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Engaging a Changing
Workforce through Evidence-
Based Practice and HR
Analytics
September 29, 2014
Joseph Cabral
Chief Human Resources Officer
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North Shore-LIJ Health System
• 16 Hospitals/more than $7 billion operating margin
• Opened a new Medical School in 2011
• Nation’s third largest, non-profit, secular health system
• Service area of 7 million people
• Recipient of the National Quality Forum’s 2010 National
Quality Healthcare Award
• More than 48,000 employees – the largest employer on
Long Island the 3rd largest private employer in New York
City
2013
Operating Statistics:
• More than 9,440 physicians*
• More than 10,000 nurses*
• More than 3,200 volunteers
• More than 6,000 hospital
and long-term care beds*
• 4 million patient contacts
• 25,600 births
• 283,700 hospital discharges
• 640,000 emergency visits
• 133,400 ambulatory
surgeries
• 91,400 ambulance transports
* Does not include affiliate organizations
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1.0M 0.7M
0.8M0.6M
(Wyoming)
(Montana) (N. Dakota)
(S. Dakota)
0.6M
1M
(Washington DC)
(Vermont)
(Delaware)
(Rhode
Island)
0.9M
0.6M
North Shore LIJ has a service area of 7 million
people in Manhattan, Queens , Staten Island and
Long Island0.7M
(Alaska)
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Fortune 500 – Potential Ranking (2012)
$8.5B - $6.1B
$8.53
$8.29
$8.07
$7.93
$7.12
$6.71
$7.0
$6.33
$6.31
$6.26
$6.19
$6.11
303
309
319
324
354
370
384
385
388
391
400
Ranking Revenue
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Tertiary
Hospitals
Community
Hospitals
Nursing &
Rehabilitation
LabsCommunity
Health
Centers
Home Care
& Hospice
Assisted
Living
Physician
Offices
Specialty
Hospitals
Ambulance
Services
Tertiary Hospitals
Specialty
Hospitals
Community
Hospitals
Nursing &
Rehabilitation
Specialty
Centers
Physician
Offices
Community
Health Centers
Assisted
LivingHome Care &
Hospice
Patients &
Families
Community
Health
An Integrated System• Not just a collection of distinct, individual entities
• Administratively and clinically integrated
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BUSINESS ENVIRONMENT
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7
HEALTHCARE
DELIVERY’S
PERFECT
STORM
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External Pressures
8
Health Care Reform Crisis
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The Business Environment
9
Uncertainty
National & Regional
Physician Shortages
Consumerism &
Transparency
Increasing Costs
Increasing
Government Oversight
Fragmented Care
Health Reform Aging Population
Growing Diversity
Increasing Life
Expectancy
Declining
Reimbursement
Questionable Quality
& Satisfaction
Increased Need for
Skilled Workforce
Medical Technology
Advancements
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Higher Costs Higher Quality
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The Aging Population
• Significant trends in New York State
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Growing Diversity
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The Educated Consumer
• Patients are prepared with media and internet information
• Informed questions about diagnosis and treatment options
• Drug advertising
• Consumer cost concerns
• Options
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Age of Transparency
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Change in the Business Model
• Shifts lower acuity case load from inpatient to
outpatient setting
• Advancements in minimally invasive techniques and
procedures
• Diagnostic efficiencies
• Patient satisfaction
• “Boutique” services
• Health Clinics located inside pharmacies
Shift To Ambulatory
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Dissatisfied Patients
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NYC Area Hospital Closures Since 2000
19
In 10 years, 20 hospitals (4,562 beds) have closed,
putting added pressure on remaining hospitals in the
N.Y. metropolitan area to raise performance
standards.
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Healthcare Reform and
Value Based Care
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U.S. Healthcare System
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Let’s Start at the Beginning…
“The only thing we know about the future is
that it will be different.”
“The best way to predict the future is to
create it.”
- Peter Drucker
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Our Workforce, the Driver of
Change
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24
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July 21, 2011
Companies are Laying Off
Companies are laying off employees at a
level not seen in nearly a year, hobbling
the job market and heightening fears
about the pace of economic recovery.
October 28, 2008
Time Inc. Plans 600 Layoffs
Time Inc., the world’s largest magazine
publisher, plans to cut 6% of its work
force—more than 600 positions.
