The Healthcare Organization of the Future: Arriving …...The Healthcare Organization of the Future:...

Medical/Surgical Nurse Leadership Conference

The Healthcare Organization of the

Future: Arriving Now

Kim Henrichsen, RN, MSNSenior VP, Clinical Operations & CNE

August 30, 2017

2017

2017

2017

2017

Mobile Education

20202017

3D Printing

2017 2020 2027

10% of everything produced

will be 3D printed

Cars

2017 2020 2030

Homes

2035

Health Care

2040

The Digital Era

The Digital Era

The Traditional Staffing Model

• Core staffing is based on average daily census plus 10%.

• We tell you when we want you but cancel you if volumes change.

• You must sign up for shifts on a certain day or all the desirable shifts are taken.

• You “get” to sign up based on your tenure with the unit you are hired to.

• We will only approve your vacation 8-12 weeks in advance.

• If you want time off after the schedule is made, you have to find someone to cover for you.

• Managers spend a good portion of their day “managing” the schedule

By the Numbers

9,523 Intermountain RNs

4,895 Bedside RNs

668 Open RN positions

430 Bedside RNs

40% Bedside RNs are millennials

100 RN travelers

$9 million RN contract labor 2016

150 Nurses called off every pay period

$236,000 Overtime premium every pay period

5,500 Unfilled shifts per pay period

$50 million premium paid to nurses in 2016

XXXX hours Nurse Manager time spent on staffing

Disrupting the Traditional Staffing Model

Marketplace Concept• Core staffing is based on minimum daily census.• Open shifts are posted to the marketplace.• Mobile access is enabled.• Rules are built into the system to ensure appropriate levels and staff

skills.• Bedside nurses gain flexibility and own their schedule.• Caregivers Care for Their Community.• Leverage “Geographic”resources versus “Entity” resources

Recommendation

• Establish safe, cost – effective staffing targets

• Predictive analytics that powers on-demand staffing

• Embed flexibility to respond to unexpected mismatches

• Create flexible scheduling model

• Fully leverage the skills and training of each care team member

• Remove the siloes

Intermountain Healthy Futures: Clinical Labor Observations

• Intermountain nursing staff are mission driven Highly aligned nurses are dedicated to care delivery Satisfied and loyal on the whole, with strong overall employee retention Part of a system that is a recognized as a successful integrated payer-provider

• Productivity and budgeting process lag There are variations in budgets and effective staffing ratios within each department type, ranging from wards to the ED and procedural units There is a perception that each department has unique demands and staffs accordingly There is significant opportunity to standardize staffing across the organization

• There are challenges with first year retention First year turnover is significant and being actively addressed by CNOs Pay is lower than market rate and is a particular issue for early career nurses It will be important to prioritize active initiatives and build loyalty at onboarding

and beyond

Intermountain Healthcare

Goal: Healthiest state with most affordable care

Intense focus on the individual lives we touch

Well-positioned to improve healthcare worldwide

Utah Economy Ranked #1 by

Healthcare Costs Play a Role in Attracting Jobs

in

Utah Ranked #1 for Business by

U.S. Chamber of Commerce

Total Medical Spending (among commercially insured – 350 cities)

