2011 Baldrige Application - Henry Ford Health System

HENRY FORDHEALTH SYSTEMDetroit, Michigan2011 Malcolm Baldrige National Quality AwardApplication

Table of ContentsGlossary of Terms and AbbreviationsOrganizational ProfileP.1 Organization Description.......................................................................................................................................iP.2 Organizational Situation.......................................................................................................................................ivCategory 1: Leadership1.1 Senior Leadership.................................................................................................................................................11.2 Governance and Societal Responsibilities............................................................................................................3Category 2: Strategic Planning2.1 Strategy Development...........................................................................................................................................62.2 Strategy Implementation.......................................................................................................................................9Category 3: Customer Focus3.1 Voice of the Customer.........................................................................................................................................103.2 Customer Engagement........................................................................................................................................12Category 4: Measurement, Analysis, and Knowledge Management4.1 Measurement, Analysis, and Improvement of Organizational Performance......................................................154.2 Management of Information, Knowledge, and Information Technology...........................................................17Category 5: Workforce Focus5.1 Workforce Environment......................................................................................................................................195.2 Workforce Engagement.......................................................................................................................................21Category 6: Operations Focus6.1 Work Systems.....................................................................................................................................................256.2 Work Processes...................................................................................................................................................28Category 7: Results7.1 Health Care and Process Outcomes....................................................................................................................307.2 Customer-Focused Outcomes.............................................................................................................................387.3 Workforce-Focused Outcomes............................................................................................................................417.4 Leadership and Governance Outcomes..............................................................................................................447.5 Financial and Market Outcomes.........................................................................................................................48

5 Million Lives Campaign IHI-sponsored nationalinitiative to protect patients from harm; 5M refers to goal—eliminate 5M harm events nation-wide100K Lives Campaign IHI-sponsored national initiativeto reduce mortality through implementation of evidencebasedpractices in hospital careAA&CC Audit and Compliance Committee of the BOTACC American College of CardiologyACGME Accreditation Council for Graduate MedicalEducation—Responsible for the accreditation of U.S. post-MD medical training programs; accomplished through a peerreview process and based upon established standards andguidelinesAction Plan Collection of specific actions, resources,responsibilities, and timelines that respond to short- or longtermstrategic initiatives.ADLI Approach, deployment, learning, integrationAHA American Hospital AssociationAHRQ Agency for Healthcare Research and QualityAIP Annual Incentive PlanALA Advanced Leadership Academy. 18 month formalLeadership development program/cohort for individualsselected by SL as potential successors to PerformanceCouncil.Allopathic Medical training that leads to a Doctor ofMedicine degree (M.D.)AMA American Medical AssociationAmbulatory Services provided on an outpatient basisAME Annual mandatory educationAMGA American Medical Group AssociationAMI Acute Myocardial Infarction (heart attack)AOA American Osteopathic Association—Nationalaccrediting body for osteopathic health care organizationsAOHPH Association of Occupational Health Professionalsin HealthcareAOS Available on siteAPM Action Plan MonitorAugmentation Helping labor progress by doingsomething to stimulate contractions.BAA Business Associate Agreement—Requirement in thevendor policy for all vendors to follow all HIPAA guidelinesBBP/OPIM Blood-borne Pathogen/Other PotentiallyInfectious MaterialBCBSM Blue Cross and Blue Shield of MichiganBCN Blue Care NetworkBHS Behavioral Health ServicesBOB Book of BusinessBOG Board of GovernorsBOT Board of TrusteesBU Business UnitGlossary of Terms and AbbreviationsBundle Set of separate but interdependent clinicalprocesses or practices that together drive a desired outcomeCCA CancerCABG Coronary Artery Bypass GraftCAHPS Consumer Assessment of Healthcare Providersand Systems—Member satisfaction survey used by HAPCAP College of American PathologistsCapitated A payment mechanism by which a health plangives the provider a set fee per member per month (PMPM)regardless of treatment required.Care Coordination Approaches in the process of careto ensure patients’ needs are met and hand offs between caregivers and settings are error freeCARF Commission on Accreditation of RehabilitationFacilitiesCarePlus Classic Original version of the EMR andassociated data repository of patients’ medical recordsCBC Complete blood countCC Community Care—Market segment which includescommunity-based and in-home servicesCCs core competenciesCCS Community Care ServicesCDC Center for Disease ControlCDS Corporate Data Store—A secured, comprehensivedata warehouse which includes information from variousclinical, revenue cycle, and business systemsCE Customer EngagementCenters of Excellence Programs certified as Centers ofExcellence by external agenciesCEO Chief Executive OfficerCEU Clinical Education Units—Education required bynurses and other Allied health professionals to maintainlicensure and certificationCESC Customer Engagement Steering CommitteeChampion (Safety, Engagement, etc.) Internalconsultants to individual BUs. For example, engagementchampions focus on employee engagement and retentioninitiatives. They develop and recommend department, BU andSystem-wide initiatives based on Engagement Survey data todrive improved engagement scores and decreased turnover aswell as create tools and resources for managers to help thembuild and sustain a highly engaged workforce environment.Safety Champions perform a similar role focused on safety.CHAP Community Health Accreditation ProgramCHASS Community Health and Social Services Clinic(Federally Qualified Health Centers)CHNA Community Health Needs AssessmentCHP Community Health ProgramsCHRO Chief Human Resource OfficerCIO Chief Information Officer

CISC Care Innovation Steering Committee—A cross-System team focusing on innovations in prevention andchronic disease managementClinical job function Allied health, behavioral health,clinical support, nursing, physician, researchCME Continuing Medical Education—Education requiredby physicians and other clinicians to maintain licensureCMO Chief Medical OfficerCMS Centers for Medicare and Medicaid Services—Federal agency responsible for the administration ofMedicare/MedicaidCNEC Corporate Nurse Executive CouncilThe Code Code of Conduct—Expectations for ethical andmoral behaviorCOI Conflict of InterestCommunity Care Patient segment for all CCS servicesCON Certificate of need—State laws and programs torestrain health care facility costs and allow coordinatedplanning of new services and constructionCOO Chief Operating OfficerCore Measures Standardized, or “core,” qualityperformance measures reported by The Joint Commission(TJC) accredited hospitals, aligned with measures required byCMS, and endorsed by NQF; viewed as integral to improvingthe quality of care provided to hospital patients and bringingvalue to stakeholders by focusing on evidence-based careprocesses for AMI, HF, pneumonia, and surgical infectionpreventionCOS Culture of SafetyCPM Customer Potential Management—HFHS’s customerrelationship management vendor’s databaseCPNG Care Plus Next Generation—significantly enhancedEMR implemented in 2011CPOE Computerized Physician/Provider Order EntryCPT Community Pillar TeamCQO Chief Quality OfficerCrimson Physician performance improvement softwarefrom the Health Care Advisory BoardCRM Customer relationship management—patientpreference databaseCrucial Conversations HFHSU class offered to leadersto improve retention and enhance conflict managementCSCM Catastrophic Senior Case ManagementCSR Customer Service RepresentativeCTO Combined Time Off—vacation, sick and personaltimeCV CardiovascularDays Cash on Hand Measures the number of days thatoperating expenditures are covered by cash balancesDME Durable medical equipmentDNV DNV Healthcare—a hospital accrediting agency.DR Disaster recoveryDVT Deep Vein Thrombosis—blood clotDDVT Protocols Approaches to minimize risk ofpotentially fatal blood clotsEA Environmental assessmentEAG Employee Advisory GroupEAP Employee Assistance ProgramEC Executive CabinetED Emergency DepartmentEDS Electronic Data SystemsEEOC Equal Employment Opportunity CommissionEHS Employee Health ServicesEMR Electronic Medical Recorde-Nancy Direct email access system to the HFHS CEOEOS Employee Opinion SurveyEPA Environmental Protection AgencyePrescribe/ePrescribing Software that allows creationand distribution of prescriptions electronicallye-Visits Structured online clinical interviews betweenpatients and their physicians; physicians to make clinicaljudgments and recommend next steps/treatmentsEFFCR First Call ResolutionFMEA Failure Modes and Effects Analysis—Structuredmethod to identify, prioritize, and address potential failures inhigh-risk processes with the aim of preventing themFQHC Federally Qualified Health CenterGallup Q12 An evidence-based survey tool of 12questions most highly correlated with employee satisfactionand organizational productivityGantz Wiley Employee Opinion Survey vendor used byHFHS prior to 2008Governance Institute conducts research studies, trackshealthcare industry trends, and showcases governancepractices of leading health care boards across the country.GHHAP Health Alliance PlanHarm Any unintended physical injury resulting fromor contributed to by medical care (including the absenceof indicated medical treatment) that requires additionalmonitoring, treatment or hospitalization, or that results indeath. Such injury is considered harm whether or not it isconsidered preventable, resulted from a medical error, oroccurred within a hospital.HCAB Healthcare Advisory Board—Research organizationwhich provides industry data and literatureHbA1c Glycosylated hemoglobin, measured in a bloodtest commonly used to assess blood sugar control in diabeticpatientsHCAHPS Hospital Consumer Assessment of HealthcareProviders and Systems—CMS’s national inpatient satisfactionsurvey

HE Health EngagementHEART Hear, Empathize, Apologize, Respond, andThank—HFHS’s service recovery modelHEDIS Health Employer Data and Information Set—Toolsused by U.S. health plans to measure performance on careand service; widely accepted as measures for ambulatory careHenry HFHS’s intranetHF Heart FailureHFH Henry Ford HospitalHFHS Henry Ford Health SystemHFHS-employed physicians Physicians employedby HFHS on contract for specific clinical or administrativeservicesHFHSU Henry Ford Health System UniversityHFKH Henry Ford Kingswood HospitalHFLS Henry Ford Leadership SystemHFMC Henry Ford Medical Center(s) Fairlane (FRL)Sterling Heights (SH) West Bloomfield (WB)HFMG Henry Ford Medical GroupHFMG physicians Members of the HFMG multispecialty,salaried group practice, one of HFHS’s BUsHFMH or HFMH-CT Henry Ford Macomb HospitalHFMH-WC Henry Ford Macomb Hospital-Warren CampusHFPN Henry Ford Physician NetworkHFWBH Henry Ford West Bloomfield HospitalHFWH Henry Ford Wyandotte HospitalHFWH-CHS Henry Ford Wyandotte Hospital-Center forHealth Services (ambulatory site)HHC Home Health CareHICS Hospital Incident Command SystemHIHCP HAP In-Home Care ProgramHIPAA Health Insurance Portability and Accountability ActHR Human ResourcesHR Business Partner BU HR Professional whoseprimary job function is to work closely with leadership toanalyze data and drive strategy. The role aligns HR workwith BU and system strategy. HR and business data are keydrivers, focusing efforts in areas such as workforce planning,retention and engagement.HRA Health Risk AssessmentHRET Human Resources Executive TeamHRIC Human Resources Investment CenterHyperlipidemia Hyperlipidemia is a condition wherethere is an elevation of lipids, or fats, in the blood. This couldbe due to an increase in triglycerides, cholesterol, or both.Untreated hyperlipidemia may lead to heart disease.IICU Intensive Care UnitIDP Individual Development PlanIHI Institute for Healthcare Improvement—Not-for-profitorganization leading global health care improvementiMDSoft Software tool for tracking patient care in intensivecare unitsInduction Induction of labor: involves using artificialmeans to assist the mother in delivering her babyINR International Normalized Ratio—Blood test to assessthe effect of oral anticoagulation therapyIntegrated system management models and structuresthat allow for coordination of care experience for patientsand their families and teamwork among care givers andemployeesIOM Institute of MedicineIP InpatientIPA Independent Practice AssociationIRB Institutional Review Board—Approves, monitors,and reviews biomedical and behavioral research involvinghumans with the aim to protect the rights and welfare of theresearch subjectsIT Information TechnologyITDR IT disaster recoveryIVR Interactive Voice ResponseJIT Just-in-timeJust Culture “Just Culture” policy and training is abest practice, standardized approach to manage employeebehaviors toward open communication (“speak up”), safety,and high performance.JKKeystone project State collaborative on patient safety,nationally recognized for excellenceKirkpatrick Four levels of training results including:1. Reaction of student—what they thought and felt aboutthe training;2. Learning—the resulting increase in knowledge or capacity;3. Behavior—extent of behavior and capability improvementand implementation/application; and4. Results—the effects on the business or environmentresulting from the trainee’s performanceKW Knowledge WallLA Leadership Academy. Year-long development program/cohort for individuals identified through Talent Reviewprocess as potential successors to LEAP. Focus is on Pillarsand strategic objectivesLasting Impressions Service Excellence frameworkadopted by all HFHS BUsLean Improvement methodology focused on eliminatingwaste and reducing cycle timeLEAP Leadership Execution and Planning TeamLeapfrog Group Voluntary employer membershipprogram to recognize and reward big leaps in health caresafety, quality, and customer valueLOS Length of Stay—The number of days a patient staysin an inpatient facility; often used as a measure of efficiencyand effectivenessL

LT Long termMMarket Measurement Vendor used by HAP to conducttelephone surveys of patients about their satisfaction withHAP physicians and networksMC Metrics CommitteeMDCH Michigan Department of Community HealthMEC Medical Executive CommitteeMHA Michigan Health and Hospital AssociationMI MichiganMIOSHA Michigan Occupational Safety and HealthAdministrationMI-STAAR MI State Action on AvoidableRehospitalizationsModel for Improvement HFHS approach to processdesign and improvement based in PDCAMorbidity Rate Measures the incidence rate or prevalenceof a disease or medical conditionMortality Rate Measures the number of deaths in a givenpopulationMQC Michigan Quality Council—Michigan’s Baldrigebasedaward program. Their Leadership Award is the highesthonor givenMFI Model for ImprovementM/S or Med/Surg Medical/Surgical—Refers to patientsadmitted for medical and/or surgical careMTM Medication Therapy ManagementMVV Mission, Vision, ValuesMyHealth Consumer Health PortalNNCQA National Committee on Quality Assurance—Notfor-profitorganization dedicated to improving health planquality through accreditation, certification, and recognitionNDNQI National Database of Nursing Quality IndicatorsNHSC No Harm Steering CommitteeNHSN National Health Safety Network (formerly NNIS)NIH National Institutes of HealthNIMS National Incident Management SystemNLA New Leaders Academy. Formal leadershipdevelopment program/cohort for all new leaders based onpromotion/hire. 40 hours classroom and 20 hours onlinetraining in the first 6 months. Focus is on HFHS LeadershipCompetencies.Non-clinical job functions Admin. support, business,facility/security/support services, information technology,leadership/management, vision centerNQF National Quality Forum—non-profit organization todevelop and implement a national strategy for health carequality measurement and reportingNRC National Research CorporationNSQIP National Surgical Quality Improvement Program, anational collaborative focusing on reducing surgical mortalityand complicationsOASIS Outcomes and Assessment Information Set—National database of quality indicators for home health careOB ObstetricsOMB Circular A133 Office of Management and Budgetaudit of federal research awardsOP OutpatientOPR Organizational Performance ReviewOR Operating RoomOSHA Occupational Safety and Health AdministrationOsteopathic Medical training that leads to a Doctor ofOsteopathy degree (D.O.)OWD Office of Workforce DiversityOPPC Performance CouncilPCP Primary Care Physician/ProviderPCTC Patient Centered Team CarePerformance Measures Metric used to quantifyperformancePerformance Targets Short- and long-term goals basedon projected performancePDCA Plan Do Check Act (improvement cycle); HFHSadds a “debrief” step (PDCAd)PG Press Ganey: Supplier of patient and physiciansatisfaction surveys, research, and improvement toolsPI Performance ImprovementPillars, The pillars The 7 pillar strategic frameworkPLI Physician Leadership InstitutePMP Performance Management ProcessPN PneumoniaPost-Acute AmbulatoryPremier Membership organization of not-for-profit healthcare organizations; serves as HFHS’s Group PurchasingOrganizationPress Ganey (PG) Supplier of patient and physiciansatisfaction surveys, research, and improvement toolsPrivate-Practice Physicians Independent physicianswho have practice privileges at HFHS community hospitalsQA Quality AssuranceQuality Expo Annual week-long improvement projectexhibit and live team presentationsRadicaLogic (RL) On-line patient/stakeholder risk andfeedback reporting and tracking systemR&E Research & EducationRevenue Cycle Systems Inpatient and outpatientregistration, scheduling, real-time eligibility verification,charge capture, and billing systemsSC System CommunicationsQRS

SCIP Surgical care improvement programSCM Supply Chain ManagementSE Service ExcellenceSEM (SE MI or SE) Southeast Michigan—Includes thethree counties of HFHS’s primary service area (Wayne,Oakland, and Macomb) as well as Livingston, Washtenaw, St.Clair, and Monroe countiesSentinel Event Defined by the Joint Commission (TJC)as any unanticipated event in a healthcare setting resulting indeath or serious physical or psychological injury to a patientor patients, not related to the natural course of the patient’sillness.SESF System Employee Safety ForumSg2 Health care membership organization, providingclinical and technology research and consultingSHC Self-Health CoachSI Strategic Initiative—A project designed to achieve ourstrategic objectives and related goals/targetsSix Clinic Group Group of large, employed physicianpractices across the U.S. who share research and processimprovements—HFHS is a memberSix Sigma Improvement methodology and an associatedset of tools to reduce variability and eliminate defectsSL Senior LeadershipSMART Specific, measurable, attainable, relevant, timeboundSO Strategic Objective—Projected future state of theorganization resulting from implementation of strategicinitiativesSPP Strategic Planning ProcessSQF System Quality Forum—The Quality/Safety PillarTeamST Short termStrategic Advantage A significant aspect of theoperation that is done exceedingly well. Advantages that wehave that make it easier to succeed.Strategic Challenge A weakness or inadequacy in amajor activity or resource that reduces the organization’sability to achieve its strategic objectives. Factor that makes itharder to succeed.SWOT Strengths, Weaknesses, Opportunities, and ThreatsSystem The Henry Ford Health SystemSystem Integration Linking services together to providecoordinated experiences for patientsSystem Net Income Operating gain includinginvestments for the whole SystemSystem Operating Net Income Operating gain (doesnot include investments) for the whole SystemTTAT Turn-around-timeTB TuberculosisTeam Member Standards The Team Member Standardsof Excellence (P.1a(2)) which apply to all employed staff andleadersTHFE The Henry Ford ExperienceThomson Reuters An international companyspecializing in information and decision support tools forhealthcareTJC The Joint Commission—National accrediting body formany different types of health care organizationsTrainees Those in physician training programs at HFHS atall levels, including students, residents, and fellows.Tri-county Area Wayne, Oakland, and Macomb countiesin SEMTS Talent SelectionUAT User-acceptance testingUVVAP Ventilator Associated PneumoniaVATs Value Analysis Teams—Teams of operational leaderswho work with Supply Chain Management to address supplycosts through standardization and innovationVOC Voice of the CustomerVodcast Video communication available to all workforcemembers via HenryWWHO World Health OrganizationWPM Work Process MeasuresWSU Wayne State University

Preface: Organizational ProfileP.1 Organizational DescriptionA century ago, pioneer automaker Henry Ford recognized theneed for health care for the growing city of Detroit. He broughtto health care the same drive that made him a visionary leaderin transportation. He committed to building Henry Ford Hospital(HFH) in the heart of Detroit, staffed with employed physicians(later the Henry Ford Medical Group (HFMG)), to servethe average person. He encouraged research and professionaleducation, creating a tradition of innovation and learning thatcontinues today.Our history is one of overcoming great obstacles while neverwavering in our commitment to our community. With financiallosses due to unreimbursed care, and suburban patients unwillingto go downtown, HFH and HFMG could have left Detroitfor the suburbs. Instead, we committed to Detroit by creatingpartnerships with the city and adding ambulatory centers in thesuburbs. Today, although Detroit faces one of the worst economiesin the U.S. with nearly half its children living in poverty,Henry Ford Health System (HFHS) remains committed to Detroitwhile serving all Southeast Michigan (SEM), over 4.7Mresidents in 2010.Fragmented, high-cost service delivery is a well-known failingof U.S. health care, yet HFHS has long focused on integratingservices. Early leaders recognized that patients and familiesneed services linked together to ensure coordinated, high-quality,safe, personal care. From HFH’s opening in 1915, we integratedinpatient (IP) and outpatient (OP) departments underone innovative management structure. As we grew, we continuedto lead the industry in spreading and advancing models tointegrate care delivery. We were early adopters of electronicmedical records (EMR), an essential tool for coordinating care.To integrate financing and delivery, we added a health insuranceplan (Health Alliance Plan, HAP) that encourages lowcostand high-quality care. Today, HFHS is one of the nation’sleading comprehensive, integrated health systems, with a fullspectrum of services.HFHS supports research and education to ensure discovery anddelivery of state-of-the-art care, contribute to the well-beingof our communities, attract talent, and through innovation andknowledge sharing, set an example of leadership for the healthcare industry. We rank in the top 6% of institutions grantedfunding by the National Institutes of Health (NIH). Integrationof patient care with research, education, community health, andinsurance offers significant competitive advantages. HFHS hasreceived numerous awards and recognitions for contributionsto SEM and the U.S. that exemplify the ongoing Ford traditionsof innovation, excellence, and learning (Fig.7.4-2).P.1a(1) Service Offerings. HFHS is a not-for-profit integratedhealth care delivery and insurance system (Fig. P.1-1). We offerservices across the care continuum through nine businessunits (BUs) with a diverse network of facilities (Fig. P.1-2).Our key customer groups and associated health care servicedelivery mechanisms include:Fig. P.1-1: HFHS Integrated SystemKey Elements of SystemContinuum of CareProvides state-of-the-art, coordinated services throughoutthe System and into the Community• HFH • Community Hospitals • Ambulatory Centers• Community Care Services (CCS) • Community Health Programs (CHP)*HFMG Physicians, HFHS Employed Physicians, Private Practice PhysiciansHealth Alliance Plan (HAP)Encourages value and innovationResearch & Education (R&E)*Provides focus on innovation, trains 1/3 of MDs in MI, attracts talent• Basic science, population and clinical research • Healthcare provider training*Community Health Programs and Research & Education are cross-business unitprograms managed through the Community and R&E Pillar infrastructureFig. P.1-2: HFHS BUs, Services, and Delivery MechanismsBUSINESS UNIT*Henry Ford Hosptal (HFH)(802 beds)Henry Ford MacombHosptal (HFMH) (349 beds)Henry Ford MacombHosptal─Warren Campus(HFMH-WC) (203 beds)Henry Ford WyandotteHosptal (HFWH) (379 beds)Henry Ford WestBloomfeld Hosptal(HFWBH) (191 beds)Henry Ford Medcal Group(HFMG)41 specialties, 30ambulatory centersBehavoral Health Servces(BHS)(150 beds; 7 clinics─behavioral health only)Communty Care Servces(CCS)%REV%EMPL SERVICES18 25Same as community hospitals(below) plus level 1 trauma,certified centers of excellencein Oncology, Transplant,Trauma, and Stroke8 12 Community hospitals provideacute IP and hospital-basedOP services, including2 4 emergency, ambulatorysurgery, and diagnostic6 10services plus both on- andoff-site employed practice OPservices, behavioral health4 7 services (at many),prevention, and wellnessPreventive care, primary15 21care, specialty care, seniorcare management, four1 26 10Health Allance Plan (HAP) 39 4centers of excellenceComprehensive psychiatricand psychological services foradults and children, includingpsychiatric hospital and IP/OPaddiction medicineDialysis; in-home, nursinghome, and hospice care;retail services to support careacross all life stages andhealth levelsInsurance products, includingHMO, PPO, consumer-drivenhealth plans*Relative importance is indicated by net % revenue and % employees.Though not technically a BU, Corporate Services accounts for 4% ofemployees and, where appropriate, is represented in data segmented byBU.• Patients. Service is delivered through direct collaborationwith our clinicians and multi-disciplinary teams, hospitalstays, ambulatory and home visits, and educational programs.Our online interactions with patients include e-visits, resultsreporting through health information portals, and online appointmentscheduling and prescription renewals (3.2a(2)).• Community. Service is delivered through interactions in ourfacilities, our Web site, print media, and educational TV, andprograms at community locations, often delivered jointlywith partners or collaborators. We contribute to communityhealth care service delivery through community leadership,collaborative arrangements, and funding, especially for theun- and under-insured (1.2c(1,2), Figs. 7.5-4, 7.4-8).• Purchasers. Service is delivered through HAP’s health insuranceproducts for individuals and employers, which offercoverage for health-promotion and disease-management

iiservices, delivered in our facilities, the workplace, online,by telephone, and in print media.P.1a(2) Vision and Values. We are driven by a passion forexcellence and a pervasive “can-do” spirit. Our culture, characterizedby our focus on clinical excellence, community commitment,System integration, and efficient business practices,aligns to and supports our mission, vision, and values (MVV,Fig. P.1-3), which set the direction for the System and serve asthe basis for strategic planning and management of operations(1.1a(1), 2.1a(1)). Our culture pulls together our wide range ofresources and services to create what we call The Henry FordExperience (THFE).Fig. P.1-3: HFHS Mission, Vision, and ValuesMISSION: To improve human life through excellence in the science andart of health care and healing.VISION: Transforming lives and communities through health andwellness—one person at a timeVALUES: We serve our patients and our community through our actionsthat always demonstrate: Each Patient First, Respect for People, HighPerformance, Learning and Continuous Improvement, and a SocialConscienceOur values drive the decision making and personal behaviorof leaders and the workforce (1.1a(2)). To reinforce living ourvalues, senior leaders developed the HFHS Team MemberStandards, which pertain to everyone in the workforce: Displaya positive attitude; Take ownership and be accountable;Respond in a timely manner; Commit to team members; Becourteous and practice established etiquette; Respect patientprivacy; Foster and support innovation; and Honor and respectdiversity. Our core competencies (CCs) are fundamentalcontributors to our success in fulfilling our mission and differentiatingHFHS in our marketplace (Fig. P.1-4).Fig. P.1-4: HFHS Core CompetenciesINNOVATION: Expertise in discovering and applying new knowledge,from new clinical techniques and technologies to anticipating andmaking improvements in processes, products, services, andorganizational structuresCARE COORDINATION: Proficiency in providing coordinated careacross the continuum of providers and delivery sites, enhanced by amultidisciplinary team approach and information technologyCOLLABORATION/PARTNERING: Relationship-building, collaboration,and partnerships with patients, key stakeholders, and othersAmong many examples, the following illustrate how we leverageour CCs to achieve the excellence that enables us todramatically improve human lives:• Aligned with our top priority of reducing harm (1.1a(3)), HFHserved as one of the first “mentor” hospitals and contributinginventor in a national harm reduction campaign. The HFHSNo Harm Campaign model was recently tapped to contributeto the new Health & Human Services Partnering for PatientSafety campaign. (Innovation, Collaboration/partnering)• HFMG physicians performed the first robotic removal ofa cancerous prostate gland in the U.S., an innovation thatrevolutionized prostate cancer treatment globally; today fivesurgical specialties have expanded into the robotics field, andHFMG is recognized for its widespread expertise in minimallyinvasive surgery. (Innovation, Care coordination)• HFHS opened HFWBH in 2009, an innovative hospitalwith a wellness focus, designed with substantial input frompatients, families, the community, and caregivers. (Innovation,Care coordination, Collaboration/partnering)P.1a(3) Workforce Profile. Our workforce numbers more than31,000 with 76% HFHS employees. Fig. P.1-5 shows the diversityof our employed workforce, which reflects the communitieswe serve. In specific areas, contract employees, mainlyfrom our key suppliers and partners, work alongside HFHSemployees; they comprise about 7% of the workforce. Smallbargaining units represent just over 2% of employees.Fig. P.1-5: Workforce DiversityJOB Leadership/management–6% Non-management–94%FUNCTION Clinical–67%Non-clinical–33%GENDER Female–78% Male–22%African American–22% Asian/Pacific Is–8%RACE/Caucasian–68%Hispanic–2%ETHNICITYOther–1%65–3%TENURE 55 with 5+ yrs service–18%Physicians (including those in training) comprise 17% of theworkforce. More than 1,350 salaried HFMG physicians staffHFH and 30 ambulatory centers. More than 2,200 private-practicephysicians serve on community-hospital medical staffs andrefer patients to HFMG. A small number of HFHS-employedphysicians provide clinical and administrative services on contract.We have more than 1,500 physicians in training annually.Some 2,000 volunteers, about 6% of the workforce, performcustomer-service or administrative tasks. Workforce educationlevels range from high school to doctoral level, with years ofadvanced training for clinicians, researchers, and administrativestaff, consistent with their job functions and professionalinterests. Fig. P.1-6 shows key elements affecting workforceengagement (5.2a(1)). Drivers for employees and volunteersare based on the Gallup Q12.Fig. P.1-6: Elements Driving Workforce EngagementGROUP/SEGMENT ENGAGEMENT DRIVERSEmployees Q1. Know what is expected of me(leadership/mgt, Q2. Have materials and equipment neededclinical, Q3. Do what I do best every daynon-clinical) Q4. Recognition in last 7 daysQ5. Supervisor/someone at work cares about meQ6. Someone at work encourages my developmentQ7. At work, my opinions seem to countQ8. Mission/purpose makes me feel importantQ9. Coworkers committed to qualityQ10. Have a best friend at workQ11. Reviewed my progress in last 6 monthsPhyscans(HFMG, HFHSemployed,private-practice,trainee)VolunteersQ12.Opportunities to learn and grow this yearQuality of care I/HFHS deliverLeadership and communicationTime spent working, my productivityAcademic mission of HFHSCommunity reputation of HFHSSame as Q1, Q3, Q4, Q9, Q10All workforce members require a healthy, safe, and secure workenvironment. Our approaches to address these requirementsinclude System-wide programs and activities targeting risks inparticular settings, such as exposure to diseases, blood and bodyfluids, hazardous materials, and other workplace safety concerns.(5.1b(1)). Our services, policies, and benefits are designed withemployee input and tailored to diverse needs (5.1b(2)).

