Prepared for the Foundation of the American College of Healthcare Executives

Session 13AB Stewards and Catalysts: Aligning

Boards, Management and Physicians to Improve the Patient Experience

Presented by: Anthony C. Stanowski, DHA, FACHE

Shelly Buck

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Stewards and Catalysts: Aligning Boards, Management and Physicians to Improve the Patient ExperienceMarch 27, 2017

Session 13A: 10:00 am - 11:30 am

13B: 2:15 pm - 3:45 pm

Shelly Buck, MBA, DNP. COO/CNE. Bon Secours Baltimore Health System

Anthony C Stanowski, DHA, FACHE. Board Member, Chair Quality Committee, Bon Secours Baltimore Health System.

Disclosure of RelevantFinancial RelationshipsThe following faculty of this continuing education activity has no relevant financial relationships with commercial interests to disclose:

• Shelly Buck, DNP, MBA

• Anthony Stanowski, DHA, FACHE

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Presenters

• Shelly Buck, DNP, MBAChief Operating Officer and Chief Nurse Executive

Bon Secours Baltimore Health System

• Anthony Stanowski, DHA, FACHEBoard Member, Chair of Board Quality Committee

Bon Secours Baltimore Health SystemPresident and CEO

Commission on Accreditation of Healthcare Management Education (CAHME)

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Agenda• Learning Objectives

• Background

• Hardwiring Behaviors: Management Initiatives

• The Board’s Role

• Outcomes

• Questions

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LEARNING OBJECTIVES

• Illustrate how the board can be a partner in improving the patient experience.

• Apply leadership methods effective at Bon Secours to positively influence change at attendees' organizations.

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BACKGROUND

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Bon Secours Health System

NYNY

MDMD

VAVA

SCSC

FLFL

KYKY

1 Hospital, Home Health, Practices

3 Hospitals, 2 Skilled Nursing Facilities, Home Health, 

Practices

4 Hospitals, Free‐standing ED, 2 Surgery Centers, Home Health,  

Practice Locations

1 Hospital with 2 locations,                     2 Outpatient Surgery Centers, Home Health, 

practice locations 

3 Hospitals (+1 Joint Ventured), Free‐standing ED, 3 Surgery Centers, Home Health, Skilled Nursing, 

Assisted Living Facility,  Practice Locations 

1 Hospital, 12 specialty and outreach centers

Skilled Nursing, Assisted Living, Home Health

Skilled Nursing, Assisted Living, Home Health

3 Joint Ventured Hospitals, practice locations

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Bon Secours Baltimore Health System

70 Bed Acute Care

Mission: To help people and communities to health and wholeness by providing compassionate, quality healthcare and being “good help" to all in need in West Baltimore, with special concern for the poor and dying.

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Maryland All-Payer System

• Implemented: 1977• Exempts Maryland from the Inpatient and Outpatient

Prospective Payment System • Maryland sets rates for these services• All third parties pay the same rate• CMS Waiver renewed in 2013. Global budgeting core

components.• Overall per capita expenditures for hospital services• Improvements in the quality of care• Population health outcomes.

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Maryland Health Services Cost Review Commission (HSCRC)

• Regulates payments to hospitals

• Approximately a 1.5 year lag (i.e. calendar 2011 performance impacts revenue in rate year 2013)

• Maryland Quality Based Reimbursement (QBR) measures include clinical process opportunity & appropriateness, HCAHPS, Outcomes, and Safety

• Weighting of QBR measures vary over time; HCAHPS increased in importance

• Hospital reimbursement also impacted by other HSCRC mandated programs: hospital acquired infections and readmissions

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QBR Components Impact on Bon Secours Baltimore

$425$435 $420 $380 $365 $320

$590

$1,200

30% 30% 30%50%

40% 45% 50%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

$-

$250

$500

$750

$1,000

$1,250

$1,500

2010 2011 2012 2013 2014 2015 2016 2017 2018 Inp

atie

nt

Rev

enu

e at

Ris

k (p

erce

nt)

Fin

anci

al I

mp

act

(000

)QBR Financial Impact by Component

Clininical Process - OpportunityClinical Process - AppropriatenessHCAHPSOutcomesSafetyI/P Rev at Risk

???

**

* In 2017 and 2018, Inpatient Revenue is at risk for 2% as a penalty, and 1% as reward.

