differentiating on service implementing key tactics … · implementing key tactics such as...

1 © 2008 Studer Groupwww.studergroup.com

Differentiating on Service: Implementing Key Tactics such

as Interdepartmental Support Service Evaluations

Patrick F. Jordan, III, MBAChief Operating OfficerNewton-Wellesley HospitalNewton, MA

What’s Right in Health CareSM | Evidence to Outcomes

Presentation Objectives

• Background on NWH• Care First Service• Interdepartmental Service Support

Cards• Outcomes• Lessons Learned



-25,000-20,000-15,000-10,000-5,000

05,000

10,00015,000

FY 1993 FY 1994 FY 1995 FY 1996 FY 1997 FY 1998 FY 1999 FY 2000

Operating Losses


NWH 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



Strategies

• Stabilize Finances

• Clinical Integration Partners

• Maintain Focus on Quality

• Enhance Brand Position

• Service Differentiation


0%

20%

40%

60%

80%

Overallquality of

care

Up-to-datetechnology

Physicianquality

Caring,personaltreatment

Ease ofaccess

Emergencydept.

Quality ofsupportservices

NWH Glover Waltham Norwood BWH MGH

Consumer Attitudes toward NWH



The Market

MetroWest

Caritas Norwood

NWH

BWH

Mt. Auburn

St. E’s

BIDMC

MGH

NEMC

10 mi

BIDMC N


• Benchmark with Marriott, RMV

• Healthcare Advisory Board

–Baptist & Greenwich

• Management Team and Care Teams to Pensacola, Greenwich, and Studer Group

• Set goals, objectives, and accountability at all levels

FY03 Create Loyalty



CareFirstService

People Quality/ Safety Finance Growth

Mission: To exceed the expectations of our patients, physicians, staff and students. To be the premier community teaching hospital through the relentless pursuit of excellence.

Top 5% in Patient

Satisfaction.

Voluntary annual turnover rate of 7% or less.

Employee Survey in Q3 FY08.

Act on results of FY07 Physician

Satisfaction Survey

Achieve margin of $6.6M for NWH

and Affiliates

Meet or exceed performance based

contract targets: Achieve 100%

of withhold

Achieve $1.125M savings from

operations improvement

activities

Compare Groups:Inpatient & ED – MAOutpatient & Amb Surg –AHA1UCC - National

Reduce diversion hours to 50% to 32 hours per month

Maintain transfers due to lack of beds to 9 or less

per month.

Prevent the 28 NQF Severe Adverse Events

Fully implement Leapfrog recommendations for

quality and safety leaps

Achieve full Joint Commission accreditation

90% use of Meditech allergy repository

Achieve budgeted FY08 volume representing 3.1% growth

in inpatient stays, and 6.6% growth in outpatient activity.

FY 08 Operating Goals & Objectives


CareFirstService

Top 5% in Patient Satisfaction.

Compare Groups:Inpatient & ED – MA

Outpatient & Amb Surg – AHA1UCC - National

PeopleVoluntary annual turnover rate of 7% or

less.

Continue 100% of Employees evaluated using the standards of excellence in Q1

Employee Satisfaction Survey in Q3 FY08.

Act on results of FY07 Physician Survey

FY 08 Operating Goals & Objectives



Benchmark Must Haves

• Rounding with Purpose• Thank You Notes• Leadership Development• Service Recovery• Discharge Phone Calls• Scripting – Key Words at Key Moments• 45 & 90 Day Interviews


NWH Service Tactics

• Discharge Phone Calls*• Rounding with Purpose*• Scripting/First Impressions/Entering a Patient Room*• Service Recovery*• Greeter Program• Support Cards• Tool Time• “We want your opinion” Comments• Managing Up

* = Must Have



Service Recovery


Service Operations Committee

• 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 departmentsChaired by President of the HospitalLeaders investigate, comment, follow-up with patient and staff as appropriate and provide a summary of their investigation, outcome and follow-up on every complaint



Dr. waited 2 hrs. to start Pitocin. I tore internally and had to wait 45 minutes for stitches. I overheard a doctor say that they had run out of lidocaine kits. How does a hospital run out of that!? Shouldn’t there be enough lidocaine to cover all the “what ifs?”

