1 Confidential. For internal use only. Not for distribution.

February 10, 2017

MNDAKSPAN WINTER CONFERENCE

MOVING AHEAD

2 Confidential. For internal use only. Not for distribution.

Sarah Held, RN, MBACarol Machemer, RN, MA

LEADING SURGICAL SERVICES IN A

SYSTEM ENVIRONMENT

3 Confidential. For internal use only. Not for distribution.

INTRODUCTIONS

▪ Sarah Held, Clinical Director of Surgical Services

- St. John’s Hospital, Maplewood, MN

▪ Carol Machemer, Clinical Director of Surgical Services

- St. Joseph’s Hospital, St. Paul, MN

4 Confidential. For internal use only. Not for distribution.

OVERVIEW OF HEALTHEAST CARE SYSTEM▪ A non-profit health care provider organization located in St. Paul, Minnesota and the surrounding

suburban area. It includes 14 clinics, home care, a medical transportation center, and four hospitals – Bethesda Hospital, St. John’s Hospital, St. Joseph’s Hospital, and Woodwinds Health Campus.

Founded in 1986 as a system:

- Health Resources Baptist Hospital Fund

- Optional Care

- Bethesda Lutheran Medical Center

5 Confidential. For internal use only. Not for distribution.

ABOUT HEALTHEAST CARE SYSTEMInspired by a heritage of Christian tradition, HealthEast remains committed to a ministry of compassion and healing in a way that respects the dignity of every person and honors her/his faith, culture, and community.

Mission–We are called to improve the health of our neighbors.

Vision–Optimal health and well-being for our patients, our communities and ourselves.

Values–Create a "customer first" experience–Act with courage–Nurture trust and confidence– Find joy in what we do

6 Confidential. For internal use only. Not for distribution.

SURGICAL SERVICES ORGANIZATIONAL STRUCTURE

▪ Partnership Model- Physician Leadership- Service Line Executive-Operational Vice President

▪ System Nursing Alignment under Chief Nursing Officer- Site Nursing Executives for each hospital

▪ Clinical Directors and Clinical Managers for OR, Preop & PACU

7 Confidential. For internal use only. Not for distribution. 8 Confidential. For internal use only. Not for distribution.

SURGICAL SERVICES LEADERSHIP

Brian GagerVP OperationsAcute Care &

Surgical Services

Peter Kelly, MDVP/Executive

Medical Director Surgical Services

Andrew Fink, MD

Medical Director Surgical Services

Dave ScottService Line

ExecutiveSurgery

Sarah HeldClinical Director

Surgical Services

St. John’s

Michelle Draxton

Clinical DirectorSurgical Services

Woodwinds

Amber ReedHR Business

PartnerDoug Bergstrom

Finance

Jon RauenService Line

ExecutiveBrain/Spine/Orth

opaedics

Margaret Wallenfriedman,

MDHealthEast

Neurosurgery

Kendra Langmade

OR Business Manager

St. Joseph’s

9 Confidential. For internal use only. Not for distribution.

HEALTH EAST SURGICAL SERVICES – ST. JOSEPH’S

▪11 OR’s

▪1 CV hybrid room

▪1 Interventional radiology room

▪14 SAU (pre-op/phase 2)

▪11 PACU (phase I recovery)▪ Founded by the Sisters of St. Joseph of Carondelet in 1853, St. Joseph's is proud to

hold the distinction as Minnesota's first hospital. Located in the heart of downtown St. Paul, MN

10 Confidential. For internal use only. Not for distribution.

HEALTH EAST SURGICAL SERVICES – WOODWIND’S

▪ 5 OR’s▪ 1 procedure room▪ 11 SAU (pre-op/phase 2)▪ 7 PACU (phase 1 recovery)

▪ All the services you need in one convenient location, known for attention to detail — and attention to patients. The calming ambiance of Woodwind’s Hospital in Woodbury, MN is enhanced by the surrounding woods and wetlands.

11 Confidential. For internal use only. Not for distribution.

HEALTH EAST SURGICAL SERVICES – ST. JOHN’S

▪7 OR’s▪13 SAU (pre-op/phase 2)▪11 PACU (phase 1 recovery)

▪ St. John’s – a community hospital for 100 years in Maplewood, MN, with a warm, inviting atmosphere and caring, personal staff - an innovative healing environment.

