Operating Officer Bentley College June 18, 2009

1. Newton-Wellesley HospitalRising From the Ashes!Pat JordanChief Operating OfficerBentley CollegeJune 18, 2009

2. State of the Union – FY01 • $1M per month loss for 54 months • Total clinical revenue $122M • No capital, no training • Limited patient satisfaction surveying • (39th percentile - Inpatient) • Employee turnover 20+% • Low morale

3. State of the Union – FY01 NWH Operating Income

4. FY01 – 02 Increase Volume • Financial State-of-Emergency • Capital investment • Grow with Partners affiliation • Consumer image campaign • Maintain focus on quality

5. Partners Collaborations Teaching Collaborations: Residency program in Surgery Residency program in Pediatrics Residency program in Medicine Residency program in Anesthesia Residency program in Psychiatry (MGH/McLean) Clinical Collaborations Mass General Hospital for Children Breast Center/Breast & Ovarian Cancer Risk Assessment Program Spine Center Joint Center Cardiology (EP and ECHO) Vascular Surgery Thoracic Surgery Obstetrics Maternal Fetal Medicine Gyn Oncology Radiation Oncology Endocrinology General Surgery PET/CT MIGS Assisted Reproductive Medicine Psychiatry 50+ MGH staff physicians on campus 50+ NWH medical staff training with MGH

6. NWH Growth New Emergency Department 4 new Operating Rooms Joint Center Bariatric Center Cancer Center/Radiation Oncology Primary Care Cardiology/Vascular Services UCC New Beds ASC

11. The Market BIDMC MetroWest Mt. Auburn NEMC St. E’s NWH MGH BWH Caritas Norwood 10 mi BI N

12. FY03 Create Loyalty • Benchmark with Marriott, RMV, Greenwich • Healthcare Advisory Board • Baptist • Management Team to Pensacola • Connect with Quint • Adopt pillar model/balanced scorecard

13. FY09 Operating Goals & Objectives People Quality/ Safety Finance Growth CareFirst Service Achieve a patient fall rate below the NDNQI 25th percentile Implement EMAP for 75% of licensed inpatient beds by Q1 FY10 Achieve 90% hand hygiene compliance before and after patient contact Achieve Influenza Vaccine Rates, Q2 FY09 80%- eligible employees 80%- eligible inpatients Ambulatory E-Prescribing of 80% by end of Q4 FY09 Maintain transfers due to lack of beds to 9 or less per month Achieve margin of $12.7M for NWH and Affiliates Meet or exceed performance based contract targets: Achieve 100% of withhold Achieve $1.625M savings from operations improvement activities Prepare for COMPASS system implementation in Q1FY10 Achieve budgeted FY09 volume representing 4% growth in inpatient discharges, and 9% growth in outpatient activity. Recruit 10 PCP’s Improve patient through-put to reduce LOS by 4 hrs without a statistically significant increase in re-admission rates Build Cancer Center and 24 bed I/P unit to increase bed capacity Voluntary annual turnover rate of 8% or less. Employee Survey in Q2 FY09. Plan for Physician Satisfaction Survey FY10 Top 5% in Patient Satisfaction.

14. CareFirst Service

15. CareFirst Service

16. CareFirst Service

17. CareFirst Service

18. CareFirst Service

19. Service Tactics Greeter Program Tools & Equipment Scripting in Key Areas Support Cards Service Recovery Discharge Phone Calls Service Operations Committee Service Academy

20. Support Cards

21. Service Recovery

22. SOC Service Recovery SOC • Purpose: • Timely review of patient positive/negative comments by all leaders will lead to investigation, service recovery and ultimately service improvement and an increase in patient satisfaction scores • Scope: • All leaders of clinical and support departments • Chaired by President of the Hospital • Leaders investigate, comment, follow-up with patient and staff as appropriate and provide a summary of their investigation, outcome and follow-up on every complaint

23. SOC SOC

24. SOC SOC

25. People

26. People Tactics Thank You Cards 45 & 90 Day Interviews 180 Day President’s Lunch Reward & Recognize Fitness Center Cambridge College EFAP Enhance Employee Orientation Physician & Employee Satisfaction Survey

