Newton-Wellesley HospitalRising From the Ashes!

Pat JordanChief Operating Officer

Bentley CollegeJune 18, 2009

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

-25,000

-20,000

-15,000

-10,000

-5,000

0

5,000

10,000

15,000

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

State of the Union – FY01

NWH Operating IncomeNWH Operating Income

FY01 – 02 Increase Volume

•Financial State-of-Emergency

•Capital investment

•Grow with Partners affiliation

•Consumer image campaign

•Maintain focus on quality

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

Teaching Collaborations:

Residency program in Surgery

Residency program in Pediatrics

Residency program in Medicine

Residency program in Anesthesia

Residency program in Psychiatry (MGH/McLean)

50+ MGH staff physicians on campus

50+ NWH medical staff training with MGH

Partners Collaborations

New Emergency Department

4 new Operating Rooms

Joint Center

Bariatric Center

Cancer Center/Radiation Oncology

Primary Care

Cardiology/Vascular Services

UCC

New Beds

ASC

NWH Growth

MetroWest

Caritas Norwood

NWH

BWH

Mt. Auburn

St. E’s

BIDMC

MGH

NEMC

10 mi

BI N

The Market

FY03 Create Loyalty

•Benchmark with Marriott, RMV, Greenwich

•Healthcare Advisory Board

•Baptist

•Management Team to Pensacola

•Connect with Quint

•Adopt pillar model/balanced scorecard

FY09 Operating Goals & Objectives

Top 5% in Patient

Satisfaction.

Voluntary annual turnover rate of 8% or less.

Employee Survey in Q2 FY09.

Plan for Physician Satisfaction

Survey FY10

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

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 employees80%- 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