January 26, 2009
Layoffs Spread to More
Sectors of the Economy
Furloughs, wage reductions, hiring
freezes and shorter hours did not do
enough. A year into this recession,
companies across the board are
resorting to mass job cuts.
February 8, 2009
Economy Shed 598,000
Jobs in January
In a bleak report on Friday, the Labor
Department said that almost 600,000
jobs disappeared in January and that a
total of 3.6 million jobs had been lost
since the beginning of the recession
in December 2007.
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27
Focusing on Talent Management
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Why Talent Management?
• Roughly 62% of our revenue is spent on
Human Capital
• Critical for business continuity
• High correlation between customer
satisfaction and employee satisfaction
• 20% of our workforce are over the age of
55 and nearing retirement
• 32% of our leaders are over the age of 55
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The U.S. Healthcare Workforce
TABLE 1A.3
Prospects for Growth in
the U.S. Health Care
Workforce, 2008–2018Note: Columns may not add to total due to omission of occupations with small employment.Source: U.S., Department of Labor. Bureau of Labor Statistics. (2010). National employment matrix, 2008–18. Retrieved September 16, 2010, from
http://www.bls.gov/oco/cg/cgs035.htm.
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Physician Workforce
• Growing shortage
- Specialists in high demand
- Primary Care
• Greatest demand
• Lowest compensation
Projected Shortfalls of Physicians Relative to
Demand
Source: Advisory Board; Recruiter Benchmarking Survey; 2009 Report
based on 2007 data
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Nursing Workforce
• Recession delays retirement giving false sense
of security
- Mean age of Nurses in NY State = 47.3
- 75.5% of NY state nurses are >40 years old
- Applicants turned away from RN schools due to
lack of faculty
Source: HANYS; June 2010 Nursing Workforce Survey
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Allied Health Workforce
• Growing demand particularly for Nurse
Practitioners and Physician Assistants
• Difficulty recruiting
• Demand will continue to rise due to
Health Care reform and physician
shortage
- Will play vital role in improving access
to primary care
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Health System Mid Level Provider- Growth
2003- 2012
YearNurse
Practioner Headcount
Physician Assistant
Headcount
2003 156 228
2004 166 233
2005 206 295
2006 225 333
2007 223 354
2008 313 435
2009 333 443
2010 376 524
2011 433 604
2012 540 673
*Includes all business units in the system
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Driving Performance through
Your Workforce
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Alignment
BaldrigePerformance Appraisal
Employee Survey
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36
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Linking Metrics to Performance
• Establish the
organization’s line of sight
and direction
• Create clear measures
• Communicate the metrics
Dashboard
Organizational
ScorecardMonth/Year
Date
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Linking Metrics to Individual Performance
38
ScorecardQUALITY
Financial
PerformancePatient
Experience
Dashboard
Month/Year
Date
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Linking Metrics to Performance
Do not forget
to focus on the
values!
“If you throw your
heart over the fence,
the rest will follow.”
-Anonymous
Patient Experience
Excellence Integrity
Caring TeamworkInnovation
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Organizational Alignment
Smith, Anne, RN NSUH
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Incentive Compensation
NSLIJ Health System - Annual Incentive Plan CalculationYOUR NAME AND TITLE HERE
Base Salary $200
20.0% $40
Target Total Cash Compensation $240
Actual Bonus as of 13.5% $27
Actual Total Cash Compensation as of $227
Above (Below) Target ($13)
SYSTEM (100% Weight)
Weight Thr. Tgt. Max.
Patient Experience 25% 85.1 85.1 86.1 84.3 0% Weight * Result * Target Bonus $0.0
Quality 25% 85% 85% 95% 70% 0% Weight * Result * Target Bonus $0.0
Quality/Financial Perf. Excess Days 25% 8,244 10,305 12,367 11,162 121% Weight * Result * Target Bonus $12.1
Financial Performance 25% 0.3% 0.4% 0.7% 1.1% 150% Weight * Result * Target Bonus $15.0
System Results $27.1
OK
Target Bonus
Result Payout
Likelihood to Recommend (Inpatient)
September 17, 2007
Goal
CMS Overall Indicators
Controllable Margin
100%Target
Maximum
50%Threshold
Payout
150%
Performance
Link between performance and bonus payout:
Circuit breaker is assumed to be "achieved".