P.1a(4) Assets. HFHS facilities have the equipment and technologiesrequired for excellent care in a wide array of settingsand for virtually all medical and surgical conditions, with manyleading-edge approaches to diagnosis and treatment. State-ofthe-artequipment and technologies include, for example, interoperativemagnetic resonance imaging for delicate operativeprocedures. Our facilities, equipment, and technologies alsosupport and enhance our research and education programs.More than 150 medical specialists and research scientists areengaged in several hundred research projects. Our Center forSimulation, Education, and Research, with computers andmannequins simulating hundreds of clinical scenarios, has enabledmore than 12,000 participants to develop skills and tryout new approaches in a risk-free environment (5.2c(1)).Clinical information is linked across all our facilities throughCarePlus Next Generation (CPNG), a longitudinal EMR, witha portal for private-practice physicians (4.2a(2)). AdditionalIT systems supplement CPNG, including an ICU informationsystem, electronic medication administration system, andclinical information systems for obstetrics, cardiac care, transplantation,chronic disease, specialized data repositories, andpatient care tools. Business management tools support patientscheduling, registration, billing, marketing, planning, quality,and research. Our System dashboard provides for timelydistribution and monitoring of key performance measures andstrategic initiatives (SIs). IP and OP data are stored in CorporateData Store (CDS) and can be accessed through query tools(4.2a(2)).P.1a(5) Regulatory Requirements. HFHS is subject to andmeets all federal, state, and local laws, regulations, and applicablehealth care accreditation and research standards designedto protect and promote health care quality and safetyand ensure that patients and employees receive fair and equaltreatment. Michigan is a Certificate of Need state; capital expendituresexceeding $2.9 million and changes in hospital bedsand other specified clinical services require state approval.P.1b(1) Organizational Structure. The 24-member SystemBoard of Trustees (BOT) is responsible for ensuring and overseeingour mission, finances, strategic planning, and potentialacquisitions and mergers. The BOT maintains certain reservedpowers for HFHS (the System), including fiduciary responsibilityfor all hospitals and other entities. BU affiliate and advisoryboards provide guidance to BU leaders and local communitystakeholder perspectives. Boards communicate withthe BOT through quarterly meetings of board chairs. The HAPBoard of Directors oversees the health plan.The HFHS senior leadership (SL) team is called the PerformanceCouncil (PC). The PC includes the Executive Cabinet(EC, comprised of the System CEO, COO, CMO, CFO, andHAP CEO) plus all BU CEOs and senior corporate leaders.The PC is responsible for strategy development and implementation,organizational performance review (OPR), andoversight for HFHS’s performance improvement (PI). Otherkey leadership groups include pillar, System, strategic initiative(SI), and BU teams. These teams also participate in thestrategic planning process (SPP), contributing to SI and actionplan development and implementation (2.2a(2)), OPRs(4.1b), and PI (4.1c). SL provides opportunities for strategyinput and two-way communication through the LeadershipExecution and Planning (LEAP) team, which includes the PCplus HFHS vice presidents and directors; 45% are physicians.The HFMG Board of Governors (BOG) provides oversight toHFMG physicians. The System CMO is a BOG member. Anelected medical executive committee (MEC) oversees clinicalpractices at each community hospital. The BOG and MECsare accountable to local boards and the System BOT. In 2010,anticipating health care reform legislation and leveraging thelongstanding cooperation among our physicians, we formedthe Henry Ford Physician Network (HFPN), a physician-drivenorganization comprised of HFMG, HFHS-employed, andprivate-practice physicians. The HFPN strategy includes standardizingcare based on leading practice; using technology toshare clinical data and improve care coordination and continuity;establishing uniform performance expectations, metrics,targets, and thresholds; and developing common goals and rewardstructures. A 15-member board of trustees, with HFMGand private-practice physician representatives, reports to theSystem BOT. Results are anticipated by year end for this newventure.P.1b(2) Customers and Stakeholders. Patients, community,and purchasers comprise our customers and key stakeholders.Fig. P.1-7 shows each group and key segments, and their key requirements.Our community includes the SEM tri-county area(Wayne, Oakland, and Macomb counties), where our facilitiesare located and 95% of our patients reside. We segment communityresults by hospital service area. Patients have private(including HAP), public, or no insurance, and HAP membersare not required to seek their care from the HFHS delivery system.HAP purchasers include both individuals and companiesseeking to manage costs while keeping employees and beneficiaries—fromfewer than 10 to tens of thousands—healthy andhappy. To better understand and address their requirements, weinvolve patients and stakeholders in our design and improvement/innovationprocesses (Fig P.1-8, 6.2a(1)).Fig. P.1-7: Key Patient / Stakeholder RequirementsHFHS PATIENTS(IP, OP, ED, CCS)COMMUNITY(Hospital service areasin Wayne, Oakland,Macomb counties)PURCHASERS(employers,individuals)Safe, reliable careTimely and efficient careEffective, evidence-based carePatient-centered careEquitable careHealthier citizens, healthier communitiesEquitable health care and access, especiallyfor the un- and under-insuredFinancial benefitTimely and efficient (cost-effective) careEffective, evidence-based careAccess to high-quality providersP.1b(3) Suppliers and Partners. HFHS builds relationshipswith suppliers, partners, and collaborators. They contribute toour key work systems and processes (Fig. 6.1-1), supportingour capacity to achieve strategic objectives (SOs). Their rolesand mechanisms are outlined in Fig. P.1-8. Our most importantsupply chain requirements are value, safety, availability/timeliness,reliability, and innovation. In addition, we are committedto supplier diversity (Fig. 7.4-13).iii

Fig. P.1-8: Suppliers, Partners, Collaborators, & RolesREPRESENTATIVE TYPESMajor supplers(e.g., Aramark for foodservices)Local & mnorty(dverse) supplersContnuum of CareCommunty partners(e.g., CHASS clinics, twofederally qualified healthcenters, 1.2c(2))Strategcally sourcedvendors(e.g., Siemens, 4.2b(1))Research & EducatonEducatonal nsttutons(e.g., WSU, 1.2c(1))Health PlanEmployer-purchasers(e.g., Detroit automakers,6.1b(2))Contnuum of CareHealth care coaltons(e.g., IHI, MHA, 6.2a(4))Patents(e.g., patient advisorycouncils, 3.1a(1), 3.2a(1))Health PlanEmployer-purchasers(e.g., Detroit automakers)ROLE IN DELIVERY OFSERVICES & SUPPORTDeliver essential services outsidescope of HFHS’s businessexpertiseDeliver products & services whileenabling HFHS to contribute toregional economy, support diversityPartner on delivery strategies,methods, locations for primary careservices, wellness, housingProvide on-site staff, support 24/7availability of clinical technology &information systems, assist withdesign & improvement of clinicaltechnologiesProvide physicians in training; HFHserves as clinical campusPartner on delivery strategies,methods, locations for beneficiariesParticipate in process & qualityimprovementROLE IN INNOVATIONSUPPLIERSNew products/services,expertise in their businessareaPARTNERSUnique approaches fordelivering higher-quality,lower-cost care within thecommunityExpertise & leading-edgetechnologyIdeas, expertise, cuttingedgetechnology used inbreakthrough waysIdeas, funding, & strategicoversight for methods toimprove access &convenience, lower costCOLLABORATORSExpertise, knowledge ofstakeholdersProvide input, serve onteamsCollaborate to ensureaffordable, effective carefor their workforceRELATIONSHIP & COMMUNICATION MECHANISMSContracting process, electronic data exchangeQuarterly meetings with key suppliers where they reportagainst quality, cost & customer satisfaction metricsVendor orientation/educational meetingsHFHS participation on suppliers’ Boards/CommitteesParticipation in strategic planningParticipation on leadership & quality improvementteamsRepresentation on advisory boards & boardcommitteesParticipation in strategic planningParticipation in joint task forcesHFMG faculty appointmentsJoint research programsHFHS participation in collaborators’boards/committeesHFHS participation in quality improvement effortsCollaborators’ participation in HFHS quality/processimprovement activitiesP.2 Organizational SituationP.2a(1) Competitive Position. HFHS competes in many servicesacross the continuum of care with large health systemsand smaller, independent hospitals and health providers. Currently,HFHS holds 17.5% IP market share in the tri-countyarea and 15.4% in all SEM. HFHS’s 2.1 million ambulatorypatient visits represent about 19% of tri-county OP marketshare. Our four major competitors currently hold 10.5-17.5%of IP market share in the tri-county area, with the remaining24% split among several independent providers. HAP’s statewidemarket share is 22.4% for HMO products and 5.4% forcommercial products. CCS’s Home Health Care (HHC) isMichigan’s largest home health provider. Because of its diversearray of services, CCS has many different state and localcompetitors.P.2a(2) Competitiveness Changes. The SEM economy, nationalhealth care reform, and the entrance of for-profit ownershipare key competitive changes that create challenges andopportunities for HFHS. With our “can-do spirit” and usingour CCs, we are leveraging partnerships (1.2c, 5.1a(2)) andmaintaining focus on our SOs to drive differentiation and sustainablesuccess.P.2a(3) Comparative Data. HFHS uses comparative andcompetitive data sources common to the industry and alignedwith the pillars (Fig. P.2-2). People: AMGA, CDC, Gallup,Gantz-Wiley, HRIC, Saratoga; Service: CAHPS, HCAHPS,JD Power, NRC, Press Ganey (PG); Quality & Safety:AHRQ, BCBS, CMS, Crimson, EDS, FCR, HCAB, HE-DIS, IHI, MHA, MIOSHA, NDNQI, NHSN, TJC; Growth:AMGA, MHA, MIDB, Premier, SEM Data Exchange; Research& Education: ACGME, NIH; Community: GovernanceInstitute, MDCH website; Finance: Moody’s, Premier,S&P, competitor financials. In addition, many departmentscompare results to outcome and process data shared withintheir industry segment or published by relevant professionalorganizations. Key limitations include limited availability ofrelevant benchmarks for large, integrated health systems; lackof standard definitions and databases for many clinical measures;and long delays in data availability, with many key reportingsources lagging by 3 to 18 months.P.2b Strategic Context. Fig. P.2-1 outlines our strategic challengesand advantages.P.2c Performance Improvement System. Through the HenryFord Leadership System (HFLS, Fig. 1.1-1), our leaders set thedirection for performance excellence and model how to achieveit. They set visionary goals, with bold performance targets;communicate expectations and engage the workforce; monitorperformance and analyze results to learn; recognize and rewardhigh performance; and take action to drive improvement andspread best practices. A focus on excellence, learning, and innovationis embedded in our culture and continually reinforcedthrough systematic approaches that are integrated into ourHFLS and comprise the key elements of our PI system.iv

Fig. P.2-1: Strategic Challenges and AdvantagesCHALLENGESSC1: Accelerating pressures requiring cost control, revenue growthand diversification.SC2: Growing transparency of results and aligning physicians to driveaccountability for improvement.SC3: Potential increased competition due to possible mergers andacquisitions.SC4: Increased publicly available information and the effect onconsumer decision-making.SC5: Redesigning care to maximize health and effective outcomeswhile reducing costs.SC6: Addressing health care needs of our diverse populationincluding the un- and underinsured.SC7: Retaining, training and engaging an effective, collaborativeworkforce and developing leaders.ADVANTAGESSA1 “Can Do” Spirit: a focus on workforce engagement, talentdevelopment, and recognition creates unique energy and a “can do”culture to continuously improve the quality and safety of our services.SA2 Strategc geographc postonng: HFHS’s provider andinsurance representation in all SEM regions, growing into other MImarkets, is fundamental to the integration model and growth.SA3 Long-term presence n and support of our communtes:HFHS has been an active community member in Detroit since 1915while also creating relationships and facilities in each of our suburbs.SA4 Commtment to dversty and equty: HFHS is located in ahighly diverse community and this commitment creates a desirableenvironment in which to work and receive care.SA5 System Integraton: a vast continuum of services, unique inhealthcare, provides a means of achieving success across all sevenperformance pillars.SA6 Academc Msson: our extensive clinical training and researchprograms attract physicians and allied professionals to HFHS fromaround the globe.• 7-pillar framework. We use a 7-pillar framework (Fig. P.2-2) to organize and evaluate our performance. The 7 pillarsrepresent the areas most important to our success: People,Service, Quality & Safety, Growth, Research & Education,Community, and Finance. The framework aligns SystemSOs, SIs, and related performance measures and targets forthe System and within BUs, from the top of the organizationto the individual employee. System pillar teams evaluateand address progress within each pillar, while the PC setspriorities, evaluates progress, and coordinates improvementaction across pillars (P.1b(1)).• OPR and metrics. System-wide, leaders and managers atall levels engage in systematic, fact-based OPR (4.1b), supportedby a cascading system of organizational performancemeasures, work process measures, and action plan monitorsFig. P.2-2: The 7 Pillar Strategic FrameworkPeopleServiceQuality &SafetyMission and VisionGrowthResearch &Education(Fig. 4.1-2). The purpose of OPRs is organizational learning.OPRs serve as the foundation for our approaches toidentify best practices to be shared, project and address futureperformance, and recognize opportunities for improvementand innovation (4.1c(1-3), 6.2a(4)).• Dashboards and Knowledge Wall. We make performancedata and demonstrated best practices readily accessible tothe workforce to support organizational decision-makingand drive improvement and innovation at all levels (Fig.4.2-2). Information-sharing methods include online dashboards(Fig. 2.1-3, 4.1b) and our Knowledge Wall (KW),which captures and shares internal and external best practices(4.2a(3)).• Baldrige assessment. We have used the Baldrige criteriasince 2007 for annual assessment of key leadership andmanagement processes, analyzed our feedback, and setpriorities to drive major improvements. Examples includeimprovements to the HFLS, SPP, OPR, dashboarding, andleadership development. Throughout the year, we benchmarkour processes and results against Baldrige recipientsto learn and improve. The Baldrige criteria are the foundationfor the multidimensional excellence represented inour 7-pillar framework and are reflected in our LeadershipCompetencies (5.2a(3)), which drive leader developmentand evaluation.• Model for Improvement (MFI). Deployed System-wide,our MFI is a flexible, PDCA-based methodology adaptedfrom IHI’s widely used approach (Fig. 6.1-2), with a companiontoolkit of methods and tools appropriate for a widerange of change initiatives from informal work-unit improvementprojects to innovative breakthrough design andredesign.• Innovation teams. We encourage and invest in opportunitiesfor our workforce to develop and test new ideas andapproaches, with oversight by senior leaders and often theiractive involvement as preceptors. Examples include theSimulation Center (5.2.c(1)), where clinicians can practicetechniques in a safe environment; our leadership academies(5.2c(1)), where high-potential leaders conduct innovativeprojects (5.2c(1)); and “innovation units,” where teams developand pilot new approaches, often supported by speciallytrained internal experts, or participate in care designteams that include patients. Innovation teams also includethe many national and state partnerships andcollaboratives in which we develop and testnew ideas and benchmark with high-performers,such as IHI’s 100K and 5M Livescampaigns and MHA’s Keystone project.Community FinanceThe Henry Ford ExperienceSystem ValuesCore CompetenciesBaldrige PrinciplesNote: Throughout category 7, the symbol indicates a result in text only, not ingraphic. This symbol helps the reader findresults. For example, Bond Rating is coveredin text in 7.5a(1) and appears as follows:Bond Rating. These results may bereferenced in process categories by the criteriasection they appear in, so rather thana figure number, 7.5a(1) would be used toreference the results.

1 Leadership1.1 Senior Leadership1.1a(1) Vision and Values. The PC sets our MVV during theannual SPP, Step 1 (Fig. 2.1-1). In 2010, the PC decided to updateour vision to reflect our evolving aspirations and strategicchallenges. A Vision Subteam created a comprehensive listeningand design process that included focus groups with all employeesegments, employed and private/contracted physicians,patients, community leaders, purchasers and trustees. Based onthis input, the team created three draft vision statements whichwere voted on by the workforce and trustees. The resulting visionstatement was approved by the BOT (Fig. P.1-3).SL deploys the MVV through our Leadership System (HFLS,Fig. 1.1-1) to all BUs and workforce segments, key suppliersand partners, and other stakeholders as appropriate. HFLSfollows PDCA, reflecting our longstanding commitment toperformance improvement. The PC sets aggressive SOs andSIs for all 7 pillars during Steps 2-5 of our SPP. SL deploysstrategy through action plan implementation (SPP, Steps 5-7)and data-driven management decisions. We develop people toensure our workforce has skills to accomplish our SOs and deliverTHFE. The Leadership Competencies (5.2a(3)) and TeamMember Standards (P.1a(2)) set and implement behavioral expectationsto deploy our values. OPRs occur at regular intervalsthroughout the System using dashboards (4.1b) to monitorand improve performance. Formal and informal use of theHFHS MFI and knowledge-sharing approaches (4.2a(3)) ensureimprovement in operations. We reward and recognize individualsand teams (1.1b(1), 5.2a(3)) whose work exemplifiesand contributes to the MVV. We leverage our CCs to achieveexcellence. HFLS aligns the workforce to achieve the HFHSVision. SL refines the HFLS based on our Baldrige feedback,using our approaches to improvement.To demonstrate their personal commitment to our valuesand THFE, SL members model these values to all stakeholdersthrough simple but consistent daily actions, such as askingwhat patients want and need when evaluating strategiesand process changes (vision); rounding to hear directly fromFig. 1.1-1: HFHS Leadership System (HFLS)ACTReward & RecognizeRedesignSpreadINNOVATIONVISIONTransforming lives and communities throughhealth and wellness – one person at a time.CHECKOrganizationalPerformanceReview (OPR)PATIENTSCOMMUNITY PURCHASERSCARECOORDINATIONDODeploy Strategy& Develop PeoplePerformancePillarsPLANDevelopStrategyCOLLABORATION/PARTNERINGstaff their ideas for innovations and improvements (respect);personally leading process improvement teams (learning andcontinuous improvement); and actively leading and serving oncommunity health initiatives (social conscience, 1.2c(2)).1.1a(2) Promoting Legal and Ethical Behavior. SL personallypromotes an environment that fosters, requires, and resultsin legal and ethical behavior through: 1) role modelingfor employees, suppliers, and partners; 2) communicating withopenness, honesty, and transparency in all compliance matters;3) deliberate culture building (5.2a(2)); and 4) deploying theCode of Conduct (the Code) internally to all BU and sites andwith vendors (1.2b(2)). Our CEO deploys the Code with personalmessages on video and in writing. SL cascades the Codeto the workforce and other key stakeholders through multiple,comprehensive communications (Fig. 1.1-2). The HFHS CEOand CMO personally participate in evaluating and improvingthe Conflict of Interest (COI) process. CEOs, BU leaders, andthe Board’s Audit & Compliance Committee (A&CC) analyzeannual disclosure results and take actions as needed to ensurecompliance with the Code (Fig. 7.4-4).Our CEO leads HFHS’s process to establish, deploy, evaluate,and improve our ethical and legal standards. One exampleis our Vendor Compliance Policy, which specifies vendor requirementsfor staff interaction and mandatory participationin an orientation on the Code, MVV, THFE, and other HFHSpolicies. The Policy eliminates inappropriate influence and enhancespatient safety by controlling vendor access to patientcare areas. SL initiated annual “influence free” days duringwhich employees turn in items with vendor logos. Holidaycommunications remind employees that vendor gifts cannot beaccepted.1.1a(3) Creating a Sustainable Organization. SL uses andimproves our HFLS to create a sustainable organization. Seniorleaders participate in creating a culture that fosters sustainabilitythrough their personal actions. To ensure long-term sustainability,the PC launched an Enterprise Risk Council (ERC) in2010. Led by the CFO, this team is responsible for designingand executing a robust enterprise risk management program.The ERC identifies and prioritizes the top strategic, financial,and operational risks facing HFHS and ensures that the highest-priorityrisks are addressed through new or existing SIs.• Creating an environment for performance improvement.SL leads and participates in System and pillar teams,driving performance across pillars, using the MFI, with anemphasis on accountability for SO and SI results throughdashboards and OPRs. For example, our CEO and ChiefQuality Officer (CQO) co-lead the System Quality Forum(SQF, including senior leaders from all BUs) and overseethe quality pillar, and our CMO leads the Care InnovationSteering Committee (CISC), which researches, designs, andspreads new care delivery innovations such as depressionscreening in primary care and in-home physician visits forhigh-risk seniors. SL also models our CCs. For example, ourCEO is personally committed to improving family-caregivercommunications and partnered with a deceased patient’sfamily to create a program to improve these communications.Four members of SL personally partner with Wayne

State University (WSU) on an Innovation Institute. At ournewest hospital HFWBH, we built a demonstration kitchento engage our community in cooking and eating healthier.To ensure performance leadership, SL volunteers to lead national,state, and local initiatives to create innovations. Thispractice allows early adoption of practices, personal leadershipskill development, and reinforces our CCs. SL ensuresagility by exercising their personal skills for customer listening,improvement and innovation. For example, the CCSCEO visits our pharmacy partners, interviews customersabout their service experience, and uses this information inCCS efforts to improve patient experiences (Fig. 7.2-14).• Workforce culture. SL regularly rounds on all shifts at hospitalsand OP sites to gather feedback from front-line staff.SL demonstrates its commitment by taking prompt actionon issues and by providing two-way communication, suchas e-Nancy, for all workforce segments. SL demonstratesthe importance of service by: framing, modeling and teachingTHFE; hiring service experts outside health care (theHFWBH hospital CEO and HFHS VP of service are formerRitz Carlton executives); driving rigor around review andimprovement of patient evaluations and measures; patientrounding; personal interactions with patients and families;and patient and community involvement in process designteams and HFHS boards and committees.• Organizational and workforce learning. SL models theimportance of personal and organizational learning. Theyreceive the first training for high priority SIs and participatein teaching others. SL actively participates in learningorganizations, such as the IHI, Sg2, AMGA, the Six ClinicGroup, and Healthcare Advisory Board (HCAB). SL leadsand participates in organizational learning from OPRs atPC, pillar teams, and BU teams, and oversees cascadingOPRs throughout the organization.• Enhance SL leadership skills. SL participates in numerousdevelopmental opportunities including membership inprofessional organizations and think tanks, hosting of andattendance at national symposiums and events featuring expertsinside and outside health care, and visits with companiesrecognized for best practices. SL personally leads theBaldrige process, and several are trained examiners.• Succession planning, leader development. We have systematicapproaches to succession planning and leader development(5.2c(1), 5.2c(3)). The succession planning processbegins with SL identifying individual successors forthe top 13 leaders in three categories: ready now, ready intwo years, and ready within five years. Identified high-potentialleaders work with the Chief Human Resource Officer(CHRO) to create individual development plans (IDPs)to assist them in reaching the next level. SL selects an additionaltalent pool of 50 individuals who participate in theAdvanced Leadership Academy (ALA) to prepare for otherleadership positions. PC members discuss progress and developmentof potential successors during annual SL TalentReview sessions (Fig. 5.2-2). SL also participates in staffdevelopment and identifies potential leaders to participatein learning programs. SL conducts training, teaching manysessions at our leadership academies and HFHS Universitycourses (HFHSU, 5.2c(1)).• Patient safety culture. Our BOT has defined harm reductionas the System’s top priority. AHRQ research suggestsonly 44% of patient harm is actually avoidable, yet our NoHarm Campaign (6.1b(2)) aims for an aggressive 50% reductionfrom 2008 to 2013. Creating a culture of safety isthe first of four elements in this critical SI. SL sets specificculture of safety goals during the annual SPP, and overseescomprehensive patient safety education and communicationfor all staff. The Culture of Safety action plan includespromoting and measuring employees’ willingness to speakup about actual or potential safety problems. To accelerateimprovement, SL initiated The Speak Up, Speak Out program.SL personally participates in sentinel event analyses,risk trend reviews, and emerging patient safety regulationand industry trends research to maintain performance leadership.SL members hold board and committee leadershippositions for the MHA’s Patient Safety Organization andQuality & Accountability Committee, Advisory Committeesof The Joint Commission (TJC), and other patientsafety organizations.1.1b(1) Communication. To communicate with and engagethe entire workforce, the CEO meets with the System Communications(SC) team monthly to evaluate, design and improvecommunication and engagement approaches of the HFHSCommunication System (Fig. 1.1-2) to ensure:• Two-way exchange. SL uses comprehensive tactics suchas face-to-face, print and email communication, as well associal media such as vodcasts and blogs, to encourage frankexchange throughout the organization.• Key decisions. SL communicates key decisions and reinforcesthe MVV, SOs, SIs, performance measures, andachievements and recognition. SL embeds communicationin the action plans of every SI. To ensure integrated deployment,the SC team uses a Communicators’ Roundtablecomprised of BU chief communication officers to plan andexecute communications. Consistent messages are integratedinto communications to all key workforce segments inall BUs. SL engages the entire workforce in the deploymentof Health Engagement (5.1b(1)); messaging was developedand tested through the HFHS MFI and then rolled out toemployees.• Role in recognition. Leadership Competencies (1.2a(2))and the annual Performance Management Process (PMP,5.2a(3)) set the expectation for routine recognition of employees,as measured by the Employee Engagement Surveyand leader 360° feedback. SL and all leaders recognize employeesthrough methods ranging from personal thank-younotes to award presentations honoring employees and teams.Every BU has recognition programs to reward teams or individualsfor behaviors that support the MVV and THFE.SL honors top performers with “Focus on People” awardspresented at the annual BOT caucus. Quarterly, SL recognizesrole model managers nominated by their employeeswith the “Shadow of the Leader” award.We evaluate and improve SC annually. For example, when the2008 evaluation identified the need to improve the effectivenessof sharing HFHS messages, SL led development of “Take

Five” messages and toolkits, which leaders use System-wideduring daily or weekly employee huddles.1.1b(2) Focus on Action. SL creates a focus on action andidentifies needed actions through the SPP. SL defines SOsand BU, pillar, and other System teams develop and prioritizeSIs, action plans, key performance measures, and targets(Fig. 2.1-2). Action plan milestones and targets are cascadedto all managers and the workforce using the SPP (Steps 6-7)and PMP (5.2a(3)). Performance measures are monitored aspart of OPRs using the System dashboard (4.1b). When targetsare not met, action plans are revised, using the HFHS MFIas necessary and new initiatives are developed to take advantageof market opportunities. SL creates and balances valuefor patients and other stakeholders by ensuring that the SOsand performance measures in each pillar relate directly back tocustomer and stakeholder research and analysis on needs andexpectations. Successes and/or strategy adjustments are sharedwith the workforce and stakeholders through communicationchannels (Fig. 1.1-2). For example, in 2006, HFHS leadersresponded to a Request for Proposal by Canadian officials toserve as Ontario’s back-up provider of open heart procedures.Fig. 1.1-2: Communication System Deployment of Key MessagesDemonstrating agility and leveraging our CCs of collaborationand innovation, HFHS created a referral partnership for Canadianpatients needing emergency cardiac care. Since its inception,this partnership has brought in more than 330 patients and$8.5 million in net revenue to the System.1.2 Governance and Societal Responsibilities1.2a(1) Governance System. The BOT provides oversight toHFHS and all System boards with defined, reserved powers,such as approval of mergers/acquisitions, and operating andcapital budgets. HFHS achieves key aspects of governance asfollows:• Accountability for management’s actions. The BOTholds the CEO accountable for System performance. TheBOT approves and monitors progress against the Systemstrategic plan with monthly Dashboard OPRs. At least 20%of BOT meeting time is devoted to quality and safety issues.All BOT Committees provide quarterly updates to the BOT,including all compliance-related activities. When issues areidentified, SL develops and deploys improvement plans.The BOT reviews SL’s individual performance (1.2a(2)).FACE-TO-FACE AUDIENCE FREQUENCY PURPOSEHuddles E, V, Ph, Tr Weekly Teams meet weekly for key messages and updates using theTake Five tool.New Employee/ Leader/Twice/ HFHS CEO, COO, CHRO, CMO, and other PC leaders educate, motivate, andE, V, Ph, Tr, TPhysician Orientationmonth excite employees regarding the organization and present the MVV.All-Leadership &Semi- SL communicates the System’s MVV, strategic direction and key initiatives,E,TTown Hall MeetingsAnnually recognizes best practices in each pillar, and responds to questions.Staff Meetings E,V, Ph, Tr Monthly Communicate progress against goals, roll out initiatives, and recognize staff.Medical Staff Meetings Ph Quarterly Communication on patient care, quality/safety, & performance improvement.Leader Rounding All Continually SL discusses employee concerns; safety, quality, and service initiatives.Employee AdvisorySL obtains employee feedback on issues and programs and brings employeeEMonthlyGroupsideas and concerns to appropriate leadership forums.Board Meetings T Bi-Monthly Provide oversight of HFHS, discuss any issue raised by community members.Open Door Policy E, V, Ph, Tr, T Continually All leaders discuss employee concerns and ideas and provide coaching.Community Adv. Councils C, PQuarterly Provide and obtain input on current construction projects and process designs.Patient Adv. CouncilsSupplier OrientationP, C, E, Ph, Tr, S Quarterly Provide and obtain input on care design/redesign for quality, safety, or service.SQuarterly &as neededOrient suppliers to HFHS policies and practices that will impact them andobtain written certification as to their agreement to comply.PRINT AND E-CHANNELS AUDIENCE FREQUENCY PURPOSECommunicationProvide tools for managers to communicate and understand key messagesAllMonthlyToolkitsand respond to frequently asked questions.Newsletters (System,Bi-weekly,Articles from the SL provide updates about HFHS and local business unit activities,BU, Physician, Trustee, Allmonthly orperformance, and new programs/services as well as employee recognition.Community)quarterlyHFHS Morning Post E, Ph, Tr, T Daily Daily news that shares System information, HFHS news stories, & health care articles.e-Nancy E, V, Ph, Tr Continually Direct e-mail access to CEO provides a / communication forum.DocintheD.com All Weekly Blog by HFH CEO shares personal perspective on MVV and culture.Senior LeaderWeekly, The HFHS CEO provides timely updates using both audio and visual displays; theE, V. Ph, Tr, TVodcasts and BlogsMonthly HFH CEO maintains a weekly “Doc in the D” blog.HFHS Intranet (Henry) andCommunicate key messages & progress against goals (dashboards), policies &E,V, Ph, Tr, T Dailye-mailprocedures, clinical information, special announcements, newsletters, & articles.HFHS InternetProvides services, appointments, health topics, physician finder, clinicalAllDaily(henryford.com)information, Annual Report, MVV, health screening sessions, and links.Public Area Postings P, E, V, Ph, Tr Continually Post MVV and Patient Rights throughout System in public areas.Voicemail Broadcast E, Ph, Tr As Needed HFHS CEO communicates various key messages to all employees simultaneously.Bulletin Boards E,V, P, C Weekly Recognize staff, communicate progress against goals.Thank you notes All As needed Personal messages sent to individual’s home.Supplier Newsletter S Quarterly Inform supplier and partner community of activities likely to impact them.ComplianceConfidential HotlineAllAs neededProvides a way to share directly with leadership concerns about actions of HFHS orits workforce that pose regulatory or other risks.Pulse Surveys E, Ph As needed Obtain feedback on specific topics, generally using the HFHS Intranet.Bold = Two-way; E=Employees; V=Volunteers; Ph=Physicians; Tr=Trainees; C=Community; P=Patients T=Trustees; S=Suppliers/Partners

