Quint Studer Presentation

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Hardwiring Excellence 27th Annual Education
Conference April 28, 2006
Quint Studer office 850.934.1099 cell
850.232.4648 quint_at_studergroup.com www.studergroup
.com
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• Please be sure to visit our website at
• www.studergroup.com
• for additional information, including articles,
  upcoming events,
• free toolkits, and other resources from the
  Studer Group.

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Healthcare Flywheel
Prescriptive To Dos
Bottom Line Results
Purpose, worthwhile work and makinga difference
Self-Motivation
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Questions

• Does your leader evaluation system have clinical
  quality measures for appropriate leaders that are
  objective and measurable?
• Is your organizations turnover more than 12?
• What shifts do most of your new staff work? What
  type of training do they receive?
• How many hours of training do your managers
  receive on a yearly basis?
• Is quality on all board meeting agendas,
  department agendas, department leader agendas,
  department specific agendas?

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Evidence Based Leadership
Breakthrough
Foundation
STUDER GROUP
Leader Evaluation
Must HavesSM
Performance Gap
Leader Development
Standardization
Accelerators
Aligned Goals
Aligned Behavior
Aligned Process

• Must HavesSM
• Rounding
• Thank You Notes
• Employee Selection
• Pre and Post Phone Calls
• Key Words at Key Times

• Re-recruit high and middle performers
• Move low performers up or out

• Agendas by Pillar
• Peer Interviewing
• 30/90 day sessions
• Pillar Goals

• Idea Innovation
• Technology
• Process Improvement

• Create process to assist leaders in developing
  skills and leadership competencies necessary to
  attain desired results

• Implement an organization-wide leadership
  evaluation system to hardwire objective
  accountability

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Leader Performance Evaluation Sample

PILLARS OF EXCELLENCE
1
2
3
4
5
?
?
?
?
?
GOALS AND RESULTS
Goals Results 46
51 5 50 4 45-49 3 40-44 2 39 1
Reduce Stage 1-4 Pressure Ulcers by 50
1
5
2
3
4
Weighted Value
QUALITY
x

.75
25
.25
3
Average score
Area score
Weighted value
PILLARS OF EXCELLENCE
1
2
3
4
5
?
?
?
?
?
GOALS AND RESULTS
Goals Results 50
51 5 50 4 45-49 3 40-44 2 39 1
Reduce Urinary Tract Infections by 50
1
5
2
3
4
Weighted Value
QUALITY
x

.25
4
25
1.0
Average score
Area score
Weighted value
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Leader Performance Evaluation Sample

PILLARS OF EXCELLENCE
1
2
3
4
5
GOALS AND RESULTS
?
?
?
?
?
Goals Results 83
91 5 90 4 85-89 3 80-84 2 79
1
Obtain Blood Cultures before giving antibiotics
in Pneumonia cases for more than 90 of patients
1
5
2
3
4
Weighted Value
QUALITY
x

.25
2
25
.50
Average score
Area score
Weighted value
2
PILLARS OF EXCELLENCE
1
3
4
5
?
?
?
?
?
GOALS AND RESULTS
Goals Results
86 5 85 4 82-84 3 78-81 2 77
1
Provide ACE Inhibitor at Discharge for Heart
Failure Patients for more than 85 of patients
1
5
2
3
4
Weighted Value
QUALITY
x

.25
3
.75
25
Average score
Area score
Weighted value
Total Evaluation Score_______
3.00
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(No Transcript)
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Cost of Turnover
Turnover Reduction During the First Year of
EmploymentRecommendations For the Vice President
of Human ResourcesTammye L. Kaper April 2005
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Comparison of Actual Departures
Turnover Reduction During the First Year of
EmploymentRecommendations For the Vice President
of Human ResourcesTammye L. Kaper April 2005
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30-Day Meetings

• Supervisor asks the following
• How do we compare with what we said?
• Whats working well? Have there been any
  individuals who have been helpful to you?
• Based on your prior work, what ideas for
  improvement do you have?
• Is there any reason that you feel this is not the
  right place for you?