Dr. Beatty reviewed comments and contacted the patient, followed up regarding care. Apologized for pain and addressed the availability of Lidocaine Kits (had not run out of anything, patient had misunderstood. Addressed concerns with Dr. and staff, sent personal note of apology and service recovery.

Service Operations Committee


NWH People Tactics

• Bright Ideas• 45 & 90 Day Interviews/180 Day Luncheon*• Recognition Programs• Thank You Notes*• Leadership Institutes*• Shipley Fitness Center• EFAP• Cambridge College• Standard of Excellence



Employee Satisfaction


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Orth

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Pediat

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Surgery

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Psych

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Gas

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NWH National

Physician Satisfaction



Impetus for the Support Card

• Launched ‘Organizational Excellence’ in 2002.

• Goal of achieving 75th Percentile in patient satisfaction -FY08 goal is 95th Percentile.

• Press Ganey was a good tool to measure patient satisfaction.

• We had no method of measuring the satisfaction between clinical departments from their internal customers – the support departments.

• September 2002, launched the Support Card.


Support Card UnitGina Kline, and Kristy Boyd Date:

Please rate each department on a scale of 1(very poor), 2 (poor), 3 (fair), 4 (good), 5 (very good), or N/A (not applicable)

Standard:

SHIFT Day Eve Noc Day Eve Noc Day Eve Noc Day Eve Noc Day Eve

FOOD SERVICESKevin O'Connor #57794

5 4 N/A 5 3 N/A 5 5 N/A 4 4 N/A 5 5

SUPPLIESCharlie Miceli #56584

4 4 4 4 4 4 5 5 N/A 5 5 N/A 5 5

ENVIRONMENTAL SERVICESRudy Viscomi #51460 5 4 3 4 4 3 5 5 N/A 5 5 5 4 4

TRANSPORTRudy Viscomi #51460 4 4 4 3 4 4 3 4 4 4 4 4 4 4

EQUIPMENTRudy Viscomi #51460

4 4 4 4 4 4 4 4 4 4 4 4 4 4

BIO-MED ENGINEERINGCharlie Miceli #56584 5 N/A N/A 5 N/A N/A 5 N/A N/A 5 N/A N/A 5 N/A

LINENRudy Viscomi #51460

5 5 N/A 5 5 N/A 5 5 N/A 5 5 N/A 5 5

PHARMACYSteve Clark #51308

5 5 N/A 4 5 N/A 5 5 N/A 5 5 N/A 5 5

ENGINEERING/MAINTENANCEBill Sullivan #57645

5 5 N/A 5 5 N/A 5 5 N/A 5 5 N/A 5 5

Comments:Any score of 1 or 2 should always contain a comment for follow up.

Attitude Operation

Day to day operare run effective

efficiently?

Tanger 4 West11-Oct-02

Did we receive the right product or was a

variation communicated?

Accuracy

Was it a nice experience? Did you receive service with a

smile?

Can we reach a live person or use an electronic systems tool for reach out?

Accessibility

Response time and delivery when

promised

Timeliness

Support Cards



• Initial meetings with Clinical Dept.s to determine which supportdept.s were critical and what elements of performance should be measured;

• Reviewed with Support Dept.s to provide contact information and communicate process;

• Initial presentations to Nursing Leadership and to Hospital’s Supervisory Team;

• Recently training has focused on using automated tool (to have managers enter scores directly into web-tool);

• Periodic meetings with Nursing and Support Departments to clarify scoring (some dept.s routinely score ‘4’ others a ‘5’ ) and the value of comments.

Getting Started……


Based on feedback from clinical departments, these departments were deemed critical to daily operations:

– Bio-Medical Engineering– Engineering & Maintenance– Environmental Services– Equipment– Food Services– Information Services (added more recently due to increasing

automation and CPOE)– Linen– Pharmacy– Supplies– Transport

Support Departments Being Evaluated



Based on feedback from clinical departments of what is most important to them:

1. Accessibility: Can we reach a live person or use an electronic systems tool for reach out?

2. Timeliness: Response time and delivery when promised.3. Accuracy: Did we receive the right product or was a variation

communicated?4. Attitude: Was it a nice experience? Did you receive service with

a smile?5. Operations: Day to day operations are run efficiently and

effectively?

