Board Strategic & Facilities

Planning Committee Meeting

Tuesday, February 19, 2013 Palomar Health

To Begin Immediately Following Closed Session Administration Office

456 E. Grand Ave.

Escondido, CA 92025

Mins. Page Call to Order

Public Comments

1. * Approval of January 15, 2013 Meeting Minutes 5 1

2. Physician Leadership / Engagement 25 6

3. Draft 2013-2017 Strategic Initiatives 20 25

4. Kindred Update 10

5. Adjournment

Distribution: Steve Yerxa, Chairperson Alan Conrad, M.D.

Linda Greer Hue Le

Ted Kleiter L_BOD

Jeff Griffith, Alternate Michael Shanahan

Michael Covert, CEO L_EXEC_MGT_TEAM_MTNG

NOTE: Asterisks indicate anticipated action; action is not limited to those designated items. “If you have a disability please notify us at 760-740-6375 48 hours prior to

the event, so that we may provide reasonable accommodations."

Strategic Planning Committee Page 1 of 5

Palomar Health BOARD OF DIRECTORS

STRATEGIC & FACILITIES PLANNING COMMITTEE

Palomar Health Administration Office 456 E. Grand Ave, Escondido, CA 92025

January 15, 2013 Meeting Minutes

AGENDA ITEM DISCUSSION CONCLUSION /

ACTION FOLLOW-

UP

CALL TO ORDER 6:00 P.M.

ESTABLISHMENT OF QUORUM

Present: Directors Yerxa, Kleiter and Greer.

NOTICE OF MEETING The notice of meeting was mailed consistent with legal requirements. PUBLIC COMMENTS No public comments were noted. 1. MINUTES

The minutes from the September 18th 2012 Strategic Planning Committee meeting were reviewed for approval.

MOTION: by Director Kleiter, 2nd by Director Greer and carried to approve the September 18th 2012 Strategic Planning Committee meeting minutes as submitted. All in favor. None opposed.

2. FY13 Initiatives Quarter 1 Update

Review of the Fiscal Year 2013 Quarter 2 Initiatives as follows: Lorie Shoemaker, Chief Nurse Executive, and Opal Reinbold, Chief Quality Officer presented an update on initiative 1. - Create a Culture of Accountability for Engagement, Quality, Safety and Service. Initiative Status: All milestones are at green status with the exception of 4. “Develop a plan to engage the hearts and minds of staff and medical staff in developing respectful partnerships with patients/families and each other”. PDCA cycles are in process for nurse communication, physician communication and executive leadership rounding. Patient satisfaction scores at PMC rose to 72%, nearing the 75% target. POM scores fell from 66% in Q1 to 63% in Q2; areas of opportunity include cleanliness and facility appearance. Both facilities on track to reach target scores by the end of the fiscal year.

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AGENDA ITEM DISCUSSION CONCLUSION / ACTION

FOLLOW-UP

• Patient and Family-Centered Care (PFCC) definition approved by Home team

• “Elevator speech” for PFCC developed; education to staff in process • Adaptive Design Champions identified and trained on methodology • Patient stories integrated into key organizational meetings

It was noted by Director Greer that overhead paging is being utilized to contact case managers at PMC. Policy is for overhead paging of codes only. PMC administrators to follow up in this regard. Gerald Bracht, Palomar Medical Center Chief Administrative Officer, and Sheila Brown, Palomar Health Downtown Campus Chief Administrative Officer presented an update on initiative 2. - Stabilize and Optimize Operations PMC & PHDC. Initiative Status: All milestones are at green status with the exception of 7. “Integrate transformation component into Culture Forums planning”. On hold due to budget constraints

• Patients successfully moved on 8/19 • Sentact system in use to collect operational issues, prioritize and

address. The entries to date are being consolidated for prioritization. • Coordinating Council of Leaders established and meeting weekly to align

response to common issues. • Transition Champions engaged in post-move stabilization with staff. • Escondido Surgery Center relocated on 9/6/2012. • Re-purposed Executive Rounding is being piloted as part of the VHA/IHI

Collaborative on the OB Unit. • Culture Forums on hold at this time but planning includes stabilizing

campuses Committee discussion re: acuity levels of patients presenting in the ED and the possibility of transferring those patients who do not require such a high level of to expresscare instead. Agreement to create expresscare brochure/information to be distributed to all patients upon discharge from the ED to help guide their pathway when seeking future medical care. Robert Hemker, Chief Financial Officer, Brenda Turner, Chief Human Resource Officer and Opal Reinbold, Chief Quality Officer presented an update on initiative 3. - Expense Management. Initiative Status:

PMC administrators to follow up on issue of case managers being paged overhead at PMC.