$2,623

$2,719

$2,762

$2,916

$2,919

$2,942

$2,950

$2,979

$2,996

$3,029

$4,953

$7,231

$2,000 $4,000 $6,000 $8,000

Ogden, UT

Dubuque, IA

Fayetteville, MO

Fort Smith, OK

Laredo, TX

Amarillo, TX

Salt Lake City, UT

Fargo, ND

Sioux City, IA

Provo, UT

…

National Average

…

Anderson, IN

OGDEN #1 Lowest

SALT LAKE #7 Lowest

PROVO #10 Lowest

UTAHis the only state with three communitiesin the top 10 for lowest spending

Strong Roots Current State Engaged Caregivers

ABOUT INTERMOUNTAIN

A Charge to “Be a Model Health System”15 HOSPITALS

Worth $250-$300 million in 1975

Enduring Leadership

Scott S. Parker William H. Nelson Charles W. Sorenson, MD

Trustees Focused on Communities

• Volunteer time and expertise

• Serve without pay

• Govern in best interests of the community

470+Trustees

Helping people live the healthiest lives possible®

Be a model healthcare system by providing extraordinary care and superior

service at a sustainable cost

Integrated System

22Hospitals

2,800Licensed Beds

180Medical Group Clinics

852,000SelectHealthMembers

We Are All Caregivers

Utah’s largest private employer

1,560Employed

3,500Affiliated

680Employed

1,100Affiliated

27,000+1,600

Physicians Other Caregivers

VolunteersAdvancedPractice

Clinicians

39,000+ caregivers

9,300

Nurses

1/3 of Utah’s nurses

Gallup Great Workplace:

5x Gallup award winner

Only 35 organizations awarded worldwide

Employer of ChoiceTop 100

Forbes 2016 America’s Best Large Employers

Top 100

Computerworld Best Places to Work in IT

Financial Stability and Excellence

Aa1 AA+

Highest rated of any system

in America

Uncertainties in Healthcare Legislation

LOOMING CHALLENGE IN HEALTHCARE

Providing high quality and the most affordable costs remains the right strategy

SelectHealth: Only Exchange Option in Utah for 20/29 Counties

Utah Individual Exchange Membership

SelectHealth Portion

State Totals

0

50,000

100,000

150,000

200,000

2014 2015 2016 2017

Economic Contribution Environment Education Local Needs

CONTRIBUTING TO A VIBRANT COMMUNITY

Nearly Half of Utahns Seek Care from Intermountain Annually

Economic Contribution

6.6% of Utah’s economy

Economic Contribution to the Community (1)

Net Tax Revenue

$436.3M4.8% of tax revenue

CharityCare

$419.5Min 2016*

Kem C. Gardner Policy Institute, University of Utah*Source: Intermountain Healthcare

UtahJobs

143,346 7.7% of jobs

Economic Contribution to the Community (2)

Job Earnings

$7B5.9% of Utah

Kem C. Gardner Policy Institute, University of Utah

Utah GDP

$9.8B6.6% of GDP

$35.9 million

Provided for education of health

professionals in 2016

Educating Future Caregivers

2,762

Nursing students trained in 2016

$700,000

To fund “Diversity in Nursing” scholarships

at 6 Utah schools, educating up to 200

students

$6.6 million

Provided tuition reimbursement

in 2016

Meeting Local Health Challenges

• Conducted Health Needs Assessments for 22 hospitals

• The significant health priority is prevention in four key areas:

Diabetes

High Blood

Pressure

Prediabetes Depression Prescription Opioid Misuse

Tackling Prescription Opioid Misuse

$3.5 million over 3 years

Public awareness campaign

Prescription Drop Boxes

Physician and Patient

Education

NaloxoneOpioid Reversal

Med

Opioid Community

Collaborative

Use Only As Directed

11,000 lbs. collected

2,450 physicians

trained

Available without a prescription

(at a discounted price)

Opioid Collaborative Success Story

A homeless couple successfully recovered.

They went from living in a car to a home, but most importantly – they got their son back.

Community Collaborations

Intermountain Community

Contributions

$13M

Intermountain Community

Care Foundation

$4.3M

Community Partner

Fund

$646K

Association for Utah Community HealthSupport to 15 Large Independent Community Clinics

Community health workers $1.2 Million (over 3 years)

$3.0 Million (2015-17)Health insurance premiums

• 1,673 people in 983 households

28,000+ caregivers trained (99% of leaders)

About 250,000 preventable deaths from medical errors in U.S. hospitals each year

Serious safety events significantly reduced after 2 years

Safety: Better Care, Safer Care

Reduced

30%

SPEAKING UP FOR SAFETY

Increased

26%

Quality: National Quality Measures—Central Line Associated Bloodstream InfectionsPercentile Rankings (higher is better)