• Fiscal accountability. The Finance, A&CC, Investment,and Compensation Committees review plans, budgets, andstatus of operations, investments, and compensation. TheseCommittee Chairs regularly update the BOT.• Transparency in operations. All governance meetings includea full status report by pillar and Dashboard review.Trustees receive regular communications with System activities,market and competitive information, and healthcare environment news. The BOT actively participates inthe SPP. Federal tax filings, SL compensation, and communitybenefit information are shared with the BOT annually.The COI Policy requires all trustees to sign a statement regardingpotential business or personal conflicts (Fig. 7.4-4), and the BOT A&CC and Executive Committees addressany material disclosures.• Independence of internal and external audits. The VPof Audit & Compliance reports to A&CC for all strategicmatters and to the HFHS President and COO for daily operations.He meets regularly with the A&CC in executivesessions, and the A&CC Chair meets with A&C staff annually.A&CC appoints external auditors who conduct annualindependent audits. A&CC receives all external auditreports.• Protection of stakeholder interests. Stakeholder representationon boards, the Code, and our Just Culture set thefoundation for protecting all stakeholder interests. The BOTNominating & Governance Committee reviews the compositionof all boards to ensure members possess requiredskill sets and reflect each BU’s community, culture, and demographics.The BOT Public Responsibility & AdvocacyCommittee provides stakeholder representation.1.2a(2) Performance Evaluation. HFHS formally evaluatesand improves SL effectiveness as individuals and as a team.All employees are evaluated based on the Team Member Standards,and HFHS leaders are evaluated based on the LeadershipCompetencies, which use the Baldrige categories to frameHFHS leadership expectations (5.2a(3)). The BOT reviewsthe HFHS CEO annually based on her behaviors, LeadershipCompetencies, PMP goal results, and qualitative feedback fromkey stakeholders. PMP goals are linked to the pillars and incorporateHFHS’ performance and comparisons to data on similarlysized non-profit and for-profit health care organizations.SL members, including physicians, are evaluated by their directsupervisor using the PMP. Each receives formal mid-yearand annual reviews, including review of 360° feedback andperformance on the competencies, BU or departmental goals,and individual goals. Compensation is set based on these reviews,the scope of the individual’s roles and responsibilities,and independent market data, which is reviewed and approvedby the BOT Compensation Committee. Senior leaders use theirreviews to establish individual IDPs for the coming year. Thecombined review results are analyzed to assess effectiveness ofour HFLS and identify needed improvements. One example isaddition of courses for all leaders on setting specific, measurable,attainable, relevant, time-bound (SMART) goals.The BOT and all boards complete a biennial self-evaluation.They use Governance Institute data for comparison and creatework plans to improve the lowest scoring elements (Fig.7.4-3). This evaluation resulted in 2006 governance restructuring,including streamlining membership, formal charges forkey committees, and agenda planning meetings to ensure moretrustee input. The BOT Nominating and Governance Committeeincorporates reviews of each BOT member during theannual nominating process. All Quality Committee membersand new trustees receive an educational DVD on their role inquality and patient safety; in 2011 this and other educationalprograms are being expanded to all Boards and committeesmembers based on favorable BOT feedback. Our approach toBOT education is recognized by IHI as a best practice in healthcare.1.2b(1) Legal Behavior, Regulatory Behavior, and Accreditation.HFHS proactively identifies, assesses and addresses potential/perceivedadverse societal, legal, regulatory and environmentalimpacts from its services and operations (Fig. 1.2-1):• HFHS has an integrated compliance structure across allBUs to address issues related to legal and regulatory requirements.The VP of A&C serves as the Chief ComplianceOfficer and leads the HFHS Compliance Committee,which meets monthly and consists of BU Compliance leadsand other subject matter experts. Each BU has its own ComplianceTeam with dual reporting to the BU CEO and theVP of A&C. Annually, the Committee conducts risk assessmentsand develops integrated work plans in the areas ofgreatest potential risk, providing key input to the ERC. Thecommittee reports quarterly to the A&CC and annually tothe BOT. The Committee designs, oversees delivery of, andevaluates workforce Compliance education (all key segments,BUs); updates the Code; and oversees the independent,anonymous Compliance hotline and whistleblowerprotection policies.• Quality & Safety teams operate at each BU, monitoring allactivities with the potential for having an adverse impact onpatient care. This includes risks associated with equipment,new services, or operational changes. Incidents with thepotential for patient litigation are identified and monitoredjointly with a centralized risk management team. This teammonitors trends in regulations and ensures the workforce isappropriately educated, advising HFHSU on required contentfor annual mandatory education.• Research Administration and the Institutional ReviewBoard (IRB) and Institutional Animal Rights Committeeoversee potential risks from research. Research Administrationoversees all research projects and the integration ofevidence-based research into patient care protocols. TheIRB reviews all research protocols involving human subjects,ensuring that research is not impacted by conflicts ofinterest and that all relative risks and potential concerns arereflected in participant consent agreements.• HFHS incorporates the voice of the customer into designof new and ongoing services and operations. The BOTmembership ensures that key stakeholders are representedin the governance function of every BU. HFHS conductsbi-annual community health needs assessments (CHNAs)to identify the most critical needs and ensure communitybenefit initiatives address these areas. Supply Chain Managementproactively considers the impact of services andsupplies on society.

• HFHS conserves natural resources directly and through oursupply chain. Processes include: materials recycling, pestmanagement to use less toxic materials and target our processes,cleaning with low-volatile organic compound andGreen Seal products, stocking unbleached products in bathroomsand wash stations, high-efficiency lighting, food serviceprocess redesigns to reduce food waste, use of locallysourced products, and System-wide shift to healthier foodchoices. All new construction meets “green” standards, usingrecycled flooring products with low-volatile organiccompound finishes and “green” wall coverings.to the entire workforce and allows reporting of any concernsto supervisors, SL, or the BOT. The workforce is protected byour whistle-blower policy and encouraged by our open-doorpolicy. All staff use RadicaLogic or the 24-hour ComplianceLine (Hotline) to report concerns. We analyze data from thesesources for trends and review these analyses annually withSL, ERC, and the A&CC. Breaches of ethical behavior areinvestigated through Internal Audit, Compliance and/or CorporateLegal Services. As necessary, recommendations fordisciplinary action are made to HR for final determination,up to and including termination. Non-employee contracts requirecompliance with HFHS policies and standards for ethicalbehavior.Fig. 1.2-1: Accountability, Accreditation, Compliance andRisk ManagementPROCESSES MEASURE TARGETFiscal AccountabilityInternal audits Material Weaknesses ZeroExternal audits Audit opinion CleanInsurance Commission Submission (HAP) Acceptance AcceptedOMB A-133 Research Audit Findings ZeroAccreditation/LicensureJoint Commission, DNV Accreditation FullState─DOH Licensure License IssuedNCQA onsite reviews (HAP) Accreditation FullCHAP review (Home Health) Accreditation FullAccreditation Council for GME review Accreditation FullRegulatory/Legal CompliancePolicy─Mandatory training in HIPAA % attendance 100%Adherence to laws / regulations % compliance 100%OSHA reporting % compliance 100%EPA compliance management % compliance 100%NRC plan review Compliance LicenseRisk ManagementCompliance risk assessment Completion CompleteMedical equip. / technology training Conducted 100%Patient safety training Conducted 100%Lockdown and code drills Conducted 100%Ethics ManagementCOI Disclosure Policy % submitted 100%Planned Privacy reviews Plan completion CompleteSecurity screenings % screened 100%CMS Sanctions Checking % checked 100%Criminal background checks Completed CompleteAnnual HHS Breech reporting Completed CompleteEmployee Compliance Hotline Investigated 100%IRB reviews % completed 100%1.2b(2) Ethical Behavior. HFHS promotes and ensures ethicalbehavior in all interactions through: 1) the Code and COIDisclosure Process (1.1a(2)); 2) education at employee orientations,standards for workforce learning, and other formal andinformal trainings (5.2c(1)); 3) mechanisms for the workforceto share concerns and ask questions; and 4) proactively addressingregulatory and legal requirements.The Code is posted on our intranet and deployed to all BUand workforce members immediately upon hire. It is evaluatedand updated every three years. Annually, vendors agreeto abide by HFHS policies, standards, and the Code. Privatephysicians agree to abide by medical staff bylaws and expectationsof ethical practices upon appointment and reappointment.The COI Disclosure and Review process requires firstdollar disclosure of all external relationships annually by allmanagers, employed physicians, researchers, trainees, and allother persons deemed to be in a role to influence purchasingdecisions. A standard HFHS process provides guidance1.2c(1) Societal Well-Being. Our R&E and Community pillarsframe our consideration of societal well-being and benefit instrategy and daily operations. Leveraging our CCs of partneringand innovation, we contribute to our environmental, social,and economic systems.• During the SPP (Fig. 2.1-1, Steps 2-4), the PC analyzesthe Environmental assessment (EA) and SWOT for gaps inservices, demographic, market, and technology trends. TheR&E and Community pillar teams further analyze emergingtrends in their areas and identify SIs that will enable HFHSto achieve SOs. Pillar OPRs in operational forums are usedto track measures of benefit to our communities.• We serve as an economic engine for Michigan as one of thestate’s largest employers, contributing $5.8 billion in 2010(Fig. 7.4-12). Multiple approaches ensure employees’ andtheir families’ well-being (5.1b(2)).• We train physicians, researchers, nurses, and ancillary servicesstaff at all HFHS hospitals and many clinical locationsin partnership with WSU, targeting professions in greatestneed. Our role in health professions education contributesto the well-being of MI residents; one third of all MI practicingphysicians have trained at HFHS.• HFHS contributes to discovery and innovation. The researchenterprise allows us to pursue grants and researchcontracts from government, foundations, and private companies.Recent contributions, including robotic surgery, imagingtechnologies, and vascular surgery, all contribute toleading edge technologies for health care in the U.S. and internationally.Sample innovations are listed in Fig. 7.4-14.1.2c(2) Community Support. HFHS supports and strengthensour key communities through delivering needed servicesand leading and partnering with other organizations to positivelyimpact high-priority health issues. The Communitypillar team (CPT) analyzes multiple sources of health status,demographic, and socioeconomic information to identify keycommunities, prioritize specific population needs, and determinethe focus for HFHS involvement. The PC reviews andmakes final decisions on community pillar goals. Key communitiesinclude underserved and disadvantaged populations,prioritized by those with greatest needs. The CPT leveragesour CCs of partnering/collaborating, innovation, and care coordinationto design and implement SIs and action plans toaddress these priorities. The CPT monitors progress throughOPRs of action plans and performance measures and reportsresults semi-annually to the PC.

To improve access to care for people without adequatehealth insurance (Fig. 2.1-2, Community SI), a key communitygroup, we standardized policies and processesacross BUs for treatment of the uninsured, including on-sitecounseling and application support for medical assistanceprograms, discount policies for private paying (uninsured)patients, and clinical support and provision of specialtyreferrals for multiple community health centers. HFMGphysicians voluntarily staff two Community Health & SocialServices Centers (CHASS Clinics), federally qualifiedhealth centers that serve underinsured people. HFHS provided$3 million to CHASS Southwest Detroit to rebuildand expand their facility in 2010. We also staff a NeighborsCaring for Neighbors Clinic and Faith Community NursingNetwork (Fig. 7.4-8). We built a Medical Cost Avoidancetool that measures costs avoided or saved by our safety-netproviders. Nearly $1.4M has been saved in the last year.Other HFHS programs to support and benefit high-prioritycommunities include: 1) the School-Based and CommunityHealth Program, which takes primary and preventive careto Detroit classrooms; 2) the Institute on Multicultural Health,which provides research on health and health care ethnic andracial disparities, coordination of the Healthcare Equity Campaign,and community based health screenings and educationfor diabetes, hypertension, obesity, and hyperlipidemia; 3) apartnership with the Detroit Wayne County Health Authorityto facilitate care coordination and enhance efficiencies; 4) aHAP partnership with Weight Watchers to support memberweight loss (7.4a(5)); 5) SandCastles, a division of HFHSHospice, offering open-ended grief support for children andfamilies suffering the loss of a loved one; 6) the Detroit RegionalInfant Mortality Reduction Task Force, convened byHFHS and composed of all major health systems, public healthentities, academic and community partners; and 7) the LiveMidtown housing project benefit (5.1b(2)). SL and employeesactively participate in community service programs, and SLmembers personally serve on community service boards andlead collaborative initiatives including government, competitors,and foundations.2 Strategic Planning2.1 Strategy Development2.1a(1) Strategic Planning Process. SPP steps and quarterlytimeframes are shown in Fig. 2.1-1. The PC leads the annualplanning cycle and involves the BOT, pillar teams, BU teams,and other System teams as shown. EC established our shortterm(one year) and long-term (three year) time horizons toaddress fast-paced changes in the local economy and nationalhealth reform, ensure alignment with longer-term capital andstrategic project timelines, and foster disciplined deploymentand a focus on results. HFHS’s three-year rolling SPP is evaluatedand improved annually to ensure System/BU alignment,sustainability, and vision attainment. In 2010, using the MFI,the SPP annual cycle was revised to better integrate with thecapital and operational planning processes, to include a reviewof the HFHS business model, and to confirm key inputs andoutputs of each step.Fig. 2.1-1: HFHS Strategic Planning ProcessLEARNINGAPPROACHStep 1: Q1 – Q2 Step 2: Q2 (PC, BOT)PC, BOT A. Update EnvironmentalA. Analyze entire year Assessment and SWOTperformance on B. Review/affirm strategicSystem SIsadvantages, challenges,B. Review/Affirm/ and core competenciesUpdate Mission, C. Review/Revise BusinessVision, Values ModelD. Affirm/Update SOsStep 5: Q3 – Q4PC, BU, Pillar, System TeamsA. Create/update System & BUaction plans and identify keyperformance measuresB. Finalize workforce plans requiredto execute SIsStep 7: Q1 – Q4PC,BU, Pillar & System TeamsA. Implement action plansB. Review and improveorganizational performanceC. Incorporate and reprioritize SIsas opportunities ariseStep 3: Q2 – Q3BU, Pillar, System TeamsDevelop/Assemble NewSIs that:A. Align with System SOsB. Advance BusinessModelStep 4: Q3BOT, PC, BU, Pillar, System TeamsA. Review new & ongoing SI againstdecision criteriaB. Integrate into strategic, capital &operating plansC. Approve & communicate SIs toBU/Pillar/ System TeamsStep 6: Q4 – Q1BOT, PC, BU, Pillar & System TeamsA. Communicate plans System-wideB. Incorporate plans intodepartment/individual goals viaPerformance Management SystemDEPLOYMENTThe SPP is a seven-step cycle that spans an entire year ofscheduled, facilitated meetings. In Step 1A, the PC conductsa comprehensive, year-end performance review of HFHS andits BUs to determine trends, strengths and opportunities. Semiannualreviews of all SIs are accomplished through scheduledOPR sessions at PC meetings (Step 7). The PC reviews andreaffirms the MVV and oversees any needed updates with inputand approval by the BOT (Step 1B). In Step 2A, the PCanalyzes an EA and conducts a SWOT analysis. In Step 2B,reflecting on the year-end performance review, MVV, EA, andSWOT, the PC validates and/or updates the HFHS strategicadvantages, challenges, and CCs (P.1a(2)). Scenario modelsare created in Step 2C based on future market assumptions.Scenarios highlight future needed CCs and potential blindspots and allow the PC to revise the business model if necessary.The business model defines our mix of businesses (IP, OP,post-acute, community), clinical services, and geographic distribution.The PC affirms or updates the long-term SOs duringfacilitated, criteria-driven dialogues to ensure they drive sustainableresults and align with the business model (Step 2D).The proposed SOs are evaluated and balanced against stakeholderinterests by the BOT at its Q2 retreat. Since the BOT includescommunity members specifically selected to representthe diverse interests of key stakeholder groups (1.2a(1)), themembers challenge internal leaders to systematically analyzeall SPP inputs from key patient and stakeholder perspectives.In Step 3, BU, pillar, and other System teams develop and proposethree-year SIs that align with the System SOs and supportthe future business model. Prior to Step 4, each proposed SI ischampioned by a PC member responsible for creating a writtenproposal that includes high-level impact assessments ofhow the SI will address each prioritization criterion used (Step4A). To stay focused on results and successful implementationof existing SIs, proposals for new SIs are only solicited everythird year of the planning cycle. In interim years, only a few,opportunistic SIs are reviewed against the standard decisioncriteria and integrated into the existing strategic, capital, andoperating plans as appropriate (Step 4B). Using the SOs asINTEGRATION

a guide ensures the SIs created by the various teams supportthe MVV, foster our CCs, address our strategic challenges, leverageour strategic advantages, and align with the businessmodel. The PC reviews and prioritizes proposed SIs (Step 4C)using the following criteria to ensure organizational sustainability:1) impact on System integration and SO achievement,2) return on human and financial resource investments, and3) probability of successful implementation to meet the needsof key stakeholders. Two categories, Capital and Non-CapitalSIs, are ranked by the PC and reviewed by the EC. Priority SIsare cascaded to BU, pillar, or other System teams and assignedto permanent owner(s).In Step 5A, each SI owner is responsible for creating andmaintaining detailed action plans (2.2a(1)). Estimated revenue,expense, and capital projections are forwarded to Finance andused to refine the three-year operating and capital budgets, ensuringalignment. Each BU BOT reviews the System SOs andSIs to identify actions required to align local and System activities.In Step 5B the final SI and key BU-level action plans arereviewed by the PC to ensure HR, IT, and financial resourceneeds can be met, or to adjust action plan details or timingif necessary (2.2a(3)). The System Strategic Plan for the nextthree years, including operating and capital budgets to supportthe chosen SIs, is approved by the BOT each October.Fully reconciled System and BU-level plans and budgets arecommunicated (Step 6A) to all leadership, employees, partnersand suppliers through leadership meetings, newsletters,and emails/vodcasts (Fig. 1.1-2). Step 6B of the cycle cascadesSystem and BU action plans and performance targets to departments,then to individuals, and incorporates them into the PMP(5.2a(3)) for the coming year.Step 7 is ongoing as action plans are implemented by the assignedSI owners. The PC reviews dashboard and action planprogress, led by the SI owners, at bi-weekly OPR sessions(4.1b). Each System SI is reviewed at least twice per year, withadditional SIs reviewed as required by action plans or as theyare discussed for possible addition to the Strategic Plan. Thisroutine review and discussion fosters learning from comparativeperformance analyses and best practices. Owners of SIsnot achieving expected progress use the MFI (Fig. 6.1-2) toadjust actions and implement changes (4.1c).2.1a(2) Strategy Considerations. HFHS considers a broad setof strategic elements during the SPP.• The SWOT is created by Planning and support areas forvetting and revision by the PC and BOT (Step 2A). Input tothis assessment comes from the BOT and all PC members.• The EA, created at the beginning of the SPP cycle and updatedquarterly, contains indicators of major shifts in technology,markets, health care services, patient and stakeholderpreferences, competition, the economy, and the regulatoryenvironment. Knowledge sources are both internal (CDS)and external (MIDB, NRC, CRM, Press Ganey, the HCAB,Sg2, Thomson Reuters, SEM Data exchange, MDCH website,and competitor news briefings). For example, an Sg2tool summarizes historical trends and forecasts market shiftsfor each of the next 10 years, including impacts of popula-tion shifts, legislative reform, prospective payment changes,and shifts in technology and health care services. Patientand stakeholder preferences and changes are gathered usingNRC, CRM, and Press Ganey databases and customresearch. Focus groups and patient design team membersprovide feedback about specific assumptions or SIs.• Scenario planning addresses long term organizationalsustainability by modeling key regional and national environmental,payment, workforce, and competitor activityand performance assumptions into likely future scenarioswhich inform our strategic priorities. This modeling alsohelps identify potential new core competencies.• The ability to execute the strategic plan is assured in twoways: the decision criteria used by the PC to prioritize SIs(Step 4) and ongoing OPR (Step 7) of performance metricsand action plans utilizing the MFI.2.1b(1) Key Strategic Objectives. Key elements of the HFHSStrategic Plan, including the System’s SOs, SIs, action plans,and performance measures and targets, are shown in Fig. 2.1-2.Action plans are designated as short-term (implemented withinone year) or long-term (implemented over two to three years)based on the PC’s evaluation of market urgency and stakeholderand resource needs. The most important plans for 2011-2013appear in bold text in Fig. 2.1-2.2.1b(2) Strategic Objective Considerations. Our SOs achievethe following through systematic approaches.• Address SCs and SAs. PC analyzes the System OPR, theEA, SWOT, and scenario models to update our strategicchallenges and advantages. This analysis provides input toStep 2D, when the SOs are reaffirmed or revised.• Address innovation and business model. The SOs/SIsaddress opportunities in two areas: 1) new innovations(e.g., growth in new technologies, implementing new approachesto reduce harm) and 2) sustaining the business(staying current with programs and services while ourenvironment changes). Our innovation approaches, keyelements of our HFLS, and MFI ensure that SOs and SIsincorporate best practices and spawn innovations for localand national impact (Fig. 7.4-14). Our business model isrefined in Step 2 .• Capitalize on core competencies. Our CCs inform our selectionof SOs. SIs and their implementation leverage ourCCs and SAs. When the need to develop our current orbuild a new CC is identified during the SPP, this is factoredinto the relevant pillar’s SOs, SIs, and action plans. For example,we identified the need to evolve and develop ourCC of innovation and in 2010, established an InnovationInstitute with WSU to continue to lead in this area. Learningsfrom this partnership will inform design of new R&Eapproaches and new offerings through HFHSU.• Balance short and longer term. We achieve balance byensuring that the longer-term SOs are supported by SIs withshort- and long-term action plans. The quarterly EAs androutine OPRs allow us to identify and respond to new challengesand opportunities throughout the SPP cycle.• Balance key stakeholder needs. Patient, purchaser, andcommunity needs (current and changing) are incorporatedinto EAs, scenario planning, and SI prioritization criteria to

Fig. 2.1-2: HFHS Strategic Plan—Strategic Objectives; System Strategic Initiatives; Key Plans, Measures, and Performance TargetsSTRATEGICCHALLENGE/ ADVANT.*SC7SA1, 4, 6STRATEGIC OBJECTIVESBY PILLAR(KEY STAKEHOLDERS*)People: National leader inhealthcare employeeretention and engagement(KS1,2)SYSTEM STRATEGIC INITIATIVES(CORE COMPETENCIES*)Develop a competent, agileworkforce and build a culture ofdevelopment (C1, C2, C3)Develop a high-performance workenvironment with a highly engagedworkforce (C1, C3)KEY SHORT-TERM (ST) ANDLONG-TERM (LT) PLANS(Bold = most important)Develop & implement a flexible staffing model;internal staffing pool (ST)Enhance st yr. retention programs (LT)Focus on increasing engagement scores forbottom quartile leaders (ST)Conduct semi-annual pulse surveys foremployees, including toolkits and support for allmanagers (LT)KEY PERFORMANCE MEASURES(RESULTS FIGURES)(Bold = most important)Overall Employee Turnover(Fig. 7.3-3)Overall & Nursing Engagement Index,- scale (Fig. 7.3-15 )PERFORMANCETARGETS0Stretch0BESTCOMP07.3%4.35SC3,4SA1, 4, 5SC2, 5SA1, 4, 5SC1, 2 3, 6SA1 - 5SC 2, 5, 7SA1, 2, 4,5, 6SC5, 6SA1, 3, 4SC1, 2, 3,5, 6SA1 - 5Service: Best-in-classservice to our customersamong U.S. healthcareorganizations (KS1,2,3)Quality & Safety:National leader in deliveringsafe, reliable, high-quality,& highly coordinated care toeach individual patient(KS1,2,3)Growth: Dominant healthsystem in Michigan(KS1,2,3)Research & Education:Leading independentacademic medical centerand nationally preferredclinical research partner(KS1,2,3)Community: Nationalleader in communityhealth advocacy andinvolvement (KS1,2,3)Finance: Financialstrength to fund clinicalservices, healthmanagement, people,research, and educationstrategies (KS1,2,3)Create consistency of The HenryFord Experience at all HFHSfacilities (C1, C2, C3)Fully implement the HFHS No HarmCampaign via System and localcollaborative teams (C1,C2,C3)Reduce readmissions via dischargeand post-acute coordination (C2)Execute growth plans for hospitalsto capture market share (C2, C3)Execute physician integration andaccess improvements (C1, C2, C3)Alter insurance product mix to offsetshrinking HMO market (C1, C2, C3)Strengthen research and educationprograms through new medicalschool affiliation(s) and fullyintegrated allopathic and osteopathicGME programs (C1, C3)Improve access to care/services forthe Underinsured/Uninsured (C2, C3)Leverage the refreshed CHNAreport at all BUs and addressidentified community needs. (C2,C3)Achieve operating profit andphilanthropic donations sufficient tofund 3-year capital plans (C3)Share lessons and customer feedback tospread best practices (ST);Roll-out Culture of Service plan (LT)Implement best practices for reducing harm ineach of the harm categories (LT)Implement readmissions avoidance tactics atall sites (ST); System-wide case managementsystem (LT)Implement strategies to attract new businessto HFWBH and HFH (LT) and HFMH-WC (ST)Expand HFMG ambulatory centers in highgrowth markets; recruit needed physicians(LT)Launch new HAP products in preparation for0-0 enrollment periods (LT)Expand research capabilities and clinical trials toattract new NIH and other external funding (LT)Integrate Medical Education System-wide (LT)Increase support and utilization of communityclinicsImplement Community Benefit management andreporting structures for all BUs (ST); link to CHNA(LT)Continue revenue and cost managementprograms at all sites (LT)Continue philanthropic campaigns targeting externaldonors and employee contributors (ST)HCAHPS results at/above nationalbenchmarks (Fig.7.2-5)% Top Box, “Likelihood toRecommend” (Fig. 7.2-3,8,10)Harm events per 000 acute carepatient days (Fig.7. 1-1)Readmissions within 0 Days(Fig. 7.1-13)Tri-County IP Market Share(Fig. 7.5-11)CONFIDENTIAL100%90%ilen/a8.0%20.2%IP Admissions (Fig. 7.5-9) 116,686OP Visit Volume (Fig. .-) n/aTotal HAP membership (Fig. 7.5-15)NIH research grants and contracts(7.1b(1))n/a$33MTrainee Satisfaction (Fig. 7.3-14) n/aReady for independent practice(Fig. 7.3-14)Visits to Community Clinics (Fig. 7.4-8) n/aCommunity Benefit (Fig. 7.4-11) n/aSystem Operating Net Income (Fig. 7.5-1) n/aCost per Unit of Service (Fig. 7.5-2) n/a% Philanthropic Donor Renewal(Fig. 7.4-7)n/aPhilanthropy Cash Collected (Fig. 7.5-8) n/a*Strategic Challenges: SC1=Cost Control/Revenue Growth, SC2= Phys. Align/Accountable, SC3=Increased Competition, SC4=Increased Consumerism SC5= Care Redesign SC6= Care NeedsDiverse Population SC7= Workforce Support Strategic Advantages: SA1=”Can Do” Spirit, SA2=Strategic Geographic Positioning SA3=Community Support SA4=Commitment to Diversity/EquitySA5=System Integration SA6=Academic Mission Key Stakeholders: KS1=Patients (IP, OP, ED, CCS) KS2=Community (Detroit, Regional service areas), KS3=Purchasers (Employers, Health PlanMembers) Core Competencies: C1=Innovation, C2=Care Coordination, C3=Collaboration/Partneringn/a