PMC administrators to work with Marketing re: creation of an expresscare brochure to be distributed to all patients upon discharge from the ED to help guide their pathway when seeking future medical care.

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AGENDA ITEM DISCUSSION CONCLUSION / ACTION

FOLLOW-UP

Milestones 1, 4, 6, 7 are at green status. Milestone 2 “Evaluate and begin implementation of consensus driven Physician Preference Item opportunities” is at yellow status. Evaluation in progress, with physicians sharing their interest in participating. Next steps: create implementation process. Milestone 3 “Continue to implement an effective and cost-efficient patient throughput process” at yellow status. Will implement pilot to evaluate and redesign patient flow process. New Cerner module has capability to provide throughput timeliness data, which will be shared with the Medical Staff. Milestone 5 “Implement an effective multidisciplinary decision support system” at red status. The system has been developed and is waiting implementation. Mr. Covert suggested that Human Resources consider partnering with VHA to create a standardized effective labor optimization tool that the Palomar Health could manage and leverage with comparable organizations. Ms. Reinbold congratulated Ms. Shoemaker and her team on the opening of the new observation unit at PMC. David Tam, Pomerado Medical Center Chief Administrative Officer and Brenda Turner, Chief Human Resources Officer presented an update on initiative 4. - Strengthen Physician Leadership and Integration. Initiative Status:

All milestones are at green status. For Milestone 3 “Review results of Assessment and identify targeted areas for improvement”, physicians have identified three areas to focus improvement efforts:

1. Strategic planning – already underway with November and January retreats (additional retreats being scheduled)

2. Emotional intelligence 3. General management issues

In progress:

• Facilitate monthly Physician Leadership Council meetings • Assessing new Medical Director contracts • Develop Assessment Tool for Physician Leadership skills

Gerald Bracht, Palomar Medical Center Chief Administrative Officer, presented an update on initiative 5. - Grow Business. Milestone 1 – Physician Recruitment – is complete. Initiative Status:

Chief Human Resource Officer to reach out to VHA re: creating a standardized labor optimization tool. .

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AGENDA ITEM DISCUSSION CONCLUSION / ACTION

FOLLOW-UP

All milestones are at green status.

• Recruitment: Pulmonary/Critical Care, Neurologist, EP physician recruitment completed. UCSD has placed a Neurosurgeon in Dr. Stern office to operate locally at PMC. Additional Neurosurgery recruit for Dr. Stern & Hand Surgeon is still outstanding.

• Primary Care Development: Two MDs have been brought to Graybill and working. OB group has brought in 2 new (F) physician laborists for model growth along with a replacement for one gone. Net year is a -1 due to the Vista OB group leaving. 100% done for a realignment of a 7 FP group to Arch & proceeding for a solo FP review for purchase.

• New Program Development: EP and Valve Clinic business plans

approved. Feb/Mar is the target date for commencing.

• Areas of Focus: Results of first (5) months are above target by 7.7%. Target areas at or above projection are Neurosurgery, Joint Replacement, Cath Lab, Cardiology Outpatient ,Vascular and Breast Surgery. Below Target is CV Surgery, Spine, Bariatrics, General Medicine

• Contracting: Health Net cap effective Jan 1 with 3 Groups (SCMG,

Graybill, ARCH) total of about 8,000 additional live to cap. Sharp Health Plan-in review of cap additional lives 7500 to cap. Aetna, in discussions on a narrow network adding new lives in North County to Palomar Health

Ann Braun, President, Palomar Health Foundation spoke to the possibility of building traditions with our new physicians (i.e. increased CME opportunities, PH-issued white coats) to help build brand identities and illustrate that they are welcomed and connected to and with Palomar Health. In so doing the organization would be setting standards and expectations for these physicians while assisting them in forging relationships with current Medical Staff.

3. January 2013 Strategic Planning Retreat Update

Michael Covert, President and CEO, reported on the January 11th and 12th Strategic Planning retreat, noting that he was gratified with the level of collegiality, engagement and discussion between physician leaders and nursing staff. He also noted that there will be a one-day Strategic Planning retreat in February which will pull in additional leadership to inform them of the organizational direction for FY 2014, and to garner their input re: the direction of the strategic plan itself. A discussion ensued re: the volume, depth and breadth of information being shared at the retreats. Ann Braun, President Palomar Health Foundation suggested having a “did you know” session at the next retreat, sharing the organization’s strengths and focal points with those attendees who may not be aware of all that Palomar Health accomplishes and does well.

