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COPYRIGHT © STUDER GROUP
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disseminate without Studer Group authorization
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STUDER
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Alignment & Accountability: Creating
Organizational Goals and Using An
Objective Evaluation System
Bob Murphy, R.N., JD
Studer Group Senior Leader & Speaker
Slide 2
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Execution Framework
Evidence-Based LeadershipSM
Rev 2.14
COPYRIGHT © STUDER GROUP Please do not quote or disseminate without Studer Group authorization
Example Organizational Results
Using typical Leader Evaluation
Example Distribution of Performance
Using typical Leader Evaluation
Same Organization’s Results
After implementing Weighted and Objective Evaluation
Excellence
Service
Increase Patient
Satisfaction
(Inpatient)
People
Reduce
Annualized
Turnover
Goal = 62nd
Current =
Quality
Decrease
Mortality Index
Goal = .77
Current = .77
51st
Goal = 14.5%
Finance
Operating
Margin
Goal = 5%
Current = 5.6%
Growth
Increase
Inpatient
Admissions
Goal = 2.7%
Current = 7.6%
Current = 16.7%
Increase Patient
Satisfaction
(Ambulatory)
Increase
Employee
Satisfaction
Reduce FTE
per Adjusted
Discharge
Increase
Outpatient
Visits
Goal = 1.15
Goal = 62nd
Current = 65th
Current = 1.15
Goal = 5%
Current = 8.0%
Distribution of Performance After implementing
Objective and Weighted Evaluation
Note: Percentages noted account for 93% of the leaders who have entered data as of 6.7.07.
Example Hospital
Inpatient Monthly Percentile Score
Year 1 – Year 5
100%
95%
Goal = 90%
90%
80%
70%
60%
50%
40%
30%
Leader Evaluation
Tool Implemented
20%
10%
Year 1
Year 2
Year 3
Year 4
Aug
Jun
Apr
Feb
Dec
Oct
Aug
Jun
Apr
Feb
Dec
Oct
Aug
Jun
Apr
Feb
Dec
Oct
Aug
Jun
Apr
Feb
Dec
Oct
Aug
Jun
Apr
Feb
0%
Year 5
Example Hospital
Inpatient Monthly Percentile Score
Year 5 – Year 7
100%
99%
90%
80%
Goal = 90%
70%
60%
50%
40%
30%
20%
Year 5
Year 6
May
Mar
Jan
Nov
Sep
Jul
May
Mar
Jan
Nov
Sep
Jul
May
Jan
0%
Mar
Leader Evaluation
Tool Implemented
10%
Year 7
Accountability Tools
Evaluation
Report Card
90-Day Plan
Meeting Model
Leader Evaluation Requirements
Evaluation must be:
• Objective
• Measurable
• Weighted*
• Contain metric ranges (1-5)
Right Leader
Right Goal
Right Weight
Setting Weights
10%
20%
>30%
Awareness
Focus
Urgency
Setting Weight Example: Turnover
Leader A
Leader B
Leader C
Goal: Decrease organization turnover from 18% to 14% as
measured by HR Report by FY end.
Current
Turnover:
Weight:
20.5%
16.2%
14%
30%
20%
10%
Example: Senior Team Equity Review
Pillar
Finance
CEO
(Org
Goals) CNO
Entity's Goal Description
Increase Net Operating Income to budget or higher.
Increase Inpatient admissions compared to budget.
Growth
People
Quality
Service
15%
10%
10%
10%
Increase Outpatient Revenue compared to budget as
measured by Finance Department records.
Increase employee satisfaction to 90th percentile as
measured by annual survey.
15%
10%
Reduce Average Length of Stay (ALOS) to 4.85 days or less.
10%
CMO
CFO
COO VP HR
10%
20%
20%
20%
10%
15%
15%
10%
10%
20%
10%
20%
15%
15%
10%
20%
20%
10%
Maintain overall Emergency Department patient satisfaction at
10%
90th percentile.
10%
10%
15%
10%
10%
20%
Achieve Value Based Purchasing Rollup measures.
Increase HCAHPS in 6/8 composites at 80th percentile.
Increase physician satisfaction to 85th percentile as
measured by annual survey.