address SOs. These assessments identify shifts among stakeholdergroups, such as purchasers needing new wellness-focusedinsurance products to offer their employees.• Adapt to sudden shifts. By re-evaluating our SOs/SIs annually,and through routine OPRs, PC can respond/adapt toboth evolving and sudden shifts in our environment.2.2 Strategy Implementation2.2a(1) Action Plan Development. Each SI owner creates adetailed action plan for initiative implementation using a standardformat (Step 5A-B) that includes specific tactics, performancemeasures for OPRs and Action Plan Monitors (4.1a(1)),and owners responsible for each tactic to drive accountability.Pillar or other System teams oversee implementation, monitorprogress, make midcourse corrections, and report summaryprogress to the PC at least semi-annually. Our SOs plus keySIs, short- and long- term action plans, and performance measuresare shown in Fig. 2.1-2. Key planned changes addressedin our on-site, detailed action plans include: rolling out CPNGfor enhanced clinical communications and information sharing(4.2a(2)), integrating clinical services through a new HenryFord Physician Network (HFPN), and expanding collaborationon education, innovation, and research with WSU. Ourintegrated System (SA5), CCs, and “can do spirit” (SA1) helpto keep us agile in adapting to health care reform and marketchanges (SC1, 2, 5; P.2b). Over the last five years, we havemade significant investments in our SOs, SIs, and infrastructure,made possible by our strategic and financial successes(7.5a(1, 2)).2.2a(2) Action Plan Implementation. Action plans are deployedthrough SPP Steps 6-7 using several mechanisms including:1) our communications system (1.1a(2), SPP Step 6A);2) incorporating plans into department and individual goalsthrough the Performance Management System (SPP Step 6B);and 3) implementing action plans (Step 7A), and 4) Systemwidedashboards and OPRs (4.1b, SPP Step 7B-C). A standardaction plan format and the System dashboard ensure teams usea systematic approach. The PC reviews System and BU SI plansas they are initiated and again throughout the year during OPRs.Once reviewed, aligned, and approved, new SI action plans arecommunicated and deployed System-wide to work units, suppliers,and partners (Fig. 1.1-2). The PC reviews progress andidentifies needed changes or improvements, and assigns specificaccountability for changes in plans. Changes to plans leveragethe MFI, ensuring alignment and the use of past learningto redesign the plan over time. Each team draws on our CCsto design and execute action plans. Our disciplined action planimplementation is a key element of our HFLS.The System dashboard is updated monthly and available onHenry and the BOT website (4.1b). Action plans and dashboardsare also used to convey progress to those suppliers,partners, and collaborators involved in particular SIs. Eachteam’s review of tactical status and performance outcomes ensuresthat barriers to progress are revealed and addressed andkey outcomes to action plans can be achieved and sustained.The successful processes are hardwired using the PDCA cyclein the MFI and shared System-wide through use of the KW(4.2a(3)) and other communication methods.2.2a(3) Resource Allocation. To ensure that financial, IT, andhuman resources are available to support the accomplishmentof our action plans, the PC coordinates its detailed action planningto coincide with the annual capital and operating budgetingprocess in Steps 4B and 5B. Proposed SIs and action plansundergo impact analyses, including capital and other resourcerequirements (Steps 5A-B) and implementation risks, and thecriteria used to prioritize SIs also consider impact on financialand human resources and availability of capital and operatingfunds. Capital and operating requirements for the selected SIsare included in the budget process. Human resource needs areaggregated across all action plans and reviewed by the HumanResources Executive Team (HRET) to ensure the people andskills necessary to deploy action plans are available. HRETsummarizes key gaps in human resource capacity (5.2a(1)),and the PC reconciles all resource needs during Step 5B.2.2a(4) Workforce Plans. Our key human resource SIs andplans are listed in Fig. 2.1-2 (additional People plans are availableon site (AOS)) and incorporated into the People SO ofthe strategic plan. HRET works with all BU leaders to identifyhuman resource plans, including potential future changes inkey workforce segments (P.1a(3)), to ensure each BU has thecapacity to achieve all its SOs with BU-level action plans andperformance targets. Key human resource plans for 2011-2013focus on the SIs of workforce planning, retention, and engagementand include implementing new flexible staffing models,retention approaches, and engagement toolkits to create a competentand agile workforce.2.2a(5) Performance Measures. Key performance measuresare shown in bold text in Fig. 2.1-2. Action plan progress isassessed using dashboard organizational performance measuresand action plan monitors (4.1b). The System dashboardincludes key System level performance measures associatedwith SIs. The performance measures and targets for specificplans are created to align with the System SOs (4.1a(1)). Forexample, the 2011 Quality/Safety performance target of 12.2%readmissions within 30 days aligns with the SI to reduce readmissionsvia discharge and post-acute coordination, which inturn supports the SO to be a national leader in delivering safe,highly-coordinated care.2.2a(6) Action Plan Modification. The PC conducts biweeklymeetings to review SI and BU action plans and performancemeasures to determine if adjustments are required(Step 7). SI owners not achieving performance targets use theMFI to modify action plans. Changes to the market, such asnew employers, businesses closing or downsizing, competitormoves (new facilities, new service offerings), new technologyopportunities (e.g. health care stimulus dollars for CPNG), orlegislative/regulatory changes are discussed throughout theyear by the PC. Scenario models inform PC members of potentialshort- and long-term impacts of market and economicchanges. Urgent issues requiring a more immediate responsethan the bi-weekly PC meetings are resolved by the EC. Anyrequired follow-up, including new or revised SIs or actionplans, is assigned to a specific owner for review at a futurePC meeting.

2.2b Performance Projections. Our 2011-2013 performancetargets reflect our projected performance and are based on historicaltrends, competitive benchmarking, and projected impactof implemented SIs (Fig. 2.1-2). Targets are developed by theassigned team, with input from functional experts and the MetricsCommittee (MC), and approved by PC (Step 5). In keepingwith HFHS’s commitment to “stretch” goals, our targets are usuallybased on the most aggressive comparisons to competitors,national standards, or benchmarks (4.1a(1)). Gaps and shortfallsare identified through OPRs and action plan monitoring and addressedby revising SIs or action plans. The improvement cycleapproaches described in 4.1b and 4.1c utilize each team’s pastperformance and learning to innovate and refine action plans.103 Customer Focus3.1 Voice of the Customer3.1a(1) Listening to Current Patients and Stakeholders.HFHS uses integrated listening and learning processes to hearthe Voice of the Customer (VOC, Fig. 3.1-1). VOC informationreaches us continuously from the: 1) patient satisfactionprocess (3.2b(1)); 2) relationship building process (3.2a(1)); 3)comment management process (3.2a(3)); 4) community needsassessments (1.2c); 5) access mechanisms (Fig 3.2-1); and 6)SPP (2.1a (1)). We tailor listening methods to different customergroups. Deployment of VOC methods range from leadershiprounding at all IP facilities to disseminating and responding toHAP member disenrollment data. In addition, a variety of listeningmethods recognize potential risks and/or adverse impactson our operations and address community concerns (1.2b(1)).Fig. 3.1-1: Listening and Learning MethodsMETHODSTAKE-HOLDERFREQUENCYRELATIONSHIPSTAGE*MHA Databases PT Continuous IP,OPCPM CHUI Data PT Continuous IP,ED,OPNRC PT Annually IPHCAB/Sg2PT, PU, C Semi-annually IP,ED,OP,CCSatisfaction/DissatisfactionMonthly IP,ED,OPPTSurveysAnnually HAPRadicaLogic PT Ongoing IP,ED,OP,CCComplaint System, Rounding PT Continuous IP,ED,OP,CCMarket Research PT, PU, C Ongoing IP,ED,OP,CCBOT Meetings PT, PU, C Quarterly IP,ED,OP,CC,HAPPt./Emplr Comm. Meetings PT, PU, C Ongoing IP,ED,OP,CCAdvisory Group Meetings PT, PU, C Ongoing IP,ED,OP,CCPI Teams PT, PU, C Ongoing IP,ED,OP,CC,HAPWeb site PT, C Ongoing IP,ED,OP,CCStakeholders Key: PT = Patients & Family Members; PU = Purchasers;C = Community Organizations. *Note: IP and OP include HFMGThe Planning, Marketing, and Customer Engagement (CE,3.2a(1)) Departments aggregate and analyze VOC information(Fig. 3.1-2) to identify improvements. Then, VOC informationis discussed and lessons shared across BUs through the PC, CESteering Committee (CESC), and other leadership forums todeploy best practices (4.1c(1)). Leaders also use this informationduring the SPP to shape SOs, SIs, and action plans.In all BUs, senior leaders/department heads conduct leadershiprounds to greet employees, patients, and families, and inquireabout service and safety concerns to capture actionable feedback.An hourly nurse-rounding program is deployed across allSystem hospitals, during which nurses assess the patient’s pain,Fig. 3.1-2: Voice of the Customer Inquiry ProcessHFHS Model forImprovementFig. 6.1-2Deploymentof StrategyCustomer Groups:PatientsCommunityPurchasersPrioritization(PC, SPP &BU level)CustomerListening &LearningMethodsFig. 3.1-1Analysis(PC, SPP)position, pulmonary hygiene, personal needs, possessions, andplace (the environment of the room). Following discharge orsurgery, hospital patients receive follow-up calls (based on diagnosis),and a 24/7 discharge hotline is available to patientsand their families for questions about post-hospital care, thehealing process, medications, or discharge instructions.For immediate and actionable VOC feedback, employees at allBUs and across all stages of the patient relationship close eachpatient interaction by asking “Is there anything else I can do foryou?” or “Is there anything that could have made your experiencebetter?” Employees are empowered to initiate immediateservice recovery using HEART (Fig. 3.2-2). Service recoverysteps are introduced to all workforce segments at orientationand reinforced through weekly huddles and monthly toolkits(3.2b(1)). Most of our hospitals offer patients an innovative,real-time electronic mechanism to input immediate and actionablefeedback such as concerns, requests, or complimentsduring their hospital visit. Patients express a concern and/orcompliment electronically via their television, and hospitalleadership responds immediately to the patient’s concern. Allfeedback is logged, and hospital leadership reviews it monthlyfor trends to develop action plans.For employer VOC feedback, HAP uses an outreach programthat includes four telephone touch points during the two yearsafter the employer signs with HAP, timed to occur after the employerhas rolled out key services (e.g., ID cards distribution)and completed enrollment. Feedback from HAP agents andemployer decision makers identifies systemic issues and helpsHAP design short and long-term resolutions. HAP also has anindividual member outreach program that includes four member-specifictouch points over the two years following sign-up.HAP’s Member Services staff assess the member’s understandingof the program and satisfaction with HAP services, thendocument and share feedback. HAP listening posts include theLabor Advisory Board and the Agent/Producer Advisory Board,which are employer forums conducted several times a year.To address SC4, social media experts within the HFHS WebServices Department monitor social media responses and acknowledgepatient and community member compliments andcomplaints. The team receives alerts when HFHS keywordsare used in any online venue. These posts are addressed in realtime.The staff direct customers to the right forums as neededand has authority to quickly resolve customer concerns and

complaints. HFHS has begun using Google Alerts and GoogleTrends to listen and learn from current, potential, and competitors’patients. The social media staff uses these tools to followtrends and provide insights into broad patterns for the HFHSSE Leaders, along with the summarized complaint data fromRadicaLogic (3.2b(2)).3.1a(2) Listening to Potential Patients and Stakeholders.HFHS employs formal and informal methods for obtainingactionable feedback from competitors’ customers, former patients,and community members. Formally, HFHS monitors:• Patient referrals from physicians via our concierge program• Health care trends and behaviors through the NRC surveyprocess (Fig. 7.2-1) that includes listening insights fromformer and potential customers and competitors’ customers• HFHS’s competitor database, which provides demographicand market information by service and geography• HAP member transfers to another network. We monitor thenet increase or decrease in members from one independentpractice association (IPA) to another.Informally, the Marketing and PR Departments review informationfrom local media, competitor websites, advertisements,and press releases. We also obtain feedback on our servicesthrough discussions with trustees, partners, and communitycollaborators. All these data are analyzed by demographic andservice line segments. Environmental updates are preparedby Planning, Marketing, HAP Planning, and strategic supplier/partners(Fig. P.1-8) throughout the year. These updatesare discussed at PC and other leadership venues. The PlanningDepartment also completes an annual EA that includes newhealth care issues, local community economic and politicalconditions, competitor tactics within the region, and projectedimpacts on HFHS. The PC reviews these analyses and competitivedata in Step 2 of the SPP to provide input into our SOsas well as throughout the year during routine OPRs.3.1b(1) Satisfaction and Engagement. In early 2011 SL creatednew organizational infrastructure around the Service Pillar tofocus on customer engagement. Three System leaders now ownthe entire continuum for the CE Department. This new structureis accountable for creating a System-wide approach to service,leading to a consistent experience for all HFHS customers. Thisstructure includes two new process improvement managers, ongoingleadership by the SE BU leaders, and SE Champions atthe departmental and unit level.Determining satisfaction and engagement. PG surveys areused for patient satisfaction measurement across all BUs, exceptfor highly specialized services such as medical equipmentand optical sales, which use surveys that allow for feedback onthose specific services (results on site). Questions on the IP, OP,ED and Community Care satisfaction surveys are tailored to thestage of the relationship. SE Leaders benchmark the data by surveytype to national and local peer groups. In 2008, “likelihoodto recommend” was added as an engagement and loyalty metricto the System dashboard (4.1a(1)), and specific improvementgoals were developed around this measure. In 2009, HFHSadded “top box” (the % of five ratings on a scale of 1-5) for the“likelihood to recommend” metric to the System dashboard.Satisfaction/engagement surveys are mailed to patients’ homeswithin two weeks of an encounter or discharge and returneddirectly to Press Ganey (PG). Department leaders have nextdayaccess to data through PG’s InfoEdge system, allowingrapid identification of process improvement opportunities.InfoEdge also contains analysis tools that identify top opportunitiesand key drivers of patient satisfaction that can be drilleddown to unit level performance. Educational courses (5.2c(1))presented by Quality/Safety staff and SE leaders help managersinterpret data and design and implement action plans. System-widesatisfaction and engagement results and priorities forimprovement are summarized monthly by the CE Departmentand shared with PC (3.2a(4)). PG creates quarterly reports forSL showing cross-BU results in each survey area (IP, ED, etc.)compared to benchmarks. Reports are posted on the Intranetfor employees to view. The PC also reviews PG results acrossBUs each month as part of OPRs (4.1b). Leaders overseeingvendor contracts review survey data with suppliers and partnersto identify improvements. Depending on the initiative,satisfaction and engagement results are shared with collaboratorsand partners, such as Patient Advisory Groups, automotivebenefit executives, MHA, and IHI. PG patient survey resultsare also available on henryford.com for patients, families, potentialpatients, and the community.HAP uses multiple approaches to determine member satisfaction,including the annual subscriber survey (Fig. 7.2-17), aprimary care access survey, call center spot surveys, and healthplan specific surveys such as CAHPS (Fig. 7.2-16) for eachof its insurance products. Comparisons are made to national,local, and competitor health plans. HAP’s Quality Departmentand senior leaders assess trends, then implement and track improvementplans.3.1b(2) Satisfaction Relative to Competitors.Obtaining and using comparative information. We obtain anduse comparative information on patients, families, and communitiesin two distinct ways: 1) market research and patient,family, and community focus groups, and 2) customer surveysthrough PG, HCAHPS and CAHPS, which provide satisfactionand engagement comparisons to hospitals and health plansin SEM, MI, and the U.S.Market research & focus groups. Listening methods (Fig. 3.1-1) are supplemented with patient and community focus groups,mystery shopping, and other research to ensure initiatives anddesigns meet stakeholder needs. BUs use focus groups to assesssatisfaction with competitors, identify new service opportunities,and drive improvement. Market research tools such asNRC and Market Measurement compare the satisfaction andhealth system preferences of both current and prospective customers(Fig. 7.2-1).Customer surveys. PG provides national and local levelcomparisons and practices of high-performing organizations(3.1b(1)). HCAHPS is a standard, publicly reported surveyinstrument and data collection method for measuring patients’11

perspectives on hospital care (Fig. 7.2-5). CAHPS surveys areused to rank health plans relative to each other (Fig. 7.2-16).Both HCAHPS and CAHPS surveys allow us to compare ourperformance to our competitors by name, and all three surveysallow us to identify specific issues and improve services. Eachof these data sources is used to evaluate process performanceand set priorities for improvement through the SPP (Fig. 2.1-1, Step 4), OPR process (4.1b), analysis of daily operations(6.2b(1)), Baldrige-based assessments, and all componentsof our integrated performance improvement system (P.2c,6.2b(4)).3.1b(3) Dissatisfaction. All methods for gathering, analyzing,and reporting patient and member satisfaction and engagementdata also serve to measure dissatisfaction (3.1b(1)). Quantitativedata come in the form of low scores, and qualitative dataare derived from complaints and comments, focus groups,websites, social media and through verbal or telephone commentslogged in RadicaLogic’s complaint management system(Fig. 3.2-3, Steps 2-3). Complaint information from dissatisfactioncomments in surveys is also shared with IT, food service,housekeeping, and other partners to increase patient satisfactionand evaluate partner performance (3.1b(1)). Complaintreports are generated at the BU and System levels and sharedwith SE Leaders monthly to identify common themes. Whenappropriate, work teams are created to develop improvementplans. These are reviewed for progress by the CESC.A mystery shopping program is conducted at HFMG sitesto assess our Customer Service Representatives (CSRs). Wereceive the results within 48 hours and share them with themanagement of the clinic where the shop occurred. Commonthemes are shared at monthly CSR forums to improve performance.Leadership at these sites developed key greeting expectationsfor CSRs at the front desk and used an audit tool tomonitor the PG item “Courtesy of registration staff.”3.2 Customer Engagement3.2a(1) Health Care Service Offerings. During Step 3 of theSPP, the PC draws on research (including shifts in technology,health markets, and patient preferences) and recommendationsfrom BU and other System teams on emerging best practices toidentify opportunities for innovative service offerings. Prioritizedinitiatives are translated into action plans and assigned toteams for implementation. Key inputs to this process include informationreceived through listening posts (Fig. 3.1-1) and fromhealth care research partners. For example, the CISC continuallyresearches and deploys new approaches to coordinate andcustomize care based on the patient’s specific needs and preferences(6.2b(2)). Other innovations implemented by the CISC includedeployment of Patient Centered Team Care (PCTC), ande-care opportunities such as e-visits, e-scheduling, e-prescribing,and the MyHealth portal (3.2a(2)). E-prescribing initiallystarted as an innovation with the auto industry, was extendedthroughout HAP, and is now a practice industry-wide that hassignificant impact not only within HFHS, but nationally.The PC, BUs, and Marketing use the VOC inquiry process(Fig. 3.1-2) to identify new or improved service offerings toattract new patients. Consumer Research and Listening is usedto assess the extent to which current service offerings meetor exceed prospective patients/stakeholders’ needs, includingthose of competitors’ customers. BU-tailored approaches, suchas focus groups, are used by Marketing to provide greater insightand to identify and prioritize opportunities for expandingrelationships with new or existing patients/stakeholders.Trends gathered by Planning and Marketing Departments onhealth care utilization, customer listening and learning. and patientpreferences guide determination of key patient and stakeholderrequirements (Fig. P.1-7). During the SPP and OPRs(2.1a(1) and 4.1b), the BU, pillar, and SI teams and PC discussthese data to identify differences across market segments andstages of patients’ relationship with us. This routine review enablesthe teams to design processes that respond to changingcustomer needs (6.2a(1)). Patients, community members (includingpotential patients), and other stakeholders also participateon design teams to provide input. This ensures we designhealth care services that respond to changing patient expectations,as well as attract new patients. For example, before HF-WBH patient rooms were built, more than 2,000 people – medicalstaff, patients, families and community members – touredprototype patient rooms to evaluate the facilities (such as roomconfigurations, furniture, and equipment). More than 70 designchanges were made based on extensive feedback. The samefeedback was incorporated into renovations at HFH in 2009.A Meds to Beds program was established in 2004 to improvepatient satisfaction and medication compliance at one of ourdialysis centers. Since then, pharmacy services have been expandedto provide bedside/chairside delivery to our dialysiscenters, oncology patients, EDs, and IP discharges at HFH andHFWBH and to school-based health clinics. We continue tofurther deploy personal delivery across the System.HFMG’s PCTC, modeled after Advanced Medical Home research,was created and then spread across HFMG centers tobetter manage care of patients with chronic diseases. PCTCputs responsibility for important aspects of self-care and monitoringin patients’ hands, along with the tools and support theyneed from physicians and case managers to define and implementindividualized care plans. The PCTC model ensures thattransitions between providers, departments, and health caresettings are respectful, coordinated, and efficient.3.2a(2) Patient and Stakeholder Support. SL uses the SPP(2.1a(1)), OPRs (4.1b), and the MFI (Fig. 6.1-2) to design andimprove key mechanisms to support use of health care services.Our customer listening methods (Fig. 3.1-1) are supplementedwith community focus groups and other research to ensureour initiatives and designs meet patient and stakeholder needs(3.2a(1)). We know from primary care market research that keycustomer requirements (Fig. P.1-7), regardless of the customer’sage, gender, or geographic location, include being seen within 24hours of getting sick, so improving access to physician appointmentsremains a priority for HFMG. Key support requirementsare communicated and deployed to all staff through employeeorientation, annual education, and internal communications, andto specific groups as needed through training and partner meet-12

ings. BU or segment-specific support requirements are also deployedthrough the BU Service Excellence teams.Our size and stakeholder diversity demand multiple mechanismsto support the use of health care services, including personalinteractions, mail, phone, the Contact Center, communityoutreach, and 24/7 Web-based health information through ourpersonal health page portal, MyHealth (Fig. 3.2-1). The ContactCenter and website represent recent innovations to support ourpatients and stakeholders and their changing requirements.Fig. 3.2-1: Patient and Stakeholder Support MechanismsMETHODSTAKEHOLDERSSEEKING INFO.STAKEHOLDERSUTILIZING SERVICESLetters PT, PU, C −Web, including MyHealth PT, PU, C PT, CContact Center PT, PU, C PT, CInterpreter Services PT, PU, C PT, CProviders PT, C PT, CPatient Advocates PT, C PT, CPublication, mailings PT, PU, C −Patient/Family Orientation/Educ. PT −Television / Radio PT, PU, C −Support Groups PT,C PT, CCommunity Outreach PT, C PT, CStakeholders Key: PT = Patients & Family Members, PU = Purchasers,C = Community OrganizationsUsing market and customer satisfaction data, the MarketingDepartment and SE Leaders identified convenient access bytelephone and Web as an important patient and stakeholder requirementand potential growth opportunity. As a result, HFHSimplemented a centralized Contact Center and has continuedto make improvements to better meet customer needs. It isstaffed by advocates who respond to inquiries using scriptedgreetings and defined protocols to schedule appointments,verify insurance, and provide other information about servicesfor patients, physicians, and employees. They also assist withproblem resolution and arrange lodging, language/hearingimpairedinterpreter services, and transportation.Through our listening approaches, we determined that theWeb, available 24/7, is a key mechanism for seeking informationand using services (3.3 million visits to henryford.com in2010). Since its inception in 1999, MyHealth has been used bymore than 50,000 patients to interact with physicians and officestaff for lab and test results, prescriptions, appointment scheduling,and e-visits. E-visits are available at all HFMG clinicsand provide virtual medical consultations using online patientinterview algorithms. Patient responses are reviewed by a physicianto make clinical decisions and treatment recommendations.This innovation enables patients to receive consultationon more than 6,000 health issues without an appointment. My-Health is integrated with the patient’s record to document allelectronic communications. Other offerings on henryford.cominclude the HFHS Health Products e-commerce site, PharmacyHome Delivery for new or renewed medications, and onlinemammogram appointment scheduling.To address and consider each patient’s expectations, we usecustomer listening/learning to design services that meet specificpatient needs. For example, the Detroit metro area has the largestArabic population in the U.S. To better serve this community,Arabic-speaking female providers are available for femalepatients and Arabic translation is provided on our website. Thesite also helps patients select compatible providers. For patientsand other stakeholders without online access, many other accessmechanisms are available (Fig. 3.2-1). Key communicationmethods include direct mailings from physicians, such as thosemade available through the Healthy Living Senior program(3.2b(1)). Quarterly, patients and other customers receive brochuresand invitations to conferences targeting relevant healthcare topics, such as the HAP Wise Woman program (3.2b(1)).Routine System communications (Fig. 1.1-2) help deploy newservices and ensure processes remain aligned with THFE.3.2a(3) Patient and Stakeholder Segmentation. Annually,HFHS Planning and Marketing Departments identify currentand prospective market segments by analyzing patient origindata (ours and competitors’), employer group data, servicearea demographics, incidence of disease in our target market,and trends in similar markets nationwide. Planning developsanalyses of geographic markets and estimates potential patientsin the market (competitors’ patients and HAP memberswho are not currently HFHS patients). This information is usedas inputs to Step 2 of the SPP. The PC routinely monitors marketperformance, identifying target market segment opportunities,tracking and reporting progress, and measuring results.Examples of using patient and market data to identify new segmentedservice offerings include:• Building a dialysis unit on the HFMH campus in an areashowing a significant increase in end-stage renal disease.• Building HFWBH in an area of strong growth and high patientdemand for IP services.• Building the Henry Ford Medical Center–Brownstown ina growing community that has few OP health centers in afive-mile radius.• Building an OptimEyes SuperVision Center in Oakland, anarea of strong population growth.The HAP Marketing department identifies prospective employerseach year using databases segmented by geography, employersize, and industry type. For new markets, HAP reviews demographics,businesses and industry, population, and estimatesof potential employees to determine growth opportunities.3.2a(4) Patient and Stakeholder Data Use. PG (3.1b(1)) providesuseful interpretive data, such as priority index—items mosthighly correlated with satisfaction—to provide focus on serviceconcerns. HFHS leaders use data from market research and customermeetings to increase patient, family, and community focus,improve marketing, and identify innovations. Patient, family,employee, and community advisory boards identify serviceconcerns, innovation opportunities, and product/service gaps.HCAB, Sg2, NRC, and the EA are reviewed by PC to build amore patient-, family- and community-focused culture with moretargeted marketing priorities. Opportunities for breakthrough orinnovative improvement are identified during OPRs (4.1b) atregular PC, pillar, and other leadership and improvement teammeetings. This results in targeted service offerings to patient segmentssuch as our new CCS Self-Health Centers, where we offerchronic care programs to meet the ongoing physical, psycho-social,emotional, and spiritual needs of the patient. These programs13

are managed and monitored by Self-Health Coaches (SHCs) whoprovide motivational support and assist patients with patient education,nutritional guidance, and support groups.When HAP surveys and focus groups indicated our customersoften could not leave work to see a specialist, HFMG introducedoptions for evening and weekend specialty appointments.Over the first several months of these new hours, 91.7%of available patient appointments were booked in the earlymorning, late evening and on weekends.Marketing tracks responses to advertising campaigns to determinehow to best communicate services to patients and makeinformation accessible. Through web user analysis, CRM returnon investment (ROI) analysis, and NRC preference studies,Marketing can gauge its effectiveness and improve servicesto build a more patient and stakeholder-focused culture.We use customer feedback obtained through market researchand advisory groups and pilot and review new techniques frominside and outside of health care. Yearly, the PC, with inputfrom Marketing and the SE Leaders, evaluates listening andlearning methods based on usage, results, and accuracy of data,validating these against industry benchmarks and satisfactionwith the vendor.3.2b(1) Relationship Management.Acquiring new patients and stakeholders. The PC, with BUleaders and Marketing, is responsible for identifying key targetaudiences, developing growth and relationship-buildinginitiatives, and designing marketing plans to implement newbusiness opportunities. For example, the following programswere implemented to create long-term relationships with twogrowing segments:• The Healthy Living Senior program builds senior loyalty (age55 +) by establishing connections during non-crisis times.• The WiseWoman program develops stronger relationshipswith female HAP members (age: 35-54) through targetedcommunications and special health-related events.Meeting requirements and exceeding expectations in eachstage of the relationship. As an integrated health system, HFHSis well-prepared to respond to requirements and expectations ofpatients across the continuum of care. Care coordination, a corecompetency, is critical to every stage of patient and stakeholderrelationships: OP, IP, ED, and CC (Fig. P.1-7). Requirementsand expectations vary at each stage based on demographics andhealth factors. We have built multiple processes and strategies toincrease engagement in a competitive environment.Increasing engagement. To ensure a consistent, integrated,and positive patient and stakeholder experience, we focus allteam members on excellence across the pillars to create THFE.In addition to leveraging our core competencies (Fig. P.1-4),THFE is supported through the PMP, basing performance expectationson Leadership Competencies, Team Member Standards,and personal performance goals aligned with the pillars(5.2a(3)). Leader and workforce development plans identify theknowledge and skills required for high performance and a focuson patients and stakeholders (5.2c(1)). HFHS promotes a serviceculture through both employee engagement strategies and14System-wide tools and practices such as THFE reference pocketcards, daily huddles, and the Lasting Impressions Framework,which includes a standardized service recovery approach (Fig.3.2-2). Specific courses throughout HFHSU provide training onthese tools to ensure our employees deliver THFE. By the thirdquarter of 2011, the SE Leaders will complete deployment ofthe HFHS service culture philosophy to the entire workforce,including trustees, physicians, trainees, and volunteers throughorientation programs and toolkits.Fig. 3.2-2: THFE Lasting Impressions FrameworkFIRST We will greet everyone with warmth, friendliness and aIMPRESSION smile whether by telephone, computer, fax, or in person.SERVICE We will deliver high-touch care that is reliable, responsiveDELIVERY and coordinated.SERVICERECOVERY(HEART)LASTIMPRESSIONEVALUATIONHear the concern or complaintEmpathize with the customerApologize regardless of the situation or faultRespond, reassuring the customer the problem will beaddressedThank the customerWe will thank customers for choosing HFHS and invitethem to call on us again.We measure our success by obtaining clinical excellence,customer satisfaction & positive business results.SL continually deepens customer knowledge through the patientsurvey process (3.1b(1)), market research and patient focusgroups, and participation in local and national benchmarkingand research. The CPT keeps patient relationship-buildingmethods current through our CHNA and planning processes(1.2c). SE Leaders use patient surveys, market research, andcommunity needs assessments to determine if customer relationshipapproaches exceed expectations and build engagement.Based on analysis of these assessments, SE Leaders recommendimprovements to current practices and action plans to the PC.Once improvements are defined, BU leaders are accountable forimproving customer relationships and access mechanisms at thelocal level. Process changes are shared with the PC to monitorprogress and support System-level learning.3.2b(2) Complaint Management. A standardized complaintmanagement process is used across all BUs, supported by Radica-Logic, an online system for reporting and aggregating compliments,comments, suggestions, and complaints. Feedback canbe received in person, by phone, letter, e-mail or social media(Fig. 3.2-3, Step 1). Complaints are entered into RadicaLogic,routed to the responsible manager, tracked for resolution, andtrended. Complaints are handled initially at the point of serviceand then reviewed at the BU level to promote efficient responseand follow-up. More severe complaints are escalated to higherlevels of leadership. SE staff at each BU oversee the entire compliment/complaintmanagement process and ensure appropriatefollow-up and service recovery. A System-wide service recoverypolicy makes service recovery everyone’s responsibility.HEART (Fig. 3.2-2) is the model used in all service recoveryefforts. Complaint feedback is aggregated, trended and analyzedby the CE Department Process Improvement Managers. This informationis shared at CE meetings with SE Leaders, who worktogether to identify improvement opportunities across BUs andto share best practices. In addition, the Web Team social mediaexpert monitors complaints made through social media to identifysignificant issues to be addressed. These are aggregated andprovided to the appropriate SE leader for resolution.