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Strategic Planning Committee Page 5 of 5

AGENDA ITEM DISCUSSION CONCLUSION / ACTION

FOLLOW-UP

Chairman Yerxa noted that the best way to judge if the strategic planning process is successful will be by the product / plan that gets implemented as a result thereof. There was consensus among the committee members to incorporate the Strategic and Facilities & Grounds Planning meetings into one monthly meeting which will occur on the third Tuesday of every month. The meetings will cover topics from both areas, either on a rolling schedule or ad hoc as issues arise. One meeting per quarter will be dedicated to strategic initiative review. The committee reviewed the proposed 2012 – 2013 Strategic Planning timeline, which will be shared with directors and managers at the next Strategic Planning retreat. Expectation is for the timeline to be finalized by the end of May.

Decision to keep the combined Strategic & Facilities Planning meetings on a monthly recurrence.

COMMITTEE MEMBER COMMENTS (IF ANY)

The next Strategic Planning Committee meeting is scheduled for 6:00 p.m. Tuesday, February 18th, 2013 at 15255 Innovation Drive, San Diego, CA 92128.

FINAL ADJOURNMENT Chairman Yerxa adjourned this meeting at 714 p.m. SIGNATURES

Chairperson ______________________

Steve Yerxa

Committee Secretary _______________________

Debbie Hollick

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Physician On-Boarding

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Goal Provide an optimal on-boarding experience to ensure physician’s adapt quickly to succeed in the organization and provide high quality, safe care

Objectives • Improve on-boarding efficiency for safe, high quality care

• Quick integration and alignment into the health system

• Minimize on-boarding stress factors

• Impact organizational performance

• Maximize physician satisfaction & productivity

Physician On-boarding Program

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Physician On-Boarding Spectrum

Strategic

Business Plan

Recruitment

Education &

Orientation

Assess &

Follow Up

Support

Credentialing

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Phase I 45 Days from Start

• Information,

Education, Knowledge, Application

• Orientation to service, department & system

Phase IIa (Days 46-180)

• Integration into

system/department • Provide new and

different information • Reinforce learning

from Phase I

Phase IIb (Days 181-720)

• Optional Resource

Support • Intervention Issue

Resolution • Problem

Identification

70% 20% 10%

Education - Orientation Support

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Phase I: Milestones and Timelines

Key: (Complete) (In progress)

Milestones Timeline (Start Date)

Infrastructure (goal, objectives, plan) 1/2013

Assessment & Analysis (stakeholder interviews, findings analysis) 2/2013

Model & Recommendations 3/2013

Develop Content (tools, roles, systems) 4/2013

Content Approval (test & validate) 6/2013

Implement Model 7/2013

Evaluation Data 9/2013

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FY13 Initiative: 4. Strengthen Physician Leadership and Integration

Outcome Measure: Physician Leadership Assessment Score

Initiative Status:

• Steering Committee and Advisory Group Established

• Assessment conducted, FY 13 focus areas: Strategic Planning, Engagement, Change and Emotional Intelligence

• Strategic Planning launched November 2012 and January 2013 Engagement Survey launches February 4, First Module AAPL launches April 20

• Targeting module on Change for June 2013

• Contract review has been conducted and is consistent with leadership development expectations

Milestones:

1. Create and Charter a Physician Leadership Council

2. Prepare and execute a Physician Leadership Skills Assessment

3. Review results of Assessment and identify targeted areas for improvement

4. Develop and implement a comprehensive training module for Physician Leaders

5. Modify / Develop Contract addendum for Medical Directors

6. Reassess Physician Leadership Skills

Report Date: January 4, 2012

Reporting Committees: Board Strategic

EMT Sponsors: David Tam, MD, Duane Buringrud, MD Initiative Manager: Leslie Solomon

Initiative Risks:

• Medical Staff transitioning to PMC-W

• Enrollment and time commitment

Jul 12 Jun 13

Initiative Budget: Current Physician Development Funds

Budget Status: Budget Approved for FY 13

Outcome Measure:

• Improvement of Physician Leadership Skills Aggregate Score

• Threshold – 10 % improvement

• Target – 15 % improvement

• Maximum – 20 % improvement

Sept 12 Nov 12 Jan 13 Mar 13 May 13

1 2 4 6 5 3

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Project Goals

Design and deploy Academy of Applied Physician Leadership Academy (AAPL) which will:

• Develop 90-100 physician leaders to demonstrate key leadership competencies throughout the system

• Facilitate collaboration amongst the physician, nurse leaders and administration • Drive needed culture change

