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ACCELERATING TRANSFORMATION: TRANSLATING STRATEGY INTO ACTION

PRESS GANEY SPECIAL REPORT

2 0 1 9 S T R A T E G I C I N S I G H T S

2 2 0 1 9 S T R A T E G I C I N S I G H T S

Health care market dynamics continue to shift, impacting every corner of our industry. With seismic changes being driven by value-based payment models, mergers and acquisitions, and consumer-driven demands, the expectations to deliver care that meets patients’ needs have never been greater. As systems work to keep pace with these changes, health care leaders must align their organizations around both the mission of providing exceptional care and the business of delivering it reliably every day.

This year’s Strategic Insights report provides a road map for realizing this vision, guided by key Transformational Principles™ and supported by

new data linking workforce engagement with clinical and patient experience outcomes. The road map charts a course toward accelerated transformation, beginning with an assessment of enterprise-wide change readiness and progressing toward the adoption of a platform that can support a fully integrated data strategy.

There is no shortcut for achieving transformational change in health care. Meeting the needs of patients and creating a purpose-driven workforce requires a commitment by senior leaders to work across hierarchical and functional boundaries toward an aligned culture of excellence.

By organizing teams and processes to take advantage of the performance interdependencies across safety, quality, patient experience, and workforce engagement, together we can accelerate transformation toward our goal of high-value, patient-centered care.

Sincerely,

Patrick T. Ryan, Executive Chairman

E X E C U T I V E S U M M A R Y

A C C E L E R A T I N G T R A N S F O R M A T I O N : T R A N S L A T I N G S T R A T E G Y I N T O A C T I O N 3

T A B L E O F C O N T E N T S

EXECUTIVE SUMMARY 4

Introduction 5

Defining an Enterprise-wide Strategy 6

Engaging the Workforce in the Journey 7

Empowering Leaders to Drive Transformation 11

Developing an Integrated Data and Management Strategy 12

Conclusion 14

Appendix 15


Executive SummaryTransformational shifts are occurring in every corner of health care. Value-driven payment models are transferring risk assumption to providers, where profitability hinges on quality and efficiency; merg-ers, acquisitions, and partnerships are redefining the competitive landscape; and consumer demand for performance information is changing the dynamics around brand loyalty.

To keep pace with these changes, health care organizations are being challenged to restructure op-erations and leverage interdependencies across functional areas to reliably deliver safe, high-quality, patient-centered care and grow market share.1 Sustained performance improvement requires deep insights into consumer, patient, and caregiver needs; integrated planning; cultural alignment; and a commitment to daily execution.

For authentic health care transformation to occur, leaders must have a deep understanding of patients’ needs and the adjustments that are required to deliver care that meets those needs every day. They must also recognize that data is the single most important asset they have available to them to gain this level of understanding. There is no “easy” button, nor will a single smiley face feedback icon or point solution provide the depth and breadth of operational and cultural insight that is needed. Instead, they must embrace a platform that can support a structured, comprehensive, and integrated data strategy.

Rising to this challenge requires that organizations first assess their transformation readiness based on honest answers to three critical questions.

1. Is our organization measuring integrated improvement across safety, quality, patient experience, and workforce engagement?

2. Is the rate and magnitude of our improvement enough to succeed in the competitive health care market?

3. What barriers stand in the way of horizontal integration across key business areas?

The answers to these questions will define the starting point for an organization’s transformational vision, and will ensure that the vision is guided by an integrated set of principles for aligning people, processes, and strategies with the organization’s values and mission.2 The answers will also provide di-rection for translating the transformational vision into action. For most organizations, this step—con-necting the strategic vision to execution—presents the greatest, most important challenge.

In this report, we describe the key considerations for creating a transformational road map and present the steps needed to build an organizational culture that supports patient-centered care and a purpose-driven workforce that can deliver it. The steps are as follows.

1. Align under one enterprise-wide transformational vision.

2. Build a change-ready culture by engaging the workforce and empowering leaders.

3. Adopt an integrated data and management strategy.

Each of these actions is essential to achieving and sustaining transformational change. New structures, systems, processes, and technologies can only produce their intended return on investment when they are accompanied by alignment of the individuals and teams that will be using them.