Intermountain Medical CenterMayo ClinicJohns HopkinsCleveland ClinicMass General

30%

50%

Source: data.medicare.gov, 2015 is most recent data available

2015 (most current available)

Quality: Hospital-Wide 30-Day ReadmissionsPercentile Rankings (higher is better)

Intermountain Medical CenterMayo ClinicRonald Reagan UCLACleveland ClinicMass General

20%

40%

80%

Source: data.medicare.gov, 2015 is most recent data available2015 (most current available)

60%

Cardiovascular Women and Newborns Primary Care Oncology Intensive Medicine

Our 10 Clinical Programs

Behavioral Health

Surgical Services

Pediatric Specialties

Musculoskeletal Neurosciences

In the last 5 years in the Salt Lake Valley, 99.8% of heart attack patients received lifesaving treatment to open a blocked artery in less than 90 minutes

No other hospital system in U.S. has achieved this

First program

1997

Cardiovascular Clinical Program

83%

89%

98%100% 100% 100% 100% 99%

2009 2010 2011 2012 2013 2014 2015 2016

Patients With Door-to-Balloon Time <90 Minutes at Intermountain Medical Center

PCI < 90 Min. Rate

Clinical Programs Neurosciences Improving Outcomes for Stroke Patients

2016Intermountain Medical Center

60 minutes “door-to-needle” time is the national benchmark

70Min

61Min

35Min

Nov. 2014-Feb. 2017 Intermountain

System

2014 Intermountain System

(except Intermountain Medical Center)

TeleHealth Stroke Services Launch: same care everywhere

ER VisitsReduced

23%

Primary Care Encounters

Reduced

Behavioral Health Clinical Program: Team-Based Care, Including Mental Health Integration

Saved $115 per $22 investment (per person per year)for Mental Health Integration

7% 3%

HospitalAdmissions

Reduced

11%

Payments toProviders

Reduced

2017Hearst Health Prize Recipient

Annual national award recognizing outstanding achievement

in improving health

Women and Newborns Clinical Program

30,885 Births(58% of Utah births)

INNOVATIONTeleHealth Newborn Critical Care Support

3,000 NICU Admissions390 neonatal consults since 2014,

54 transports avoided with cost savings of $980,000

Efficiencies in Supply Costs

#1 Ranked Supply Chainin the nation for 2016

Gartner Healthcare Top 25

2015: #32014: #32013: #42012: #42011: #72010: #72006 2008 2010 2012 2014 2016

$25M$96M

$177M

$278M

$480M

$667M$667 Million saved over 10 years

Improvement Ideas from the Frontline

• Systematic method to improve value for patients/members

• Reduces waste, improves safety

• 892 Continuous Improvement projects in 2016

$7.8 million in validated savings

for 2016

Expanding Access: Charity Care (Financial Assistance)

2012 2013 2015 2016

$250M$282M

$385M$353M

$419.5M

2014

239K277K 268K

245K 249K

Dollars

Total cases

Expanding Access: 52 Community Clinics

Patient Visits

2012 2013 2015 20162014

261K

325K

382K402K

457K

Mars RussellLincoln School Clinic

Serving Garfield and Piute Counties,starting May 2017

Serving 5,600 residents across 6,500 sq. miles

Nearly 2 million tourists travel in these counties annually

Reaching Patients Where They Live, Work, and PlayMobile Clinic

$254,000 investment

Connect Care: Bringing Affordable Quality Directly to Patients

Connect Care

Physician to Patient

Average Savings/Visit $55.23

ER $561

Urgent Care $79

Primary Care $67

Connect Care = $49 or less

Average savings per visit

Patient Savings

$212,597Total saved

Cost per visit

4,450 Visits (end of 2016)