8 2 13

Engage APLA Steering Committee and Physician

Champions

Module 1 Development

Module #2 Development

March May Feb June April

Project Planning

Communication and Mobilization

Module #1 - Role of the Physician Leader

(Stephen Beeson)

Application Session #1 MD’s & Nursing &

Administration Working Session:

Kickoff Meeting

Plan of Action FY 2013

Application Session #2: MD’s & Nursing & Administration: Building and Sustaining Change

Phase 1 End

4

July

Module #2: Facilitating

Organizational Change

Meeting with AAPL Steering Committee

Application #1 Session Development

Application #2 Session Development

Secure Meeting Venues and Dates

Secure Module #2 Speaker

Determine Measures of Success

Determine EI Assessment and feedback/coaching process

Administer EI Assessment

Module #1 – Readiness Workshop Nursing Transition to

MD Role

Module #2 – Readiness Workshop Nursing Transition to

MD Role

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• Launch of Engagement Survey

• Launch February 4

• Close March 18

• Target: 50% response rate

• Launch Module: April 20

• Engaged Physician Leader – Dr. Stephen Beeson

• Hold the Date and Invitation letter from Dr. Buringrud e-mailed with hyperlink to speaker sample (February 8-15)

• MD Wired page set up for enrollment and module support (February 8)

• Advisory briefing (February 7)

• MEC Announcements and brochure hand outs (February)

The Leadership Development : Current focus

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• 28 Questions

• 2 New Questions

• 1 new demographic

• 3 Sites

• PMC

• POM

• Downtown

• Outreach

• Letters from Chiefs

• MEC Announcements and Department Announcements

Engagement Survey

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Branding Academy of Applied Physician Leadership

• Branded brochure with a program description and 18-month overview.

• MD Wired Pages

• By Module

• Enrollment Tracking

• Postings, Video and Webinars

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Palomar Health Chief Executive Officer Michael Covert AAPL Steering Committee Dr. Duane Buringrud Paul Peabody Opal Reinbold Lorie Shoemaker Dr. David Tam Brenda Turner AAPL Initiative Manager Leslie Solomon AAPL Design Team Natalie Bennett Nina Kim Brad Krietzberg AAPL Advisory Committee Dr. Duane Buringrud Dr. David Cloyd Dr. Alan Conrad Dr. Eva Fadul Dr. Scott Flinn Dr. Jerry Kolins Dr. Frank Martin Dr. Sabiha Pasha

AAPL Faculty Advisors Dr. Stephen Beeson, Practicing Excellence.Com Dr. Gervase Bush Simon Frasier University Dr. Tracy Duberman The Leadership Development Group Dr. David Logan USC School of Business

I am pleased to invite you to participate in our Academy of Applied Physician Leadership (AAPL). As a physician leader, this academy will offer you the opportunity to:

learn from thought leaders and nationally recognized experts

enhance your understanding of the role of a physician leader and best practice in physician leadership

apply key concepts in collaboration with nursing and administration

define and drive a physician culture for service and quality The program will consist of 8 modules over an 18 month period. Each module will be held on a Saturday followed by a 2 hour weeknight application session to apply key learning with your nursing and administrative colleagues. Each module has a fair market value of approximately $900 per physician and has the potential for CME credit. Our first module, The Engaged Physician Leader will introduce the role of a physician leader and focus on building engagement. It will be held on April 20, 2013 at the California Center for the Performing Arts, Escondido. It will begin at 8:30 with a light breakfast and conclude at 4:30PM. Our featured presenter, Dr. Stephen Beeson, is a nationally recognized speaker who has provided tools and tactics for engaging and training physicians for hundreds of medical groups and hospitals throughout the country. Please click on the following hyperlink for a brief introduction to Dr. Stephen Beeson: http://youtu.be/RhRjXWNHjeY In order to enroll in this program and receive additional information about future

modules and dates, please access the Academy of Applied Physician Leadership site on

MD Wired at http://MDWired.palomarhealth.org

I am looking forward to working with you in the following months as we focus on

physician leadership development and integration.

Thank you,

Dr. Duane Buringrud

Chief Physician Leadership Development Officer

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Palomar Health AAPL: Agenda for Learning Module 1

Role of the Physician Leader and Enhancing Physician Performance

Saturday, April 20, 2013

Draft Objectives:

Demonstrate the burning platform for strong physician leadership at Palomar Health

Demonstrate senior leadership support

Clarify the role of the physician leader at Palomar Health

Demonstrate how to engage physicians and obtain buy-in

Share strategies and tools to manage physician leader performance

Engage participants and generate excitement around the program

Time Agenda Item Presenter

8:00-

9:00am

Introduction to APLA and View of the Future of

Palomar Health

Michael H. Covert,

F.A.C.H.E

Duane Buringrud,

M.D.