IntroductionHealth care organizations have navigated more changes in the past several years than they have in the past three decades, including electronic health records (EHRs), bundled insurance payments, value-based care, population health management, and large-scale mergers and acquisitions. Add to this the growing pressure of adapting to a consumer-driven marketplace, where more than 70% of patients rely on online reviews when deciding where and from whom to receive care, and patient experience is the strongest predictor of brand loyalty.3

To meet the challenges of this increasingly complex landscape and the changing expectations of health care consumers, leading health care organizations are beginning to redefine their operating models around transformational structures and processes that align safety, quality, patient experience, and workforce engagement efforts while also ensuring financial health.

The business case for doing so is well-supported by existing cross-domain analytics that demonstrate positive relationships across all of these domains.4 New research described in this report connecting workforce engagement with Leapfrog Hospital Safety Grades and HCAHPS Summary Star Ratings provides additional insight into the pivotal role of organizational culture in health care.

Taken together, these data clearly demonstrate that actions taken at the process or structure level can influence multiple outcomes and improve care delivery. To truly transform care, however, health systems must develop the skills and resources to understand and optimize the critical performance interdependencies, which demands leadership communication and commitment, as well as daily col-laboration across management and operational domains.

This level of collaboration requires that leaders of all of the vertical operations work together to break down the barriers that keep improvement efforts in silos. Progress toward this goal can be initiated through the adoption of established Transformational Principles.5 Built on years of best-practice insights, these guiding principles serve as the strategic and operational underpinnings of an actionable road map and reflect an understanding that, although the transformation journey will be different for every organization, the blueprint for successful change is consistent across all of them.

1. Commit to a goal of Zero Harm.

2. Put patients at the center of the planning, delivery, and assessment of care.

3. Recognize and define safety, quality, and patient centricity as the primary elements of the patient experience and understand the critical interdependencies between them.

4. Drive change using data and transparency.

5. Transform culture and leadership.

6. Focus on accountability and execution.

By anchoring the strategic vision to these principles, organizations position themselves to identify the most meaningful and immediate opportunities for transforming care. To carry out the vision and turn these opportunities into action, leadership must establish clarity on the objectives, ensure alignment of resources, and support a well-defined road map.


Defining an Enterprise-wide StrategyTo facilitate the bold, systemic change that is needed to drive true transformation, direction has to come from the top and all teams must understand their role in the journey. For this to occur, health care CEOs and senior leaders must be aligned on the strategic vision and the path needed to reach it, and they have to consistently and transparently communicate both to the entire organization.

By articulating the strategic vision as performance excellence across safety, quality, patient experience, and workforce engagement, leaders can lay the groundwork for the integrated path forward, which requires system-level participation and multiple inputs, including the following.

■ An enterprise-wide assessment: This is necessary to gain a clear and accurate understanding of the organization’s current performance and to quantify and qualify the gap between this starting point and ideal performance. The assessment should include systemwide, unit-level audits across multiple performance domains, leadership surveys, and stakeholder interviews, as well as a careful look at the total amount of money organizations are currently spending on all of these vertical domains. Collectively, this information enables leaders to examine business processes for optimization, identify high-value improvement opportunities, and uncover obstacles to progress.

■ Analyses of performance interdependencies: A clear understanding of interdependencies across safety, quality, patient experience, and workforce engagement is needed to inform integrated improvement efforts. Making the intersections of performance actionable is highly dependent on each individual organization’s operating model. Teams that work in relative silos with little cross-functional collaboration or visibility into each other’s efforts may require more significant core process redesign than those that have already reduced or eliminated silos.

■ Measurable targets: In addition to a well-articulated strategic vision, transformational plans require action-item prioritization, goal setting, and management feedback loops to monitor performance and course-correct when necessary.

■ An integrated dashboard: The ability of the CEO and senior executives to consistently maintain a comprehensive view of the organization is crucial for driving transformational change. Although leaders of individual business operations may be fully aligned with the strategic vision, their relatively vertical frame of reference can obstruct their view of the bigger picture. The CEO’s enterprise-level view is necessary for setting expectations for collaboration and cooperation and for consistently communicating those expectations to leaders and caregivers across the organization.

Building a Change-Ready Culture A resilient culture enables employees to perform at a high level and is associated with a readiness to adapt to change. During periods of large-scale disruption, an organization’s ability to pivot quickly and nimbly is predicated on the degree to which its culture—organizational values, beliefs, and work prac-tices—is aligned with the strategic vision. Therefore, ascertaining the organization’s cultural readiness for change is a critical first step.