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Talent Management Cycle(Hardwiring)
•Performance Reviews for Sr.
Execs (IDP’S)
•Salary Increases (across the
board)
•Sr. Leadership retreat
•Mail W2’s to employees
•NYSNA Negotiations
•High Potentials Kickoff
•Cascading of Goals-
CEO/COO
•EHS Annual Health Review
•Leadership Immersion Program
•360º process for high
potentials
•Application for President’s
Award
•Annual Educational Mandatorys
•Employee engagement
survey
•Applications for Summer
Interns
•403(b) auto enrollment
•Handbook for staff
•Health & Welfare benefit review
•Annual Mandatory Compliance
Training
•President Award Winner(s)
Announced
•Employee self-service-setting
up kiosks at each site (Summer)
• Resident On-boarding
• Review of metrics for Service
• Progress measured for
financial and operational
efficiency
•Quality measures tracked
•Succession Planning – key
positions identified
•High Potentials identified and
assessed
•EEO Reports to the
Department of Labor
•Finalize 2009 HR Budget
•Open Enrollment meetings
•Performance Reviews for all
employees (IDP’s)
•Flu shot distribution
•Performance Reviews for
Dept Heads/Mgrs (IDP’s)
•Open Enrollment
•High Potentials selected
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
JULY JUNE MAY
APRIL
MARCH
FEBRUARYJANUARYDECEMBER
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Employee LifeCycle
eApplications eOnboarding eOrientation
ePerformance Management eSuccession Planning
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Evidence-Based Practice
• Team STEPPS (Strategies & Tools to enhance Performance
and Patient Safety)
- An innovative infrastructure
- A systematic approach to improve quality safety
efficiency through optimizing team performance
• What is Team STEPPS – Empowerment through education
- Overall improvement in care
- Decrease in mortality
- Lower incidence of patient harm
- Reduced infection rate
Cost avoidance was over $21 million
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Meaningful Metrics
Meaningful metrics refer to those
data that actually are used to drive
change or influence management
decisions.
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Recruitment Metrics
• Turnover Rates
• Vacancy Rates
• Openings
• Promotions
• Transfers
• Terminations 30 – 90 days
• Terminations 360 days
• Total Terminations
• Cost Per Hire
• Total Hires
• Employee Referrals
• Resumes Received
• Interviews Conducted
• Advertisements
• Job Fairs
• Open Houses
• Diversity
• Sourcing Effectiveness
• Time to Fill
• Agency Fees
• Candidates in Pipeline
• Demographics
• Recruiter Effectiveness
• Declined Job Offers
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Talent Management: Keeping it Simple
Effective
Talent
Management
Engaged
Employees
Satisfied
Customer/
Patient
Strategy
Execution
Business
Results
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“However beautiful the strategy, you
should occasionally check the
results.”
-Winston Churchill
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Outcomes
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Executive Summary Sample
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Employee Engagement & Service Excellence
*Excludes hospitals/facilities that did not have patient and operational performance metrics. Green shading represents top three facilities for
each metric, red shading represents bottom three.
Facilities with higher aggregate organizational commitment scores have
higher patient satisfaction scores…Going forward, orienting your facilities and the System in general toward these elements will be an important
step in building an ongoing case for the value of investing in people
Organizational Commitment
9080706050
Overa
ll E
ntity
Mean: In
patient 2002 q
4
84
82
80
78
76
74
72
70 r = 0.803
Patient: Service
Employee* Excellence
Overall Entity
Organizational Mean Score:
Commitment Inpatient Q4
Score 2002
Hospital A 87.5% 82.6%
Hospital B 79.0% 82.5%
Hospital C 77.7% 79.0%
Hospital D 75.2% 77.4%
Hospital E 74.9% 82.5%
Hospital F 69.6% N/A
Hospital G 67.6% 81.3%
Hospital H 66.2% 78.7%
Hospital I 60.1% 71.6%
Hospital J 57.1% 72.0%
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59% Healthcare Benchmark
‘Agree / Disagree: I
am a valued
employee here’
Employee Survey Results
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88% Healthcare Benchmark
Employee Survey Results
‘I understand how
my work
contributes to the
goals of my
hospital/facility’
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54
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Sample Data Only
Current data does not meet/exceed goal
Performance Metrics ScorecardPerformance Metrics Executive Summary
Health System For the Period Ending 7/31/2008
Priority Indicators Current Data Targets Trends
Rolling Average Annual Annual Annual 3 Month
(Apr 08 - Jun 08) Threshold Goal Stretch Goal Trend
• Likelihood to Recommend (Inpatient Score) 85.6 85.6 86.0 86.9
• Likelihood to Recommend (Inpatient Percentile) 23 21 27 38
Apr 08 Annual Annual Annual 3 Month
(Preliminary) Threshold Goal Stretch Goal Trend
• CMS Blended (AMI, PNE, HF, SCIP) 97.4% 85.0% 90.0% 95.0%
Blended = applying a weight of 75% to the
CMS overall (AMI, PNE, HF) and 25% to SCIP.
