succeeding in the patient-centered age of healthcare...2. patient satisfaction a force multiplier in...
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American College of Healthcare Executives
Succeeding in the Patient-Centered Age of Healthcare
Michael J. McBride, FACHERegional Vice President / Administrator
CHRISTUS Santa Rosa Hospital
Anthony C. Stanowski, FACHEVice President, Industry Relations
ARAMARK Healthcare
March 23 – 24, 2009
2
• Learning Objectives• Who we are• Transparency’s impact on healthcare• CHRISTUS Santa Rosa’s approach to
performance improvement• CHRISTUS Santa Rosa’s results
Agenda
3
Learning Objectives
• Understand how access to new information will enable patients to shop for healthcare
• Identify how employee satisfaction can drive patient satisfaction scores, and subsequently market share and financial performance.
4
Who We Are
5
CHRISTUS Santa Rosa Health Care
6
Our Mission
Our Mission: To extend the healing ministry of Jesus Christ.
CHRISTUS Santa Rosa Health Care
7
Strategic FocusTo enhance CHRISTUS Santa Rosa’s regional delivery system
• Strengthening and growing children’s services• Expanding non-acute services• Growing targeted adult services• Enhancing physician relationships/partnerships
SUPPORTED BY OUR JOURNEY TO EXCELLENCE
Business Literacy Service Excellence Clinical Quality Community Value
by
Expa
nsio
n/C
olla
bora
tion/
Con
solid
atio
n Marketing/
PhilanthropyMission
To extend the healing ministry of Jesus Christthrough
our
8
Our Profile – Sites
FY 2007 CSR Delivery SystemExisting locationsSuburban locationsCollaboration/consolidation
CSRH– New Braunfels
CSRH- Boerne(planned)
CSRH- Westover Hills(under construction)
CSRH- Medical Center
CSRH – City Centre
CSR Children’s
9
Only faith-based, not-for-profit health system in San AntonioServing San Antonio and South Texas since 1869Licensed for 978 bedsTotal net operating revenue $400 millionTotal assets exceeding $424 million1,850 physicians on medical staffOver 3,500 associates$158 million annual hospital payroll
Our Profile – FY 2008
10
Serves 320,000 patients annually
29,254 admissions
150,393 Emergency Department visits
51 organ transplants
10,281 outpatient surgeries
141,373 outpatient visits
Our Profile – FY 2008
11
Distinguished Hospital Award for Clinical Excellence FIVE Years in a row!
Rated #1 hospital in San Antonio
Rated in the top 5% of adult hospitals nationally
Rated #1 in San Antonio for overall
•Cardiac •Pulmonary
•Gastrointestinal •Joint Replacement
12
Serves more than 1,300 hospitals and senior living communities in North America14,000 employeesFocuses on
Clinical Technology ServicesPatient and Retail Food ServicesFacility Services
ARAMARK Healthcare
13
CHRISTUS Santa Rosa and ARAMARK Healthcare
• Partnership began in 2004• ARAMARK Healthcare manages 410 employees
on site in the following:Asset Solutions Parking Management Central Transportation Plant Operations Management Customer Service Center Retail & Patient Food Services Environmental Services Uniform ServicesLinen Distribution Vending Services
Transparency: Consumerism and IT form the Eye of
the Perfect Storm
TransparencyTransparency: : Consumerism and IT form the Eye of Consumerism and IT form the Eye of
the Perfect Stormthe Perfect Storm
15
The Consumer-centric Model is Based on Choice
Cost and quality transparency will create a level playing field in healthcare. The key driver of patient satisfaction and financial success will be
16
The Consumer-centric Model is Based on Choice
Cost and quality transparency will create a level playing field in healthcare. The key driver of patient satisfaction and financial success will be customer servicecustomer service..