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90-Day Meetings

• Supervisor asks the following
• How do we compare with what we said?
• Whats working well? Have there been any
  individuals who have been helpful to you?
• Based on your prior work, what ideas for
  improvement do you have?
• Is there any reason that you feel this is not the
  right place for you?
• Do you know of anyone who would be a good fit for
  our organization?
• As your supervisor, how can I help you?

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Pre-Visit Phone Call Results
Reduced No-Shows
Reduced Tardiness
Increased patient Satisfaction
70
50 60
25 30
percentile points
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Why do Pre-Visit Phone Calls?
Better health of the patient
Better deployment of resources
Reduction of anxiety
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Pre-Visit Phone Calls Overview
Confirm appointment
Talk about test and why procedure is important
(medical necessity)
Explanation of procedure and pre-visit
requirements
Directions / Timeliness
Request patient bring a list of current
medications
Co-pay review
Answer questions
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Pre-Visit Phone Call Sample
Mrs. Smith? Hello. This is ltnamegt. I am
calling to confirm your appointment for a
mammogram on ltdategt
Confirm appointment
Mrs. Smith, your physician has ordered this
mammogram as a medical necessity for the
prevention of cancer . . .
Talk about test and why procedure is important
The procedure is to take lttimegt and there are
no special requirements for this particular test
Explanation of procedure and pre-visit
requirements
I wanted to make sure you know directions to get
here. . . Parking will take you about . . .
Directions
When you come in for your test, could you please
bring in a list of your current medications?
Request patient bring a list of current
medications
I noticed you have ltnamegt for your insurance.
Your agreement with your employer allows for you
to be covered for 90 of the total cost. The
total cost to you will be 105.00 and your
employer will pick up the rest. You can bring in
a check or for your convenience we will take a
credit card. . .
Co-pay review
Are there any questions I can answer for you?
Answer questions
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Outpatient Pre-Procedure Calls
Total procedures
2231
Attempted calls
1172
Connected calls
1364
Voice mails or messages
337
Unanswered calls
71
Digestive Disease Center February/March 2003
Reference Pre and Post Procedure Calls Scott
A. Strong, M.D., The Cleveland Clinic, 2003
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Outpatient Procedure Satisfaction
Reference Pre and Post Procedure Calls Scott
A. Strong, M.D., The Cleveland Clinic, 2003
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Reality of Adverse Events Post Discharge
Type of Adverse Events
Nearly 1 in 5 patients
Other
400 patients surveyed
Fall
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76 (19) had adverse events after discharge
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Nosocomial Infection
5
Adverse Drug Event
Procedure Related
62
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81 events occurred in 76 patients
Adverse Events After Discharge from Hospital,
Annals of Internal Medicine, February 2003
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State University of New York Study Mayo Clinic
Proceedings, August 2005

• Only 28 knew medication names
• Only 37 knew purpose of medication
• Only 14 knew side effects

State University of New York Study Mayo Clinic
Proceedings, August 2005
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Discharge Phone Calls A Success Story
Discharge Phone Calls Implemented
Overall Percentile Rank
Weeks
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Post-Visit Discharge Phone Calls

• Demonstrate empathy
• Improve clinical outcomes
• Harvest reward and recognition of the staff
• Learn about the patients perception of service
• Gather process improvement suggestions

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Post-Visit Discharge Phone Call Sample
Mrs. Smith? Hello. This is ltnamegt. You were
discharged from my unit yesterday. I just wanted
to call and see how youre doing today
Empathy and Concern
Mrs. Smith, did you get all your medications
filled? . . .
Clinical Outcomes
Do you have your follow-up appointment?. . .
Is your pain better or worse than yesterday? . .
.
Mrs. Smith, we want to make sure we do excellent
clinical follow-up to ensure your best possible
recovery. Do you understand your discharge
instructions? . . .
Mrs. Smith, we like to recognize our employees.
Who did an excellent job for you while you were
in the hospital? . . .
Reward and Recognition
Can you tell me why Sue was excellent?. . .
We want to make sure you were very satisfied
with your care. How were we, Mrs. Smith?. . .
Service
Were always looking to get better. Do you have
any suggestions for what we could do to be even
better? . . .
Process Improvement
We appreciate you taking the time this afternoon
to speak with us about your follow up care. Is
there anything else I can do for you? . . .
Appreciation
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Post-Visit Discharge Phone Calls