Other department/cascading metrics. Examples: AR Days,
Door to Doctor, Productivity, Patient Safety Measures,
Physician Satisfaction
15%
15%
10%
15%
15%
30%
10%
20%
35%
100% 100% 100% 100% 100% 100%
Cascading Goal Examples
 Chief Executive Officer
 Chief Nursing Officer
 Med/Surg Nurse Manager
 Chief Medical Officer
 Physician Practice Manager
 Primary Care Physician
Chapter Six:
Objective Leader Evaluation
System: The Birthplace of
Accountability
Example: Cascading a goal to decrease LOS
 Case Management / Discharge Planning / Social WorkIncrease % of patients discharged day the order is written
 Ancillary Department Leaders-Increase the number of
inpatient procedures completed the day the order is written
 Inpatient Nurse Managers-X% of patients discharged by (fill
in appropriate time)
 Medical Staff Leaders-Increase the % of discharge orders
written by (fill in appropriate time)
 House Supervisors-Increase % of ED admissions to
inpatient bed within XXX hours
 EVS-Improve bed turnaround time after 3pm
Chief Executive Officer (CEO) Goals
Service
30%
People
20%
Quality
20%
Finance
10%
Growth
20%
Increase
HCAHPS to 70th
percentile in
6/8 composites
Weight = 10%
Increase
Employee
Satisfaction to
85th percentile
Weight = 10%
Decrease 30
Day All-Cause
Readmissions
to 5% or less
Weight = 10%
Operating
Margin of 3.5%
Weight = 10%
Increase
Adjusted
Admissions by
2.5% (18,260)
Weight = 10%
Increase ED
Patient
Satisfaction to
80th percentile
Weight = 10%
Increase
Physician
Satisfaction to
70th percentile
Weight = 10%
Decrease CMS
Never Events to
2 or less
Increase
CGCAHPS to
80th percentile
Weight = 10%
Weight = 10%
Increase
Outpatient
billable
encounters to
37,000
Weight = 10%
Chief Nursing Officer (CNO) Goals
Service
35%
People
10%
Quality
35%
Finance
20%
Increase
HCAHPS to 70th
percentile in
6/8 composites
Increase
Employee
Satisfaction to
85th percentile
Decrease 30
Day All-Cause
Readmissions
to 5% or less
Decrease LOS to
less than 3.4
days
Weight = 25%
Weight =10%
Weight = 15%
Increase ED
Patient
Satisfaction to
80th percentile
Growth
0%
Weight = 10%
Decrease CMS
Never Events to
2 or less
Achieve
Operating
Budget
Weight = 20%
Weight = 10%
Weight = 10%
Med Surg Nurse Manager Goals
Service
30%
People
20%
Quality
40%
Finance
10%
Increase
Med/Surg
HCAHPS to 70th
percentile in
6/8 composites
Increase
Med/Surg
Employee
Satisfaction to
85th percentile
Decrease CHF
Readmissions
to 5% or less
Achieve 100%
Variance to
Budget
Weight = 20%
Weight = 10%
Weight = 30%
Weight = 10%
Growth
0%
Decrease fall
rate (never
event) to 2.5 or
less
Weight = 20%
Chief Medical Officer (CMO) Goals
Service
25%
People
15%
Quality
20%
Finance
10%
Growth
30%
Increase
CGCAHPS to
80th percentile
Increase
Physician
Satisfaction to
70th percentile
Decrease CHF
Readmissions
to 5% or less
Reduce average
Clinic no-show
rate to 10% or
less
Increase
Outpatient
billable
encounters to
37,000
Weight = 10%
Weight = 10%
Weight = 15%
Weight = 10%
Weight = 30%
Increase
HCAHPS
Physician
Composite to
70th %tile
Weight = 15%
A1C score
greater than 7
will decrease
to 25% or less
Weight = 10%
Physician Practice Manager Goals
Service
25%
People
20%
Quality
15%
Finance
15%
Growth
25%
Increase
CGCAHPS to
80th percentile
Increase
Physician
Satisfaction to
70th percentile
A1C score
greater than 7
will decrease to
25% or less
Reduce average
Clinic no-show
rate to 10% or
less
Weight = 10%
Weight = 15%
Weight = 10%
Increase
number of
billable patient
encounters to
9,000
Weight = 15%
Weight = 25%
Increase inNetwork
Referral Rate to
85%
Increase
Employee
Satisfaction to
85th percentile
Weight = 10%
Weight = 10%
Primary Care Physician Example
Service
15%
People
10%
Quality
35%
Finance
10%
Growth
30%
Increase
CGCAHPS to
80th percentile
Weight = 15%
Increase
Employee
Satisfaction
with Providers
to 70th
percentile
Weight = 10%
Increase elderly
annual flu show
vaccine rate to
85%
Weight = 10%
Generate 4,600
median work
RVUs
Weight = 10%
Increase innetwork
referral rate to
85%
Weight = 10%
Increase % of
diabetics, ages
18-75, whose
HbA1c was less
than 7% (well
controlled) to
70%
Weight = 15%
Increase
percent of
women, ages
42-69, who had
a mammogram
in the last two
years to 85%
Weight = 10%
Increase
number of
billable patient
encounters to
3,400
Weight = 20%
What is a 90-Day Plan?
Plate Manager
Prioritization Tool
 Helps define most
 Clearly defines
important use of
priorities for leader
leader’s time
and leader’s
 Allows leaders to set
supervisor
interim goals in 90
 Identifies key action
day period to
steps necessary to
achieve annual goals
achieve 90 day goals
across all pillars
 Helps get less
important items “off
the plate”
 Tactics that drive
outcomes
Communication Tool
 Creates necessary
conversations in both
directions
 Allows high
performing
employees to know
the organizations plan
 Allows leaders to
present plan of action
to supervisor and
employees
 Discuss any
resources required,
hurdles, or competing
priorities
90-Day Plan Example
Goal
Action Steps
Manage Up Level
Results
Tips for creating action steps
Involve staff
Identify 1-2 key tactics to achieve the 90 day goal
Clearly define each step to achieve the outcome
Set a realistic date to accomplish each step
Assess effectiveness of previous action steps
Monthly Meeting Model Agenda
Four Key Components
1. Review of performance (via report card and 90day plan)
2. Verification of key behaviors that are being used
to achieve results
3. Review of LDI Linkage grid to confirm status of
completing linkage assignment
4. Professional development
NOTE: Senior leader may begin the Supervisory Meeting with Rounding
on their direct report
Thank You!
Bob Murphy, R.N., JD
850-393-4481
bob.murphy@studergroup.com
www.studergroup.com

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