Dimensions Scored


• Clinical areas complete a support card weekly.• Managers obtain input from staff and are responsible

for submitting support card.• Managers can submit their report via paper, Excel or

via the intranet • Scores are compiled from all areas and published on

Wednesday. Sent to VP’s, Support Managers and Clinical Managers.

How it Works



Weekly Results Published via Intranet


Weekly Results - Comments

Negative Comment

Positive Comment

Positive Comments are shared with staff members



Support Card encouraged our support depts. to

improve their communication

5.11.04

Support Department Contact Schedule


1st Shift 2nd Shift 3rd Shift STAT If No Reponse, Call: Pager

Supplies 57508 57677 57677 57677

Response Time 30 min 45 min 60 min <10 min

Patient Transport 57677 57677 57677 57677


*Call VIP at x6683 to request transport. If no response within specified time, please elevate by calling the number above.

Environmental Services 57672 57672 57672 57672


Equipment 57677 57677 57677 57677

Response Time 30 45 60 <10 min

Linen 57677 57677 57677 57677


Biomedical Engineering 56083(800)441-5462 site number

100124

(800)441-5462 site number

10012456083

Response Time 30 min15 min

(onsite w/in 2 hrs)

15 min (onsite w/in

2 hrs)<10 min

Food and Nutrition x6198 57677 57677 57677


Pharmacy x6012 x6012 57711 x6012

Response Time(does not include order entry,

clarif ication, drug prep and drug check)

45 min 60 minPharmacist on call, here within 2 hrs

<10 min

Facilities & Engineering x6549 57862 57862 57862


Operations Area

Routine Requests

Charlie Miceli 56584




Bill Sullivan 57645


Kevin O'Connor 57794


Pharmacist on Duty 51308

Clarified response times and contact

numbers for routine and

stat requests by shift.

Response Time Standards



• Enables direct feedback on performance between support departments and internal customers.

• Holds support departments accountable to clinical care givers.

• Timely feedback.• Improves communication.

Benefits of the Support Card?


• Variation in scoring – some dept.s routinely score ‘4’while others will routinely score ‘5’ – education has helped.

• Automation is still hard for some clinical leaders.• Compliance – is generally good but there are always

a few ‘stragglers’!

Challenges



• Improved communication between clinical and support departments

• Provides focus for rounding on floors• Non-Punitive so staff feel comfortable entering

comments and feedback• Vehicle for Staff Recognition• Other Support Departments adopted the template -

HR, Volunteer Services, CSR.

Successes


Monthly Leader Report Card



Mean Mean Mean NAME TITLE DOH Feb-03 Nov-03 Jan-05

1 Dept. 1 02/11/85 2.4 2.8 2.82 Dept. 2 02/25/02 3.0 2.9 2.73 Dept. 3 07/16/01 2.6 2.3 2.74 Dept. 4 02/10/03 2.5 2.3 2.65 Dept. 5 11/25/85 2.0 1.8 2.66 Dept. 6 06/28/76 2.8 2.7 2.67 Dept. 7 02/11/03 2.5 2.68 Dept. 8 08/01/99 2.9 2.7 2.59 Dept. 9 12/03/01 2.5 2.3 2.510 Dept. 10 05/13/02 1.9 1.2 2.511 Dept. 11 04/22/02 2.5 2.0 2.412 Dept. 12 04/24/00 2.5 2.6 2.313 Dept. 13 10/21/02 2.1 1.8 2.314 Dept. 14 02/16/98 2.5 2.3 2.315 Dept. 15 09/09/96 2.1 1.5 2.316 Dept. 16 07/05/01 2.8 2.8 2.317 Dept. 17 03/26/01 2.3 1.7 2.318 Dept. 18 9/20/2004 2.319 Dept. 19 9/9/2002 1.8 2.020 Dept. 20 03/25/96 2.1 1.3 1.921 Dept. 21 07/18/88 2.7 2.5 1.922 Dept. 22 10/16/95 2.1 1.7 1.823 Dept. 23 11/17/97 2.6 1.3 1.824 Dept. 24 06/03/91 2.1 1.0 1.725 Dept. 25 05/27/86 2.3 1.3 1.626 Dept. 26 04/05/93 1.6 1.3 1.127 Dept. 27 01/03/01 2.1 RIF28 Dept. 2829 Dept. 29 07/09/01 1.5 RIF30 Dept. 30 08/27/01 2.0 1.431 Dept. 3132 Dept. 3233 Dept. 33 08/31/98 1.9 PIP34 Dept. 34 06/13/01 2.8 2.435 Dept. 35 07/26/99 2.7 2.336 Dept. 36 05/29/01 2.0 RIF37 Dept. 3738 Dept. 38 12/09/72 1.7 RIF

