A CEO's Keys to Continuous Quality Improvement

2. © 2015 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Learning Objectives 1. Understand how to engage physicians and other influencers who can drive real change 2. Understand how to use analytics to identify opportunities for improvement and make data-driven decisions 3. Understand how to drive organizational competence

3. © 2015 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Thibodaux Regional Medical Center • 2015 - Healthgrades Outstanding Patient Experience Award (ranking in top 5% eight years in a row) • 2015 Press Ganey Guardian of Excellence Award • 2015 – Best Hospital IT Department Award • 2014, 2015 - Healthgrades Patient Safety Excellence Award • 2014, 2015 - Leapfrog Group Patient Safety Score “A” • 2014 - Hospital of the Year for Clinical Excellence in Pulmonary Disease and Respiratory Care

6. © 2015 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Performance Improvement Culture Goal: Significantly enhance our culture of “Lean Thinking” by driving knowledge of methodologies, developing leadership, and establishing personal accountability for all team members. • Six Sigma deployed in 2000 • Lean deployed in 2004 • 44% of team members trained to serve as Lean Leaders

7. © 2015 Health Catalyst www.healthcatalyst.com Proprietary and Confidential The Next Step: Triple Aim & Quality Improvement Care Transformation Purpose: Create a premium value enterprise by achieving patient centered excellence through working smarter. We will succeed by… • Focusing on the Triple Aim: improving the quality of care, reducing the cost of providing care, and creating a great patient experience. • Using data-driven approaches, providing physicians with the necessary tools to lead change, and earning appropriate reimbursement for high-value healthcare.

8. © 2015 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Key #1: Engaging Physicians 1. Selecting steering team to lead care transformation initiative 2. CEO learning to share power, authority, and accountability – trusting physicians to lead the change 3. Prioritizing hospital operations through program leaders

9. © 2015 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Physician communication tool. Provides steady state domain oversight. Support projects. Refines and approves Clinical Implementation Team output. Reports to Steering Committee Provides clinical forum to develop clinical content and analytics feedback. Designs and implements processes to ignite change. Reports to Guidance Team and Steering Committee Supports development of clinical content and analytics feedback Content and Analytics Team Provides overall governance and prioritization of initiatives Clinical Implementation Team Guidance Team MD Advisory Council Steering Committee Care Transformation Organizational Structure

10. © 2015 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Steering Team • Greg Stock, CEO • Dr. Mark Hebert, General Surgeon • Dr. Paul Monier, Infectious Disease • Dr. Jay Fakier, Radiologist • Danna Caillouet, Program Manager • Executive Team Support • Dana Rodrigue, VP Quality & Compliance • Beth Norris, CNO • Bernie Clement, CIO 10

11. © 2015 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Key #2: Analytics Clinicians are willing to change when they can see the improved outcomes of their patients. Analytics are the mechanism that provides that visibility. 1. Data Warehouse 2. Key Process Analysis (KPA) Application With a data warehouse providing a single source of truth, and advanced analytic capabilities in place, Thibodaux Regional was able to quickly identify opportunities for improvement, have the data to support decisions, and rapidly implement change.

12. © 2015 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Subject Area Data Marts and Applications Data Integration and Common Definitions Population Definitions, Comorbidities, Patients, Labs, Encounters, Diagnoses, Medications, etc. Source Marts EMR EMR Financial Patient Sat. HR Administrative Claims Late-BindingTM Data Warehouse Platform Financial Patient Sat. HR Administrative Claims e.g. Epic, Cerner NextGen e.g. EPSi, Peoplesoft, Lawson e.g. Press Ganey, NRC Picker e.g. Lawson, Peoplesoft, Ultipro e.g. API Time Tracking e.g. Medicare Private Payers Data Warehouse Platform Includes Atlas: Metadata Browser/ Editor Security Auditing Monitoring 12 ©2014 Health Catalyst www.healthcatalyst.com

13. © 2015 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Analytics Solutions in Use Solution Benefit Key Process Analysis Conduct Pareto analysis of care processes to understand opportunities for reduction in variability and cost Population Explorer Analyze key hospital volume measures based upon patient demographics and other classifications Patient Satisfaction Explorer Analyze Press Ganey results to more precise levels for greater accountability and identification of performance drivers Sepsis Advanced App Reporting of process and outcome measures, as well as correlation of these measures to identify key care improvement opportunities AMI Advanced App Reporting of process and outcome measures, as well as correlation of these measures to identify key care improvement opportunities Cost Explorer Deep analysis of cost details by provider, care process, department, and cost category to precisely identify opportunities for improvement

14. © 2015 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Key #3: Driving Organizational Competence and Accountability Once teams have gained experience on a particular project, Stock expects them to take the knowledge and skills they have acquired and apply them to other problem areas across the organization. And because quality improvement requires a continuous approach, rather than ignoring “completed” projects, leadership monitors those projects to ensure gains are not lost, and intervenes to hold people accountable if performance ever starts to slip.

15. © 2015 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Knowledge Sharing Components • Standard project plan • Standard communication plan to steering team, employees, and medical staff • Celebrate, celebrate, celebrate • Be transparent in outcomes – both good and bad

16. © 2015 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Results • Advances with physician relationships as well as exciting leadership development of physicians across the organization • Increase in institutional knowledge and skill related to quality improvement among physicians and staff is an investment that will serve the hospital and Thibodaux community well into the future • Thibodaux Regional is saving 16 lives per year through its sepsis improvement project alone

17. © 2015 Health Catalyst www.healthcatalyst.com Proprietary and Confidential For the Patients The first day the sepsis protocol went into place an extremely ill cancer patient in septic shock came into the ED. His quality of life had suffered due to the amount of time he had to spend in hospitals, and he and his family fully expected that this additional illness would require a prolonged hospitalization that would most likely end in his death. With the changes in practice that had been put in place for treating sepsis, clinicians were able to intervene and treat him quickly. After a short stay in the ICU, he was able to go home, gather his family, and spend time with them at the end of his life.

18. © 2015 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Poll Question What is your greatest challenge when it comes to improving sepsis outcomes? A) Implementing analytics B) Engaging medical staff C) Formalizing performance improvement D) Establishing accountability E) All of the above 18

19. © 2015 Health Catalyst www.healthcatalyst.com Proprietary and Confidential The Joint Commission During its recent TJC survey, Thibodaux Regional shared its quality improvement methodology and improvement team results. The upshot of all this hard work? Thibodaux Regional received unprecedented approval from the surveyors. At the executive briefing, which is part of the survey, TJC commented: “This is the most sophisticated and comprehensive system I have ever seen… [Thibodaux Regional’s methodology] is a best practice in how to use data and get physicians engaged.” Q & A