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QBR HCAHPS Impact onBon Secours Baltimore

$126 $114 $110 $160 $236

$540

30% 30% 30%

50%

40%

45%

50%

0%

10%

20%

30%

40%

50%

60%

$-

$250

$500

$750

$1,000

$1,250

$1,500

2010 2011 2012 2013 2014 2015 2016 2017 2018

HC

AH

PS

as

a P

erce

nt

of

Tota

l Q

BR

Fin

anci

al I

mp

act

(000

)

HCAHPS Financial Impact

???

*

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Community Reputation

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Key Executive Appointments

• 2007: CEO- Sam Ross, MD

• 2009: CFO- Richard Jones (Retired 2014)

• 2015: COO/CNE: Shelly Buck

• 2016: CFO: Laura Ellison

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HARDWIRING BEHAVIORS MANAGEMENT INITIATIVES

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Patient Experience Improvement Tactics

Frontline Staff Focus• Purposeful Hourly

rounding

• Bedside Interdisciplinary Rounds

• No Pass Zone

• Bedside Shift Report

• 60-90 Second Connection

• Leader Rounding to Influence

Administrative Focus• Staff Rounding to

Influence

• Increased Survey Response

• Transparency of scores and verbatims

• Patient experience stories at Board meetings

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Improvement Tactics: Staff Focus

Purposeful Hourly Rounding

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Improvement Tactics: Staff Focus

Bedside Interdisciplinary Rounds

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Improvement Tactics: Staff Focus

No Pass Zone

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Improvement Tactics: Staff Focus

Bedside Shift Report

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Improvement Tactics:Staff Focus

60-90 Second Connection

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Improvement Tactics:Staff Focus

Leader & Staff Rounding to Influence

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Improvement Tactics: Administrative Focus

Increase Survey Response and Sample Size

Sample Size

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Improvement Tactics:Administrative Focus

Transparency of Scores and Verbatims

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Improvement Tactics: Administrative Focus

Patient Experience Stories at Board Meetings

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THE BOARD’S ROLE

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Encourage Management Strategy Development

• Education and simulation

• Governance/Steering Committee

• Establish realistic targets with incremental improvement

• Encourage Unit level Engagement/ Ownership

• Track/Report/Reward

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Strategy Considerations

BE PERSON CENTRIC

We recognize that those whom we serve are increasingly

engaged in their own care and are seeking convenience,

affordability and reliability.

Thus, we commit to anticipate

and respond to the changing expectations of health care

consumers, and to ensure that we engage each person in an

individualized plan for health with a focus on prevention and

wellness.

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We define patient experience as the sum of all interactions, shaped by an organization's culture, that influence patient perceptions across the continuum of care.

Beryl Institute31

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QBR HCAHPS Impact onBon Secours Baltimore

$126 $114 $110 $160 $236

$540

30% 30% 30%

50%

40%

45%

50%

0%

10%

20%

30%

40%

50%

60%

$-

$250

$500

$750

$1,000

$1,250

$1,500

2010 2011 2012 2013 2014 2015 2016 2017 2018

HC

AH

PS

as

a P

erce

nt

of

Tota

l Q

BR

Fin

anci

al I

mp

act

(000

)Financial Impact by HCAHPS

???

*

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Assessing Value of Patient Satisfaction Improvements

Measured in ...

• Patient outcomes

• Process improvements

• Strategic importance/market outcomes

• Fund raising

• Difficult, if not impossible, to measure…

• Examples—

– Community Support

– Government collaboration

– Patient Compliance

– Importance in managing population health

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Training--Essential

• New Hire Orientation

• Annual Competency Validation

• Simulation Training

• RCAM 2.0-Standards of Performance & Behaviors

• Press Ganey Conference Attendance

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Governance Needs to Be Aware of Regulatory Implications

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Recognize That the Average Trustee Has Little Knowledge of HCAHPS

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What Does the BOD Need to Know?

• Benefit realization

• Physician adoption

• Staff and culture

• Improved patient outcomes

• Contribute to financial performance and mission sustainability

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22

Bon Secours Dashboard

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HCAHPS, Clinical Efficiency & Throughput

Daily dashboards used to inform management of

clinical operations.