• Phone calls to patients who have been discharged
  from the hospital after an inpatient stay,
  outpatient surgery or ED visit

• Further connects the dots though continuum of care

• Phone call should take place within 24 48 hours
  of discharge

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Results The Impacts of These Behaviors
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Call Light Reductions After Implementing Rounds
Reduction for one-hour was statistically
significant (p.000)
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Service Patient Satisfaction Increased
One Hour n18 units Two Hour n9 units
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Quality Patient Falls Reduced
Falls cost a hospital an average of 11,042 per
fall
National Center for Injury Prevention, 2004
Rizzo, 1998
(n18 units)
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Quality Skin Breakdown Reduced
Nationwide estimates indicate a hospital-acquired
decubitus case costs an average of 15,958
AHRQ, 2005, Payments for Adverse Events
(n9 units)
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Time Saved . . .Amount of hours now available for
other tasks
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Why Do Call Lights Ring?

• Bathroom assistance 15.4
• IV or Pump alarms 14.8
• Accidental 12.8
• Miscellaneous reasons 12.6
• Pain Medication 9.5
• Need a nurse 9.0
• Positioning assistance 4.1
• Total 78.2
• Note These percentages are based on a total of
  108,882 call lights recorded by the hospitals in
  a four-week period.

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Rounding Allows Nursing Staff To Anticipate Needs

• Patients get what they need when nursing staff
  rounds every hour.
• Nursing staff specifically focused on the 3 Ps
  (pain, potty, positioning) but were able to
  reduce other types of requests with rounding.

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Rounding Makes a Difference

• One Hour Rounds
• Two Hour Rounds

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What is One Hour vs- Two Hour Rounding

• One Hour Rounding
• The units choosing One-Hour rounding did one hour
  rounds from 6 am-10 pm.
• From 10 pm-6 am they did two hour rounds to
  respect patients sleeping patterns and shorter
  staffing.
• Two Hour Rounding
• The units choosing Two-Hour rounding did two hour
  rounds on a 24-hour basis.

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Hourly Round Behaviors

• Use opening key words and/or actions to introduce
  yourself, your skill set, your experience and
  others.
• Perform scheduled tasks.
• Address the 3 Ps of pain, potty and position.
• Assess additional comfort needs.

• Conduct an environmental assessment.
• Use closing key words and/or actions.
• Explain when you or others will return.
• Document the round on the log or chart.

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Ancillary DepartmentsEnvironmental Assessment
Ancillary Staff can practice behaviors to ensure
patient needs are met and enhance hourly rounds

• Use behaviors to manage up experience and inform
  what they are there to do.
• Use key words
• Is there anything I have missed?
• Is there anything I can do for you before I leave?

• Conduct an environmental assessment and make sure
  key items are in reach (i.e. call light,
  telephone, TV control, bed light switch, kleenex
  box, garbage can, etc.)

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Implementation Lessons Learned and
Recommendations

• Choose the rounding optionwe encourage one hour,
  but two hour is better than no rounding at all.
• Rounding options
• Hourly from 6 a.m. to 10 p.m.
• Every two hours from 10 p.m. to 6 a.m.
• Every two hours on a 24-hour basis
• Rounding Logs by each patient bed-Accountability
• Call Light Logs-for tracking reasons reductions

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• Culture outperforms strategy every time . . .
• and culture with strategy is unbeatable
• Quint Studer

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Healthcare Flywheel
Prescriptive To Dos
Bottom Line Results
Purpose, worthwhile work and makinga difference
Self-Motivation
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Never Underestimate the Difference You Can Make
Quint Studer