A cultural readiness assessment evaluates perceptions and behaviors related to adaptability. Because transformation requires participation at every level, the most useful assessments include stakeholders at every level of the organization—leaders, directors, managers, and front-line employees. The assessment should consider the following readiness indicators:

■ Measurement of employee, nurse, and physician engagement and resilience

■ Workforce understanding of why change is important and how it will positively affect the organization in the long term

■ Workforce understanding of and alignment with the transformational vision

■ Workforce willingness to accept change, and to let go of “business as usual” operations and commit to new, more integrated and collaborative practices

■ Confidence in leadership’s capacity to effectively lead change, and confidence in the organiza-tion’s commitment to providing the resources needed to do so

Structured and unstructured feedback is essential to creating a holistic picture of readiness. Struc-tured feedback can be gathered through comprehensive annual engagement surveys, complemented by regular pulse checks. Annual surveys offer the global view of workforce engagement that is needed to generate high-level action plans, and pulse surveys add nuance by assessing interim progress and identifying misalignment.

Unstructured feedback, obtained through interviews, roundtable discussions, focus groups, and review of caregiver comments, can provide insight into employee sentiments and behaviors that may not be understood otherwise. This insight can be useful for identifying influencers across the organization and for uncovering opportunities and risks related to workforce attitudes and actions.

Engaging the Workforce in the JourneyWorkforce engagement is essential to transformational change. When clinicians and employees are highly engaged—when they are committed to and aligned with the organization’s goals and values—they are motivated to contribute to organizational success. This is particularly necessary during periods of major transition. If mid-level leaders, managers, and employees share the transformational vision of the organization, they will be more likely to trust the implied promise that the changes will allow the organization to achieve that vision.

Workforce engagement is also a bellwether for overall organizational performance. Previous research has demonstrated robust associations between measures of engagement and those of safety, quality, patient experience, and financial outcomes.6

New integrated analyses extend those findings by examining associations between organizations’ per-centage of units with high or low engagement and key performance outcomes.

Using workforce engagement data, Leapfrog Hospital Safety Grades, and HCAHPS performance data for 253 health care facilities for which safety, patient experience, and workforce engagement data were


available, researchers explored connections between the prevalence of high and low percentages of top-tier engagement (based on performance on a subset of survey items that are key drivers of engagement) with patient safety and patient experience outcomes.

The results of the safety analysis showed that, in 2018, substantially more organizations with a high percentage of highly engaged units earned the top Leapfrog Hospital Safety Grade compared to orga-nizations with a low percentage of highly engaged units. The corollary is also true. Substantially more organizations with a small percentage of lowly engaged units earned the top safety grade compared to organizations with a high percentage of lowly engaged units.

Specifically, as shown in Figure 1, a Leapfrog Hospital Safety Grade of “A” was earned by

■ 54% of the facilities in which more than half of the work units have Tier 1 engagement,

■ 25% of the facilities in which fewer than one-quarter of the work units have Tier 1 engagement,

■ 45% of the facilities in which fewer than one-quarter of the work units have Tier 3 engage-ment, and

■ 17% of the facilities in which more than half of the work units have Tier 3 engagement.

Figure 1

RELATIONSHIP BETWEEN % OF UNITS WITH HIGH/LOW ENGAGEMENT AND SAFETY

10 20 30

Proportion with Leapfrog Safety Grade A

*Leapfrog Hospital Safety Grades released in fall 2018

40 50 600

% of Tier 1 Work Groups % of Tier 3 Work Groups

More than 50%

Less than 25%

Between 25%and 50%

Prop

ortio

n of

Sys

tem

s w

ith

Leap

frog

Safe

ty G

rade

A*

10 20 30

Proportion with Leapfrog Safety Grade A

40 50 600

More than 50%

Less than 25%

Between 25%and 50%

The analyses looking at the relationships between tier percentages and patient experience performance based on HCAHPS Summary Star Ratings are similarly telling in that organizations with higher per-centages of Tier 1 units achieved higher star ratings and those with a greater percentage of Tier 3 units had lower star ratings.