TeleHealth: Bringing Quality Care Closer to Home

Critical Care

Crisis Care

Oncology

Infectious Diseases

Stroke

Newborn Care

Pediatric Critical Care

Pediatric Services

Connecting Specialists and Local Physicians

0

100000

200000

300000

2013 2014 2015 2016 2017 YTD

242,025

420

40,089

96,837

211,260

TeleHealth: Patients Served

RESULTS

>242,025 Consults since 2014

100+ New services in the pipeline

TeleHealth: Facility Outreach (Non-Intermountain Facilities)

Life Flight• 7 helicopters, 2 turboprop fixed-wing, 1 jet • Only jet certified to transfer organs• Certified hoist rescue operations • Over 10 million patient miles flown

0

10000

20000

30000

40000

50000

60000

70000

1978 1988 1998 2008 2016

4,000

65,000Patients transported

since 1978

27,000

44,000

56,000

Patients Transported

Moving Upstream Innovation Thought Leadership

INVESTING IN THE FUTURE

Moving Upstream to Improve Health

Ongoing investment in the health of the people we serve

• LiVe Well

• Creating a healthy eating environment at Intermountain

• Supporting community initiatives

• Health Information• Test Results• Appointments• Bill Pay• Claims• Benefits Coverage

0

50,000

100,000

150,000

200,000

250,000

300,000

2012 2013 2014 2015 2016

Helping People Manage Their Own Health

10%of Utah adults use My Health

New Businesses

• Personalizes options for stage-4 cancer

• Identifies the most gene mutations with proprietary ICG100™

• Uses outcomes data to reduce variation and improve healthcare

• Reduced supply costs at Intermountainby $90 million

• Manages supplies for more than 95,000 hospitals and clinics, helping them be more efficient

• Lowers cost to patients through integrated, point-of-care specialty pharmacies

• Members have increased access to specialty medications

*Using the search criteria for PubMed developed by the Institute for Healthcare Delivery Research

136173

335

399 402

2012 2013 2014 2015 2016

Nu

mb

er o

f P

ub

licat

ion

s

Intermountain Studies Published Annually 2012-2016

Generosity of Others Helps Meet Needs

$19 $23 $24 $26 $36

$61

2011 2012 2013 2014 2015 2016

($ in millions)Helps keep care affordable and enhances services:• Patient Programs• Charity Care • Research• Capital Projects• Technology

9%

14%

41%

49%

55%

58%

67%

Virginia Mason

Johns Hopkins

Intermountain Healthcare

Geisinger

Cleveland Clinic

Mayo Clinic

Kaiser Permanente

Intermountain

Top 5 Healthcare Models for Innovation

• One of 30 Healthcare Governors < 10 delivery systems globally

• 2,500 top leaders

• Leading contributor to global Value in Healthcare project

Working to Improve Healthcare Worldwide

Three Takeaways

Goal: Healthiest state with most affordable care

Intense focus on the individual lives we touch

Well-positioned to improve healthcare worldwide

One Intermountain

Org. HealthHow an organization aligns itself,executes with excellence, and renewsitself to achieve performance aspirations

How an enterprise delivers on service and quality, and performs financially and operationally

Success drivers: performance and health

Org. Performance

SOURCE: McKinsey & Co.

Strong Foundation

Mission

Helping people live the healthiest lives possible®

Vision

Be a model health system by providing extraordinary

care and superior service at an affordable cost.

In the eyes of our patients—FUTURE STATE

24h

Personalized

Always-on

Empowering

Frictionless

Coordinated

Transparent

We know what’s best for patients

Available during operating hours

Patients don’t know the implications of their choices

Barriers are just part of healthcare

Care starts when patients walk in the door and ends when they’re cured

Patients won’t understandthe details

We ask patients what is meaningful to them

Access is easy, convenient, digitally-enabled

We help empower the customer to take control of their care and health

We leverage technology to take friction out of the care journey

We get upstream, engaging thoughtfully throughout their care journeys

We provide what patients need to make sound financial and care decisions

GOAL FROM WHAT WE THINK TO WHAT THEY WANT

AcceleratedPerformance Smart Growth

Focused Innovation

A contemporary model: strategic direction

High-Value Delivery

Customer-Centric Support Healthy Communities

A caregiver was assaulted by a patient

1 cancer

patient was transferred

2 X-ray machines are down

3 ICU beds are open here We found

a frayed wire

Tiered Huddles: From front line to C-suite every day

Leadership is the next logical step in your career.