CareFirstService

People Quality/ Safety

Finance Growth

CareFirst Service

Inpatient Satisfaction

0

10

20

30

40

50

60

70

80

90

100

Jan

05 R

pt

July

05

Rpt

Jan

06 R

pt

July

06

Rpt

Jan

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pt

Apr

07

Rpt

Jul 0

7 R

pt

Oct

07

Rpt

Dec

07

Rpt

Mar

08

Rpt

Jun

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pt

Sep

-08

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Dec

08

Rpt

Mar

09

Rpt

Apr

-09

May

-09

Jun-

09

Press Ganey Quarterly Results

* Compared to MA Peer Group

Quarter To Date Press Ganey Results

87.1

85.8

CareFirst Service

ED Patient Satisfaction

0

10

20

30

40

50

60

70

80

90

100

Apr

il-05

Rpt

Oct

05

Rpt

Apr

il-06

Rpt

Oct

06

Rpt

Jan

07 R

pt

Apr

07

Rpt

Jul 0

7 R

pt

Oct

07

Rpt

Dec

07

Rpt

Mar

08

Rpt

Jun

08 R

pt

Sep

-08

Rpt

Dec

08

Rpt

Mar

09

Rpt

Apr

-09

May

-09

Jun-

09

Per

cent

ile

* Compared to MA Peer Group

Press Ganey Quarterly Results Quarter To Date Press Ganey Results

87.3

86.3

CareFirst Service

Outpatient Satisfaction

0

10

20

30

40

50

60

70

80

90

100

Jan

05 R

pt

July

05

Rpt

Jan

06 R

pt

July

06

Rpt

Jan

07 R

pt

Apr

07

Rpt

Jul 0

7 R

pt

Oct

07

Rpt

Dec

07

Rpt

Mar

08

Rpt

Jun

08 R

pt

Sep

-08

Rpt

Dec

08

Rpt

Mar

09

Rpt

Apr

-09

May

-09

Jun-

09

Per

cent

ile

* Compared to AHA Region 1

Press Ganey Quarterly Results Quarter To Date Press Ganey Results

93.1

92.1

CareFirst Service

Ambulatory Surgery Patient Satisfaction

0

10

20

30

40

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60

70

80

90

100

Jan

05 R

pt

July

05

Rpt

Jan

06 R

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July

06

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Jan

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pt

Apr

07

Rpt

Jul 0

7 R

pt

Oct

07

Rpt

Dec

07

Rpt

Mar

08

Rpt

Jun

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pt

Sep

-08

Rpt

Dec

08

Rpt

Mar

09

Rpt

Apr

-09

May

-09

Jun-

09

Per

cent

ile

* Compared to AHA Region 1

Press Ganey Quarterly Results Quarter To Date Press Ganey Results

93.9

93.2

CareFirst Service

Urgent Care Center Patient Satisfaction

0

10

20

30

40

50

60

70

80

90

100

Apr

il-06

Rpt

Oct

06

Rpt

Jan

07 R

pt

Apr

07

Rpt

Jul 0

7 R

pt

Oct

07

Rpt

Dec

07

Rpt

Mar

08

Rpt

Jun

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pt

Sep

-08

Rpt

Dec

08

Rpt

Mar

09

Rpt

Apr

-09

May

-09

Jun-

09

* Compared to All Facility DB

Press Ganey Quarterly Results Quarter To Date Press Ganey Results

87.987.1

Service Tactics

Greeter Program

Tools & Equipment

Scripting in Key Areas

Support Cards

Service Recovery

Discharge Phone Calls

Service Operations Committee

Service Academy

Support CardsSupport 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 Operations

Day to day operations are run effectively and

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

Service Recovery

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

SOC

Service RecoverySOC

NAME PHONE SURVEY COMMENT UNIT

(401)780-XXXX 280520709

I found *Dr. Keith Isaacson to be very honest and very compassionate. He explained everything - very thoroughly. I am pleased that I chose him and MIGS. MIGS/ART

(781)237-1648 289316175

Everything was like "clockwork." *DR. CURTIS AND HIS TEAM were EXCEPTIONAL - efficient, caring and professional. Adult Gi

(508)872-XXXX 289317702

Everyone I came in contact with was very professional, kind, courteous and knowledgeable ESPECIALLY Reno and Lyn in the radiology dept. Reno stayed by my side the entire time and was there when I woke up. She was such a comfort to me at a very trying time. She made a BIG difference in my visit. Your entire nursing and volunteer staff is outstanding. Carol in the main Lab was most helpful to me when my scheduling went off track. She made it happen. CT SCAN

(508)533-XXXX 289317317

I can't say enough about how wonderful Dr. Robinson & his staff are! Dr. Robinson is caring & concerned & I felt confident that he was looking on for both me & my baby. MFM

POSITIVE COMMENTS

SOC

SOC

NAMEPHON

E SURVEY COMMENTS UNITASSIGNE

D TO

NEGATIVE COMMENTS

292171147

The food was not of good quality. It was not very tasty and temperatures were not great. Everything was warm. Usen 6

Kevin O’Connor

   17051051

1

Please note, upon entering hospital registration area (8:30 p.m.) I was totally alone found no one for 10 minutes. Person then told me wrong directions & wrong floor to go to: Went back to registration area & had to wait 10 more minutes until someone else finally came & directed me to sleep unit. This should never, ever happen.

NEURO/ ASL Mary Murray

 (617)308-XXXX

150401752

Bed & furniture were very uncomfortable. Room noise level was constantly high. Impossible to get rest or sound sleep. Usen 4

Judy Thorpe/ Bill Sullivan

 (617)969-XXXX

256928543

The doctors whom stood in for my main doctor, need to rethink there bedside manors. I glad to say that they aren't my doctors & they happen to be women doctors. Usen 6

Fred Millham/ Priscilla Velardo

 (508)234-XXXX

259349241

One nurses' assistant was HORRIBLE - rude, mean-spirited, insensitive - after mentioning it to the regular nurse, she dismissed it as "just being her way." Very unpleasant. Usen 6