Fig. 3.2-3: Complaint Management ProcessSTEP4 Measurement, Analysis,and Knowledge Management4.1 Measurement, Analysis, and Improvement ofOrganizational Performance4.1a(1) Performance Measures. In 2009, the MC was createdto improve OPR and knowledge management. It meetsmonthly, co-chaired by the HFHS CFO and SVP PerformanceManagement, and includes operational and functional leadersfrom each BU and pillar. To further develop analytics as acore strategy, an Operational Analytics (OA) Department wasadded in 2011. Roles are detailed in Fig. 4.1-1.Fig. 4.1-1: Functions of MC and OAFUNCTIONMCOA123456ACTIONSFeedback enters the System from letters, Website,Patient Advocates, SE Departments, inpatient rounds,employees and surveys.Feedback is routed to online system: notification sent todepartment leader with direct responsibility for resolution;oversight by Service Excellence Teams or PatientAdvocates for timely resolution.Customer receives acknowledgement (by phone, email orletter), is thanked and informed that their complaint will beinvestigated, and a follow-up letter is sent within 7 days.Customer is contacted again with resolution.Feedback report available to BU Leaders who reviewtrends monthly and determine if process improvementsare needed to address recurring issues.If so, BU leaders charter process improvement teams;new processes are implemented and satisfactionmonitored by the BU leadership team.Trends in complaints across BUs are reviewed by the SELeaders at monthly meetings. System-wide trends, bestpractices, and common complaint areas are discussed atPC; plans are executed by BU CEOs.ROLEProvides oversight and counsel for development andrefinement of performance metrics and dashboards atthe System, BU, and pillar levelsPromotes vertical and horizontal alignment andintegration of the measurement systemAdvises/supports BU department leaders andimprovement teams in selection and use of processmetrics and action plan monitors in dashboardsEnsures the proper infrastructure and technology are inplace for gathering, reporting, analyzing and integratingdata and information.Oversees the content and maintenance of knowledgemanagement including the HFHS KW (a tool whichallows the sharing of improvement projects (4.2a(3).Provides the necessary infrastructure to ensurepertinent, accurate, and actionable information areavailable to decision makers.Metrics are organized into three categories: 1) OrganizationalPerformance Measures (OPMs), 2) Work Process Measures(WPMs) and 3) Action Plan Monitors (APMs). OPMs are selectedeach year by System or BU teams. The PC approves afinal set of System OPMs (Fig. 2.1-2) in SPP Step 5 after reviewby the MC. The System dashboard is used to track OPMsmonthly (4.1b). WPMs assess work process performance (e.g.,access to services, supply chain management) against key processrequirements (Fig. 6.1-3). WPMs are selected based on theknowledge needed to manage the organization, deliver patientcare, and meet/exceed regulatory and accreditation requirementsand industry standards. WPMs are updated annually by the MCand BUs. WPM results are reported daily, bi-weekly, monthly,or quarterly, as required to manage operations. APMs assessprogress of action plan tactics and monitor SIs and other PI effortsat the System, BU, and/or department level, and supporteffective decision making and execution (4.1b). OPMs, WPMs,and APMs are used at all levels of the organization (Fig. 4.1-2).Fig. 4.1-2: Alignment and Integration of MeasuresDept.HFHSEnterpriseBusinessUnitsIndividualsSystemTeamsLocalTeamsAction Plan Monitors (APMs)The MC uses criteria to guide selection of measures. All measuresmust: 1) align with internal/external customer requirements,2) be readily collectible (automated collection is ideal),including balancing utility with the ease of data collection, 3)be easily understood and consistently defined, 4) be reportableat necessary frequency, 5) have sound comparative benchmarksor historical trends, and 6) be aligned with key initiatives orwork processes so progress on the System SIs can be readilyaccessed and communicated (Figs. 2.1-2 and 6.1-3). Performanceindicators must also have defined owners, a defined audiencefor reports and reviews, and clear accountability.The annual process to review and select metrics for Systemand BU SIs (SPP Step 5) is as follows:1. SI and work process owners review current metrics, usingfunctional experts and the criteria as guides, and recommendcontinuation or alternative measures.2. MC evaluates metrics against the criteria, recommendingrefinement to owners if necessary.3. A metric scoping form is completed for each System andBU metric with measurement and reporting frequency, datasource, and process and responsibility for data collection,including specific definitions.Our IT systems support data gathering, OPRs, decision-making,and innovation (4.2a(2)). Whenever possible, these systemsautomate data-gathering and work processes, reducingreliance on costly and time-consuming chart reviews that candelay performance reporting. Selection and use of appropriateperformance metrics and comparisons, along with identificationand use of aggressive improvement targets, foster the searchfor innovative solutions to drive breakthrough performance.For example, review of positive patient engagement data atHFWBH led to deployment of the hospital’s real-time servicemeasurement system to other System hospitals (3.1a(1)).4.1a(2) Comparative Data. Selection of relevant comparativedata is an integral part of our overall measures selection process(4.1a(1), criterion 5). Comparative data (P.2a(3)) are used to15

identify improvement targets for the System, BUs, and departments.Prior to selecting a comparison, we assess the comparativedatabase to ensure: 1) best-practice or top-decile comparatorsare available 2) peer groups are similar in size or serviceto HFHS, 3) sample size is sufficient to draw conclusions, and4) the compared organizations include competitors, health carehigh-performers, and role models from other industries (to supportour innovation CC). Although availability of good comparativebenchmarks is one of the criteria we use to select ourperformance metrics, there are times when initiatives involveinnovative approaches for which comparative data are not yetavailable. In these cases, we benchmark other industries to identifycomparative approaches and lessons to guide our actionplans. If necessary, we use our own performance over time to setnext-year goals until external comparisons become available.4.1a(3) Patient and Stakeholder Data. We use data and informationfrom listening and learning (3.1a(1)) at SPP Step 3to develop SIs. Key requirements are identified from patientsurvey data on the “top ten” areas most highly correlated withsatisfaction. Service concerns and best practices are collectedfrom surveys; patient, family, and community advisory boards;and complaints (3.2b(2)), and summarized for each departmentand BU. These data are reviewed during OPRs to understand opportunitiesfor improvement or breakthrough innovation.4.1a(4) Measurement Agility. SPP Step 5 includes an annualreview and update of the metrics to ensure meaningful evaluationof new and continuing initiatives. To further ensure agility,the MC may recommend additional measures or segmentationthroughout the year based on new requirements, changes in thebusiness landscape, or new priorities. To improve display of organizationalperformance, the MC has conducted multiple cyclesof learning with the System dashboard, in place since 2007(4.1b). We stay current with emerging measurement trendsthrough participation in national and local improvement programs,such as the IHI 100K and 5M Lives campaigns, the IHIImproving Care at the Bedside collaborative, and MHA Keystoneinitiatives focused on hospital safety. In addition, seniorleaders participate in or lead national organizations such asAHA, AMA, ACC, NCQA, and NQF, where they stay abreastof changing metrics and have the opportunity to shape futurehealth care measurement.4.1b. Performance Analysis and Review. OPR occurs as partof the Check step of the HFLS (Fig 1.1-1) in all HFHS entities.The PC reviews BU and System OPMs and APMs on aspecific schedule, finalized at SPP Step 5 (2.1a(1)). StandardAPMs (e.g., on track, off track, not yet started) identify whencorrective action is necessary. These indicators mirror those inthe online PMP (5.2a(3)), ensuring alignment among System,BU, and individual action plans. System dashboard measures(Fig. 2.1-2) are reviewed by the PC monthly and BOT at everymeeting to assess and communicate performance against SOsand action plans (Fig. 1.1-2). “Stoplight” color schemes on theSystem dashboard identify metrics at or better than the target(green), within 5% of target (yellow), or more than 5% behindtarget (red), allowing the PC to focus on SIs that are behind target.Drill-down capabilities allow the PC, other leaders, and individualworkforce members to view dashboard data by BU or16pillar with a single click. Monthly dashboards showing OPMsand WPMs are available to the workforce on the intranet andthrough postings in work areas.The OPR process, regularly repeated by the PC, BU/pillar teams,or departments/local teams, provides a forum for transparency,mutual accountability, and access to assistance with initiativesas needed. Success stories are also shared to identify and deploybest practices throughout the organization (4.2a(3)). OPR includes:1) review of current results, including financial health,relative to target, 2) review of action plans and APMs, 3) celebrationof progress 4) review of root causes of stagnated or decliningresults, 5) discussion of action plan adjustments and assistanceneeded from other areas, and 6) documentation to spread innovationsand opportunities for improvement. The OPR process forindividuals occurs as part of the PMP during mid-year and annualreviews (5.2a(3)), when progress to SMART goals is assessedand individual action plans are modified to ensure goals are met.A wide variety of analytic techniques help guide teams as theyidentify opportunities for improvement and implement changes.These include fishbone diagrams, Pareto charts, run charts, controlcharts, trend lines, and “stoplight” indicators. Teams are encouragedto identify balancing metrics to test for unintended consequences(such as the impact on patient satisfaction of hourlynursing rounds to assess fall and pressure ulcer risks). Graphicaldisplays with control limits, or data trending on run charts, helpidentify when variation is “common cause” (requiring no action)or “special cause” (requiring action be defined and taken).Communication of OPR findings to improvement teams, workforcemembers, partners, and collaborators as needed ensuresongoing dialogue about lessons learned and opportunities tochange direction or spread successes (Fig. 1.1-2). In addition,comparisons to targets, prior period trends, competitors, otherexternal benchmarks and like-organizations (inside and outsideHFHS) help ensure that conclusions and any changes arebased on valid assessments. Frequency of reviews at all levels,identification of corrective actions, and communication andfollow-up allow us to respond rapidly to changing needs andchallenges at all levels and facilities.4.1c(1) Best-Practice Sharing. Knowledge to improve andinnovate (4.2a(3)) is identified through OPRs (4.1b) and othermechanisms for best-practice sharing, such as internal communications(Fig. 1.1-2) and the KW (4.2a(3)), with its summariesof PI projects and related materials. For example, OPRs at theNo Harm Steering Committee (NHSC) promote effective cross-BU sharing. Each hospital shares progress on reducing harm,such as how specific supply sourcing and standardization ofurometers reduced catheter-associated urinary tract infections.Learning from each other is part of our THFE culture, reflectedin our core value of learning and continuous improvement.4.1c(2) Future Performance. Process requirements are definedand expected levels of performance are projected usingthe MFI and action planning processes. Data from OPRs areused to project future performance by setting goals for the nextthree years as part of SPP Step 5 (2.1a(2), 2.2b). Targets are setbased on customer and other external requirements, and stretch

targets based on top-decile performance of comparison groups.Projections are estimated twice per year as part of OPR to determineif action plans are on track.4.1c(3) Continuous Improvement and Innovation. OPRs atevery level provide opportunities to identify innovations andbreakthrough improvement to achieve SIs (4.1b, 4.1c(2)). Asnew SIs are developed and modified (usually annually, butnew strategies can be adopted throughout the year), teams areidentified and made responsible for developing action plans tosupport short- and long-term OPMs. New initiatives are cascadedas appropriate through System and BU leaders, nextlevelmanagers, and front-line supervisors. Our PMP allowsindividuals to add or modify performance goals to reflect newinitiatives any time during the year (5.2a(3)). Other sourcesof innovative ideas include industry or professional societyconferences attended by team members, ongoing literature andmarket scanning by BU and functional experts, and the KW(4.2a(3)). Employees are recognized for sharing ideas and lessonsfrom improvement work throughout the year, in particularat the annual Quality Expo (6.2b(4)).The MFI is used to identify root causes, make improvements,and monitor performance (Fig. 6.1-2). When appropriate, initiativeresults and emerging ideas are shared and discussed withour partners and suppliers to clarify the intent of the initiative,their role in effecting change, and the results achieved to date(4.2a(3)). For example, our suture supply vendors work withthe surgery value analysis team (VAT) to reduce costs per netrevenue of surgical supplies. We use patients and their familiesas members of several improvement teams to learn from themhow to create patient- and family-centered care experiences.4.2 Management of Information, Knowledge, andInformation Technology4.2a(1) Properties. Fig. 4.2-1 depicts our approach to managingorganizational data, information, and knowledge withinour principal IT systems to ensure key quality properties. Wefollow a process of continuous prevention, detection, and remediationbased on the MFI (Fig. 6.1-2). Workforce membersand stakeholders participate in root cause analyses and identifycorrective actions. Cycles of learning include implementationof new technology, process improvements, and investments instaff training and upgrades, as well as IT governance and qualityassurance functions. For example, the IT Root Cause Analysisprocess showed need for a new change management approachfor partners and suppliers, which was implemented in 2010.Fig. 4.2-1: Ensuring Critical Properties of Organizational KnowledgePROPERTIES PREVENTION DETECTION REMEDIATIONChange management enabled via system testing & UAT Users report Root causeAccuracyData testing and cross validationthrough IT analysisHelp DeskIntegrity/ReliabilityTimelinessSecurity andConfidentialityHigh availability redundant solutionsData backups; disaster recovery capabilitiesInput/output validation checksMaintain & refresh infrastructure, application releasesPerformance testingReal-time enterprise system updatesUser access via wireless and remote accessData center physical securityFirewalls; password/user IDsHIPAA BAA; annual risk assessments; workforce trainingSecurity management continuous improvement programData maskingNew market and competitive information is gathered fromtrusted third-party sources, such as Sg2, HCAB, and EDS(2.1a(2)). These sources employ their own data cleansing anddata masking processes to ensure integrity, security, and confidentiality.Data are gathered from multiple sources for comparisonto ensure reliability. Both current and historical dataare used to test trend validity. Survey and feedback data frompatients and employees are tested for accuracy, reliability, andintegrity by comparing to national databases.4.2a(2) Data and Information Availability. Our approach formaking needed data and information accessible to our stakeholdersis outlined in Fig. 4.2-2. IT supports the enterprise (workforce,stakeholder groups, suppliers, partners, and collaborators)by offering a complete range of infrastructure services (e.g.,voice and data network services, data center operations, desktopdevices, mobile devices) and application maintenance and developmentservices. These capabilities are delivered to end usersvia a secure, redundant network that supports wired and wirelesscomputing, as well as remote access for authorized users. Thesesolutions provide easy access while keeping data, applications,and infrastructure protected through state-of-the-art security.Managing patient-care coordination and collaboration.HFHS caregivers and community hospital private-practice/contracted physicians can access a clinical data repository(CarePlus Classic) where more than 22 years of informationfor more than five million patients is stored. CarePlus is innovativein that it provides both IP and OP data on our patients.Physicians can share clinical information with patients duringface-to-face clinic visits or through secure electronic messageexchanges during e-visits. An integrated network of clinicalinformation exchange within HFHS connects the clinical datarepository and specialized departmental applications (e.g., radiology,laboratory, ED, surgery, cardiology). These data arealso processed through a clinical rules engine from a patientregistry that provides real-time preventive screening remindersand chronic care clinical alerts to ensure timely, evidencebasedcare. While other organizations have implemented registrieslike this for patients with one particular type of insurance,HFHS implemented this enterprise registry for the benefit ofall our patients.HFHS has rebuilt and expanded CarePlus to include collaborativecare management, structured clinical documentation, andquality reporting. This new enterprise EMR solution, CPNG,has a common platform of normalized data from over 150InfrastructuremonitoringtoolsExternalauditsInternal QAResponse andresolution timeSLAs (warrantedto includeliquidateddamages forfailedperformance)Follow-up with enduser to ensureremediationsources. Normalizing the data allowsus to share information with othersystems for analytics. We have alsoimplemented tools geared towardoptimizing care, throughput, andprocesses in particularly challengingareas, including EDs, ICUs, and Surgery.Beginning in 2011, CPNG hasan interface to a private health informationexchange which allows privatepractice/contracted physicians toshare information through the HFPNPhysician Portal.17

Fig. 4.2-2: Data & Information AccessUsers Access / Availability viaManaging PI and supporting clinical research. Through ahighly integrated CDS, which contains clinical, revenue, andcost information from all HFHS BUs, as well as a separate reportinginterface from CarePlus, we can conduct comprehensiveprogram reviews; develop dashboards to facilitate performancemeasurement, analysis, and improvement; and provide a repositoryfor clinical research. Data are available for process analysisand improvement within minutes of being posted to CarePlus inthe clinical setting. The CDS warehouses data from systems supportingregistration, billing, lab, and radiology. These tools areaccessible by all HFHS workforce members through passwordprotectedlog-ins. The CDS is the basis of the System dashboard(2.2a(6)). This analytical capability is being extended in 2011 toinclude physician- and hospital-level dashboards.Managing the revenue cycle. Through HFHS enterprise-widesystems, CSRs in any clinic or contact center can view physicianappointment and procedure availability across multiple sites,identifying times and locations most convenient for each patient.Registration and insurance information are collected once (whena patient first enters the health system), and updates to demographicsand insurance coverage can be made at the time the patientis seen. Charges are billed to insurance payers electronically.18PatientsCommunity&CollaboratorsHFHS CliniciansWorkforcePrivatePracticePhysiciansSuppliers/PartnersHenryford.comPatient portalEmailOp/IP visitsInternet cafePhonePrint, radio, TVFocus groupsHenryford.comPrint, radio, TVFocus groupsHenryPhysician portalEmailSecure private networkSecure remote accessSecure wirelessMobile devicesKiosksVodcasts, podcastsHenryEmployee self serviceEmail and mobile devicesSecure private networkSecure remote accessSecure wirelessKiosksVodcasts, podcastsPhysician portalHealth information exch.Henryford.comSecure wirelessMobile devicesInternet cafeHenryford.comVendor Compliance ProgramSecure private networkEmail, phoneInternet cafeConferencesType of Data / InformationElectronic Health RecordAppt./prescription requestsMessages to-from physiciansLab and radiology resultsCare plansChronic care reminders/alertsDisease/wellness informationStatements, paymentsInsurance claims, claim statusPhysicians, specialtiesDisease/wellness programsCommunity health partnershipsLocations and servicesCare innovationsNews and informationEnterprise systemsCarePlus, EMRCrimson Analytics, CDSQuality metricsPerformance dashboardsMessages to/from patientsLab and radiology resultsAlerts and remindersEmail/file/printHFHSU and CME/CEUNews and informationPolicies and proceduresHFHSUHR/payroll/benefitsEnterprise systemsCDSPerformance dashboardsDepartmental systemsEmail/file/printEMRDisease registryLab and radiology resultsNews and informationCMEPhysician scorecardPolicies and proceduresElectronic transactionsPerformance dashboardsNews and informationPrograms and InnovationsFor HFMG medical center patients receiving services at HFH,HFWBH, and some community hospitals, an innovative singlestatement is generated that combines IP and OP charges, as wellas professional and technical charges, simplifying compliancewith payment requirements. Patients can request an electronicstatement or pay online using our Consumer Health Portal.Managing the business. Through enterprise-wide HR, Finance,and Supply Chain systems, HFHS leverages automatedfinancial and resource management controls and tools, and extensiveonline reporting. Employees use self-service tools toupdate personal information and change benefit status, whilemanagers use them to process virtually all employee-relatedHR transactions. Managers create and route purchase requisitionsonline. IT systems transitions supported the HFMH acquisitionin 2007 and HFWBH launch in 2009, and IT revenuesystems were significantly improved to standardize revenuecycletransaction processes at our hospitals.Managing employer–based insurance products. HAP utilizesstate-of-the-art systems for managing the unique business operationsof the payer organization, including member enrollment,billing, claims payment, and disease and utilization managementfor its members and provider organizations. HAP’s insurancesystems are intentionally managed separately from the patientcare facilities to ensure confidentiality for non-HFHS providers.4.2a(3) Knowledge Management. The enterprise systemsdescribed in 4.2a(2) are the principal knowledge assets usedto enable coordinated patient care, provide data for PI analysisand research, support the revenue cycle, and manage thebusiness. These repositories of knowledge are accessible toall workforce members, as authorized, for cross-training andknowledge transfer via kiosks, desktop computers, wirelessdevices, online through HFHSU, and remote access using automatedtools to analyze and present information.Information and knowledge is shared with patients and familymembers in print and through other mechanisms in the patientcaresetting. We also share information and knowledge with patients,customers, partners, and collaborators through our internet(henryford.com) and intranet (henry.hfhs.org). As describedin 3.2a(1) and 3.1a(2), patients, community members (includingpotential patients), and other stakeholders receive direct mailingsfrom physicians or brochures and invitations to participatein conferences and design teams targeting relevant health careissues. In addition, HFHS uses television and radio broadcaststo reach a broader audience and share information about theSystem’s health care advances. Often, these stakeholders areinvited to participate in the design of key work processes. TheKW provides a systematic and secure way to capture and sharebest practices. The KW currently houses best-practice repositoriesfrom both internal and external sources such as IHI, andincludes three years of HFHS Quality Expo projects and a numberof PI team outcomes. By making the KW available to allmembers of the workforce, as well as partners and collaboratorsas appropriate, groups with common roles or interests haveready access to projects, research, and best practices within theSystem to rapidly identify and share best practices for implementationin their organizations.

Knowledge Management includes information to accomplishwork, such as policies, procedures, and job specific training;improve and innovate once an opportunity is identified throughthe OPR; and address changing organizational needs as part ofStep 2 of the SPP (2.1a(1)). Under the direction of the PC, andin response to OPR findings, pillar and other System teams areformed with cross-organizational representation to innovateand improve key processes or work systems (6.2b(4)).4.2b(1) Hardware and Software Properties.Infrastructure. To protect, secure, and ensure the reliabilityof HFHS information and knowledge, we deploy proven technologiessupported by a trained technology team.• The data center physical plant and the computer room technologiesare protected by intelligent key card access, signin/sign-outprocedures, and video monitoring.• Firewalls, intrusion detection tools, email monitoring andfiltering capabilities, and automatic security patches forservers and desktops protect against cyber attacks.• Data encryption secures sensitive outbound information,such as email with electronic patient information.• Automated alert systems and monitoring tools notify technicalsupport personnel if a database, application, network, orserver exceeds performance thresholds.Reliable telephone communications for patients, employees,suppliers, and partners are enabled by a three-tiered network.Voice circuits and software provide service to multiple contactcenters using interactive voice response (IVR) and skills-basedrouting tools. Siemens, our infrastructure services provider,serves as the custodian of our environment through a long-termpartnership agreement. Through comprehensive service-levelagreements (SLAs), Siemens is contractually committed to99.99% system availability and prompt IT Help Desk responseand resolution (Fig. 7.1-41). HFHS IT and business managersreview operational performance results regularly with the ChiefInformation Officer (CIO), who reports concerns to the PC.Applications. All HFHS IT systems are either purchasedcommercial products licensed through a competitive procurementprocess or applications designed and developed by ourIT application partner, CSC. IT employs extensive user collaborationto define requirements. Users evaluate alternatives,configure vendor products, and assist in the design, build, andimplementation of in-house solutions. To ensure user-friendliness,IT utilizes various user groups such as Patient AdvisoryGroups and the eHealth Steering Committee and the ClinicalSystems Steering Committee (physicians and other caregivers)to gather feedback regarding ease-of-use, reliability andintegrity. CPNG includes an innovative “Feedback Button” toprovide immediate feedback at the point of patient care. Theapplications development team analyzes this feedback to incorporatesystem improvements. In addition, IT oversees systematicuser-acceptance testing (UAT) when implementingsystem improvements and new releases. Users interact with thesystem to evaluate functionality and usability before the “golive”decision is made. Intensive end-user training, businessprocess re-engineering, “go-live” support, and rapid problemcall resolution by the IT Help Desk are incorporated into eachinstallation.4.2b(2) Emergency Availability. The IT disaster recovery(ITDR) program is part of HFHS’s overall emergency readinessprogram (6.1c). It ensures rapid recovery of all criticalsystems. We employ both local recovery capabilities and aremote warm site through a third-party vendor. A number ofprogressive improvements have been implemented, such asour three-tier redundant network with geographically separatedhubs. This prevents the network from crashing if one orthe other site is disabled, further ensuring data integrity andprompt system recovery. Major upgrades to backup and recoverytechnologies were completed in 2009.The design of CPNG includes a unique high availability/ failoverarchitecture to ensure this critical tool is available and accessible24/7 for both IP and OP care. IT ensures constant readiness andthe effectiveness of ITDR capabilities by testing at least annually.Business continuity capabilities are tested throughout theyear during scheduled system downtime. Numerous process improvementsidentified through testing have been implemented:enhanced Incident Response Management process and procedure,updated “call-trees” for IT and the user community, validationof recovery plans for over 200 non-critical business systems,and end-user participation in system recovery. A new ITDR testscorecard monitors DR capability and helps identify improvementopportunities. Finally, in response to pandemic concernsin 2009 and 2010, a comprehensive pandemic preparation effortwas coordinated with the System’s Hospital Incident CommandSystem (HICS) program (6.1c). Following each incident, resultswere evaluated to identify and implement improvements.5 Workforce Focus5.1 Workforce Environment5.1a(1) Capability and Capacity. HFHS assesses workforcecapacity and capability during the SPP, OPRs of workforcemetrics, and annual PMP and development planning processes(Fig. 5.2-4). During the SPP, the PC reviews HR’s analysis(expected growth, vacancy rates, turnover, future competencyforecasting, training needs, staffing ratios and quality indicators)(Fig. 2.1-1, Steps 1-2). This drives People pillar SOs, SIs,and action plans (Steps 2-6). Each month, the PC, BU leaders,and HRET review System and HR dashboards as part ofOPRs (4.1b). Requests for new positions are evaluated by BUleadership teams against budget requirements, staffing ratios,and business plans, including growth and expansion SIs. Actionplans address skill shortages, existing competencies and gaps,succession planning, pipeline development, diversity needs, andonboarding to improve retention (Figs. 7.3-2 – 7.3-4). Physiciancapacity analyses incorporate current and projected patientvolumes, new clinical service needs, and quality measures. In2009, HRET created a pilot workforce plan for System Pathologyand Lab, forecasting 10-year needs. Based on key learnings,HRET is applying a new workforce planning strategy andguidelines to other critical areas. We are also piloting a staffingmodel to move HFHS to a more flexible blend of fixed and variablehuman capital resources, easily adapted to changing staffingneeds. Talent Selection Specialists (TSSs) and HR BusinessPartners (BPs) work with System and BU teams on staffing andcapacity changes. In 2010, based on Baldrige feedback, HFHSimplemented a System-wide process to track volunteer demographics,time, activities, and assignment trends.19

