Aligning a Large System around Studer Group …

1 1 2009 Studer Disclosure Accreditation Statement Studer Group is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical di f hii education for physicians. Designation of Credit Studer Group designates this educational event for a maximum of 12 AMA PRA Category 1 Credits . Physicians should only claim credit commensurate with the extent of their participation in the educational event. Disclosure Policy Disclosure Policy Debra S. Landers has disclosed that she does not have any relevant financial relationships with any commercial interests related to the content of this educational event. Aligning a Large System around Studer Group PrinciplesDebra S.

2 LandersVP and Chief Marketing Officer, Community Health SystemsCommunity Health SystemsNashville, TN2 2009 Studer Objectives Implement a Standardized InitiativeInitiative Define Expectations Promote Progress Through Transparency Drive Results Across a System 121 Hospitals in 29 States Sole Provider in Over 65% of Markets QHR 150+ Facilities in 39 StatesGeographically DiverseQHR Managed Facilities 150+CHS Acute CareFacilities - 121of Markets3 2009 Studer ,196,602663,328 AdmissionsAdmissionsAdmissionsAdmissions AdjustedAdjusted Admissions *Admissions *AdjustedAdjusted Admissions *Admissions ** Include a factor for outpatient business* Include a factor for outpatient businessCHS: Industry Leader in Admissions Growth255,770303,677379,604434,570493,77 6538,445605,511848,707139,407165,100205, 607238,774267,390291,633326,235463,21220 00 2001 2002 2003 2004 2005 2006 2007 20082000 2001 2002 2003 2004 2005 2006 2007 2008$1,5251300140015001600($MM)$10,84010 ,00011,000 RevenuesRevenuesEBITDA *EBITDA *($MM)Strategy Results.

3 Rapid and Sustained Growth$203$251$291$349$429$494$573$572$8 273004005006007008009001000110012001300$ $1,306$1,531$2,039$2,677$3,204$3,738$4,1 80$7,1272,0003,0004,0005,0006,0007,0008, 0009,000$108$122$166$2031002001996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008$622$742$855$1,052$1,30601,000,1996 19971998 19992000 2001 20022003 20042005 20062007 20084 2009 Studer : FY 2008 Information Surgeries: 540,000ED Vi it 1 785 000 ED Visits: 1,785,000 Physician Visits: 4,219,000 Approximately 18,000 licensed beds CHS affiliates responsible for providing CHS affiliates responsible for providing care to 2% of US populationCHS ModelRecruit Quality PrimaryPhysicians andSpecialistsEffectivelyIntegrateAcquis itionsSpec a stsImprove HospitalOperationsIncreaseER PatientExpandServicesOperating ModelER PatientVisits5 2009 Studer AboardCommunity culture that is creating great places for employees to work places for employees to work.

4 Physicians to practice and patients to receive 2009 Studer Approach Drive results across the scorecard for each CHS hospital Adopt best practices and standardize approaches so we all get better Infuse proven Studer Group tactics and tools into the Community Cares culture Reduce turnover Improve employee, physician and patient satisfaction Grow volumesCompany Dashboard7 2009 Studer Formula:Happy Employees==HappyPatientsHappy Physicians==Happy CEOsHappy Corporate OfficeLeadership Accountability Train the Trainer Quarterly corporate LDI s for Hospital CEO s and Corporate Leadership Quarterly hospital LDI led by CEO and Champion for all hospital leaders Divisions Monitor Hospitals Corporate Rounds Operations Review LEM.

5 50% tied to annual leader evaluation C-suite Incentive Comp 25%8 2009 Studer Timetable(LDI Leadership Development Institute)LDI #1 CHS HospitalsRounding LDI #1 CHS07 HospitalsRounding LDI #2 Combined HospitalsGoal LDI #3 AIDET Key Words at Key LDI #4 Audit of current toolsPhysician LDI #5ER Nuts and BoltsHigh / Middle LDI #6 Low ConvLDI #7 Service Recovery Always and Thank you NotesStandards of Performanceand Thank you NotesStandards of PerformanceDevelopmentLeader Evaluation Manager (LEM)TimesNurse Hourly RoundingCollaborationEmployee SatisfactionED Discharge Phone 07 Aug 07 Oct 07 Feb 08 June 08 Oct 08 Feb 09 June 09 The Healthcare Flywheel at CHSB ottom Line ResultsPrescriptivePurpose, worthwhile workand makinga differenceBottom Line Results(Transparency and Accountability)PrescriptiveTo Do sSelf-MotivationCommunity Cares Culture9 2009 Studer Line Results for CHSP eopleCustomer ServiceClinical QualityFinancialSuccessful GrowthPatient Satisfaction:Percentile Ranking vs.