As illustrated in Figure 2, a 4- or 5-star rating was earned by

■ 31% of the facilities in which more than half of the work units have Tier 1 engagement,

■ 11% of the facilities in which fewer than one-quarter of the work units have Tier 1 engagement,

■ 38% of the facilities in which fewer than one-quarter of the work units have Tier 3 engage-ment, and

■ 14% of the facilities in which more than half of the work units have Tier 3 engagement.

Figure 2

RELATIONSHIP BETWEEN % OF UNITS WITH HIGH/LOW ENGAGEMENT AND SUMMARY STAR RATINGS

10 20 30

Proportion with 4 or 5 HCAHPS Summary Stars

40 50 600

% of Tier 1 Work Groups % of Tier 3 Work Groups

More than 50%

Less than 25%

Between 25%and 50%

Prop

ortio

n of

Sys

tem

s w

ith 4

or 5

HC

AHPS

Sum

mar

y St

ar R

atin

g

10 20 30

Proportion with 4 or 5 HCAHPS Summary Stars

40 50 600

More than 50%

Less than 25%

Between 25%and 50%

Longitudinal comparisons looking at the impact of improving engagement in Tier 3 work groups on safety grade (Figure 3) and patient experience outcomes (Figure 4) show that reducing the percentage of Tier 3 units by at least 10% one year is associated with the following:

■ A 1.59 times increased likelihood of at least a one-letter improvement in Leapfrog Hospital Safety Grade the following year.

■ A 3.80 times increased likelihood of a 3% or more improvement in Overall Rating top-box percentage the following year.


Figure 3

SAFETY IMPACTS OF REDUCING % OF TOP TIER 3 UNITS OVER ONE YEAR

*Leapfrog Hospital Safety Grades released in fall 2018

10 20 30

Facilities Achieving at Least One Step Safety Grade* Improvement

40 50 600

Achieved Minimum 10%Reduction in Tier 3 Units

Facilities that reduced theirTier 3 units by at least 10%are 1.59 times more likely to improve their Leapfrog HospitalSafety Grade by at least oneletter the following year.

Did Not Achieve 10%Reduction in Tier 3 Units

Figure 4

OVERALL RATING IMPACT OF REDUCING % OF TIER 3 UNITS OVER ONE YEAR

10 20 30

% Facilities Achieving Minimum 3% Improvement in Overall Rating Top-Box %

40 50 600

Achieved Minimum 10%Reduction in Tier 3 Units

Facilities that reduced theirTier 3 units by at least 10%are 3.80 times more likely to improve their Overall Rating by at least 3% the following year.

Did Not Achieve Minimum10% Reduction in

Tier 3 Units

Considering the consistently positive associations between the percentage of highly engaged employ-ees and performance on these and other measures that influence the delivery of patient-centered care, workforce engagement should be viewed as a critical dimension of change readiness.

To optimize opportunity for performance gains and prepare the workforce for transformation, improv-ing engagement of Tier 3 work units should be a top priority. Doing this entails identifying the Tier 3 units based on engagement data, determining their action planning readiness based on specific engage-ment survey items related to leadership assessment, and focusing on the capabilities of the unit leaders to generate the best work from their teams.7


Empowering Leaders to Drive Transformation Leadership capability is a lynchpin for true transformation. For this reason, readiness assessment is especially crucial at the leadership level, as it allows an organization to identify gaps between the trans-formational vision and the ability of leaders to execute on it. Bridging these gaps can mean the differ-ence between a successful, sustained transformation and a short-term campaign that fails to achieve the strategic vision. Therefore, a systemic and explicit approach for evaluating and enhancing the readiness of leaders to become true change agents should be part of the transformational plan. Key activities of this approach include the following.

■ Convening senior leaders from vertical domains, including safety, clinical quality, patient experience, medicine, nursing, finance, human resources, marketing, and technology, to align them with the transformational vision and ensure that they understand their respective teams’ roles in achieving it.

■ Sharing analyses of performance interdependencies to communicate the need for cross-functional collaboration, and providing specific examples of areas in which the performance metrics that guide one team’s progress intersect with those of other teams.