5.1a(2) New Workforce Members. In 2010, based on resultsand feedback from applicants and hiring managers, we enhancedrecruitment, hiring, placement, and retention approachesSystem-wide. On-site TSSs partner with hiring managers tounderstand local requirements and cultural needs, and ensureright person/right job/right time. We also assess quality-of-hireand new-hire satisfaction (AOS).Recruiting, hiring. HFHS uses traditional and non-traditionalmethods and sources to attract talent: college recruiting, internships,volunteers, on-site job fairs, student career days, employeereferral bonuses, job boards, social media and networking sites,niche organizations, optimized search engine capabilities, and anational online presence. We use interactive recruiting tools andautomated job marketing to target potential employees. Referralsources include employees, volunteers, physicians, and patients.Our applicant tracking system has separate portals for key workforcesegments. Managers receive status reports for each opening,and senior leaders receive monthly summary data (System,BU) on open positions, days to fill, and vacancy rates (includingphysicians) (Figs. 7.3-1 and 7.3-2). To recruit HFMG physicians,we solicit referrals and use online campaigns, announcementswithin physician communities, and presence at relevantconferences. Volunteers are recruited through internal referralsor community relationships; interviewed, selected, and orientedusing System-wide processes; then placed after mandatory trainingbased on skills, desired schedule, and BU need.Retaining. We promote retention System-wide through behavioral-basedinterviewing, consistent placement and onboardingprocesses, and ongoing reinforcement of our vision andculture, THFE, performance expectations, and robust rewardstructures. Supported by HR, managers review results of Gallupsurveys (5.2b(1)), exit interviews, and focus groups to formulateand execute department-specific action plans to reduceturnover (Figs. 7.3-3 and 7.3-4). Career development opportunities,such as HFHSU and the leadership academies, buildemployee skills and incorporate mentoring relationships thatfurther promote retention (5.2c(1,4)).Ensuring diversity. To ensure the workforce reflects our communities,we develop diverse candidate pools from employeereferrals, community outreach, and organizational partnerships.In areas of under-representation, Talent Selection Team(TST) and Office of Workforce Diversity (OWD) collaborateon outreach to community organizations, local churches, andonline diversity job boards. HFHS actively promotes health carecareers through a community consortium with the Detroit WorkforceDevelopment Department, Henry Ford Community College(HFCC), and other innovative partnerships:• Hire Detroit: With community development organizations,source entry-level talent for jobs with competitive pay andbenefits.• Henry Ford Early College: With local schools and HFCC,prepare students for health care professions (1.2c(1)).• Professional Development Program: For entry-level employeeswishing to advance to professional positions.• Annual Diversity Celebration: Link HFHS and communitypartners to celebrate diversity, promote health care careers,and grow diverse feeder pools.205.1a(3) Work Accomplishment.• We organize work around fundamental processes on whichwe overlay key leadership structures, such as the PC, pillarteams, and LEAP, creating a cross-functional, collaborativeculture. Continual focus on THFE enables us to accomplishour work (Fig. 6.1-1) and address challenges by implementingSystem and BU action plans (2.2a(1,2)) and the PMP(5.2a(3)).• We capitalize on our CCs of innovation and collaborationby aligning and cascading goals through the PMP.• We capitalize on our CC of care coordination to reinforceour focus on delivering exceptional care to each patient;by setting bold goals (6.1b(2)) and sharing best practices(4.2a(3)), we exceed performance expectations routinely.• We use our learning academies and other HFHSU offeringsto build team-based skills (5.2c(1)) and empower theworkforce to leverage our capabilities in ways that exceedperformance expectations and differentiate us from competitors(3.1b(1,2)).• We address our strategic challenges through organizationalperformance and dashboard reviews (4.1b) and deploy multidisciplinaryteams to address and accomplish action plans.5.1a(4) Workforce Change Management. Prior to openingHFWBH, we redesigned our recruitment, orientation, and communicationsprocesses to ensure System capacity and capabilityneeds were met as we staffed the new facility and encouragedexisting employees to consider redeployment options. WithLean tools, we reduced HFWBH time-to-fill, dramatically improvingvacancy rates, a best practice adopted System-wide(Fig. 7.3-2). We prepare our workforce for changing capabilityand capacity needs by conducting regular gap analyses anddesigning training for workforce segments with the greatestneed. When faced with the need for workforce reduction, HRand managers partner on placement solutions that leverage oursize and integration to redeploy talent internally. We conductadverse impact analyses and match deployed individuals to positionsthat are specifically suited to their qualifications and talents.We assist displaced employees with resume development,interview techniques, and career counseling. A displaced employeewho leaves HFHS receives a generous severance, maybe recalled for up to one year, and if rehired within two years,re-acquires prior seniority. We prepared for and managed periodsof rapid workforce growth at HFWBH and HFWH byconducting workforce planning sessions with HR, finance, anddepartment leaders. These strategies reduced agency staff use(Fig. 7.3-2) and established new best practices for System deploymentas we continue to grow.5.1b(1) Workplace Environment. Fig. 5.1-1 shows key measuresand targets for workplace health, safety, and security.Workforce health. All workforce members undergo pre-placementhealth screening that creates a baseline for annual healthstatus monitoring by Employee Health Services (EHS). Systemwidepolicies and processes address TB exposure, immunizations,and respiratory fit testing (Fig. 7.3-5). HFHS partners with HAPto offer Health Engagement (HE), a health benefits approachthat ties employees’ clinical results and healthy behaviors tolower premiums. Participants meet with a primary care physician

Fig. 5.1-1: Workforce Health, Safety, and SecurityMEASURE TARGET FIG. REF.HEALTH % of patient-contact workforceExceed CDC national 7.3-5immunized against flu average rateWorkplace wellness Year-over-year increase 7.3-6program participationHRA Lifestyle scores Year-over-year increase 7.3-6SAFETY MIOSHA injury frequency Year-over-year reduction 7.3-7per 100 workersWorkers Compensation Cont. improvement; 7.3-8outcomeslevel below MI industryBBP/OPIM sharps injuries Cont. improvement; 7.3a(2)level below MI industrySECURITY Public order incidents Year-over-year reduction 7.3a(2)(PCP), complete an online health risk assessment (HRA), andaccess recommended wellness interventions in an online SystemWellness Resource Guide (Figs. 7.3-6). Wellness programs areavailable to employees, physicians, trainees, and volunteers.Workforce safety. We manage workplace safety through Systemwideprocesses and a network of Safety Officers and multidisciplinarySafety Committees, all aligned through the SESF. Supervisorsreceive consistent training and are responsible for accidentinvestigations and documentation of interventions in the Radica-Logic incident reporting system. AHA awarded HFHS a safetyfellowship to explore innovative ways to increase employee reportingof both workplace safety incidents and “near-misses,”an initiative that aligns to our No Harm campaign (7.3a(2)).All employees must demonstrate mastery of three safety modulesin AME (general safety, personal safety, and infection control);compliance is 100%. System-wide, we require regular fireand building evacuation drills, and department- and job-specificsafety training, such as proper use of personal protective equipmentand handling dangerous materials. We offer a System-widehealth assessment program, recognized by the AOHPH, for employeeswho handle chemotherapy drugs. Consistent with oursafety focus, we were first in our region to require all patientcontactemployees to receive the seasonal flu vaccine or weara protective mask when working with patients (Fig. 7.3-5). OurBBP/OPIM program reduced sharps injuries among cliniciansserved by our largest EHS clinic and was expanded to all SystemEHS clinics (7.3a(2)). EHS treats work-related injuries at consistentlylower than state costs (Fig. 7.3-8).Workforce security. HFHS security police have a presence oneach campus. Building and parking lot security is maintained withphoto identification, card-access doors and gates, staffed securityposts, surveillance cameras, and vehicle patrols. We partner withWSU campus police to expand employee, patient, and visitor securityat HFH, and with local municipalities to ensure cooperativepolicing at other HFHS locations. Security staff provide BUleaders with monthly data on security incidents, and work closelywith each BU Safety Committee to resolve problems and increasesecurity (7.3a(2)). Our CHRO is on the board of CrimeStoppers-Detroit, a program that empowers people to make theirneighborhoods, schools, and businesses safer by anonymouscrime reporting. Deployed at each BU, our workplace violencepolicy also promotes workplace safety and security.5.1b(2) Workforce Policies and Benefits. Our policies are reviewedand updated annually, or as necessary, by cross-functionalteams with HR leadership and are posted on our intranetfor easy employee access. We support the workforce with flexible,integrated benefits and services for all full- and part-time,benefit-eligible employees and other rewards to private-practicephysicians, trainees, and volunteers. We use employee feedbackand benchmark data to design programs for a diverse workforce(Fig. 5.1-2). Eligible employees receive credits to select benefitstailored to their individual needs. We systematically evaluateand improve our Total Rewards program through annual surveysand employee focus groups (Fig. 7.3-9). In 2011, we reinstatedemployer matching contributions to our retirement savings plan,implemented a salary increase program, and absorbed nearly50% of employee health care cost increases based on employees’input and our strong financial results. HAP’s Health Engagementproduct (5.1b(1)) enables us to offer tailored benefits while loweringemployee health care costs. In its first year of implementation,more than 85% of HAP-covered HFHS employees methealth qualification standards and received lower co-pays andout-of-pocket costs. Our focus on workforce wellness improvesemployee health and productivity while lowering costs (Fig.7.3-6). An advisory team of HFMG physicians systematicallyanalyzes employee claims data from HAP to identify opportunitiesto impact employee and family health, and works with HRleaders on design of benefits and wellness programs. All workforcesegments, including trainees and volunteers, can accesswellness programs. We address differing workforce needs withtailored benefits and services. We provide complete immigrationservices for our international workforce. An integrated EAP processsupports employees facing personal or professional challenges.Major SEM employers have engaged HFHS to providetheir EAP, evidence of our program’s quality and effectiveness.We negotiate with area businesses on employee discounts andsavings offers. Innovative “Live Midtown” provides employeesfinancial incentives to buy, rent, or improve housing in Detroit’seconomically challenged Midtown area, home of HFH, HAP,and HFHS’s headquarters (1.2c(2)).Fig. 5.1-2: Workforce BenefitsFOCUS BENEFIT PROGRAMHealth & Low-cost medical, vision, dental coverage; flexibleWellness spending; preventive care waivers; wellness program,fitness center; transitional work program; HRA,*ergonomic assessment,* healthy café food choices*Financial Retirement savings plan; income replacement & survivorbenefits; LT care; credit union, discounted bank services*Work-Life Generous paid time-off; personal protection insurance;Balance same-sex domestic partner benefits; child care*; adoptionassistance; immigration services; EAP,* teleworking,flexible scheduling,* Helping Hands*Professional Tuition reimbursement; mandatory training,* continuingDevelopment education,* employee & leader development **Available to private-practice physicians, trainees, and/or volunteers.5.2 Workforce Engagement5.2a(1) Elements of Engagement.We select well-researched survey tools from widely recognizedvendors, thereby leveraging their research on key elements affectingworkforce engagement and satisfaction: Gallup Q12 foremployees, AMGA survey for HFMG physicians (5.2b(1)). Allleaders are trained to examine Gallup survey results with theirwork groups. These conversations, as well as leader rounding,exit interviews, and two-way communications, enable us tovalidate key elements for employees and HFMG physicians onwhich the surveys are based. To determine key engagement andsatisfaction elements for other workforce segments, appropriateleaders, including the HRET, community hospital CMOs,21

directors of residency programs and volunteer services, use focusgroups, individual interviews, group meetings, and otherlistening posts. We formalize this determination in internallydeveloped tools to assess these elements (5.2b(1)).5.2a(2) Organizational Culture.Orientation and Renewal. All new employees attend Systemorientation (WOW) on their first work day, which fosters ourhigh-performance culture from day one. Senior leaders defineand model our culture: our excellence focus, “can-do” spirit;THFE, Team Member Standards (P.1a(2)); 7 pillars (Fig. P.2-2);and MFI (Fig. 6.1-2). Leaders and managers continually reinforcethese in the workplace, starting with BU- and departmentleveltraining right after WOW. In their first year, all employeesattend two-day cultural Renewal, a program to reinforce THFEvalues and behaviors. All physicians and volunteers are also orientedon these topics, and get customized onboarding. New leadersattend New Leadership Academy (NLA), aligned to THFEand our Leadership Competencies (5.2a(3)). Deployed Systemwide,this three-month onboarding program, with five full-dayworkshops, represents a cycle of learning in leader orientation.Workforce development. Investment in development is keyto high performance and high engagement, and differentiatesHFHS in a challenging economic environment (Fig. 7.3-17). Seniorleaders teach and mentor in our leadership academies. Annually,our CEO cascades goals tied to employee and leadershipdevelopment to all leaders. HFHSU offers a robust curriculumto meet organizational and personal needs (5.2c(1)). Developmentties directly to our PMP and key elements driving engagement(Fig 5.2-1). It also supports movement through the talentpipeline (Fig. 5.2-2), recruiting from within, and cross-Systemtraining to foster collaboration, skill sharing, and engagement.Fig. 5.2-1: PMP Supports Engagement/High PerformanceHFHS PMPENGAGEMENT ELEMENTSPerformance Goal Setting & TeamQ1. I know what is expected of meMember Standards/Leadershipat work.CompetenciesQ6. Someone at work encouragesDevelopment Goals & Talent Profilemy development.Goal Setting (resources identified to Q2. Have the materials & equipmentachieve goals)I need to do my work.Performance Notes Tool (facilitates Q4. In the last 7 days, havereal-time feedback on performance) received recognition or praise.Q11. In the last 6 months,someone at work has talked to meMid-Year and Annual Performanceabout my progress.ReviewsQ12. This last year, have hadopportunities to learn and grow.Open communication. SL modeling (1.1b(1)) and the TeamMember Standards of ownership, accountability, and respectfoster open communication, reinforced through HFHSU skillbuildingin courses such as Speak Up, Just Culture, and CrucialConversations (Figs. 7.3-18 and 7.3-19). A peer-elected EmployeeAdvisory Group (EAG) in every BU meets monthly todiscuss BU performance and work climate issues. EAG leaderscommunicate ideas and concerns to BUs and SL. In addition,a CEO Advisory Group meets monthly to discuss the sameissues with our System CEO. Informal employee-supervisorconversations reinforce System values and, with Just Cultureprinciples, resolve most work-related issues. Employees mayrequest review by progressively higher leadership, and an improvedpolicy for advanced dispute resolution was deployed in22Fig. 5.2-2: PMP, Talent Review, and Succession PlanningSEPT• ALA begins• LA begins• PLI beginsNOV/DECExec Cabinet MeetingEC reviewsdevelopment & progressof high potentialsDECSystem CEOpresentssuccession & devplans to HFHS BOTJULY/AUGEC approvesall BU benchcharts &developmentopportunitiesJANAnnualPerformanceReviewsJULYMid Year Reviews• Managers & employees discusscareer dev & IDP progress• High potentials adjust IDPs toadd appropriate developmentFEBPerformance& Dev GoalsCompleteJUNE/JULYSystem President & CEOs• Review proposed BU benchcharts• Match potential successorswith dev opportunitiesAPRIL/MAYBU Dev Committee• ID critical positions &potential successors• ID BU developmentopportunities• ID LA participants2010. Our CEO shares her email address with all employeesand personally responds to all concerns, comments, and ideasfor improvement.Innovation and diversity. We capitalize on the diverse ideas,backgrounds, and experiences of our workforce, to promoteinnovation and engagement, through 1) employee resource,network, and advisory groups, 2) improvement teams with diversemembers (different job skills, education, gender, raceethnicity),and 3) employee focus groups designed to capturemultiple points of view and promote system integration (Fig.P.1-1). Leaders are trained to create an inclusive culture throughcourses such as Generational Diversity, Cultural Sensitivity,and Leveraging Diverse Teams. We evaluate effectiveness byreviewing engagement, turnover, and other metrics by variousdemographics (Figs. 7.3-10 – 7.3-15).5.2a(3) Performance Management.High-performance work and engagement. The PMP is a yearrounddynamic process between employees and supervisors(Figs. 5.2-1 and 5.2-2). PMP steps align to key engagementelements, an integrated approach that supports both engagementand high-performance work. Private-practice physiciansare evaluated by peer-review groups according to BU-specificcriteria. Trainees receive periodic performance evaluations bytheir supervisors. Managers evaluate volunteers assigned totheir areas annually on their skills and responsibilities.Compensation, rewards, recognition. Compensation alignsto employee and organizational performance. Annual reviewsdirectly impact base and variable compensation for all leaders,including merit increases and Annual Incentive Plan (AIP)payments. Each year, incentive plan targets are established forfinancial, service, and quality and safety performance; no incentivesare paid if the System net operating income target isnot met (Fig. 2.1-2). Group Performance Award (GPA) targetsfor non-leaders are tied to financial and service engagement,and starting in 2011, engagement pulse survey participation.Non-compensation rewards and recognition also drive workforceengagement and, in turn, better service to patients andother stakeholders (Fig. 5.2-3).Patient, stakeholder, health care focus. Our PMP aligns System,BU, and department goals with individual goals to focus employ-

Fig. 5.2-3: Rewards and Recognition ApproachesREWARDS AND RECOGNITIONEMPLOYEESFocus on People Awards x x x x HFHS AnnualService Awards x x x HFHS AnnualShadow of a Leader Award x x HFHS AnnualShadow of Influence Award x x HFHS AnnualVolunteer Appreciation Week x BU AnnualEmployee of the Month Award x BU MonthlySpirit Awards x x x BU QuarterlyThank You Notes x x x x ALL OngoingCelebration of PerformanceMEDx x x xMilestonesDIR.OngoingEmployee Appreciation Picnic x x x x BU AnnualEmployee Summer Events(e.g., “HFHS Idol” contest)x x x x BU AnnualOnline PMP Feedback Notes x x x ALL OngoingAppreciation “Bucket” Drops x x x x ALL OngoingQuality Expo Awards x x x x HFHS Annualees on patients and stakeholders, THFE, and accomplishing SOsand SIs. Employees set individual SMART performance goalsrelated to the pillars, which account for 60% of their annual review.The other 40% is determined by review against the TeamMember Standards for non-leaders or the Leadership Competenciesfor leaders. These Baldrige-based competencies are centralto leader development, evaluation, and advancement: Leadership,Strategic planning, Patient/customer focus, Performanceanalysis and knowledge management, Staff focus, Process managementwith safety focus, and Results accountability/execution.In 2009-10, HFWBH and eight other sites served as pilots foran innovative online PMP. Surveyors from hospital accreditingagency DNV noted favorably that all HFWBH employees couldarticulate their goals and personal impact on the hospital’s success.Engagement scores at the nine sites were 11% higher thanthe rest of HFHS. Based on our pilot results and learning, wefully deployed the online PMP in 2010 to strengthen alignmentof individual and organizational goals.5.2b(1) Assessment of Engagement. We use formal and informalmethods to assess workforce engagement and satisfaction.We assess employee engagement and satisfaction with theGallup Q12 every 18 months, augmented with pulse surveys oftargeted questions every 6-9 months. We also use exit surveys,quality-of-hire surveys, National Database of Nursing QualityIndicators (NDQI) surveys of nurses, as well as focus groupsand various leadership communication channels. We surveyHFMG physicians biannually using the AMGA survey, whichcompares to group practices nationally. We use internal surveysfor private-practice physicians and trainees, complemented byinteractions at periodic meetings, such as medical staff meetingsin community hospitals. We survey all volunteers with atool developed in 2010 after benchmarking with a Baldrige recipientand the MI Council of Directors of Volunteer Services(7.3a(3)). We segment engagement and satisfaction resultsby BU, job function, and demographics to analyze differencesamong respondents, and when possible compare our results externally.HRET uses engagement and satisfaction results as inputsto the SPP. We believe engagement is influenced most at theworkgroup level; all managers get training and tools to analyzeLEADERSPHYSICIANSVOLUNTEERSGIVEN BYFREQUENCYand plan how to improve engagement. Employee EngagementConsultants (EECs) and HR BPs coach managers in data analysisand development of targeted Impact Plans, with 100% compliancein 2010. EECs, HR BPs, and managers track progress,and EECs meet monthly to share innovative approaches for Systemspread. Annually, managers recalibrate and update their ImpactPlans. We also analyze absenteeism, grievances, turnover,and employee safety and correlate results with satisfaction andengagement to identify improvement opportunities. Workforcevolunteer participation, such as Heart Walk and CommunityGiving, Helping Hands and Combined Time Off (CTO) Donations(Figs. 7.4-9 and 7.3-16), also shows engagement.5.2b(2) Correlation with Organizational Results. Annually,the CHRO reviews the correlation of workforce engagement withturnover, patient engagement, and patient safety with the BOTQuality Committee and PC. This analysis is an input to the SPPand development of SOs and SIs. Gallup has demonstrated andour own studies confirm the relationship between engagementscores and individual PMP outcomes, workforce safety incidents,department-level turnover, patient satisfaction, and culture ofsafety perceptions: our workgroups in the top quartile for engagementperformed higher on the business indicators listed, a findingthat supports our work-unit focus on improving engagement.5.2c(1) Learning and Development System. Our corporatelearning management system, HFHSU, offers an array of learningprograms and partners with other resources, such as nursingand medical education and the Simulation Center.CCs, SCs, and action plans. We introduce and reinforce understandingof our CCs, SCs, SAs, and action plans through Orientation,Renewal, and AME. Specific courses strengthen our CCs,such as Crucial Conversations (collaboration) and MFI (innovation,collaboration, care coordination). Our leadership developmentprogram, aligned with talent management and successionplanning (Fig. 5.2-2), develops the leadership knowledge andskills required to sustain our CCs, address challenges, and accomplishaction plans. Topics include creating SMART goals,conducting SWOT analyses, deploying action plans, and motivatingteams (2.1b(1)). Each academy has a specific focus:• NLA: System integration and modeling the LeadershipCompetencies (5.2a(3)).• LA: the strategic pillars and completing innovative improvementprojects• ALA: higher-level Leadership Competencies and completingstrategic System improvements with BU CEOs as sponsors.In 2009, SL defined systems thinking/integration, innovation, engagement,community representation, knowledge of the market,and business acumen/savvy as competencies required at PC level,and made them the ALA focus to support leader engagement andsuccession planning. The CHRO meets annually with the PC andpillar leads on workforce development needs (2.2a(5), Fig. 5.2-4).This approach led to Crucial Conversations in 2008 (Fig. 7.3-19)to support engagement action plans (People pillar), and PatientSafety 101 and Just Culture training in 2009 (Fig. 7.3-18), helpingemployees feel safe to “speak up and speak out” to supporta culture of safety (Quality/Safety Pillar). Training was deployedto LEAP, then System-wide to all leaders and employees. Based23

Fig. 5.2-4: Learning / Development Needs Review CycleCHRO and Pillar leadsevaluate prior year’slearning effectivenessmetrics. HFHSU AdvisoryGroup evaluates BU trainingLearning deployed viamodality for optimaleffectiveness and efficiency(ie.classroom, online, &action learning)CHRO, HFHSU director andPillar leads identify learningneeds to achieve new fiscalyear’s System learningpriorities for SOs and SIsOngoingBUtrainingrequestssubmittedtoHFHSU.HFHSU completes designand development of trainingwith SME inputHFHSU completes learningneeds assessment with SMEsincluding timelines, budget,and SI/BU action plansLEAD metrics (Kirkpatrick’sLevel 1-2) and LAG metrics(Kirkpatrick's 3-4) identified forevaluation of effectivenesson our 2010 review cycle, we developed an innovative interactivetraining, Speak Up, that builds on Crucial Conversations andJust Culture using real events at HFHS. Deployed System-wide,it has earned two national awards for training excellence. Also in2010, we added Influencer training to LA and ALA curricula tobetter equip leaders to manage innovative change and collaborativeimprovement teams across the System.Performance improvement and innovation. To build workforcecapability, promote engagement, and support our CC ofinnovation, we address improvement and innovation throughoutour development curriculum: all orientations introduce theMFI, and Renewal focuses on innovation and change management.In 2010, we deployed new training System-wide to supportMFI refinements. Advanced PI training in LA and ALAis also recommended for all leaders and employees directingproject teams. In 2011, building on our leadership academy approach,we deployed the Physician Leadership Institute (PLI).Developed from best-practice research and benchmarking, itaims to prepare future physician leaders to direct organizationalimprovement and innovation. Trainees build improvementknowledge through their training programs and hands-on participationon improvement teams.Ethical health care and business practices. New employeesreceive HIPAA and Code training. AME for all employees addressesethical health care and business practices, including newor changing compliance requirements. Just-in-time training addressesemergent risks. NLA provides leaders advanced trainingin business ethics and HR legal practices, and Just Culture trainingfor leaders addresses ethical practice in managing behaviorsand reporting risk (Fig. 7.3-18). Physicians and other cliniciansreceive training on effective communication techniques withpatients and families, including disclosure of medical errors;the Simulation Center offers interactive role play to practiceand reinforce skills. Annually, employees complete online COItraining, and all physicians and leaders sign a form disclosingpersonal conflicts. Vendors are accountable to strict policies thatreinforce ethical business practices (1.2b(2)). The CPT has designedapproaches to build workforce knowledge of health caredisparities, a key SI for 2011-13. Corporate Compliance annuallyreviews workforce development to address federal and stateregulations, best practices, and risk trends.Patient and stakeholder focus. Aligning learning and developmentobjectives and resources to the SOs and SIs promotes apatient and stakeholder focus. For example, patient-centeredcare is the focal point of new employee orientation. Comprehensivecompetency reviews, including assessment, training, practice,and return demonstration build patient-care skills in clinicalareas. Trainees develop procedural skills training, in robotictechniques and ultrasound-guided catheterization, for example,and receive frequent feedback from faculty, peers, clinicians,and patients. Physician learning and development is coordinatedthrough our CME office, to standardize and align medical educationcontent for HFMG and private-practice physicians (Fig.7.3-20). The Simulation Center allows all clinical team membersto practice critical skills, such as surgical procedures and teamcommunication, in an interactive, feedback-rich environment.Learning and development needs. The CHRO and HFHSUleader identify workforce learning needs from annual discussionswith the PC, pillar leads, and leaders in BUs and clinicalareas (Fig. 5.2-5); periodic OPRs (4.1b); employee performancereviews; and ongoing input gathered by leaders from SL roundingand daily huddle meetings. Supervisors coach all employeeson creating an IDP, as part of the PMP, to address requiredtraining and their individual needs. Supervisors also collaboratewith HR to provide learning for specific workgroup needs. Employees,as well as HFMG physicians, trainees, and volunteers,have access from work or home to a Web-based learning managementsystem and can self-select opportunities to meet theirprofessional and personal goals (Fig. 7.3-20). The system includespersonal learning sites to track assigned courses, coursecompletions, transcripts, and certificates. For example, nurseshave unlimited access to current evidence-based protocols,clinical skills training programs, and hundreds of online credithours to meet competency and licensure requirements.Fig. 5.2-5: Training Outcomes and Organizational NeedsCORE COURSES/CURRICULA→ORIENTATIONNLALAALAKIRKPATRICK’SLevel 1 X X X X X X X X X X XLevel 2 X X X X X X X X X X X XLevel 3 X X X X X X X X XLevel 4 X X X X X X X X X XAUDIENCEEmployees X X X X X X X X XLeaders X X X X X X X X X X XHFMGPhysiciansX X X X X X X X X X X XTrainees X X X X X X XVolunteers X X X X XPvt-practicePhysiciansXXPILLARSPeople X X X X X X X X X X XService X X X X X X X X X X X XQuality/Safety X X X X X X X X X X X XGrowth X X X X X X XResearch Ed X X X X X X XCommunity X X X X X X XFinance X X X X X XPLIAMERENEWALJUST CULTURECRUCIAL CONVSPEAK UPPT SAFETY 101INFLUENCER24

