three to one: a process, not a score

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Three to One:A Process, Not A Score

New Horizons for Catholic Health Care Partnerships at KentuckyOne Health

Ruth Brinkley, President and CEOBrian Yanofchick, Senior Vice President, Mission

Elements of Today’s Process

• Hear from you

• Tell the story of KentuckyOne Health

• Describe what we have set out to do and how we have done it

• Share our lessons learned

• Dialogue

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Hearing From You

Hearing From You

• What are you hoping to hear from us today?

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Hearing From You

From Your Experience…• Name one thing that you think makes a merger work

• Name one thing that makes a merger go bad

Our Story

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Our Story

Forming KentuckyOne• Formation of JHSMH in 2005

• Formation of SJHS in 2007

• Beginning of conversations to form statewide network in 2009

• Failed merger in 2011

• KentuckyOne in 2012

• ULH/JGBCC in 2013

Public Debate

Physicians• Concerns about loss of control to academic physicians in

merged entity

• Perceived limits on care due to ERD compliance

• Communication gaps due to minimal physician leadership

Community• Acquisition of state facility by a religious organization

• Limitations on existing women’s services because of ERD

• Concerns about Catholic approach to end-of-life care

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Our Structure

Sponsorship• CHI - Majority Equity Ownership and Operational Support

• Jewish Heritage Fund for Excellence – Minority Equity Ownership

Relationship to the Church

Interaction with the Archdiocese of Louisville• Nihil Obstat

• Approval prior to RFP response

• Annual ERD Audit

• Frequent update meetings

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WHY?

Looking Ahead• Need for scale in an evolving environment

• Passage of ACA in 2010

• Long-term sustainability

Building a Culture

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Building a Culture

Culture is…• Stories

• Symbols

• Heroes

• Myths

• Narratives

Building a Culture

Defining Culture“A culture . . . is far more complex than the popular definition,

‘what people do around here’. Rather a culture tells its members how to view the world and, above all, how to experience it emotionally. In this sense, a culture primarily resides deep in the hearts of people, not in their heads as structures do. It is the emotional glue that binds people together, giving them a comforting sense of meaning and predictability, often in a confusing and changing world.”

Fr. Gerry Arbuckle, S.M.

Humanizing Healthcare Reform

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Building a Culture

What do you think?What is helpful about this definition for you?

Building a Culture

Defining Purpose and Values:

A New “Symbol” for a New System• Needed a statement that was inclusive

– Expressing Catholic values in new language

– Jewish Hospital remains Jewish

– ULH remains an entity of the state even though employees are KYOne

• Employee and board involvement

• Succinct and memorable

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Building a Culture

KentuckyOne Purpose and Values

Building a Culture

KentuckyOne Purpose and Values

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Paying Attention

to the Heart

Paying Attention to the Heart

The Catholic Heart• Guiding virtues:

– Compassion

– Excellence

– Justice

• Merger worries:

– Catholic identity in a pluralistic system

– Loss of “control” to a new entity

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What Do You Think?A Jewish Hospital is an expression of Jewish faith

in the same way a Catholic hospital is an expression

of Catholic faith. T/F


The Jewish Heart• Guiding Virtues

– Excellence

– Innovation

– Service: Tikkun Olam (תקון עולם)-Repairing the World

• Merger Worries

– Loss of control

– Alienation from the Jewish community

– Creeping Catholicism

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What Do You Think?There are few differences between the mission of

an academic hospital setting and the mission of a community

hospital setting. T/F


The Academic Heart• Guiding Virtues

– Teaching

– Research

– Patient Care

• Merger Worries

– Lack of respect/understanding for academic enterprise

– Operational efficiencies hurt learning environment

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Moving from

Three to One

Moving from Three to One

Moving to One Heart• Leadership

• Staff

• Physicians

• Board

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Moving to One Heart: Leadership• Senn Delaney

– “unfreezing” leadership

– Leadership leads and models

– Leadership is consistent for the long term

• Reinforcing messages

– “culture practice” at executive team

– Reinforcing concepts at every opportunity e.g., missing “f’s”, “blue chip”, etc.

– Process brought deeper into the organization


Moving to One Heart: Staff• Staff

– Same “unfreezing” experience

– ID “champions” and “facilitators” to lead this as trained trainers

– Over two years, everyone will have this experience

• Same “language” and reference points

• Ongoing reinforcement

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Engaging Physicians• Newly merged physician enterprise

– Identify physician leadership who own governance

– Physician Compact

– Engage in shaping the future

– Participate in same culture building efforts

• Building Primary Care Capacity

• Relationship with University of Louisville Physicians– Separate group and not included in JOA

– Ongoing work of engagement


Moving to One Heart: Board Development• Consultant hired to help board understand its role

and dynamics

• Movement from “legacy representatives” to a true “system” governance body

• Movement from attention to the trees to attention to the forest – the “generative question”

• Introduction to Senn Delaney concepts

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Best Laid Plans…


Environmental Shift

Volume to Value

Inpatient to Outpatient

Reimbursement

MethodsNewly Insured

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Environmental Shift

Reshaping the

workforce

Reshaping priorities

of services

Reshaping Cost

Structure


Pressure on the Culture• Communicating a new future

• Framing expectations

• Managing change

• Testing our ability to

“walk the talk”

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Communicating Change• Choice for transparency

• “Becoming KentuckyOne”

– Video messages that define the challenge and progress to goals

– Internal web communications at various phases

– Ongoing communication on growth


Ongoing Areas for Attention• Leadership Formation

– Determining the core “competencies” for leaders across KentuckyOne/CHI

– Determining additional “competencies” for leaders of our Catholic ministries

– Finding language the transmits key values of the Catholic health ministry and yet is inclusive of our Jewish and academic partners

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Ongoing Areas for Attention

A new system requires clarification of roles and processes

• Two sponsors with different heritages

• Learning to work within a national system

• Clarifying roles at KentuckyOne system and local levels

• Clarified pathways for physician communication

• Expectations of system leadership presence

• Extending relationships beyond legacy organizations


Ongoing Areas for Attention• Moving from hospital system to health system

– ACA accelerating change in delivery models

– Culture work must be a companion to all the re-structuring we must accomplish

– Population Management model

• Internal

• External

• Quality, Safety, Service

• Continued cost reductions

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Ongoing Areas for Attention• Mission

– Traditional staffing focused on acute care

– Movement toward expanded model that includes:

• Physician enterprise

• Outpatient services

• Off site support services

• Clinically Integrated Network interaction/influence

– Defining mission on secular campus


Lessons Learned• Deep understanding of academic/public culture and a passion

for its mission

• Grasp of all cultures in a merger

• Start up leaders have different gifts than maintenance leaders

• Mergers are hard work

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Lessons Learned• Pay attention to the politics of academic vs. private physicians

• New system membership changes the system

• New board membership changes the board

• Maintaining focus on “systemness” vs. legacy

• Understand the community’s stake in the merger


Questions• What are the similarities between our story and your

experience?

• What insight have you gained from this discussion?

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An Invitation• Orientation video inserted here

Thank You!

three to one: a process, not a score

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