■ Conducting informal surveys and small-group discussions to assess perceived and actual collaboration across teams. Some questions to consider: Do leaders feel as if their teams are aligned with others on business objectives? Are shared metrics defined? Is goal setting, tracking, and reporting transparent within and between teams, and is it accessible to the board, CEO, and other C-level leaders? How often do you meet with senior leaders of other domains to identify/discuss immediate opportunities for driving patient-centered care across domains? Is there a governance structure or high-level cross-functional champion in place to oversee complex decisions on various projects?

Based on observations from strategy sessions with health systems from across the country, transforma-tional change requires aligning leaders with the integrated vision, and working with them to iden-tify barriers that may be keeping silos intact and limiting multidisciplinary coordination. Examples of barriers include a lack of a dedicated governance structure to support collaboration; merger and acquisition activity between culturally different organizations; a lack of consensus among stakeholders; absence of performance transparency across vertical operations; and insufficient resources to support an aligned vision.

With this information, leaders can work together to eliminate the barriers that are impeding their progress. This might include establishing a governing entity to facilitate and oversee leadership align-ment and convergence, mapping how the efforts of each operational unit roll up to the strategic vision for the organization, and identifying and formalizing opportunities for integrated efforts to drive progress toward this goal (see “Cross-Functional Partnerships Fuel Transformation”).


Cross-Functional Partnerships Fuel TransformationTo take advantage of the performance interdependencies across safety, quality, patient experience, and work-force engagement, leaders of historically siloed operational areas are forging new collaborative relationships. Following are examples of some key strategic partnerships.

■ HR–Nursing: Given the links between bedside nurse turnover and engagement, safety, quality, and experience outcomes,8, 9 nurse leadership should work closely with HR leaders to design strategies to improve rates of intent to stay.

■ Technology–Clinical–HR: EHR and other technologies have been linked to clinician burnout.10, 11 Chief medical officers, chief nursing officers, chief technology officers, and chief human resources officers should work together to make sure the technology, training, and support being provided meet clinicians’ needs; that engagement and resilience data are collected before and after a new technol-ogy or process is deployed to identify areas of vulnerability; and that education is provided to help clinicians understand how the right technology used in the right way can actually simplify processes and help them find the joy in the practice that led them to a career in medicine.12

■ Clinical–Financial: The business of health care can no longer be considered distinct from the caring mission of health care. The question that chief financial officers have to ask today is “How can we improve the patient experience and health of our population while stabilizing or reducing per capita costs?” In this regard, CFOs have to become partners with HR, nursing, and physician leadership.

■ Patient Experience–Marketing: Patient experience is your brand. Marketing leadership must be part of strategic planning to navigate the consumer-driven landscape.

■ C-Suite–Clinical–HR–IT: Analytics are increasingly recognized as a critical enabler of health care transformation. The ability to derive meaningful insights from the large volume of safety, quality, patient experience, engagement, and financial performance data that health systems collect requires that the experts who understand the data become integral members of the improvement team.

Developing an Integrated Data and Management Strategy Organizations collect data on safety, quality, patient experience, and workforce engagement and ana-lyze it in relationship to financials. Yet the insights derived from analyses of these data are often used in isolation to inform initiatives targeting incremental performance improvement. Recognizing and leveraging the linkages between domains constitutes an important opportunity for organizations look-ing to transform care.

In this regard, creating an integrated data and management strategy is an essential component of the health care transformation journey. As with all enterprise-wide, business-critical initiatives, the data strategy should have executive sponsorship and a governance structure to ensure ongoing alignment with organizational objectives. It should also include clearly articulated criteria for success based on data from multiple domains, coupled with a commitment to performance transparency so that leaders understand how their work influences performance outside their vertical domains.


Although data strategies will differ based on the unique needs and resources of organizations, the fol-lowing core features will accelerate transformation and support continuous improvement.

■ High-quality data: Scientifically rigorous data and reliable sample sizes will engage stakeholders and ensure accuracy of planning.

■ Integrated analytics: More than a static snapshot of aggregated performance measures across time, the platform should house multiple layers of knowledge and be highly dynamic, allow-ing users to look at the broad data through a wide-angle lens or zoom into the minutiae by filtering and segmenting the data to dig deep into performance variables.

■ Shared key performance indicators: This is essential for governing how initiatives are measured, evaluated, and tracked across all levels of the organization, and guiding how to leverage cross-functional data as an asset.

■ Cross-functional input: Cross-functional collaboration empowers leaders across domains to work as strategic partners, builds engagement in the process, and supports ownership of the outcomes.