17
• A clean hospital positively impact how patients perceive you
• When support services are coordinated and efficient, it makes you feel that your hospital is well run
• A well-maintained physical plant can impact patient, employee, nurse, and physician satisfaction
• The hospital environment is critical to patient outcomes
• Support services are an important contributor to patients’ view of the hospital
• Support services make a big impact on clinical care
89%
87%
82%
80%
79%
75%
Source: ARAMARK Healthcare Stakeholder Proprietary Quantitative Research
94%
76%
78%
75%
82%
79%
% Who Strongly AgreeNurses Doctors
Clinicians Affirm that Non-clinical Services Significantly Impact Clinical Care.
18
41%of a consumer’s choice is based on
non-clinical experiences(An additional 20% is based on clinical reputation.)
Source: McKinsey Study, 2008
19
Consumer’s Main Reason for Hospital Preference
Patient Perception
8%
Insurance/Cost6%
Doctor's Recommendation
5%
Tradition12%
Other/Uncertain
20%
Proximity22%
Good Medical Care27%
Source: PRC National Consumer Perception Study, 2008Reported in Hospitals and Health Networks, June 2008
20
Patients’ Perceptions Correlate with Infection Rates
Source: Press, Ganey Associates and Pennsylvania Health Care Cost Containment Council (n=87 hospitals), 2007, based on 2005 data.
21
Healthcare Executives Perceive Quality and Patient Satisfaction as Top Issues
1. Quality of Care
2. Patient Satisfaction
A Force Multiplier in the Consumer-centric Model is:
The Internet
22
23
Consumer Use of the Internet for Healthcare Information Has Grown
Source: Harris Interactive, Vol. 8, August 20, 2008n = 1,010 in 2008
24
Hospital Compare Web Hits Increased 500% following the First Public Report of HCAHPS data
CMS placed print advertisements in 58 newspapers across the US to highlight results and the Hospital Compare website
0
2
4
6
8
10
12
March April May June
Hospital Compare Web Hits (in millions)
Ad
2008
The Sea ChangeThe Sea Change
Positive customer experiences
25
Patient transaction focus
First choice provider
26
And Hospitals Will Respond to Service Expectations
27
And Hospitals Will Respond to Service Expectations
Source: Press Ganey, 1,158 hospitals reflecting 1,512,272 patients. 9/24/2008
Employee Satisfaction
The Major Driver of Patient Satisfaction Is, Simply,
28
29
Relationship of Employee to Patient Satisfaction
Source: Press Ganey, Employee and Nurse Check-Up Report, 2008 (10/14/2008)
Figure 1: 356,625 responses from employees and patients from 148 facilities.
Figure 2: 28,308 responses from employees and physicians at 26 facilities.
Figure 3: 353,893 responses by employees and patients from 147 facilities
All data is from January 1 to December 31, 2007
(1) (2)
(3)
30
Reputations are Built Over Time as Word of Mouth Spreads through a Community
• Hospitals with patient satisfaction in the 90th percentile experience nearly a one-third increase in patient volume.
• On average, this equated to an additional 1,382 patients per year.
• Hospitals at the bottom 10th
percentile saw an average volume loss of 17%
Source: Press Ganey, “Increased Patient Satisfaction – Increased Volumes,” 2005. As reported in by Mel Hall, HFMA journal, October2008
80
81
82
83
84
85
Patie
nt S
atis
fact
ion
1 2 3 4
Profitability (Quartile)
Patient Satisfaction and Hospital Profitability
Leas
t Pr
ofita
ble
Mos
t Pro
fitab
le
31
CMS’ Value Based Purchasing Program Will Have a Direct Impact on Revenues
• Incentive payment• Phased in approach
32
How Will Transparency Impact the Hospital’s Market Position?