9:00-

9:30pm

The Case for System Based Care: The Role of

Physician Integration and Partnership

Stephen Beeson, MD

9:30-

10:15am

Role of Physician Leader and Critical Success

Factors

Stephen Beeson, MD

10:15-

10:30am

BREAK

10:30-

12:00pm

Establishing Physician Confidence and Trust Stephen Beeson, MD

Time Agenda Item Presenter

12:00-1pm LUNCH

1:00-

2:30pm

Creating Physician Buy-In &

Attributes of Elite Organizations

Stephen Beeson, MD

2:30-

2:45pm

Break

2:45-

3:45pm

Physician Performance Measurement and

Feedback

Stephen Beeson, MD

3:45-

4:00pm

Q&A

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Potential Application Session Activity (May 2013)

Role of Physician Leader at Palomar

1. How shall we define the role of a Palomar Health Physician Leader? 2. What are the key responsibilities of Physician Leaders 3. What support do Physician Leaders require from their sphere of influence to be

successful? 4. How should Palomar Health measure Physician Leader performance?

a. Define Outcomes – Hard outputs, The “What of the Job.” Define Behaviors – Soft inputs, The “How of the Job.”

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2013 Medical Director Goals 1) Facilitate daily physician/nurse rounding on patients to improve the overall coordination of patient care. Inherent in this goal is that you will role model this behavior by rounding with the registered nurses in the care of your own patients.

2) Support and facilitate the implementation of ISBARR communication methodology to foster better communication and respectful partnerships between the professions.

3) Support hospital and unit-specific initiatives to improve the patient’s experience of care.

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Palomar Medical Center Floor

West East

8 Dr. Julie Chuan - Medicine Dr. George Moore - Medicine

7 Dr. Richard Schumann - Neuro Dr. Laurence McKinley - Ortho

6 Dr. Greg Hirsch – Med Step Dr. Greg Hirsch - Telemetry

5 Dr. Roger Acheatel - ICU Dr. Roger Acheatel - Cardiac

4 Dr. Jay Grove - Surgical

Dr. John Steele - Trauma

Dr. Jay Grove – Surgery Acute

ER Dr. Jaime Rivas - ER

Med Directors - PMC

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Medical Directors - POM

Pomerado Hospital

IR Dr. Mikhail Malek - Cardiac

5 Dr. Karen Kohatsu-Yee - Obstetrics

4 Dr. Sabiha Pasha – Med Surg

3 Dr. Sabiha Pasha – Med Surg

2 Dr. Craig Burroughs

ER Dr. Jaime Rivas

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Med Directors – PMC-DT

Palomar Health Downtown Campus

9 Dr. Keyvan Esmaeili - Rehab

4 Dr. Brano Cizmar – Obstetrics / Midwives

Dr. Silverio Chavez - Obstetrics

3 Dr. Jaime Rivas – Express Care

2 Dr. Badalin Helvink – Behavioral Health

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DRAFT - 5

Palomar Health

Strategic Initiatives

2013 – 2017

Palomar Health will be recognized as the dominant provider of integrated health services as measured by market

position and value based metrics of care.

Strategic Initiatives

I.a . Achieve and maintain Center of Excellence status in orthopedics/spine and rehabilitative care, cardiac and

cardiovascular care, neuroscience and women’s services.

I.b. Continue to maintain and enhance access to the availability of general surgery, oncologic, urological, and

bariatric services in the primary market area served by Palomar Health.

II. Become the dominant provider of primary care in support of the total patient health experience provided by

Palomar Health through the expansion and growth of Arch Health Partners; effective affiliations with local

providers and development of a strong regional primary care network in the secondary markets.

III. Promote efficient coordination and collaboration across all transitions of care with emphasis on proactive and

effective acute and chronic disease management in the ambulatory and community settings.

Operational Initiatives

I. Build and operate a decision analytics structure that supports the real time availability and standardized use of

information and expertise for knowledge management and measurement of value based metrics of care.

II. Improve the effectiveness of care and service by improving clinical and business throughput and efficiency

through all transitions of care such that 95% of all users (patients/families/physicians, etc.) indicate a positive

experience with the health system.

III. Develop and implement a strong physician integration and alignment model that allows for effective

communication, partnership and accountability in the management and care of patients and interaction among

physicians of the health system as measured by positive physician engagement and leadership scores (through

appropriate survey mechanisms) and increased use of the health system’s services.

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