Priscilla Velardo

 (978)451-XXXX

230422821

Would've been nice if someone explained how the bed worked & showed me where all the lights were. In the morning I discovered the subtle over-the bed lights that I would've liked to have used the previous night. 5 West

Mary Ellen Olson

 (978)725-3855

264089872

Metal staples were used even though I told the doctor of METAL ALLERGY. Got a BAD INFECTION!! 3 West Fred Millham

SOC

SOC

People

Annualized Employee Turnover Rate

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09

Tu

rno

ver

Rat

e

Annulized Turnover Rate FY09 FY09 Turnover Goal

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

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

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

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

Management Relative Performance Rankings

Low(Rarely meets standards) Points out problems in a

negative way Positions leadership poorly Thinks they will outlast

you

Medium(Sometimes meets standards) Loyal most of the time Influenced by low and

high performers Could just need more

experience

High(Consistently meets standards) You relax when you know

they are scheduled Good influence on others Strong sense of ownership

Attitude

Appearance

Commitment to Customer Needs

Customer Waiting

Privacy

Safety Awareness

Sense of Ownership

High, Medium, and Low

Leader Evaluation

CAREfirst Standards

Compassion

Attitude

Responsibility

Excellent & Quality

Accomplishment of Goals & Objectives

Service

People

Quality, Regulatory, and Safety

Finance

Growth

Leadership & Management Competencies

Practices & promotes ethical behavior

Problem solving/Decision-making

Leadership

Communications & Interpersonal Skills

Accountability

Vision & Strategic Planning

Leader Evaluation

Leader Report Card

•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

October 2002

Creating a Culture of Service Excellence

Roger 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 

Leadership Institutes

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..  

Service Discharge Phone Calls in Surgery

Purposeful Rounding, Expand PG to Outpatient Arena, Support Cards, Service Recovery Program, Discharge Phone Calls in Inpatient, Greeter Program Service Hotline

Standards of Excellence

SOC, Enhanced Leader Rounding, MHQP Satisfaction Survey in Primary Care, Roll-out Discharge Phone Calls to Additional Patient Care Areas, Enhancements to Service Recovery

Concierge Service for Patients, Visitors, EE Bonus Program

InfrastructureCare First, EMT RPR G&O, LI

Leader Report Card, Communication Boards Leader Eval

ST RPR, Empl. Eval, & HML

PeopleCF Awards, NEO, Cambridge College Masters Program, EFAP

Thank You Cards 45 & 90 Day Interviews, Presidential Lunch Care Teams, OE Team Awards Peer Interviewing

EE Sat. Survey, Bright Idea's, Tool Time, Six Sigma 1

MD Sat Survey, Six Sigma 2, Shipley Fitness Center

EE Sat Survey, Outlook Mtg Request

MD Sat. Survey, CF Service Academy, Lean

Pre FY03 FY04 FY05 FY06 FY07

NWH Time-Line

What Have we Learned?

•Leadership from the top

•Focus

•Perseverance not brain surgery

•Accountability

•Start with people

•Reward and recognition

•Low performers

Finance - Operating Income(000’s omitted)

FY99 FY00 FY01 FY02 FY03 FY04 FY04 FY06 FY07 FY08 FY09($15.0)

($10.0)

($5.0)

$0.0

$5.0

$10.0

$15.0

Financial Results

• 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

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

Outcomes

Unaided Awareness of NWH by Area: 2002-2007

47.5%

60.0%55.9%

61.3%

0%

20%

40%

60%

80%

100%

TOTAL Core Primary RemainderPrimary

Western Northern SouthernProportion Identifying NWH as Having Best Overall Reputation: 2002-2007

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

11.5%

18.8%22.8%

0%

20%

40%

60%

80%

100%

TOTAL Core Primary RemainderPrimary

Western Northern Southern

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.

Image Impact

• 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

How We Did It

• Leadership from the top• Focus• Perseverance not brain surgery• Accountability• Start with people

• Reward and recognition• Low performers

What Did We Learn?

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”