Building A Healthy Work Environment

1. Building A Healthy Work Environment

2. Who Is HCA? • Nation’s leading provider of healthcare services • 182 locally managed hospitals • 94 outpatient surgery centers • Imaging centers • Physician clinics and offices • 22 states, England & Switzerland • Revenues exceeding $24.5 Billion (2005) • Assets of more than $22 billion (2005) • 190,000 employees

3. What are we trying to achieve? • Stronger retention • Greater productivity • Better place to work  PatientSatisfaction • Increased Quality & Service • Reduced claims risk • Expanded volumes • Higher revenue HEALTHCAREPROVIDEROF CHOICE  Physician Satisfaction EMPLOYEROF CHOICE  Employee Engagement

4. So How Do We Get There • Establish High Performance Criteria • Balanced focus • Patient/Physician Satisfaction (Top Quartile) • Productivity/Retention • Financial Indicators (EBDITA, Operating Expense/Adjust Admit) • Employee Engagement Rankings • Consistent or Improving over multiple years • Identify High Performing Facilities Within The System • Research differentiating practices and behaviors

5. Much Lower Turnover Turnover at HPFs decreased 3.9% while increasing 1.4% at low performers

6. Lower levels of riskHigher Patient Safety Source: HCI – Issues in Review – 2004 & 2005. Risk level determined by and representative of actual claims for incidents that occurred over a three year period from January 1, 2002 and December 31, 2004

7. Financial Performance $15m more in average EBDITA per facility

8. Higher Engagement Ratio

9. What We Learned The basic leadership and workplace behaviors and practices we’ve said for years matter . . . really do impact a hospital’s success. • External Consultants • Internal OE Team

10. Healthy Work Environment Doing well in these five areas is key to transforming good places to work into GREAT places to work

11. Leadership Effectiveness Senior Leadership Vision/Direction • Distinct leadership styles practiced • Leaders available and approachable • Clear vision communicated and shared Supervisor/Management • Coach • Work/Life Balance • Skills/Career Development • LESSONS • Philosophy that drives decision making and communication • Prototype for selection/cultural fit • Balance Scorecard Accountability • Effective visibility

12. Voice/Communication • Two-way communication • Willingness to share good and bad news • Employee Advisory Groups exist • HR is perceived to be employee advocate • LESSONS • Employee Advisory Groups • Communication Toolkits • No Employment At Will

13. Staffing and Workload • Quality drives staffing decisions • Resources/Technology support caregivers • Selection based on behavioral fit • Solid focus on learning and development • LESSONS • Role clarity • Management Development • Staffing Models

14. Compensation Practices • Market competitive pay practices • Flexibility is rewarded • Understanding of total compensation • Fair and equitable rewards • LESSONS • Articulated Philosophy to include market position/communication strategy • Leveling • Recognition Programs • Variable pay practice guidelines

15. Recognition/Service Culture • Recognition and appreciation occurs formally and informally at all levels • Regular and frequent activities to promote community • Strong standards put patients first, and include family, physicians and colleagues • Physicians take ownership for facility outcomes and accountability for behaviors • LESSONS • Diversity Management • Medical Staff Leadership Consultation/Support • Community Involvement Programs • Longevity/Retention Programs

16. High Performance sustainable outcomes The #s People Culture balanced focus