Leading Indicators: Employee Sat = Patient Sat = Market Share
Mar
ket
Shar
e
Patient Satisfaction
AC
B
D
F
Low
Low
High
High Cat Bird Seat
GrowthResumeWriters
At Risk
Source: SRK Solutions
33
Pre-Implementation Status
34
CHRISTUS Santa Rosa: Pre-Partnership State• Some departments managed internally, some
managed by separate external vendorsUncoordinated approach to service response
• Poor inter-departmental communication• Multiple cultures in departments outsourced to
disparate organizations Duplication of efforts among support departments
35
CHRISTUS Santa Rosa: Pre-Partnership State
• Silo approach to work• Lack of tracking system for work orders• Lack of one system to call to place work orders, resulting
in numerous calls• Leadership turnover• Low skill level in Maintenance Associates• Culture of “it’s not my job” and finger-pointing among
departments• Reluctance to change• Lack of credibility of support departments within
organization
36
CHRISTUS Santa Rosa: Rationale for Comprehensive Partnership
• “Best Practice-Touchstone Award Winner” at CHRISTUS St. Michael Health System
• Skilled in integrating support departments for a seamless delivery of care.
• Expertise in management of multiple support departments• Establishment of Central Transportation and automated
Call CenterSeamless, one-call approach for multiple services
37
CHRISTUS Santa Rosa: Rationale for Comprehensive Partnership
• Cost savings realization.• Revenue growth opportunities• Innovation• Improvement in employee satisfaction• Coordination, coordination, coordination
38
CHRISTUS Santa Rosa: Rationale for Comprehensive Partnership
• Transform the culture from the bottom up.• Set the tone of a true partnership• Treat associates in ways consistent with our values• Experience in culture changes
39
CHRISTUS Santa Rosa: Rationale for Comprehensive Partnership
• Allow long term associates to remain as CSR Associates.
• Benefit transition• Capital improvements
Call centerRetail food serviceEnergy saving software and equipment
40
CSRHC Challenged ARAMARK Healthcare to Impact Its Clinical Support Services by Creating
Patient-focused and Cost-effective Solutions:
• Seamless support of the healthcare continuum.Provide expert managementDaily execution of integrated support services
• Patient, visitor, physician, and associate satisfactionDining experiencesMaintenance and cleanlinessCustomer-focused services.
41
CSRHC Challenged ARAMARK Healthcare to Impact Its Clinical Support Services by Creating
Patient-focused and Cost-effective Solutions:
• Implement technical and programmatic solutionsImprove operational efficiencyImprove financial outcomes within support services.
• Increase morale among support service staffProvide broader career development opportunitiesAccess ARAMARK Healthcare’s competitive benefit offerings.
42
Implementation Approach
43
Philosophy: The Healthcare Environment is a Healing Atmosphere Supported by a Broad Network of People Who Are All Connected.
44
We Expanded The Definition of Patient Care.
45
We Focused on the Patient ExperiencePatient-Centered Culture
• Patient Engagement• Respect• Personal Touch• Patient-centeredness
Physician Relations
Capacity
Nurse Shortage
Personnel Shortages
P4P
Reimbursement
Quality
Patient Safety
Patient Sat
Regulatory
46
Service Was Aligned With Overall Vision, Mission, Values, and Goals.
Programs
• Room Service
• OrganizationalDevelopment
• HospitalityAssociate
• MultiServiceAssociate
Evidence-based Behaviors
• Rounding onStaff
• Thank You Notes• Key Words/
AIDET• Rounding on
Customers
• Peer Interviews • High-Middle-Low
Creates a culture of:• Patient Engagement• Respect• Personal Touch• Patient-centeredness
Enhanced Patient and Client Satisfaction
Vision, Mission, Values, Goals
47
• Establish a preventive maintenance minded culture in facility services
Increased preventive maintenance completion rates from 320 preventive work orders per year to more than 1,200 work orders per month
• Implemented ARAMARK Healthcare’s Integrated Service Information System (ISISpro)
Improve coordination of work ordersMonitor service response timesRecord compliance with regulatory standardsAssess productivity
Operational Efficiency and Service Excellence
48
Operational Efficiency and Service Excellence
• Customer Service Center“One-call” handles requests with patient transport, environmental, maintenance, biomedical, and linen servicesMore than 16,000 calls per monthAverage call answer time: 20 seconds.