Session L


Sense of Ownership

Safety Awareness

Privacy

Customer Waiting

Commitment to Customer Needs

Appearance

Attitude

High(Consistently meets standards)

You relax when you know they are scheduledGood influence on othersStrong sense of ownership

Medium(Sometimes meets standards)

Loyal most of the timeInfluenced by low and high performersCould just need more experience

Low(Rarely meets standards)

Points out problems in a negative wayPositions leadership poorlyThinks they will outlast you

High, Medium, Low



Leader Evaluation

CAREfirst StandardsCompassion

AttitudeResponsibility

Excellent & Quality

Accomplishment of Goals & Objectives

ServicePeople

Quality, Regulatory, and SafetyFinanceGrowth

Leadership & Management CompetenciesPractices & promotes ethical behavior

Problem solving/Decision-makingLeadership

Communications & Interpersonal SkillsAccountability

Vision & Strategic Planning


Leader Evaluation



Leadership Institutes•24 LI’s conducted

•Invitees include 180 leaders (supervisors and above, including Chiefs and Chairs)

•Quarterly for two days and off site

•Largely in house trainers with key note speakers

October 2002Creating a Culture of Service ExcellenceRoger Dow, Sr. V.P. Marriott CorporationDan Grabouskas, MA Registrar of MV

January 2003The Goal of ChampionsJeff Taylor, Founder, Monster.ComRobin Brown, G.M. Four Seasons Hotel

May 2003Balancing Dollars and SenseBarry & Eliot Tatelman, Jordan’s FurnitureKate Walsh, COO, Novartis


• Service Operations Committee

• Service Academy

• Session L of ST

• High, Medium, Low

• High Performance Medicine

New Programs



Finance - Operating Income(000’s omitted)

FY97 FY98 FY99 FY00 FY01 FY02 FY03 FY04 FY05 FY06 FY07

($25.0)

($20.0)

($15.0)

($10.0)

($5.0)

$0.0

$5.0

$10.0

$15.0

$20.0


• Double digit growth-$350m in revenue

• Gross revenues doubled since FY01

• Market share growth of 5.1 percent

• Top 100 Hospital 5 of past 6 years

• Consumers Digest Top 50 hospitals for Patient Safety 2005

• BBJ Best Places to Work 2007

Outcomes



• Patient satisfaction 80th – 95th percentile

• Employee Turnover <7%

• 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

Outcomes


Proportion Identifying NWH as Having Best Overall Reputation: 2002-2007

Market Advantages

Market Street Research: April 2007

47.5%

55.9%61.3%

0%

20%

40%

60%

80%

100%

TOTAL

11.5%18.8%

22.8%

0%

20%

40%

60%

80%

100%

TOTAL

Top of Mind 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.



• Accountability(leader and support cards, session L)

• Leadership Development

• LI, Service Academy

• S.O.C.

• Reward/Recognition

• Bonuses, Celebrations, Team Awards

• Transparency

• Must Haves

How We Did It


What did we learn?

• Leadership from the top

• Focus

• Perseverance not brain surgery

• Accountability

• Start with people– Reward and recognition– Low performers



Questions?

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