Leadership means leveraging your own expertise

and experience.

You spend time where you get the most immediate return.

You tackle pressing problems and perform.

Leadership is a commitment, a calling— your Higher Ambition is to serve.

Leadership is your craft and you leverage other peoples’ strengths.

You make time for deliberate practiceand the aim is mastery.

You contribute today and build capabilities for tomorrow.

© Center for Higher Ambition Leadership, February, 2017

IncidentalLEADER

IntentionalLEADER

Intentional Leadership

Plant trees you will never see

Intermountain Leadership ExpectationsLeadership Expectations describe how we live and work. Leadership is a privilege that we earn every day from those that we lead.

• Caregiving. We are all caregivers. We treat our patients, families, and each other the way they want to be treated.

• Purposeful. We believe leadership is a high calling and our purpose is to advance the greater good.

• Teamwork. We believe that the best results come from working together and including everyone.

• Courageous. We have the courage and discipline to take action for our patients, families, and community — even in the face of fear and adversity.

• Innovative. We ask “why” and pursue new insights courageously.

• Empowered. We are empowered, and we empower others to action.

• Results Oriented. We focus relentlessly on implementation and believe that data provides the foundation for excellent decision making.

High-valueDelivery

ConsumerCentric

HealthyCommunities

AcceleratedPerformance

SmartGrowth

FocusedInnovation

DIFFERENTIATORS

High-value Delivery

ENABLERS

A Contemporary Model: Our Strategic Direction

Safety ● Quality ● Patient Experience ● Access ● Stewardship | Caregivers

Charles Sorenson, MDBill Nelson Scott Parker

South Region

2014

2015

2016

2017

30

2324

4

BE SAFE FOR EVERY PATIENT

Serious Safety Events By Year, 2014-2017 (YTD)Central Region

20142015

2016

2017

31

5351

8

North Region

20142015

2016

2017

2224

6

Safety

48

Southwest Region

20142015

2016

2017

1525

8

5

Medical Group

20142015

2016

2017

1811

24

8

Primary Children’s

20142015

2016

2017

1412

9

6

Homecare

20142015

2016

2017

4

82

0

Resulted in Death?No Yes

DELIVER QUALITY EVERY TIME FOR EVERY ONE

Mean Days Between Infections: 1

Quality

2.93.4

4.2

15.0

1.0

0

5

10

15

20

CLABSI CAUTI Colon SSI Hyst SSI All Infections

12-month rolling average July 12, 2017

CREATE THE BEST PATIENT EXPERIENCE

VBP Dashboard Summary (through July 3)

Patient Experience

BE CONVENIENT TO USE AND EASY TO WORK WITHAccess

MAKE CARE MORE AFFORDABLE

$1,197 $1,026

$466 $244

$0

($307) ($388)($636)

($748)($886) ($897) ($930)

($1,500)

($1,000)

($500)

$0

$500

$1,000

$1,500

Stewardship

2015 Intermountain Added Cost / (Opportunity) Using Cost Structure of Each System ($ Millions)

STRENGTHEN AND SUPPORT OUR CAREGIVERSEngaged Caregivers

Star ValleyBear Lake

Uintah Basin

Blue Mountain

San Juan

William B. Ririe

Kane County

St. Vincent’s

EXTEND OUR ABILITIES TO OTHERSSmart Growth

TeleHealth: Facility Outreach

Table Discussions: Reflect and Capture

• What is your personal priority area of focus for strengthening your leadership?