• Quarterly improvement plan for employee safety100 percent reduction in service employee slips, trips, and fallaccidents in the first quarter following program implementationOverall reduction of incidents and accidents by 75 percent from the prior year
• Enhancements to indoor air quality and comfortARAMARK Healthcare’s comprehensive Asset Solutions Program
49
Operational Efficiency and Service Excellence
• Central Transportation ProgramImpacts patient throughput and clinical productivityManages more than 100,000 patient moves and 1,000 equipment moves per yearNearly 90 percent of transport requests are completed within 30 minutes of the request.
• Combine internal management and external vendors into a “one in-house team”
Brings current contractor expertise in houseEstablished a synergy of purpose
50
Outcomes Outcomes
51
Improvements in Clinical Quality PerformanceClinical
Quality Percentile*
Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Goal
AMI 100 100 100 100 100 100 100 100 97 95 94 100 100
Heart Failure 100 93 86 89 89 91 92 93 94 94 95 100 100
Pneumonia 100 85 88 90 90 91 90 91 90 90 91 100 100
Discharge Instructions for HF
89 90 88 85 85 84 85 85 83 84 83 81 87
Blood Culture for Pneumonia
94 96 95 94 94 95 95 95 93 94 94 89 93
Initial atb Selection for Pneumonia
89 92 91 92 91 91 91 93 91 91 90 100 89
Pre-op atb Timing for SIP
90 91 90 90 90 91 91 91 92 91 91 94 93
Post-op atb Timing for SIP
86 82 82 81 81 82 82 83 83 83 83 96 96
All numbers are percents
52
Employee Safety Claim Rates Improved
14.1
9.5
4.6
02468
10121416
2006 2007 2008
Source: CSR Internal Reporting
53
Employee Satisfaction Improved
• Sustained a culture of employee engagement during a workforce conversion of 410 service workers from hospital to ARAMARK Healthcare payroll
Established regular round-table sessionsOpened key lines of communication.Maintained employee satisfaction levels
• 79.5% in 2007; 80.8% in 2008
• Supported an organizational culture changeHosted a highly received leadership retreat facilitated by ARAMARK Healthcare’s Organization Development experts.
54
Improvements In Associate Satisfaction
POM Associate Satisfaction
0
20
40
60
80
100
2005 2006 2007 2008
55
Improvements in Associate Satisfaction
Dietary Associate Satisfaction
0
20
40
60
80
100
2006 2007 2008
56
Improvements In Employee Turnover
POM Turnover
0
10
20
30
40
50
2006 2007 2008
57
Nurse and Physician Satisfaction Improved• Improved nurse satisfaction with support services
Implemented ARAMARK Healthcare’s I Impact behaviors• Manager-to-manager conversations uncover “what’s working well”• Nurse manager preferences for improved collaboration.
• Improved surgical department satisfaction and productivityInstalled a “super-cooling” system in 13 operating suites which enables surgeons to rapidly alter room temperatures during procedures.
58
Visitor Satisfaction Improved • Retail dining experience improved
Added menu varietyIntroduced a Java City coffee barRenovated dining seating areasImproved dining room cleanlinessImproved dining room air temperature control.
