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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?