■ Clear and proactive communication: Communication is a cornerstone of successful trans-formation. Disseminating updates at regular intervals throughout the change process to all stakeholders reinforces leadership’s commitment to the vision and manages expectations.

■ Accountability: Leaders’ willingness to hold themselves and their teams accountable for incorporating insights into their decision making is essential, as is their willingness to trust the insights derived from the data, even when the insights point to the need for a course correction.

Organizations that have been able to incorporate some or all of these considerations into their data strategies create significant value and gain a competitive advantage through cross-functional collabora-tion.

For example, by adopting an integrated data perspective, leadership at Dallas-based Parkland Health and Hospital System was able to identify a direct relationship between performance on the Likelihood to Recommend global patient experience metric and three key workforce metrics: employee engage-ment, employee turnover, and number of Tier 1 leaders. Based on this information, patient experience and HR leaders collaborated to address the workforce issues that the data suggested were most likely to influence patients’ care experience, including ensuring shift coverage and nurturing communication and trust between employees and managers.

Through this approach, over a three-year period the system saw the following improvements.

■ The mean employee engagement score rose by nearly 6%.

■ The number of Tier 1 leaders jumped from 32 to 122.

■ Turnover rates decreased from 18.5% to 15.1%.

■ The organization saw improved performance on the Likelihood to Recommend metric, both for the system overall (86.4 to 88.7) and for inpatient services (86.6 to 91.3).


Another organization that is leveraging performance interdependencies to transform care delivery is Mount Sinai Health System. Multidisciplinary leaders at the New York-based organization have implemented an integrated strategy that aligns physician engagement with safety, quality, and patient experience performance.

The goal of Mount Sinai’s cultural alignment strategy is to create a cohesive framework for physicians to understand the ways in which their interactions with patients influence patient experience outcomes, as well as safety and quality. To this end, they have begun sharing patient experience data in a way that connects to clinical outcomes and shows trends over time. Though the transformational strategy is still in its early stages, the leadership has observed that the focus on connecting physician behavior to outcomes and showing quantitatively that top-box scores on patient experience drive safety and quality has increased physician engagement in improvement efforts and ownership of the patient experience.

Although the specific focus of these improvement efforts differs, commonalities include the pursuit of performance excellence through shared goals, collaborative leadership, clarity of expectations, trust in the data, open communication, and a strong sense of accountability—all of which are vital fuel for transformation.

ConclusionTransformation entails moving away from siloed strategies that drive short-term, vertical performance improvements and toward collaborative initiatives that leverage performance interdependencies be-tween safety, quality, patient experience, and workforce engagement.

The necessary degree of change extends far beyond practices and processes to encompass mindsets, behaviors, and culture. It demands organization-wide alignment with the transformational vision that starts at the top with a CEO who sets the strategic direction to create focus, clarify priorities, and demonstrate commitment to change.

For the change to take root, development of transformational leaders across the organization should be prioritized. The return on investment for cultivating leaders who take personal and collective owner-ship for the strategic vision and are prepared to steer their teams toward that vision is an engaged workforce and organizational culture that can support and sustain transformation.


Appendix

LEAPFROG HOSPITAL SAFETY GRADE MEASURES AND METHODOLOGY

Measure CategoryMeasure

(Example measure)Primary

Data SourcePrimary

Reporting Period*Secondary

Data SourceSecondary

Reporting Period

Process and Structural Measures

(13 indicators)

Process Measures(Bar Code Medication Administration)

2018 Leapfrog Hospital Survey

2018AHA Annual Survey

IT Supplement2018**

Safe Practice(Safe Practice 1: Leadership Structures and Systems)


2018 --- ---

HCAHPS Communication (H-COMP-3: Staff Responsiveness)

CMS 10/01/2016 – 09/30/2017

--- ---

Outcome Measures

(15 indicators)

Adverse Events (Air Embolism) Data.cms.gov

10/01/2015 – 06/30/2017

MHCC10/01/2015 – 06/30/2017

Hospital-Acquired Infections (CAUTI)


01/01/2017 – 12/31/2017

CMS Hospital Compare

10/01/2016 – 09/30/2017

Patient Safety Indicators(PSI 3: Pressure Ulcer Rate)