Knowledge transfer from departing/retiring workers. Weuse multiple methods to transfer knowledge from departing/retiring workers: 1) continuously updating department, BU,and System policies; 2) cross-training, mentoring, and otherknowledge transfer tools, such as an improved exit interviewprocess deployed System-wide in 2010; and 3) completionof transition checklists by incumbent with interim/permanentreplacement employee prior to departure. HFMG requires athree-month contract termination notice for physicians. Physiciandepartures trigger a process for notifying patients andproactively identifying a new physician, and CPNG providesseamless transfer of patient information to the next provider.The KW (4.2a(3)) and Baldrige applications are also methodsto preserve and share knowledge.On-the-job reinforcement. An onboarding checklist for managersreinforces job expectations. BU and department orientationsset expectations and check for understanding. Clinicalareas assign each employee to a personal preceptor. Duringthe preceptor period (3-9 months for nurses), employees areobserved for transfer of learning and are required to completerelevant online courses. Periodic 90-day audits assess competency,compliance, application of learning, and additionalneeds.5.2c(2) Learning and Development Effectiveness.HFHSU uses Kirkpatrick’s four levels of learning andan annual review cycle with leaders (Fig. 5.2-4), focusedon action plan accomplishment, to assess learning anddevelopment effectiveness. We relate participation andeffectiveness to cost to assess efficiency. In 2009, for efficiency,we consolidated internal experts in instructionaldesign, technical training, and organization developmentin the HFHSU; over 50 online clinical and nonclinicalcourses were developed in 2010 at a cost avoidance of$800,000. Engaging HFHS leaders who are health careexperts as HFHSU faculty is another efficiency.5.2c(3) Career Progression. Employees enter their IDPsin the online PMP, and leaders complete a personal profilesection for short- and long-term career interests, aswell as past and current work experiences. With supervisors,they discuss career development opportunities at thegoal-setting and mid-year reviews. HFHS supports career progressionwith defined career paths for various jobs, daily onlinepostings of all available positions, and the online Careersfor Life program, with resources that span the career life cycle,deployed System-wide through HFHSU. Succession planningis a key business strategy to build a leadership pipeline, retainbench strength, increase engagement of high potentials, andensure business continuity (Fig. 5.2-2). We use criteria to identifycritical positions and high-potential candidates. SL selectshigh potentials and outlines development opportunities, witha focus on job rotations, confirms their own identified successors,and updates progress of leaders in the talent pool. The ECrecommends participants for the three academies, which prepareleaders to advance: NLA prepares all leaders; LA, leadersfor LEAP; and ALA, leaders for PC. Position-specific successorsare in place for PC and BU leadership members.6 Operations Focus6.1 Work Systems6.1a(1) Design Concepts. HFHS work systems include the infrastructure,people, materials, and measures necessary to executeour work processes. We assess each of these elements annuallyduring the SPP. Our SPP, with its focus on measurement, use ofpillars, workforce planning, and participation of all BU key leadersallows us to identify and address work system issues and opportunitiescohesively and effectively leverage the many assets ofour integrated System. The PC and SL identify work systems requiringdesign or redesign, innovation, or improvement throughthe annual SPP (Fig. 2.1-1, Steps 1-6) and ongoing OPRs (SPPStep 7, 4.1b). Work systems are designed and innovated, oftenthrough SIs, using the MFI (Fig. 6.1-2), based on PDCA methodology.In 2010, through a cycle of learning and improvement, ourwork systems and key work processes (Fig. 6.1-1) were realignedto more closely tie to patients and stakeholders (Fig. P.1-7) andcore components of our integrated System of care (Fig. P.1-1),sharpening our focus on patient/stakeholder value.Our CCs are the foundation of our integrated System. We leveragethem to create effective work systems and processesFig. 6.1-1: HFHS Work Systems and Key ProcessesWork SystemsInpatientOutpatientEmergency Dept.Community CareServicesCHPResearch &EducationOur Work Is Designed to Serve Each Patient FirstKey Work ProcessesContinuum of CareAccess to ServicesAssessment, Planning and CareDeliveryPatient Education, Transition andCare CoordinationOther Components of System IntegrationHealth Plan (HAP) Member Health Status ImprovementPublication of Research,Acquisition of FundingEducationBusiness & SupportEnvironment & Supply Chain Mgmt.Financial Mgmt.Information Mgmt.Workforce Mgmt.“Each patient and customer is the center of our universe, theguest in our home, the reason we are here.”Fig. 6.1-2: HFHS Model for Improvement (MFI)ContinuousImprovement& InnovationEmployeeEngagementAct dCheckPlanWork System/Work ProcessRequirementsDeterminedfromStakeholderRequirements(P.1-7),RefinedThroughVoice ofCustomer(3.1a)CustomerNeeds &Engagementd = Debrief and evaluate effectiveness of improvement methods and toolsDo25

that better serve our stakeholders. For example, continuum ofcare work systems are designed and innovated by collaborativemultidisciplinary teams with expertise in care coordination toincrease coordination across care settings, such as from IP to OPor CCS. We engage physician experts and researchers to leadthe design/redesign of key health care processes to “bring thebench to the bedside,” improving health care outcomes often atreduced cost (Fig. 7.4-14). The synergy between our three CCscreates improved outcomes for patients. Examples include: 1)HFHS innovations in controlling blood glucose levels duringinpatient stays and transitions from IP to OP care (7.1a) and2) safely managing outpatient therapy with Warfarin, a commonlyused oral anticoagulant that requires frequent bloodtests and rapid dose adjustments to maintain safe, therapeuticlevels (Fig. 7.1-16). These are among many HFHS innovationsthat are now standards of care in the U.S. (Fig. 7.4-14).The PC decides which System processes to outsource during theSPP (Step 2c). BU leaders use a similar approach for BU processes.We keep processes internal when HFHS has expertiseto meet/exceed requirements for quality, cost, and efficiency.These typically include processes critical to maintain and reinforceour CCs and fulfill our mission. We consider outsourcingothers, capitalizing on our CC of collaboration/partnering,when relationships align with our MVV and deliver stakeholdervalue (6.2b(3)). For example, we achieved a dramatic reductionin CCS’s durable medical equipment (DME) inventory byoutsourcing the distribution process and collaborating with oursuppliers (Fig. 7.1-34). Outsourced processes are managed byinternal contract owners with appropriate SL oversight.6.1a(2) Work System Requirements. We use patient/stakeholder listening posts to understand their requirements(3.2a(1,2)). Our work systems align to patients’ and stakeholders’requirements. Work processes align to work systems,and requirements flow from systems to processes (Fig. 6.1-3,6.2a(2)). The MC reviews and refines requirements at least annually(4.1a.1)) to ensure patient and stakeholder requirementsas well as organizational needs are incorporated.6.1b(1) Work System Implementation. Work systems andwork processes are managed and improved using the approachesdescribed in 6.2b(1). We manage, innovate and improveour work systems to function as a cohesive integratedSystem (Fig. P.1-1). We measure and review work system performance,using our 7 pillar framework, action plans, and systematicreviews of System, pillar, and BU performance (4.1b,4.1c(3)). Effective coordination between work systems createsagility (2.1a(2)) and an ability to create differentiated serviceofferings (3.2a(1)), such as managing patients at high risk forhospital readmission by coordinating efforts among hospitals,physicians, CCS, and HAP (Figs 7.1-9 – 12).6.1b(2) Cost Control. To improve outcomes and control cost,we leverage our CCs, integrated System strategy (Fig. P.1-1),and MFI by reducing process variation, deploying standardizedbest practices, and increasing coordination and integrationof services, thus maximizing efficiencies across the Systemand effectively managing processes (Figs. 7.1-24, 7.5-2). Wedeploy processes to reduce process variation and standardized26best practices to minimize the cost of health care while improvingoutcomes. Examples include admission reductions forchronic populations (Fig. 7.1-9) and HFMG partnerships withHAP and Detroit automakers to design innovative workplacehealth programs. E-Prescribing, now a national best practicefor increasing safety and reducing costs, began as a collaborationbetween HAP/CCS/HFMG and Detroit automakers.Our highest priority is to become a harmless organization(1.1a(3)). The Institute of Medicine (IOM) estimates U.S. costof harm at $17-29B. Designed to improve safety across allpractice settings, the No Harm Campaign includes a comprehensiveand highly-sensitive definition of harm (see glossary).Under Q&S Pillar oversight, a mulidisciplinary No HarmSteering Committee identifies process owners accountable forSystem-wide outcomes, conducts OPRs, benchmarks, removesbarriers, and ensures that the MFI is effectively leveraged toreduce harm. Our System-wide approach has four elements:1.2.3.4.Enhance culture of safety (Fig. 7.1-3, 7.4a(1), 1.1a(3)).Improve clinical communication quality/clarity (Fig. 7.1-3).Identify top causes of harm overall and at specific points inthe continuum of care (Figs. 7.1-1-8).Redesign work systems and processes to eliminate commoncauses of harm (Figs. 7.1-8, 7.1-25 – 29).We use an innovative approach to report and study harm events,research causality, identify priorities, and change practice toeliminate all harm to patients and staff (Figs. 7.1-1 – 8). Ourrigorous methodology for measuring harm, called cutting-edgeby IHI, includes 23 measures in six broad categories. Any eventadds to our highly sensitive composite measure (Fig 7.1-1).We also lead in development of rigorous methods to calculatecost savings from harm reduction (7.5a(1)). Our Just Cultureprogram, deployed System-wide in 2009, is a standardized approachto error and behavior management to promote a safetyculture (5.2c(1), Fig. 7.3-18). Our Safety Champions program,with our 200 trained champions located in every BU, reinforcessafety practices though ongoing education awareness and peerrole modeling. Communications are continuously improved, forexample, through collaborative rounds and improved handoffswithin and across BUs (Figs. 7.1-9-14, 7.1a-referrals).The IOM identified medication errors as a leading cause of harm.Hospitalizations secondary to adverse drug events cost $847Mannually in the U.S. HFHS developed an award winning innovative,cost-effective approach to optimize medication therapyfor high-risk outpatients. HFHS’s Medication Therapy Management(MTM) capitalizes on collaboration with patients andcare coordination among our hospitals, HFMG and communityphysicians, and clinical pharmacies within CCS and HAP. Apharmacist reviews all medications, calls the patient to provideeducation and assess needs, and collaborates with the patient’sphysicians on an outpatient medication regimen. First targetedfor Medicare HAP patients, the program is being deployedSystem-wide to all patients at high risk for readmission due tomedication issues. MTM undergoes continuous improvement:effective approaches are quickly and systematically deployedto all MTM programs (Fig. 7.1-33). The No Harm Campaignitself is regularly reviewed and improved by the NHSC, withinputs from the BOT, stakeholders, and partners (6.2a(4)).

Fig. 6.1-3: Key Work Processes, Work Systems, Requirements, and MeasuresKEY PROCESSWork SystemSample Key Workgroups RequirementsACCESSIP, OP, ED, CCS, CHPScheduling,Contact Center,Case Mgmt.Timely, Efficient,EquitableASSESSMENT, PLANNING & CARE DELIVERYIP, OP, ED, CCS, CHPLab,Radiology,Multidisciplinary Team,Nursing, PhysiciansTimely, Efficient,ReliableSafe, Reliable,Timely, EfficientPATIENT EDUCATION, TRANSITION & CARE COORDINATIONIP, OP, ED, CCS, CHPPhysicians,Nursing, Case Mgr.,CCS, HHC Liaison,PartnersPt. Centered,Safe/Reliable,Promotes &ImprovesCommunityHealth/WellnessMEMBER HEALTH STATUS IMPROVEMENT (HAP)HAPHAP with CCS, HFMG,care coordinators, etc.EDUCATIONR&ETimely, Efficient,Effective,AccessibleTimely, Efficient,EffectiveKey In-Process Measures(Results Reference – Fig.# or )KEY CONTINUUM OF CARE PROCESSESLength of Stay (.-); Bed TAT(.-)Left Without Completing Service (.-)HFMG Clinic—Unanswered Calls (.-)Online Appointment Requests (.b())% Discharge Pts seen by CCS in hrs (.-0)% ED CBCs & STAT Tests in 0 Minutes (.-)% Discharge Pts seen by CCS in hrs (.-0)CMS Bundles/Core Measures (.-, .-, .-)Seclusions and Restraints (.-)Management of Blood Glucose (.a)Medical/Surgical Length of Stay (.-)Smoking Counseling/Discharge Instructions (.-)% Discharge Pts seen by CCS in hrs (.-0)Stroke Care (% Discharged on Statins) (.-)PMPM Cost & Prescription Generic Use Rate (7.1-32)Medication Therapy Management Results (7.1-33)Medical/Surgical Length of Stay (.-)HEDIS Measures (.-0-, .b())PMPM Cost & Prescription Generic Use Rate (7.1-32)Medication Therapy Management Results (7.1-33)HAP Claims Processing (.b())HAP First Call Resolution (.b())Accreditation Council on Graduate Medical Education(ACGME) Duty Hours—Requirements (AOS)RESEARCH: Publication of Research, Acquisition of FundingSafe, ReliablePerfect SEPSIS Bundle (.-)R&ECare, EconomicManagement of Blood Glucose (.a)StimulusRelated Pillars* & Core Competencies**Key Outcome Measures(Results Reference – Fig.# or )S, Q&S, G, F; C2Visits to Community Clinics (7.4-8)Patient Emergency Medical Needs Fund (7.4a(5))P, S, Q&S, G, R&E, C, F; C1, C2, C3Days to Readmission for High Risk Patients (7.1-11)MISTAAR Unit 30-Day Readmission Rates (7.1-12)No Harm Campaign Outcomes (7.1-1–8)Admission/ ED Visit/Readmission Reduction (7.1-9–13)Clinical Outcomes (7.1-14,7.1-16–17, 7.1a)Mortality (7.1-18–22)P, S, Q&S, R&E, C; C1, C2, C3Admission/ ED Visit/Readmission Reduction (7.1-9–13)Referrals among BUs (7.1a)Culture of Safety Scores (7.1-3)Suicide Rates (7.1-14)Cost Savings from Care Coordination (7.1b(1))Community Clinic Visits/Weight Watchers(7.4-8, 7.4a(5))OTHER KEY INTEGRATED SYSTEM PROCESSESS, Q&S, C, F; C1, C2, C3HAP Admission and ED Visit Reduction (7.1-9)Cost Savings from Care Coordination (7.1b(1))Referrals among BUs (7.1a)Weight Watchers (7.4a(5))HAP State Area HMO Market Share (7.5-15)P, S, Q&S, R&E; C2, C3Trainee Satisfaction & Preparation (7.3-14)CME Activity (7.3-20); Culture of Safety (7.1-3)Blood Stream Infection Rate (7.1-5)KEY BUSINESS AND SUPPORT PROCESSESEnvironment & Supply Chain ManagementALLSafe, Reliable, CCS Inventory Reduction & Productivity (.-)Supply Chain Efficient, Product Recall Alerts, Days to Close (.-)ManagementEffective Emergency Preparedness (.-)Financial ManagementALLFinanceTimely, Efficient, CCS Inventory Reduction & Productivity (.-)Effective, Cash Collections at Point of Service (.-0)Equitable Days Cash on Hand (.-)Q&S,G, R&E, F; C1Publications & Funding (7.1b(1))Sepsis Mortality (7.1-20)HFHS Research Innovation Impact (7.4-14)S, Q&S, C, F; C3Supply Expense as % of Net Patient Revenue (7.1-24)Supplier Diversity Leadership (7.4-13)S, Q&S, G, C, F; C3Supply Expense as % of Net Patient Revenue (7.1-24)Financial and Market Outcomes throughout 7.5Information ManagementS, Q&S, G,R&E, F; C1, C3ALLTimely, Efficient, Patient Admin. Systems Availability (.b()) CPNG Participation/Use of Key Features such asIT (& Siemens) Effective IT Help Desk First Call Resolution (.-) Medication Reconciliation, Electronic Discharge (AOS)Workforce Management:All Pillars; C1, C2, C3Time to Fill (.-)ALLEfficient, Effective,7.3 Workforce Outcomes (capability & capacity,Incident Reporting: Employee Safety EventsHRSafe, Equitableclimate, engagement, and development results )(.a())*Related Pillars: P – People, S – Service, Q&S – Quality & Safety, G – Growth, R&E – Research & Education, C – Community, F – Finance**Core Competencies: C1: Innovation, C2: Care Coordination, C3: Collaboration/Partnering Bold Measures = Daily OperationalFig. 6.1-4: Reduction of Errors and WasteAPPROACH REPRESENTATIVE APPLICATIONSProcess and Multidisciplinary care design teams work with site champions to design and deploy evidence-based approaches to chronicProductdisease management throughout the organization (Fig. 7.1-9, 7.1b(1) ─ cost savings)Standardization VATs help standardize and innovate med/surg products to reduce costs and improve outcomes (Fig. 7.1-24, 7.1a).The EMR supports error-free clinical decision-making by making complete patient information available wherever the patientTechnology and is seen, identifying interventions through alerts, and providing automated medication safety checks (4.2a(2)).Automation Card-swipe access, patient bar code identifiers, unit dosing, and ePrescribing support medication safety (Fig. 7.1-2).Replacing paper communication with an online system permits instantaneous deployment of product “alerts,” including recallnotices in fourteen high-risk domains (e.g., biologics, laboratory products) (Fig. 7.1-39).Prevention System-wide use of evidence-based approaches prevent errors and promote safe, effective care (Figs. 7.1-25-29, 7.1-8).Targeted training, observation and feedback, and demonstration of learning provide consistent and accurate performance ofTrainingerror-prone tasks. Examples include mandatory resident training in line placement, with observation by senior physician staffLearning fromExperiencemembers, which has helped reduce bloodstream infections (Fig. 7.1-5)RadicaLogic enables front-line staff to report and route risk and customer issues for investigation and action (3.2a(3)).Detection of high-risk and near-miss events permits intervention before harm occurs (Figs. 7.1-1-2, 7.3a(2)-reporting).In the annual Risk Trends Reviews, a broad array of safety data is analyzed and correlated to identify priorities and actionitems; results are fed into the SPP (Fig. 2.1-2, Steps -) and ongoing OPR by the PC for deployment to all BUs (Step )).Reviews have led to redesign of new product introduction (e.g., rigorous clinician evaluation and user training), newapproaches to vendor management, and design of System-wide sentinel event protocols (e.g. Figs. 7.1-2, 7.1-18-21)27

We systematically integrate five fundamental approachesin process design/redesign or managementto prevent medical errors and minimize inspectioncosts and rework (Fig. 6.1-4). The fifth approach,“learning from experience,” provides a feedbackloop to identify further opportunities for standardization,automation, education, and prevention,all of which can be captured in the KW (4.2a(3)).Lean and Six Sigma concepts are integrated into ourlearning and development programs (5.2c(1)) andused within our MFI to support waste reduction anddefect elimination. These methods have led to improvedquality and efficiencies in processes, includingover 1,300 team-based process improvements inthe HFHS Pathology service line (Fig. 7.1-37).6.1c Emergency Readiness. HFHS uses a hazard andvulnerability analysis tool as a best practice to designand maintain comprehensive emergency preparedness.A committee with cross-System representation,operating under the HFHS Environment of Care Committee,is responsible for the System’s plan. To ensurea coordinated emergency or disaster response, HFHSparticipates in local, regional, state, and national planning,in cooperation with other health care providers, communityrepresentatives, and government agencies, from city governmentsto Homeland Security. The emergency preparedness planincludes an array of prevention approaches. For example, theInfluenza Planning Committee annually anticipates flu seasonand guides the immunization program, while overseeing plansfor a potential flu pandemic and quarantine. Each HFHS facilityis prepared to activate an Incident Command System, based onthe HICS. HFHS also activates the HICS in local non-emergentbut high-risk situations to ensure communication and control.To ensure effective emergency or disaster management, and promotecontinuity of operations, all workforce segments receive appropriatetraining for their roles. This includes required NationalIncident Management System (NIMS) training, basic and advanceddisaster life support, decontamination training, and crosstrainingto fulfill multiple patient care roles. The plan includesguidelines for how all facilities and BUs communicate with andsupport each other. It addresses food, shelter, transportation, andchild and elder care for health care workers and volunteers, includingformal arrangements with vendors for critical suppliesand for staff and emergency personnel. We promote constantreadiness by performing various drills within facilities and inpartnership with others (Fig. 7.1-42). We review our performanceduring drills and real-time emergencies. These reviews have ledto improvements in surge capacity, communication, decontamination,patient tracking, and evacuation, all of which are testedthrough drills. We estimate that 300% more trauma victims couldbe treated during a disaster due to these improvements. Planningfor emergency availability of hardware and software systems is asubset of overall emergency readiness (4.2b(2)).6.2 Work Processes6.2a(1) Design Concepts. The MFI (Figs. 6.1-2, 6.2-1) is usedto design and innovate work processes to ensure they meet customerrequirements, operational requirements for efficiency28Fig. 6.2-1: MFI Process Steps and Sample Tools from MFI ToolkitPHASE SYSTEMATIC APPROACH SAMPLE TOOLS• Clearly identify the problem statementPLAN• Identify process owners & champions, teamA3 problem-solvingmembers (partners, strategic supplies, patientstool, stakeholder andand family members)customer analysis,• Understand stakeholders & customer needsFMEA, root cause• Observe/document current condition/processanalysis, SIPOC,• Data collection (data mining for root causes)SMART goals,• Identify root causes (through observations,Waste Walk,interviews, data)Pareto analysis,• Create SMART GoalsBenchmarking• Idea generation• Develop work planDOCHECKACTANDDEBRIEF• Identify improvement (create new process)• Communicate the change• Pilot/implement• Collect data on processCheck (determine if process change is effective)• Data on Process Improvement• Customer view on change• Worker view on change• Continue improving process or monitorperformance, hold the gain, & spread improvements• d = Debrief: document and share improvements(added in 2009 as a cycle of improvement)Process analysis,current/future statemapping, standardwork, one piece flow,process scorecardsRun charts,statistical analysis,sampling plans,feedback tools,action plansControl plans, smalltests for rapidevaluation, debriefprocessand effectiveness including cost control (6.1b(2)), and to incorporatenew technology or knowledge. The PDCA cycle isthe core of our model, which includes tools such as Lean, SixSigma and change management and systematic approaches toinnovation (6.2a(4)) that are deployed System-wide througha comprehensive curriculum that includes classes for leadersand team members. Front-line staff receive just-in-time (JIT)training from skilled facilitators and team leaders. HFHS implementswork process designs/innovations in pilots wheneverpossible, with close observation, data collection, and analysisagainst design requirements. Effective implementation isachieved through phased roll-out and staff training, often ledby peers experienced in the new work process.Work process design and innovation approaches are alignedwith work system approaches described in detail in 6.1a(1).Key processes that need to be designed or innovated to fullymeet stakeholder requirements are identified using multipleinputs, including: 1) VOC methods (3.1a), 2) SPP analyses ofexternal environmental changes like health care reform and regulatorychanges, 3) SI analyses such as OPRs of the No HarmCampaign and other SIs (4.1b), and 4) workforce and collaboratorfeedback. The PC and SQF then prioritize System levelprocess improvements and BU leadership teams prioritize localimprovements. This approach ensures alignment and agility.Evidence based approaches are essential to both our No HarmCampaign and our research methods and contributions (Fig.7.4-14). For example, we have incorporated the World HealthOrganization (WHO) surgical checklist, an evidenced basedapproach to improve surgical safety (Figs. 7.1-6, 7.1-26), inall System operation rooms (ORs) and we now are incorporatingthis evidence-based approach into all procedural areas.We consistently implement proven bundles of care throughoutthe System (Figs. 7.1-8, 7.1-25 – 29). Many HFHS programsare certified for using evidence-based approaches, such as ourtransplant program certified by CMS (Fig.7.1-22). Service

excellence is hardwired through multiple approaches such asconsistently providing a “warm welcome” (6.2b(2)).6.2a(2) Work Process Requirements Our process for determiningwork process requirements is consistent with our approachfor work systems, described in 6.1a(2), in which designteams use the input to determine process requirements. Input isgathered through various listening posts to understand the requirementsof all stakeholders (3.1a(1,2)). Design teams analyzeinput including VOC to determine process requirementsand identify best practices, including internal innovations, toguide the new process design (Fig. 6.1-2). Stakeholders, suchas patients and employers, actively participate in design teams,giving input throughout the design process. For example, patientswere members of HFWBH process design teams, and patientsand employers provide ongoing input to the CISC as weimplement new chronic disease programs and Patient CenteredTeam Care (PCTC) (Fig. 7.1-9), modeled after Advanced MedicalHome research (6.2b). Partners, suppliers, and collaboratorsalso participate on design teams. For example, partners such asCovansys worked with us in design and implementation of ourcontact center. A stakeholder analysis tool from our MFI Toolkitis used to ensure teams charged with determining key workprocess requirements have representation or input from all keystakeholders as appropriate. Fig. 6.1-3 summarizes requirementsand measures of key processes, which are reviewed and refinedat least annually during Steps 3 and 5 of the SPP. The owner ofan initiative is responsible for review and refinement of requirements,with assistance from Operational Analytics and the MC.6.2b(1) Key Work Process Implementation. Fig. 6.1-1 showsour key work processes in relation to our work systems. Thekey Continuum of Care processes—access; assessment, treatmentplanning, and care delivery; and patient education, transition,and care coordination—are common to all work systems inthe continuum of care (Fig. 6.1-3). The key integrated Systemprocesses align to the HAP and R&E work systems; the keyBusiness and Support processes serve as a foundation. Processowners and operators manage work process performance on adaily basis using customized dashboards with data on customer,supplier/partner, and operational requirements (4.1a(1)). Dashboardsare widely deployed across BUs and Pillar Teams, andmanagers use data to make day-to-day operational decisions relatedto work processes. For example, all hospital leaders andmanagers review dashboards with census, volumes, revenue,bed availability, and productivity data (4.1b). Those at HFMGambulatory centers review dashboards of patient access/appointmentavailability, phone access, and timely response andclosure of patient telephone messages. HAP managers reviewdaily member IP census, phone access, and claims throughput.Fig. 6.1-3 shows sample measures used for control and improvementof key processes, with daily operations measures in bold.Process owners often supplement such data with real-time inputfrom internal customers, patients and families, and supplier/partnerinput from performance reviews. Our System-wide OR TVs,inspired by gas pump TVs used for advertising, represent an innovationto ensure process requirements are met. These smallTVs, mounted in work areas such as handwashing stations, areused to introduce new processes, such as the WHO checklist,and other changes in the operating suites (6.2a(1)).6.2b(2) Patient Expectations and Preferences. To better understandindividual patient expectations and preferences, wetrain care providers, including trainees, in patient communication,including role-play sessions with live actors at the SimulationCenter (5.1c(1)). Krames-on-Demand patient educationmaterials, available System-wide, offer up-to-date informationon a broad range of topics, in multiple languages and literacylevels. They can be integrated into the patient’s EMR andprinted for the patient.HFHS PARTNERS in Patient Safety is a set of behaviors introducedto patients and family members in all care settings to motivateinvolvement in safety and decision-making (Fig. 6.2-2).Fig. 6.2-2: PARTNERSP: Participate in all decisionsA: Ask questionsR: Review your health informationT: Take a list of ALL medicationsN: Notify the nurse or doctorE: Educate yourself about your healthR: Request a family member be involvedS: Speak to your health care teamTo meet the needs of patients in particular care settings, we usecustomized approaches:• An innovative, nationally acclaimed HFMG program offerspatients with prostate or breast cancer, and their familymembers, “one-stop shopping” to learn about treatment options:a comprehensive educational session tailored to thepatient’s learning needs and style, followed by individualvisits with a surgeon, radiation oncologist, medical oncologist,and nurse. Deployed to other tumor programs and integratedSystem-wide, these programs leverage our CCs ofcollaboration and care coordination.• Consistent with our MVV, nurses develop individualizedcare plans for IP, with customized goals and expected outcomes,reviewed with patients and family members at leastdaily. Whenever possible, such as with patient-controlledanalgesia (pain management), protocols enable patients toexercise greater input to their plans.• A toll-free line enables designated family members of HFHICU patients to access information about the patient’s clinicalstatus every shift so they can stay fully informed andparticipate in care decisions.• “Warm Welcome” is a cycle of improvement based on patientfeedback from follow-up calls. Patients referred toHHC receive a “Warm Welcome” call the day of their referralto discuss expectations, address scheduling, and answerconcerns, leveraging our CC of care coordination.6.2b(3) Supply-Chain Management. Supplier selection isbased on patient/stakeholder satisfaction and value of price,quality, service, and delivery. We also seek local and diversesuppliers in alignment with our values (Fig. 7.4-13). Often, innovationand technology are also key factors. Vendor orientationis mandatory, and 100% compliance with all supply chainmanagement policies and procedures is required. Supplier certificationincludes a review of financial statements, customerreferences, and industry reputation and success. We managethe supply chain through automated processes. Suppliers receiveorders electronically; purchase, receipt, distribution, and29

payment for products and services requested by customers aremanaged through our “order to pay” process, fully integratedwith Accounts Payable. We conduct quarterly performancereviews with key strategic suppliers, such as Premier, whichaccounts for 55% of our supply spend. HFHS staff, includingkey stakeholders, meet with supplier representatives to analyzecost, quality, service, and delivery as well as internal customersatisfaction. We address poor performance with plans andtimelines for corrective action. Without timely improvement,suppliers may be dismissed.6.2b(4) Process Improvement. We use the MFI and appropriatetools selected from our toolkit to improve health care outcomesand services, achieve better performance, and reduce variability(Fig. 6.1-2, 6.2(a)). This model has been systematically improvedover many years to incorporate new methodologies andbest practices. For example, a new emphasis on change managementin 2010 aligned with our strategy to increase employeeengagement and innovation. We evaluate work process performanceand set improvement priorities through the SPP (Fig. 2.1-1), performance reviews (4.1b), management of daily operations(6.2b(1)), and Baldrige-based assessments (P.2c).We foster innovation through multiple approaches, includingculture, workforce strategy, setting high goals that requirebreakthrough change, creating incubators for innovation suchas the Simulation Center, and sharing innovations through theQuality Expo, performance review, research methods, andother means. We apply our MFI to promising new ideas to develop,refine, deploy, and spread innovations. In our search forbest practices and innovative ideas (part of “Plan”), we capitalizeon our CCs, internal research and education, the expertiseof our own clinicians, knowledge from our collaborative partners(e.g., surgical care improvement project (SCIP), IHI’s 5Million Lives Campaign, Keystone), collaborations with professionaland industry experts (e.g., Press Ganey and Premier),and benchmarking with Baldrige recipients and other high performersin and outside of health care. Sharing our innovationsnationally helps us learn and improve faster. For example, IHI,AHRQ, MHA and others have considered our No Harm Campaigna starting point for a potential national model. This hasled to further refinements as more experts are exposed to ourinnovations and are able to test them on a broader scale.System-wide teams of performance improvement specialistssystematically review and improve process improvement approachesusing analysis against ADLI, best practices, and lessonslearned. Improvements and lessons learned are deployedcontinuously by means of performance reviews by the PC andBU/Pillar teams (4.1c(1)); key leadership meetings, such asquarterly LEAP retreats and All-Leadership Town Hall meetings;publications for the workforce, such as News and Viewsor Monday Monitor; and the HFHS Website and KW (4.2a(3)).An annual sharing method is the HFHS Quality Expo, a weeklongposter exhibition of over 70 projects, including a competitionamong top project teams judged by outside experts. TheExpo online catalog profiles process changes and results followingthe MFI format (Fig. 6.1-2). All projects are cataloguedin the KW to spread learning across the organization.307 ResultsNote: Throughout category 7, the symbol indicates a resultin text only, not in graphic. This symbol helps the reader findresults. HFHS is a large integrated System, and representativeresults are provided as space allows. Additional or furthersegmented results are available on site (AOS).7.1 Health Care and Process Outcomes7.1(a) Patient-Focused Health Care Results. Relentless inour pursuit of clinical quality and patient safety, we excel inmany patient outcomes: No Harm: Our top priority is reducingharm: achieving results four times faster than our peers.Reduced Hospitalization: We leverage our integrated Systemto keep patients healthy and out of the hospital. Clinical Outcomes:We address the physical and mental health of our diversecommunity (for example, we are the national benchmarkfor suicide prevention). Mortality: As a result of our efforts,we have reduced mortality by 40% in the last decade.No Harm Campaign. Our top priority is to reduce harm. HFHSis a national leader in harm reduction achieved, reducing harmfour times faster than the next best (Fig. 7.1-1). Over the pastthree years variation from hospital to hospital has been reducedFig. 7.1-1: Global Harm60Global Harm Events Per1,000 Patient Days55504540Overall harm rate drops by 24% inthree years vs. next best of 6%Q108Q208Q308HFHSQ408Q109through successful efforts to increase reporting and spread practices(4.1c(1)) to decrease harm (AOS). While there is no directcomparison as HFHS uses a more rigorous approach to harmmeasurement than other organizations (6.1b(2)), significantbenchmarking with IHI, AHRQ and others revealed that themaximum harm reduction reported elsewhere is approximately2% per year. Global harm is a highly sensitive composite measureadding any instance of harm from 23 distinct measures includingall hospital acquired conditions and more. We compareeach of these distinct measures to existing benchmarks available(e.g. Figs. 7.1-4, 8). In each case, HFHS exceeds 75 th %ile.To aid performance review and action planning, measures aregrouped into categories such as procedural, medication-related,and infection-related harm (Fig. 7.1-2). The No Harm SteeringCommittee ensures that deep dives identify root causes and improvementsare deployed across the System.HFHS recognizes that harm is avoided in a culture that emphasizespatient safety. As a result of our Safety Champion programand our COS education, our employees’ perceptions and attitudesabout safety, as measured by our EOS, continue to improve withfive out of six areas exceeding 75 th %ile (Fig. 7.1-3).Hospital-acquired infections are a major cause of complications,mortality and increased LOS. We have dramaticallyQ209Q309Q409Q110•GoodQ210Q310Best Reported ComparisonQ410