27. People Tactics-Employee Survey - Surveyed in October 2005 (Sperduto) 1205 employees participated in the survey (56% response rate) 73% of employees surveyed showed positive morale – 93d percentile New England - Key areas of strength: NWH image, goals/mission, meaningful work, pride in working at NWH, would recommend NWH as place to get care, value in Partners affiliation

28. People Tactics-Physician Satisfaction - Surveyed in June 2006 (Press Ganey) - “Overall facility” scored in the 99th percentile of All Facility grouping & 99th in the Community Hospital grouping - “Quality of patient care” scored in the 99th percentile for both grouping - “Quality of the nursing staff” scored in the 99th percentile in both benchmark groups - “Likelihood of recommending to family & friends” scored in the 99th percentile

29. Management Relative Performance Rankings

30. High, Medium, and Low

31. Leader Evaluation Accomplishment of Goals & Objectives Service People Quality, Regulatory, and Safety Finance Growth CAREfirst Standards Compassion Attitude Responsibility Excellent & Quality Leadership & Management Competencies Practices & promotes ethical behavior Problem solving/Decision-making Leadership Communications & Interpersonal Skills Accountability Vision & Strategic Planning

32. Leader Evaluation

33. Leader Report Card

34. Leadership Institutes October 2002 Creating a Culture of Service Excellence Roger Dow, Sr. V.P. Marriott Corporation Dan Grabouskas, MA Registrar of MV January 2003 The Goal of Champions Jeff Taylor, Founder, Monster.Com Robin Brown, G.M. Four Seasons Hotel (  May 2003 Balancing Dollars and Sense Barry & Eliot Tatelman, Jordan’s Furniture Kate Walsh, COO, Novartis • 26 LI’s conducted • Invitees include 180 leaders (supervisors and above, including Chief s and Chairs)  • Quarterly for two day’s and off site • Largely in house trainers with key note speakers

35. External Leader Development • Studer Group • Pensacola Baptist Hospital • Greenwich Hospital • Multidisciplinary teams with executive management • Typically 3 days away • Goal is to train in Service Excellence and re-recruit good employees • Since 2003 we have sent nearly 1,400 trainees to training in places like Pensacola, San Diego, LA, Dallas, Las Vegas, Orlando, etc..

36. NWH Time-Line

37. What Have we Learned? • Leadership from the top • Focus • Perseverance not brain surgery • Accountability • Start with people • Reward and recognition • Low performers

38. Financial Results FY99 FY00 FY01 FY02 FY03 FY04 FY04 FY06 FY07 FY08 FY09 Finance - Operating Income(000’s omitted)

39. Outcomes • Double digit growth-410M in revenue • Gross revenues tripled since FY01 • Market share growth of 6 points • Top 100 Hospital 5 of past 7 years • Consumers Digest Top 50 hospitals for Patient Safety 2005 • BBJ Best Places to Work 2007, 2008

40. Outcomes • Patient satisfaction 80th – 95th percentile • Employee Turnover 8% • Employee Satisfaction 93rd percentile • Physician Satisfaction 99th percentile • Highest RN Satisfaction 2,000+ • Partners Quality Close(ex: not a single central line infection for past 18 months) • Unannounced Joint Commission survey eg. Clean, handwashing

41. Image Impact Proportion Identifying NWH as Having Best Overall Reputation: 2002-2007 Unaided Awareness of NWH by Area: 2002-2007 NWH is separated from MGH by a one 10th of a percent in having the best overall reputation and is number 2 in our service area.

42. How We Did It • Goals and Accountability(leader and support cards, session L) • Leadership Development • LI, Service Academy • S.O.C. • Reward/Recognition • Bonuses, Celebrations, Team Awards • Transparency • Must Haves

43. What Did We Learn? • Leadership from the top • Focus • Perseverance not brain surgery • Accountability • Start with people • Reward and recognition • Low performers

44. Current Focus • Hardwire Service and People • Process Improvement • Action OI • Growth • “Get more efficient (current AOI is 18th %ile), while maintaining course of making NWH a great place to get care and a great place to work”