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Saving Lives through Performance Excellence. Priscilla Nuwash, MBA, CLM President, Center for Performance Excellence Poudre Valley Health System. Private, locally owned, not-for-profit Full spectrum of healthcare services 2 tertiary hospitals, outpatient campus, numerous satellite clinics

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Saving Lives through Performance Excellence

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Saving Lives through Performance Excellence

Priscilla Nuwash, MBA, CLM

President, Center for Performance Excellence

Poudre Valley Health System

poudre valley health system
Private, locally owned, not-for-profit

Full spectrum of healthcare services

2 tertiary hospitals, outpatient campus, numerous satellite clinics

Regional medical hub for cardiac, trauma, orthopedic & oncology services, neonatal intensive care & bariatric surgery

Poudre Valley Health System
poudre valley health system1
Definition of World-Class:

Striving for results in the 90th percentile

or top 10% of available national

comparative databases

Poudre Valley Health System

Vision: To Provide World-Class Healthcare

poudre valley health system2
Service area: Northern Colorado, Wyoming & Nebraska

5,200 employees, 600 primarily independent physicians & 800 volunteers

$1.3 billion in annual revenue

Poudre Valley Health System
Community hospital serving Fort Collins, Colorado

1,500 employees, 300 independent physicians & 575 volunteers

24% annual employee turnover

5 CEOs in 4 years

$250 million in annual revenue

Changing healthcare market

Demand for physician integration

Where Our Journey Started (1997)


Where Our Journey Started (1997)

  • Leadership: Find an improvement model
  • Decision: Baldrige National Quality Program
Systems perspective

Manage your whole organization, as well as components, to achieve success


Notes major strengths

Highlights impact of opportunities for improvement

Measures progress

Guides improvements

Why Baldrige?

2000 Submitted first application, with each Category written by separate team

Baldrige happened outside of “normal” work

Category teams met just to write Application

2001 Took a year off “to work on improvements”

2002 Applied again, expecting “success”

2003 Repeat the process

The Early Years


Communicate Direction

Set Direction

Our Beliefs

New Employee Orientation

Forums for Employees & Volunteers

Quarterly updates on performance & action plans that support each Strategic Objective

Name Badges

Meeting Templates

Learn & Lead Program

Vision/Mission/Values Team

Leadership Meetings

Medical Executive Committees

Communicate Direction

Identify strategic opportunities

How can we provide a lifetime of care?

Align economic incentives & build relationships

Outpatient services, home health, sub-acute care, third-party administrator, strategic vendor relationships

Win-win for PVHS, other healthcare providers, patients & community

Improve clinical quality

Partnering: An Innovative Strategy

Rural dilemma

Insufficient volumes to ensure quality

Choice: Revenue or optimal outcomes?

New alternative

PVHS + Regional West Medical Center = Medical Center of the Rockies

Improved outcomes & revenues for all

The Ultimate PartnershipPVHS & Regional West Medical Center

Interdisciplinary teams: engage the workforce

Benchmarking: top 10%

Consideration of new ideas: Business Decision Support Process

Reward innovation & high performance, support strategy: R&R Program, Optional Performance Plan

Build innovation into improvement methodology: PDCA using LEAN

Guide best practice inquiry with stakeholder involvement & using the voice of the customer: Building MCR

Driving Innovation

Performance Review Process

Reward & Recognition, including Peer-to-Peer Coupons

Optional Performance Plan

Learn & Lead, Building Blocks of Leadership

Learn & Grow

Grand Rounds, Tuesday Afternoon Conferences

Mentoring Program

Tuition Reimbursement

Professional Associations, Conferences

Develop People

Performance Review Process

Best Practice: Integration of Values, Behavior Standards, Core Competencies, Key Customer Requirements & Personal Goal Cards

Develop People

Performance Excellence Teams

Baldrige-driven improvements

PDCA Model for Process Improvement

Process Design

Best practices: Stakeholder involvement & Voice of the Customer

Learn, Share & Innovate

20 interdisciplinary teams with staff, physicians, partners, vendors & community members

Community focus groups

Wayfinding, spirituality, furniture, menus, naming

National site visits with physicians, staff & vendors

Mock-ups for OR, trauma suite, patient room & elevator

Day-in-a-Life Scenarios

An Example: Medical Center of the Rockies


Healthcare Outcomes

Risk-Adjusted Mortality Rate


Customer-Focused Outcomes

Top Box Scores for Patient Satisfaction

8 years of consistent improvement


Customer-Focused Outcomes


*Hospital Consumer Assessment of Healthcare Providers & Systems


Financial & Market Outcomes

Patient Discharges: 50% increase since 1st Baldrige application

50% increase in PVHS discharges

from 2000 to 2008

11% population growth in Larimer

County from 2000 to 2008

18% increase in Competitor

discharges from 2000 to 2008

39% population growth in Competitor’s

home county from 2000 to 2008


Workforce-Focused Outcomes

Staff Voluntary Turnover


Workforce-Focused Outcomes

Physician Engagement Scorecard

health care advisory board 10 18 2010 moodys downgrades outpace upgrades for first time in 2010
In a "material shift" from previous quarters,

Moody's Investors Service issued more

downgrades of not-for-profit hospitals and health

systems than upgrades in the third quarter, illustrating

the industry's ongoing financial pressures.

Health Care Advisory Board 10/18/2010 “Moodys: Downgrades outpace upgrades for first time in 2010”
Sept 2009: Moody’s andStandard & Poors upgrades PVHS bond ratings, citing strong financial performance. “We expect performance in fiscal year 2010 to be strong as well,” Moody’s stated.

May 1, 2010: PVHS receives bond upgrade from Standard & Poor's. S&P's report recognized:

continued excellent financial results and robust cash flow

improvements a combined effort by staff, physicians and volunteers to drive quality, minimize expenses and reduce capital expenditures


Ensuring Financial StabilityFinancial Flexibility Index

  • Total Margin
  • Return on Investment
  • Replacement Viability
  • Equity Financings
  • Days Cash on Hand
  • Cash Flow to Total Debt
  • Average Age of Plant
Increased hospital discharges almost 50% with only 11% population growth

Doubled the workforce

Added 2nd hospital, outpatient campus & numerous offsite clinics

Expanded service area from Fort Collins community to 50,000 square miles in Colorado, Wyoming, Nebraska

Challenging Times…

Top 10% for inpatient mortality, patient satisfaction, employee satisfaction & physician engagement

Thomson Reuters Top 100 Hospital for 5 consecutive years

Top 100 Best Places to Work, Modern Healthcare 2008, 2009, 2010

Magnet designation since 2000

NDNQI Outstanding Nursing Quality Award for last 3 years

World-Class Results

Consider it productive time

Make it how you do your business

De-emphasize the award

It’s hard work

Start now

Lessons Learned: The Journey


What’s Next?

  • Continue with teams
  • Continue with self-assessment
  • Assist others in their performance excellence journey
To provide


health care

Our Vision


4th generation treated at PVH

Additional Information:

PVHS Center for Performance Excellence