CMS10/01/2015 – 06/30/2017

MHCC10/01/2015 – 06/30/2017

* Reporting period corresponding to Fall 2018 Leapfrog Hospital Safety Grade ** ICU Physician Staffing is from the 2016 AHA Annual Survey

■ Aggregates 28 different measures into easy-to-understand letter grades A, B, C, D, or F

■ Safety measures cover both Process and Outcome measures

■ Measures are individually weighted by three dimensions:■ Evidence – strength of research base■ Opportunity – capacity to improve■ Impact – event frequency and potential for harm

■ Extreme values are capped and scores standardized


ENGAGEMENT AND PATIENT EXPERIENCE DATA

Q1 Median Q3

Number of Respondents 210 380 658

Respondents per Work Group 8 13 23

Number of Work Groups 16 23 35

■ Engagement data:■ Used most recent survey available

– 2017: 173 facilities

– 2016: 80 facilities■ Number of work groups per CCN >=10■ Restricted responses to only RNs■ Work group must have n>=5 responses

■ PX data:■ Used CMS-published HCAHPS Summary Star Rating■ Measurement period: Jan. 1, 2017 – Dec. 31, 2017

■ 253 CCNs with data for Safety, Engagement, and PX


LONGITUDINAL PERFORMANCE ANALYSES

■ 86 CCNs have longitudinal data:■ Engagement Results for 2015 and 2016■ PX Results measured in 2016 and 2017■ Leapfrog Hospital Safety Grades measured in 2016 and 2017*

■ Engagement improvement:■ Defined as at least 10% reduction in Tier 3 work groups■ To control for large structural changes:

– For CCNs with fewer than 20 units, filtered out CCNs with more than 20% difference in

number of units

– For CCNs with greater than 20 units, filtered out CCNs with more than 10% difference in

number of units

■ Leapfrog Hospital Safety Grade improvement:■ At least one-letter-grade increase■ Filter out clients with grade A in both 2016 and 2017* as improvement is not possible

■ PX improvement:■ Summary stars are not comparable year-over-year as cut points change■ Selected outcome used: VBP “Overall Rating” Top-Box %■ Scores are patient-mix adjusted by CMS

* Corresponds to Leapfrog Hospital Safety Grades released fall 2017 and fall 2018


Press Ganey pioneered the health care performance improvement movement more than 30 years ago. Today Press Ganey offers an integrated suite of solutions that enable enterprise transformation across the patient journey.

Delivered through a cutting-edge digital platform built on a foundation of data security, Press Ganey solutions address safety, clinical excellence, patient experience, and workforce engagement.

The company works with more than 33,000 health care facilities in its mission to reduce patient suffering and enhance caregiver resilience to improve the overall safety, quality, and experience of care.

1. “Achieving Excellence: The Convergence of Safety, Quality, Experience and Caregiver Engagement.” 2017 Strategic Insights white paper, Press Ganey Associates, Inc.

2. “A Strategic Blueprint for Transformational Change.” 2018 Strategic Insights white paper, Press Ganey Associates, Inc.

3. “Consumerism: The Role of Patient Experience in Brand Management and Patient Acquisition.” 2018 Performance Insights white paper, Press Ganey Associates, Inc.

4. Press Ganey, “Achieving Excellence” Strategic Insights white paper.

5. Press Ganey, “A Strategic Blueprint for Transformational Change” Strategic Insights white paper.

6. Press Ganey, “Achieving Excellence” Strategic Insights white paper.

7. “Rules of Engagement: Assessing and Addressing Employee Engagement and Readiness for Change.” 2017 Press Ganey Associates, Inc.

8. “Resilience for a Multigenerational Nursing Workforce.” 2018 Performance Insights white paper, Press Ganey Associates, Inc.

9. “Optimizing the Nursing Workforce: Key Drivers of Intent to Stay for Newly Licensed and Experi-enced Nurses.” 2018 Nursing Special Report, Press Ganey Associates, Inc.

10. “EHR Technology a Key Contributor to Physician Burnout.” EHR Intelligence, March 28, 2017.

11. “Medscape National Physician Burnout & Depression Report 2018.” Medscape, Jan. 17, 2018.

12. “Burnout and Resilience: A Framework for Data Analysis and a Positive Path Forward.” 2018 white paper, Press Ganey Associates, Inc.

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