• Enhanced visitor satisfactionImplemented ARAMARK Healthcare’s Facility Operations Management and Environmental Services ProgramsImproved temperature control in roomsImproved cleanliness in rooms
59
Patient Satisfaction Improved
• Improved patient satisfactionIncreased the quality and variety of patient mealsImproved the cleanliness and maintenance of patient care areasResult: within 12 months, went from the 51st percentile to the 90th
percentile
60
Patient Satisfaction by Quarter
0102030405060708090
100
2004
2005
2006
2007
2008
Perc
entil
e
Overall Room Meals Nursing Personal
Source: CHRISTUS Santa Rosa Press Ganey Results 2004-2008
61
Patient Satisfaction by Quarter
0102030405060708090
100
2004
2005
2006
2007
2008
Perc
entil
e
Admission Tests/Trt Vistors/fa Discharge Ov Asses
Source: CHRISTUS Santa Rosa Press Ganey Results 2004-2008
62
Statistical Summary of Patient Satisfaction Trends
Patient Satisfaction Category Regression Coefficient R2 ValueMeals 2.0070 0.4502Tests/Treatment 1.9281 0.4464Overall Assessment 1.6386 0.1988Personal 1.2772 0.1154Overall 1.1649 0.1157Discharge 0.8982 0.0622Visitors/Family 0.7789 0.0843Room 0.4474 0.0364Nursing 0.1491 0.0020Admission -0.2368 0.0089
63Source: CMS, Sept 2008
HCAHPS Results 2007
64
11.0% 11.0% 10.9%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0%1.2% 1.8%
11.3% 11.0%11.7%12.9%13.3%
13.9%14.6%14.2%14.4%14.4%
30.4% 29.3%31.1%
29.2% 28.7%30.8% 30.9%
32.5% 32.7% 33.5%
34.8%34.3%34.4%34.6%35.3%36.2%35.7%34.4%36.6%36.9%
11.8% 12.8% 12.9%12.0% 12.4% 11.7% 11.5%
2.0%1.9%
7.8%8.8%8.7%8.9%9.0%8.9%8.5%7.4%6.9%6.4%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
1998(n=147,713)
1999(n=154,229)
2000(n=163,653)
2001(n=175,035)
2002(n=181,568)
2003(n=185,144)
2004(n=189,957)
2005(n=191,233)
2006(n=193,693)
2007(n=200,342)
CSRHC Baptist Methodist University TexSAn Other
Market Share 1998 - 2007
65
At Risk
Resume Writers
Cat BirdSeat
Growth
Methodist
University
Baptist
TexSanHeart
CHRISTUSSanta Rosa
Size of bubble designates number of beds.
Market Opportunity Grid
66
CSRHC Operating Margin and Operating Income Steadily Improved
Operating Margin
0%2%4%6%
FY03 FY04 FY05 FY06 FY07 FY08
$2,617$6,903
$9,095 $10,016
$14,663
$22,300 $20,501
$0
$5,000
$10,000
$15,000
$20,000
$25,000
Net
Ope
ratin
g In
com
e (m
illio
ns)
FY03 FY04 FY05 FY06 FY07 FY08 FY09 Budget
Net Operating Income
Source: CHRISTUS Financial Reports
67
Relative to Market Competitors CHRISTUS Operating Margin Improved
Percent Change in Operating Margin From Prior Year
-50%
0%
50%
100%
150%
FY04 FY05 FY06 FY07 FY08
Perc
ent C
hang
e in
Ope
ratin
g M
argi
n %
CHRISTUS Santa Rosa* Methodist Baptist University Texsan Heart
Source: CHRISTUS Financial Reports, American Hospital Directory
68
Summary
69
In Review:
• Transparency effects the health care marketConsumerism and availability of dataThe Internet as a force multiplier
• We implemented programs that:targeted clinical process improvementtargeted employee satisfaction, physician satisfaction, and ultimately, patient satisfaction
70
• These programs resulted in:Improved patient and visitor satisfactionDecreased employee turnoverImproved clinical performanceStabilized market share; poised for growthGrew financial performance.
In Review:
71
Questions/Comments
72
Contact Information
Michael J. McBride, FACHERegional Vice President / Administrator
CHRISTUS Santa Rosa HospitalPhone: (210) 704-3336
michael.mcbride@christushealth.org
Anthony C. Stanowski, FACHEVice President, Industry Relations
ARAMARK HealthcarePhone: 215-238-3550
stanowski-anthony@aramark.com
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