12 Confidential. For internal use only. Not for distribution.

SERVICE LINE OPTIMIZATION▪ Surgical Specialization by site

- Woodwind’s▪ Orthopedics- St. John’s

▪ Spine▪ Robotic Surgery- St. Joseph’s

▪ Cardiovascular (including CV hybrid room)▪ Neurosurgery

▪ Employee Contract and Non-Contract

- Employees hired by site versus system

- Opportunity to hire as a system

13 Confidential. For internal use only. Not for distribution.

HOW WE WORK TOGETHER

14 Confidential. For internal use only. Not for distribution.

VIRTUAL MEETINGS HAVE BECOME THE NORM▪ Reduces travel for meetings between sites

▪ Allows for more meetings

▪ Does lead to “multi tasking”

▪ Not a total replacement for meeting in person

15 Confidential. For internal use only. Not for distribution.

VIRTUAL MEETINGS – HOW DO THEY REALLY WORK?

16 Confidential. For internal use only. Not for distribution.

COMMITTEE STRUCTURE – SYSTEM LEVEL

▪ Block Committee

▪ Central Products Committee

▪ Central Flow Committee

▪ Strategy Deployment

▪ Director Meetings

▪ Weekly Leader Huddles

▪ Monthly Leader Entity Meetings

▪ Quarterly Retreats

▪ Focused Improvements

- Sterile Processing Department Huddle Calls

17 Confidential. For internal use only. Not for distribution.

COMMITTEE STRUCTURE – SITE SPECIFIC

▪Unit Council

▪Charge nurse meetings

▪Staff meetings

▪Daily huddles

18 Confidential. For internal use only. Not for distribution.

PERIOPERATIVE NURSING PRACTICE AS A SYSTEM

• Surgical Services System Nursing Educator

• Lead Preceptor Role for Surgery Admitting/PACU/Phase II and Operating Room

• Monthly Nursing Leaders and Lead Preceptors Meeting

• Orientation Planning

• Annual Competency Requirements

• Nursing Department Mandatory Education

• Surgery Admitting, PACU, and Phase II Educational Session

• Standard nursing work across the system

• Epic Electronic Record part of weekly huddle calls (workflow and optimization)

• Policies and Procedures

• Nursing Standard Monitoring and Auditing

• Contract and Non-Contract Nursing

19 Confidential. For internal use only. Not for distribution.

QUESTIONS?

20 Confidential. For internal use only. Not for distribution.

STRATEGY DEPLOYMENT

CLINICAL QUALITYCUSTOMER EXPERIENCEEMPLOYEE AND PHYSICIAN

ENGAGEMENTSMART GROWTH AND FINANCIAL

HEALTH

21 Confidential. For internal use only. Not for distribution.

FRONTLINE MANAGEMENT SYSTEM

▪ Value Based Improvement on the frontline – starts with staff input

22 Confidential. For internal use only. Not for distribution.

HOW CAN EMPLOYEES IMPACT THROUGH VBI?

This process positively challenges everyone to come up with ideas to reduce waste and improve care.

2016 HealthEast

FTE'sOne Idea Savings

HealthEast Impact

5,500 $100 $550,000

5,500 $200 $1,100,000

5,500 $500 $2,750,000

23 Confidential. For internal use only. Not for distribution.

SURGICAL SERVICES: CLINICAL QUALITY

Theme: Flawless Care

▪ Scorecard Objectives: Percentage compliance with Regulatory Requirements

▪ Pillar leader – Dr. Fink, Medical Director Surgical Services

24 Confidential. For internal use only. Not for distribution.

SURGICAL SERVICES: CUSTOMER EXPERIENCE

Theme: “Customer first”….Always!

▪ Scorecard Objectives: 50% of units will meet their overall rating of care individual goal

▪ Pillar Leader – Carol Machemer

25 Confidential. For internal use only. Not for distribution.

SURGICAL SERVICES: EMPLOYEE AND PROVIDER ENGAGEMENT

Theme: Empower and Engage Our Employees

▪ Scorecard Objectives:

▪ Number of Ideas Implemented▪ Reducing Voluntary Employee

Turnover

▪ Pillar Leader – Michelle Draxton, Clinical Director Woodwind’s Surgical Services

26 Confidential. For internal use only. Not for distribution.

SURGICAL SERVICES: SMART GROWTH AND FINANCIAL HEALTH

Theme: 2% Continuous Improvement

▪ Scorecard Objectives: Improve expense per unit

▪ Reduce Overtime

▪ Pillar Leader – Sarah Held

27 Confidential. For internal use only. Not for distribution.

ADVANTAGES OF SYSTEM WORK

▪ Collaboration and support for best practice

▪ Consistency around project planning and system improvement.

▪ All sites participate and then implement the same process

▪ Reduces system variation for patient care

▪ Improves patient and family experience

▪ Reduces duplicate and overlapping work – “divide and conquer”

▪ Built in peer group and “think tank” of ideas

▪ Standardization of equipment and products – leads to lower costs

28 Confidential. For internal use only. Not for distribution.

QUESTIONS?