6 National DatabaseCore Measures FallsDecubitiJoint CommissionFinancial Performance Compared to BudgetAdmissions GrowthPhysician RecruitmentEmployee Satisfaction:Physician SatisfactionPercentile Ranking of Employee SatisfactionEmployee TurnoverCommunity Cares any Always culture10 2009 Studer does Community Cares mean to you? VIDEO INSERTAn Owner, not a Renter11 2009 Studer Ability to measure leadership engagement, progress and results from the beginning Qt l li (LAS i 2008) t Leadership Assessment Survey Quarterly online survey (LAS in2008) to measure implementation progress of early tools introduced during CHS LDI 12 questions that ask leader to rate themselves on a scale from 1-5 Over 4,000 leaders surveyed ,y Results automated by hospital, division and company to produce quarterly assessmentQuestion: As a result of Hourly Rounding, I have seen a decrease in Q2 08 Leadership Assessment SurveyRounding, I have seen a decrease in falls on our units?

7 Answer: 100%12 2009 Studer Hourly Nurse Rounding is a Growing Trend around the Country Growing Trend around the Country58% reduction in falls39% reduction in bed sores30% reduction in call lightsPatient Sat. soared from 73% to 83%"The whole concept is to reduce anxiety," said nursing chief Walls, "and make the patient feel less nervous about being in the hospital. It makes the family know you care about that person as a person, they're not just a room number." 13 2009 Studer Actual Agency NC$621 28 Nursing Contract Hours Per MonthAgency Nurse Usage Declines1220497606155*289610617490072821 0610129477361239020040060080010001200140 07ilyelystrrrr8yhilyelystNurse Cost: $621,7282008 Actual Agency Nurse Cost: $185,573 SAVINGS $436,155 March, 2007 AprilMayJuneJulyAugustSeptemberOctoberNo vemberDecemberJanuary, 2008 FebruaryMarchAprilMayJuneJulyAugustPonca City, Oklahoma% Annualized Nursing Turnover by quarter (RN/LPN)Nursing Turnover Improvement42410261122221015202530080705 1st Quarter2nd Quarter3rd Quarter4th QuarterPonca City, Oklahoma14 2009 Studer 08 Leadership Assessment SurveyQuestion.

8 I round consistently on all my direct reports and/or support staff?Answer: 98%South Baldwin Reg. Medical Center15 2009 Studer Results: Turnover More than 20% of all CHS hospitals reduced turnover to 15% or lessreduced turnover to 15% or less 5% reduction in 2008 Company turnover below industry standardsLeadership Evaluation Manager Currently in second year of LEM 118 facilities loaded and locked by February 15th2008 Over 4,000 facility leaders aligned around 22 core company goals CEO report card reviewed on a monthly basis with Division leadershipp Company goals cascade down through leadership at each facility16 2009 Studer Goals: TurnoverCHS CompanyCEO CHS Company Goal Reduce employee turnover by 3% from previous year performance CEO-CHS Facility Reduce employee turnover to 15% Current performance 18%COCNOHR DirectorHR ManagerNurse ManagerAssistant Nurse Manager CNO Reduce employee turnover to Current performance 20% RN Nurse Manager Reduce department staff turnover on 2 South to Current performance 15% RN Assistant Nurse Manager Reduce department staff turnover on 2 South to Current performance 15% RN Assistant Nurse Manager Reduce department staff turnover on 2 South to ManagerAssistant Nurse ManagerCurrent performance 15% HR Director Reduce employee turnover to 15% Current

9 Performance 18% HR Manager Reduce employee turnover to 15% Current performance 18%Joe Dorko, CEO, Lutheran HospitalVideo17 2009 Studer Leadership Site Visit Meeting Model Company Community Cares Dashboard LEM Resultsesu ts Linkage Grid from Current LDI Rounding Logs Thank You notes People Trends and Issues2008 Learning Opportunities Accountability starts at the top Trust but Verifyust but e y Division leadership selects top priority goals for facility CEO CEO cascades priority goals down to Senior Leadership Facility leaders adopt three global goals Facility leaders adopt three global goals with weight specific to leader impact Permit what you Promote18 2009 Studer Department Culture AIDET in the ED Implement use of my work life was challenging today because forms

10 Reinforce pull to full (triage as a process not a location) Reinforce hourly rounding (Q 30mins) Change signs from waiting room to reception room Implement the no delay in nursing report concept Remove/reduce NO signs Complete discharge phone calls by nurses and physiciansand physicians Reinforce physician communication and closure (at end of visit) Design a company-wide dashboard for ED excellenceED Post-Visit CallsWho do we call?9ED discharged home patients9 LWOT9 AMA19 2009 Studer Call Administrator (DCA) Results2009 Q1 DCA Summary Over 120,000 completed calls over Q1 2009Q1 2009 96% would recommend your hospital 53% recognized someone for outstanding service Transparency--Rank each Division pyand Facility Improve ED quality and service20 2009 Studer Projected Call Volume for 2009500,000completed callsResults: CHS Aggregate ED Satisfaction64%809010058%57%56%60%010203 040506070802008 Q1-Q47% Top Box Improvement4thQtr'071stQtr2ndQtr3rd Qtr4thQtr21 2009 Studer 2009 Enhancements9 Eld Cli i C llb k9 Employed Clinic Callbacks9 Inpatient CallbacksWhat does this all mean?