3 Mo. Variance
YTD YTD YTD YTD (YTD Actual
Actual Threshold Goal Stretch Goal to YTD Goal)
• Operating Margin (in thousands) $ 29,939 $ 16,825 $ 18,694 $ 22,433
3 Mo. Variance
YTD YTD YTD YTD (YTD Actual
Actual Threshold Goal Stretch Goal to YTD Goal)
• Reduction in Excess Days 16,170 7,237 9,649 12,061
favorable/(unfavorable)
Current data meets or exceeds goal
Current data does not exceed goal
1 Patient Experience (Press Ganey)
2 Quality
3 Financial Performance
4 Productivity
0
0
0
0
0
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Excess Days – LOS Reduction
5.26 5.20
5.024.91 4.93
4.00
4.20
4.40
4.60
4.80
5.00
5.20
5.40
2007 2008 2009 2010 March 2011
There has been a decrease of 96,213 days, which has resulted in a
increase of 275 beds of capacity
Occ % 89.5% 89.2% 89.4% 87.3% 90.2%
(Excl. Newborn, exempt units and pediatrics)
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Service Excellence
* Through February 2011
65
70
75
80
85
90
95
100
2007 2008 2009 2010 2011*
ER Satisfaction 6.6% Improvement
Inpatient Satisfaction 1.4% Improvement
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Service• Glen Cove Hospital percentile rank
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Core Measure Composite Score
Source: Premier
Q1 2006 – Q1 2008
80.0
85.0
90.0
95.0
100.0
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2006 2007
North Shore - Long Island Jewish Health System
Core Measure Composite Score
AMI
HF
PNE
SCIP
11.6 %
9.3 %
3.2 %
8.2 %
Improvement
Improvement
Improvement
Improvement
2008
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70% Reduction ICU Central Line Associated
Bacteremia Index
ICU Ventilator Associated
Pneumonia Index
Surgical Site Infection
(Class I & II) Rate
MRSA (Methicillin-Resistant
Staphylococcus) Index
50% Reduction
24% Reduction
23% Reduction
Source: NSLIJHS Quality Management
Quality Outcomes
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$0
$2
$4
$6
$8
2003 2006 2009 2012
Source: Finance
North Shore-LIJ Health SystemRevenue
(in
billio
ns)
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Employee Engagement Pays Off
-Companies with high levels of
employee engagement show turnover
rates that are 40% lower than
companies with low levels of
engagement. Estimated cost of
replacing employees is between 50%
and 150% of salary.
-Hay Group Research
“Disengaged employees can
undermine the success of an
organization - they are not strongly
committed to achieving a company’s
goals and objectives, and may not be
motivated to act in accordance with its
mission/values.”
-Enterprise Engagement Alliance
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National Quality Healthcare Award
- “Today the National Quality Forum (NQF) announced North Shore Long Island Jewish (LIJ) Health System as the recipient of the 2010 NQF National Quality Healthcare Award for its ongoing commitment to providing high-quality, transparent, patient-centered healthcare.”
-“North Shore-LIJ is a clear leader in striving to make high-quality care commonplace for every patient and a central part of its culture. We are at the precipice of change in healthcare in America, which will have implications for every healthcare facility in every community.”
~Janet Corrigan, President & CEO, NQF
-“For us to succeed as a healthcare organization and strengthen public trust, we recognized long ago that quality must be a top priority for every employee, regardless of whether they’re cleaning patients’ rooms or performing surgery in the operating room.
~Mr. Dowling, President & CEO, North Shore-LIJ
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Our Workforce is Our
Competitive Advantage!
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`
Every Life Deserves World Class Care