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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
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What’s Right in Health CareSM | Evidence to Outcomes
-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
What’s Right in Health CareSM | Evidence to Outcomes
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
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Strategies
• Stabilize Finances
• Clinical Integration Partners
• Maintain Focus on Quality
• Enhance Brand Position
• Service Differentiation
What’s Right in Health CareSM | Evidence to Outcomes
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
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What’s Right in Health CareSM | Evidence to Outcomes
The Market
MetroWest
Caritas Norwood
NWH
BWH
Mt. Auburn
St. E’s
BIDMC
MGH
NEMC
10 mi
BIDMC N
What’s Right in Health CareSM | Evidence to Outcomes
• 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
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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
What’s Right in Health CareSM | Evidence to Outcomes
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
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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
What’s Right in Health CareSM | Evidence to Outcomes
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
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Service Recovery
What’s Right in Health CareSM | Evidence to Outcomes
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
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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
What’s Right in Health CareSM | Evidence to Outcomes
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
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Employee Satisfaction
What’s Right in Health CareSM | Evidence to Outcomes
0.010.020.030.040.050.060.070.080.090.0
100.0
Oph
thalm
ology
Podiat
ry
Othe
r Surg
ical S
pec
Surg, O
ral
Orth
oped
ics
Card
iovasc
ular D
iseas
e
Neo
natol
ogy
Rad
iolog
y
Emergen
cy M
edicin
e
Otol
aryng
ology
Hos
pitali
st
Othe
r Med
ical S
pec
Gen
Inter
nal M
ed
Anesth
esiolog
y
Family
Medicin
e
Neu
rolog
y
Pediat
rics
Surgery
, Gen
eral
Obs
tetric
s/Gyn
ecolo
gy
Psych
iatry
Surgery
, Plas
tic
Derm
atolog
y
Gas
troen
terolog
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NWH National
Physician Satisfaction
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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.
What’s Right in Health CareSM | Evidence to Outcomes
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
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• 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……
What’s Right in Health CareSM | Evidence to Outcomes
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
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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
What’s Right in Health CareSM | Evidence to Outcomes
• 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
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Weekly Results Published via Intranet
What’s Right in Health CareSM | Evidence to Outcomes
Weekly Results - Comments
Negative Comment
Positive Comment
Positive Comments are shared with staff members
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Support Card encouraged our support depts. to
improve their communication
5.11.04
Support Department Contact Schedule
What’s Right in Health CareSM | Evidence to Outcomes
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
Response Time 30 min 45 min 60 min <10 min
*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
Response Time 30 min 45 min 60 min <10 min
Equipment 57677 57677 57677 57677
Response Time 30 45 60 <10 min
Linen 57677 57677 57677 57677
Response Time 30 min 45 min 60 min <10 min
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
Response Time 30 min 45 min 60 min <10 min
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
Response Time 30 min 45 min 60 min <10 min
Operations Area
Routine Requests
Charlie Miceli 56584
Charlie Miceli 56584
Charlie Miceli 56584
Charlie Miceli 56584
Bill Sullivan 57645
Charlie Miceli 56584
Kevin O'Connor 57794
Charlie Miceli 56584
Pharmacist on Duty 51308
Clarified response times and contact
numbers for routine and
stat requests by shift.
Response Time Standards
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• 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?
What’s Right in Health CareSM | Evidence to Outcomes
• 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
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• 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
What’s Right in Health CareSM | Evidence to Outcomes
Monthly Leader Report Card
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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
What’s Right in Health CareSM | Evidence to Outcomes
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
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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
What’s Right in Health CareSM | Evidence to Outcomes
Leader Evaluation
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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
What’s Right in Health CareSM | Evidence to Outcomes
• Service Operations Committee
• Service Academy
• Session L of ST
• High, Medium, Low
• High Performance Medicine
New Programs
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What’s Right in Health CareSM | Evidence to Outcomes
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
What’s Right in Health CareSM | Evidence to Outcomes
• 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
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• 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
What’s Right in Health CareSM | Evidence to 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.
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What’s Right in Health CareSM | Evidence to Outcomes
• 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’s Right in Health CareSM | Evidence to Outcomes
What did we learn?
• Leadership from the top
• Focus
• Perseverance not brain surgery
• Accountability
• Start with people– Reward and recognition– Low performers
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What’s Right in Health CareSM | Evidence to Outcomes
Questions?