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Board as a Cheerleader

• To Management

• To Physicians

• To Staff

• To Community

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OUTCOMES

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Patient Satisfaction vs. Engagement

HCAHPS Staff & Physician Engagement

40%

42%

44%

46%

48%

50%

52%

54%

2010 2011 2012 2013 2014 2015 2016

Willingness to Recommend

3.5

3.6

3.7

3.8

3.9

4.0

4.1

4.2

4.3

2010 2011 2012 2013 2014 2015 2016

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Impact of TacticsSept 2015 - Oct 2016

Sept Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sept Oct

Willingness to Recommend 50% 67% 17% 36% 50% 60% 45% 27% 25% 27% 40% 50% 53%

Overall Rating 17% 36% 50% 60% 50% 71% 71% 27% 39% 52% 50%

Threshold 63% 63% 63% 63% 63% 63% 63% 63% 63% 63% 63% 63% 63% 63%

Percentile Rank 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1%

N Size 2 2 6 11 5 20 9 11 8 34 20 26 20

Overall and Willingness to Recommend Compared to Threshold

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Contact InformationPresenter Title Contact Information

Shelly Buck, MBA,DNP

Chief Operating Officer and Chief Nurse ExecutiveBon Secours Baltimore Health System

2000 West Baltimore StreetBaltimore, MD 21223-1597(410) 362-3618shelly_buck@bshsi.org

Anthony C. Stanowski, DHA, FACHE

Board Member, Bon Secours BaltimorePresident and CEO, Commission on Accreditation of Healthcare Management Education

CAHME6110 Executive BoulevardSuite 614Rockville, MD 20852301-298-1825 astanowski@cahme.org

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Shelly Buck, MBA, DNPDr. Buck is the Chief Operating Officer and Chief Nursing Executive at Bon Secours

Baltimore Health System since 2015. In this role, she leads organizational performance and culture change of a 125-bed acute care facility, now funded for 72-beds. She has developed diverse leaders and inclusive teams across ancillary departments, nursing departments, perioperative services, facility and operations, Patient Experience, food services, environmental services, outpatient renal department, safety, disaster preparedness, case management, and ambulatory clinics and physician practices.

Prior to her role in Baltimore, Shelly served at Bon Secours facilities in the Richmond and in Hampton Roads, VA markets. She has led nursing teams in large academic medical centers (Thomas Jefferson), for profit hospitals (HCA), and non-acute systems (Sterling Medical).

Shelly has received numerous awards, and most recently was awarded the Healthcare Leader Recognition for Significant Contributions to Healthcare by NAHSE in 2016.

She received her Doctorate of Nursing Practice (DNP) from Old Dominion University, Norfolk, VA. MBA from the University of Maryland, and her BSN from Virginia Commonwealth University..

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Anthony C. Stanowski, DHA, FACHE

Dr. Stanowski has served as a board member of Bon Secours Baltimore Health System, Baltimore, MD since 2008. He has chaired the Quality Committee since 2016.

He is the President and CEO for the Commission on Accreditation of Healthcare Management Education (CAHME), Rockville, MD. CAHME serves to advance the quality of graduate healthcare management education.

Prior to CAHME, Anthony held executive/management roles at Applied Medical Software, Aramark, Thomson Reuters Healthcare Division (now DBA as IBM Watson Healthcare), and Philadelphia area providers Jefferson Health System, Main Line Health, and Graduate Health. In 2015, Anthony co-authored We Have A Match: My Journey through America’s Transplant System which details the challenges of providing a positive patient experience in the US transplant system.

Anthony received his doctorate degree from the Medical University of South Carolina, where his doctoral thesis focused on the relationship between patient experience and costs. He holds graduate degrees from Drexel (Marketing) and Widener (Health Care Administration) Universities, and a bachelor’s from the University of Pennsylvania (Communications and Psychology). He is a Fellow in ACHE.

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BibliographyGregory, S., Tan, D., Tilrico, M., Edwardson, N., & Gamm, L. (2014, October). Bedside

shift reports: what does the evidence say? Journal of Nursing Administration, 541-545. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25208269

Kahn R. & Stanowski, A. (2015). We Have a Match: My Journey through America’s Transplant System. Pennsauken, NJ. https://www.amazon.com/We-Have-Match-Americas-Transplant/dp/1682223493/ref=cm_cr_arp_d_product_top?ie=UTF8

Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2000). To Err is Human: building a safer health system (pp. 26). Washington, DC: Institute of Medicine.

McLeod, J., & Tetzlaff, S. (2015, November). The value of purposeful rounding. American Nurse Today, 10(11). Retrieved from http://www.americannursetoday.com/value-purposeful-rounding/

Process Measures: Quality Based Reimbursement (QBR). (2016, December). Maryland Health Services Cost Review Commission.http://www.hscrc.state.md.us/init_qi_qbr.cfm

Stanowski, A., Simpson, K., & White, A. (2015, July/August). Pay for performance: are hospitals becoming more efficient in improving their patient experience? Journal of Healthcare Management. 60(4):268-85.

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