Fig. 7.1-2: Medication, Infection, & Procedure Related HarmMedication, 20 Procedure and Infection Harm Each Decrease Over 30%Harm Events per1,000 Patient Days100806040200reduced infections System-wide (Figs. 7.1-4 – 6). HFHS participatesin the MI Keystone ICU Care Improvement Initiative,which includes reducing Ventilator Associated Pneumonia(VAP) rates. Through consistent application of evidencedbasedbundles of care aimed at reducing local outbreaks (7.1-4), HFHS rates exceed 75 th %ile.Education improves care. Since implementing our innovative,interactive DVD, “Pokes and Prods,” teaching best practice suchas central line insertion technique based on the bundle concept,blood stream infection rates now approach zero (Fig. 7.1-5).Infection rates for coronary artery bypass graft (CABG), hip,and knee surgeries show continued improvement, at or betterthan the 75 th %ile (Fig. 7.1-6). HFHS was an early adopter ofFig. 7.1-4: Ventilator Associated PneumoniaInfections per 000Vent Days1510506543210Q108Safety aPriorityQ208Q308Q408Q109Q209All Hospitals Between75 th and 90 th %ile •Good2005 2006 2007 2008 2009 2010HFH HFMH-WC HFWHHFMH HFWBH NHSN 90%ileNHSN 75%ileQ309Q409Q110Q210Infection Procedure MedicationFig. 7.1-3: Culture of Safety ScoresScoreGoodAbove 75 th %ile for 5 Out of 6 MeasuresEncouraged toSpeak UpCommunication breakdownrareFeel safe as apatient hereResolvedClinicalDisagreements•GoodQ3102006 2008 2010 AHRQ 75 %ileFig. 7.1-5: Blood Stream Infection Rates—ICU5.0ICU Blood StreamInfections Per ,000Central Line Days4.03.02.01.00.0•GoodQ410ClinicianTeamworkStrong Improvement Trends, Manyat or Approaching 90th Percentile2003 2004 2005 2006 2007 2008 2009 2010HFH HFWH HFMH-CTHFMH HFWBH NHSN 90%ileNSHN 75%ileFig. 7.1-6: Surgical Infection Rates5Infection Rates Improving at or Surpassing 754th %ile3•Good210Infections Per00 Cases20072008200920102007the SCIP bundle to reduce surgical infections and participatesactively as a thought leader in this and other surgical improvementcollaboratives. (Fig. 7.1-26).HFH saw a sharp rise in Clostridium Difficile (C-Diff), a seriousinfection, in 2009. A multi-pronged approach of intensivehandwashing campaigns, elimination of unnecessary antibioticuse, and changes in cleaning protocols resolved the problemand further improved results over baseline. HFWH respondedto a single quarter spike in 2010 with stricter protocols thathave been deployed System-wide. System rates approach orexceed national best practice (Fig. 7.1-7).OB elective induction bundles designed to decrease birthingcomplications are incorporated as part of our care deliverywork process. Increased compliance to near 100% has resultedin a dramatic decrease in birth trauma (Fig. 7.1-8). No comparisonis available. This is an important area of focus given ourincreasing market share and commitment to patients throughouttheir life stages.Reduction of Admissions, ED Visits and Readmissions. Aspart of a key SI, we leverage our integrated System to keeppatients out of the hospital. Our efforts focus on chronic populationsand high risk patients where better coordination ofservices can have a substantial impact. Process improvementshave reduced admissions and ER visits for chronic populations(Fig 7.1-9) through improved care coordination and programs20082009201020072008CABG Hip KneeNHSN 75%ile NHSN 90%ileFig. 7.1-7: C-Diff RatesC. diff per 0,000Patient Days302520151050Q108Q208Q308Q408Q109Q209Q309Q409Q110Q210Q31020092010At or Approaching Best Practice•GoodQ410HFH HFWH HFMH-WCHFMH CDC Best HFWBHHFHSFig. 7.1-8: OB Bundle Compliance & Birth TraumaBundleComplianceBundle Approaching 100%, Birth Trauma Approaching 0100%580%60%40%20%0%01/1003/1005/1007/10Infant Birth TraumaInduction Bundle09/1011/10-Q208Q408Q209Q409Q210Q41043210Birth Trauma per,000 BirthsBirth TraumaAugmentation Bundle31

Fig. 7.1-9: HAP Admission & ED Visit ReductionVisits per ,000 Members600500400300200100Keeping Seniors/Chronic Populations Healthy:Admissions and ER Visits Down 10%+•Good06 07 08 09 10 06 07 08 09 10HAP Overall - IPHAP Overall - EDHAP Seniors - IP HAP Seniors - EDHAP Chronic - IP HAP Chronic - EDsuch as the Catastrophic Senior Case Management (CSCM)and HAP In-Home Care Program (HIHCP). In 2009 we instituteda series of System interventions to improve handoffs andincrease care coordination between settings. HAP and CCShave worked closely with the rest of the System to managepatient care in outpatient settings longer and, as a result, referralsamong BUs have increased by 150% in two years.System innovation and vendor collaboration resulted in an assessmenttool to systematically identify and flag high-risk patientsfor readmission. This tool is now used as a best practice atother U.S. hospitals. The high-risk flag shows up in the referralto HHC, improving handoff communication. HHC ensures thatall willing patients are seen within 48 hours and usually within24 (Fig 7.1-10). The goal is not 100% because some patientsrefuse or do not answer. No benchmark is available.Fig. 7.1-10: % of Discharge Patients Seen by CCS-HHCwithin 48 hrs% seen within hours95%85%75%01/0903/09Achieved and Sustained Theoretical Best05/0907/0909/09The combination of services brought to bear for these high riskpatients has actually resulted in a lower 30 day readmissionrate and higher number of days until readmission for CCS’shigh risk patients than for non-high risk patients (Fig. 7.1-11)Benchmarks are not available for these measures. CCS-HHCaccepts a significantly more acute population than competitorsin alignment with System goals to maximize the health andwellness of our total population.HFHS actively participates in the MI State Action on AvoidableRehospitalizations (MI-STAAR) initiative to develop/spread best practices. Piloted on congestive heart failure (HF)patients (Fig. 7.1-12), it is now being deployed more broadly.In addition to focused efforts for high risk and chronic populations,research and education projects are leveraged to decreasereadmissions. Internal Medicine residents perform monthlyreadmission reviews to identify preventable admissions andshare best practices. Monthly reviews are attended by CCSand other stakeholders. Overall readmissions have begun to11/0901/1003/1005/10Good07/1009/10% within 48 hours Goal11/10Fig. 7.1-11: CCS HHC Days to Readmission, High Risk# of Days toReadmissionCoordinating65Care to Keep High Risk Patients Out Longer60Good5550454002/1003/1004/1005/1006/10HR Patientsdecline in some areas, but this remains a key SI for the System(Fig. 7.1-13).Clinical Outcomes. All HFHS BUs are working to measureand improve care for specific patient populations. Several ofthose initiatives are highlighted in Figs. 7.1-14 – 17).Our cutting edge Perfect Depression Care initiative drove thesuicide rate for HFMG-assigned HAP patients to zero (Fig.7.1-14). Our model won national recognition as a best practice,earning the 2006 TJC Codman Award. Innovations suchas open access scheduling and drop-in group visits loweredthe suicide rate for patients with depression to near the rateof the general population—an achievement sustained for multipleyears. There were 3 suicides in 2010, still one fifth thenational rate of suicides in patients in remission, and far belowexpected rates for this population. Root cause analyses of thesesuicides resulted in identification and implementation of threeadditional process improvements.Fig. 7.1-14: Suicide Rates25007/1008/1009/1010/10All PatientsFig. 7.1-12: MISTAAR Unit 30-Day Readmission Rates% ofReadmissions30%20%10%0%11/10Pilot 40% Successful: HF Patients Readmissions down by 30%•Good12/10Q109 Q209 Q309 Q409 Q110 Q210 Q310 Q410HF Patients Readmitted for All CauseHF Patients Readmitted for HF CauseFig. 7.1-13: Readmissions in 30 Days0 DayReadmission RateSuicide RateNow Spreading Piloted Improvements to General Population:Expect Overall Readmission Rate to Decline15%10%5%0%20015010050007080910HFHHFMH-WCHFWH000107080910020307080910040506•Good0708091007080910HFMHHFWBHCrimson 75th%ileSuicide Rate for Depressed PatientsNear the Rate of General Population07•Good0809'# Suicides/100,000 HFMG Assigned HAP pts.Expected with active mood disorder (21x)Expected rate for normal patients (4-10X)Expected rate in general population - US 20001032

A key safety metric for psychiatric inpatients is use of seclusionand restraints. If possible, less risky alternatives for controllingbehavior should be used. (Fig. 7.1-15).Fig. 7.1-15: Use of Seclusion and RestraintsRate Per ,000 Days7.06.05.04.03.02.01.00.020052006Improved by a Factor of 5, Approaching ZeroRestraints2007200820092010SeclusionsManagement of blood glucose levels is tied to lower infectionrates and higher medication safety for diabetic patients oninsulin drips. HFH created nurse-driven protocols in 2001 thatare continually refined based on analysis of our data and publishedliterature. Changes are piloted before being rolled out.The goal is to minimize the number of patient days with bloodglucose levels higher than 40. The incidence of unacceptablelevels has been cut in half in 2 years. No national benchmarkexists for this measure.HFMG developed one of the nation’s first programs to coordinatemanagement of therapy using oral anticoagulators, a commonlyprescribed but high-risk medication. We created collaborative“virtual clinics” of nurses and pharmacists, supported byevidence-based protocols and CarePlus, to increase appropriateInternational Normalized Ratio (INR) ranges (6.1a(2)). Comparativedata from published research studies suggest that INR inrangevalues average 34-47% among patients managed in primarycare and 55-60% among patients managed in specialty clinics likeours. By contrast, almost 69% of our patients have INRs in range,an industry best practice (Fig. 7.1-16).Fig. 7.1-16: INRs in Range70%68% Good66%64%62%60%% of Time INRin RangeCCS’s HHC nurses manage patients in their homes with thegoal of keeping them out of the hospital and the emergencyroom. Despite an increasingly acute population, HFHS patients’functional status is maintained. Metrics such as ambulationand ease of getting in/out of bed exceed the nationalaverage for all patients regardless of acuity. This helps patientsreturn to healthier and safer behaviors sooner.Dialysis. Close collaboration between CCS and HFMG physiciansis leading to earlier identification of renal problems andearlier intervention to plan for and place appropriate dialysisaccess routes. HFHS achieves CMS best practice benchmarksfor key dialysis metrics (Fig. 7.1-17).20052006200720082009Exceeding Industry Best Practice20102004 2005 2006 2007 2008 2009 2010HFMG Industry BPFig. 7.1-17: CCS Dialysis—URR and Hemoglobin LevelsUrea reduction ratio (URR) measures how well blood is cleansedduring dialysis. CCS’s URR results have met or exceeded theCMS best practice benchmark for the last yearsCMS targets for 0% of dialysis patients to maintain hemoglobinlevels between 10 and 13. Levels that are either too low or too highlead to increased morbidity and mortality. HFHS has exceededCMS’s goal for the past 3 years. In 2010, updated recommendationstarget 80% exactly (not above or below) for ranges between 10 and13 to minimize unnecessary treatment which can cause harm.HFHS achieved CMS updated recommendation in 00—maintaining exactly 0% in range.Mortality. Mortality has decreased 40% System-wide over thepast decade. We incorporate evidence based approaches, applyour own research, and coordinate care to improve critical outcomes.Sample quality initiatives that contributed to the significantimprovement in mortality are graphed. These SIs andour EMR have also contributed to a 51% decrease in claims.Claims data lag one year (Fig 7.1-18).Fig. 7.1-18: System Mortality & Malpractice ClaimsFrequency, Key Quality InitiativesClaims FrequencyQuality 0.06 Initiatives Lower Mortality by 40% in Last Decade 2.8%0.050.040.030.020.010•Good200020012002SCIP100K Lives:Rapid ResponseTeamsGlucoseICU200320042005Glucose allHFHAggressiveInfection Control2.6%2.4%2.2%2.0%1.8%1.6%1.4%1.2%Despite impact on mortality rates, HFHS’s policy encouragestransfers of acute patients into our System to ensure that ourcommunity gets the best care possible. Even with transfers, ourmortality is better than MI expected (Fig. 7.1-19). Four offive HFHS hospitals are in the MI top quartile, a remarkableaccomplishment since Michigan mortality is among the lowestin the U.S.HFH physicians and researchers demonstrated that a bundle offive actions (Fig. 7.1-28) delivered in a timely manner dramaticallydecreases mortality from sepsis, a serious infection affectingthe bloodstream that often leads to multiple organ failure.The bundle was piloted at HFH in 2005, and then spreadas a best practice to all System hospitals. In 2007, our approachbecame the national best practice now used in about 10% of20062007Sepsis Protocol2008DVT ProtocolNo HarmCampaign2009Total ClaimsPaid ClaimsHFHS Mortality - 1 Yr Moving AvgFig. 7.1-19: MI Hospitals Actual to Expected MortalityHFHS 1.1 Better Than Expected Even with Transfers 6,0001.0515,0000.95•Good 4,0000.90.850.83,0000.752,0002004 2005 2006 2007 2008 2009 2010Without TransfersWith TransfersActual = Expected# TransferredObserved toExpected Ratio2010Mortality Percent# Transfers to HFH33

hospitals nationwide. Per IHI, sepsis mortality averages between30 and 50%. Our rate is 400% better than average (Fig.7.1-20). No best practice benchmark exists.Fig. 7.1-20: Sepsis MortalitySepsis Mortality50%40%30%20%10%HFHS Innovation: Four Times Fewer Deaths fromSepsis than National Average and Improving•Good0%2004 2005 2006 2007 2008 2009 2010HFH HFMH-WC HFWHHFMH HFWBH National Ave.HF is a leading cause of death. HFHS has decreased our mortalityrates to 30% less than expected (Fig. 7.1-21).Fig. 7.1-21: Heart Failure Mortality430% Fewer HF Deaths than ExpectedMortality Rate (%)32102004 2005 2006 2007 2008 2009 2010ExpectedActual•GoodTransplant graft survival rates have improved to exceed expectedpercentages while the number of failed grafts has droppedbelow expected rates (Fig. 7.1-22). Improvements have beenrealized through better selection and donor criteria, multidisciplinaryrounding, and sooner post-op follow-up.Fig. 7.1-22: Transplant Graft Survival Rates & Failures# of Failed Grafts35302520151050Strong Improvement Trends; AllResults Better Than Expected07/0701/0807/0801/0907/0901/1007/1001/1107/0701/0807/0801/0907/0901/1007/1001/1194%92%90%88%86%84%# Failed # Expected to FailActual SurvivalExpected Survival7.1b(1) Operational Effectiveness.Work Systems: We leverage our integrated System to delivermore value to HFHS stakeholders. Our key processes includingContinuum of Care, Other Integrated System, and Businessand Support demonstrate operational effectiveness.Work System effectiveness is demonstrated by Figs. 7.1-23– 25, 7.1-9, and many other results such as 7.1-15, 7.1-20 andthroughout 7.5. Medical/surgical length of stay (LOS) remainsin the top decile (Fig. 7.1-23, lower is better) despite localeconomic challenges including fewer Medicaid beds availablefor post-acute care and increased homelessness. HFHS oftenGraft Survival RatesFig. 7.1-23: Medical / Surgical Length of Stay (LOS)Crimson’05 ’06 ’07 ’08 ‘09 ’10 90th %ile ’10HFH 4.6 4.7 4.7 4.7 4.6 4.6 4.6HFMH 4.7 4.5 4.5 4.6 4.6 4.6 4.6HFWH 4.5 4.6 4.5 4.5 4.3 4.4 4.6HFMH-WC 5.2 5.2 5.2 5.4 4.9 5.0 4.6HFWBH 3.4 3.5 4.6keeps such patients in the hospital longer to ensure successfuloutcomes.Even with reduced revenue due to increasing uncompensatedcare (Fig. 7.5-4), supply expense as a % of net patient revenueis stable performing in the top quartile (Fig. 7.1-24). This isdue to the success of our System SI which established 12 VATsto reduce supply costs, increase standardization, and maximizeutilization, all supported by a new centralized SCM function(6.2b(3)). Recently, SCM partnered with vendors and surgeonsto reduce the price of implants, resulting in $1.4M inannual savings, without compromising quality.Fig. 7.1-24: Supply Expense as % of Net Patient RevenueExpense as % ofNet Revenue20%18%16%14%12%10%1Q07•Good2Q073Q074Q071Q08HFHS at or Better Than Benchmark2Q08HFHS3Q08Cost savings from care coordination: One example of thesesavings is the HAP disease management program for memberswith three chronic diagnoses. Each patient is assigned a casemanager or health coach and provided telephone support andmonitoring to address issues proactively. This resulted in a netsavings of $21.9M per year and dramatic reductions in IP andER utilization (Fig. 7.1-9).External grant funding measures our effectiveness in research,which is essential to support our focus on innovation.Our Research Enterprise has attracted more than $50M in grantfunds each year for the past five years, increasing to $52.5M in2010. Grants from the National Institutes of Health (NIH) arethe gold standard for peer reviewed funding. NIH awarded 78grants to HFHS scientists, totaling $20.2M in 2010, putting usin the top 6% of all NIH funded institutions. In addition, HFHShas over 500 New IRBs and over 1,600 open IRBs. In 2010,HFHS researchers achieved 778 publications, an increase ofover 75% since 2007.Key Process Results. CMS Compliance Bundles and CoreMeasures are an essential indicator of health care process effectiveness.HFHS has innovated, piloted, and been an earlyadopter of many of bundles to reduce complications and savelives (Figs. 7.1-25 – 29). We measure “perfect” bundle compliance;if any part of the bundle is not done, no credit is given. Ourperformance has improved to 90% or higher for most measures.BCBSM provides a bonus for hospitals reaching 95%, which4Q081Q092Q093Q094Q091Q102Q103Q10Premier Top Quartile4Q1034

many of our hospitals have earned in full each year. Ventilatorbundle compliance (Fig. 7.1-25) reduces VAP (Fig. 7.1-4).c% of Perfect VentBundle100%95%90%85%80%GoodStrong Improvement:All Hospitals At or Above Bonus Level06 07 08 09 10HFH HFWH HFHM-WCHFHM-CT HFWBH BCBS BonusSurgical infections (Fig. 7.1-6) can be fatal. The SCIP bundle(Fig. 7.1-26) decreases the risk of infections and mortality.Compliance improved at all System hospitals, nearing orexceeding the U.S. average of 90 th %ile. Compliance with theacute myocardial infarction (AMI) bundle (Fig. 7.1-26), alsoexceeds benchmark.Fig. 7.1-26: Perfect SCIP and AMI Core Measure BundleCompliancePercent PerfectBundle Compliance100%95%90%85%80%75%70%65%60%SCIPGoodAMIImprovingTrends, Most Above Benchmark05 06 07 08 09 10 05 .06 07 08 09 10HFH HFWH HFMH-WCHFWBH HFMH US AvgMI Avg.In 2008, nurses System-wide took ownership of an initiativeto prevent future complications and promote overall wellnessfor HF, AMI, and pneumonia (PN) patients. Their innovativeimprovement strategies involved care coordination across themultidisciplinary team resulting in System-wide improvementand near-perfect results in providing education and counselingto these groups at risk (Fig. 7.1-27).Fig. 7.1-27: Core Measures: Smoking Counseling andDischarge Instructions100%Percent80%60%40%20%0%SmokingCounselingGoodHeart FailureDCInstructionsMost Hospitals At or Approaching Top Decile05 06 07 08 09 10 05 06 07 08 09 10HFH HFWH HFMH-WCHFWBH Nat'l 90%ile HFMHUS AverageHFHS invented the Sepsis bundle, now the national best practiceapproach. With sepsis 100% bundle compliance is notpossible because one bundle element depends on the patient’sresponse to the therapy. The best reported bundle compliancein the literature is 54% (Fig. 7.1-28).Fig. 7.1-28: Perfect SEPSIS Bundle80%At or Approaching Best Practice60%% SepsisPerfectBundle ComplianceThree HFHS hospitals are among the 20% of MI hospitals thathave achieved stroke certification from TJC or DNV. We haveimproved over the past four years and approach the certifiedhospital benchmark (Fig. 7.1-29).Health employer data and information set (HEDIS) measuresare used by more than 90% of health plans in the U.S. to measureperformance of important dimensions of care and preventiveservices. HAP uses HEDIS to track and improve OP care.For HEDIS measures overall, HAP scores close to 75 th %ile(73.2%) with a score of 72.4%, and HFMG exceeds the 75 th%ile with a score of 73.7%. HFHS approaches the national90 th %ile for screening and care timeliness (Fig. 7.1-30). Targetedinterventions such as the new EMR preventive servicesalert system and clinic process redesign have contributed tothis success.Fig. 7.1-30: HAP & HFMG HEDIS Measures Timeliness—Cancer Screening, Childbirth100%90%80%70%60%50%40%30%20%10%0%40%20%0%2006 2007 2008 2009 2010HFH HFMH-WC HFMHHFWBHBest PracticeFig. 7.1-29: Stroke Care (% Discharged on Statins)% of Patients onStatins100%90%80%70%60%50%40%Screening at or Approaching 90th %ileGoodColonCancerScreen0607080910N 90Cerv.CancerScreen0607080910N 90BreastCancerScreen0607080910N 90PrenatalTimely0607080910N 90Yellow = National 0th %ileGoodImproving; HFH Above Certified Hospital Benchmark2007 2008 2009 2010HFWHHFMHHFH GoodCertified Hosp. BchmarkPostPartumTimely0607080910N 90A multi-pronged approach to diabetes management (Fig.7.1-31) focuses on timely blood sugar (HbA1c) and lipidstesting and aggressive management of patients whose diabetesis poorly controlled (lower is better for diabetes inpoor control).Pharmacy care management has successfully kept per memberper month prescription drug costs from rising faster by35

Fig. 7.1-31: HAP & HFMG HEDIS Measures Treatment—Asthma, Diabetes4 of 5 Measures at or Above 90100%th %ile90%80%70%DM Poor60%Approp. DMDM Control50% AsthmaTxHbA1c Lipid40% Mgt. Children DoneProf. •Good30% 5-9yrw/URIDone20%10%0%0607080910N 90Good0607080910N 90engaging HFMG to use generic drugs. Generic drug use forHAP members is significantly higher than local pharmacies(Fig. 7.1-32). Our MTM collaboration between HAP, CCS andphysicians (6.1b(2)) has achieved significant savings and improvedcare (Fig. 7.1-33).CCS has partnered with suppliers to reduce durable medicalequipment inventory and increase productivity resulting in adramatic increase in net income as a percent of revenue comparedto competitors (Fig. 7.1-34).Increasing access to care is a key SI. HFMG partners with theHAP Access Task Force to continually monitor and analyzeFig. 7.1-34: CCS Inventory Reduction & Productivity•Good0607080910N 900607080910N 90Yellow = National 0th %ileGood0607080910N 90Fig. 7.1-32: PMPM Cost & Prescription Generic Use Rates$5085%Exceeding Competitors$4880%$4675%$44$4270%Only a 2% in 4 Years$4065%Drug Cost perMemeber per Month20062007200820092010GUR-HFMG & CompetitorsPer Member Per Month CostFig. 7.1-33: Medication Therapy Management ResultsOver $.M saved from 2006-2009 in prescription drug costs andmedical cost savingsOn average . interventions are recommended per patient and0% of HFMG interventions (75% of total patients) accepted.Arthritis had a statistically significant decline in gastrointestinalbleed rate pre- to post-enrollment (0% relative risk reduction)% of enrollees would recommend MTM, % agreed that totaldrug cost was reduced while maintaining high quality careEnrollees increased from % to % from 2009 to 2010URAC 00 gold award for best practice for consumerempowerment and protectionHFMGCompetitor ACompetitor BCompetitor C% of Generic Use Ratemeasures to drive improvement. A key system metric is ED-Left Without Completing Service (Fig. 7.1-35), as treatmentcompletion is essential to improved outcomes. In 2010, HFHED began a Lean effort resulting in 20% improvement. Serviceimprovements, such as creating the Contact Center, on-lineschedule requests, e-Visits, and self-scheduling, contributed tothis improvement.Fig. 7.1-35: Left Without Completing Service% of Patient LWCS5%4%3%2%1%LWCS Improves 20% in 2 Years on Average•Good0%2008 2009 2010HFH HFMH HFWBHHFWH HFMH-WC HFMC-FRLHFMC-SH HFMC-C HFWH-CHSDHFHS SystemIn 2007 the Contact Center Steering Committee redesignedoperations based on EDS’s industry best-practice technologyand processes. As a result, the Contact Center now fields 1.2Mmore calls while decreasing dropped calls by 44% in two years(Fig. 7.1-36).Fig. 7.1-36: HFMG Clinic Contact Center—Unanswered Calls% Calls Dropped15%10%5%44% Dropped Call Decrease Post Improvement•Good0%0.52006 2007 2008 2009 2010% Dropped EDS Best Practice Calls ReceivedHFHS created online appointment requests, which haveincreased over 60% in 4 years. In 2007, we began offering e-Visits and volumes have grown to 1,600 per year. Patient selfschedulingbegan in 2008 to increase mammography access.Patients can book exams for any System facility using henryford.com.Self-scheduling has increased 8 fold in two years.An important measure of patient throughput and timely treatmentis laboratory turnaround time (TAT). System-wide successachieving the most important ED lab result, completeblood count (CBC), far exceeds our target of 90% completedwithin 30 minutes. Results of “stat” orders−those the doctorneeds most urgently–are consistently delivered in less than 30minutes at all labs throughout the System (Fig. 7.1-37). Thereis no industry standard for these measures. Improvements wereachieved through the System-wide Lab Lean Journey.2.52.01.51.0# Calls Received(Millions)Housekeeping efficiency is one driver of patient throughput.Although increases in the number of beds cleaned has affectedour overall turnaround time, the System bed turnaround timeremains below HCAB benchmark (Fig. 7.1-38).HAP claims processing measures ability to process claimswith no manual intervention. This increases timely claims pro-36

Fig. 7.1-37: % ED CBCs and STAT Test in 30 Minutes100%% Completedwithin 0 Minutescessing and member/provider satisfaction. HAP has improvedto exceed 90% processing without intervention in 2010.We improve patient safety by using a web-based alert tool tonotify staff of product recalls so defective products can be removedand replaced quickly. Process improvements have ledto dramatic improvements in case closure timeliness (7.1-39)aligned with our No Harm campaign and associated SIs.Fig. 7.1-39: Product Recalls Alerts, Days to CloseAverage Daysto Close35302520151050Q107Q207Q307Q407Q108HFHS Avg DaysNon-Urgent GoalQ208Patient Safety Improved ThroughRapid Product RecallsQ308Revenue Cycle improvements in late 2009 have helped identifyprior patient balances and co-pays due at time of service.This has led to reduced billing process rework and increasedcollections and patient convenience. Efforts to date have increasedcollections and decreased days in Accounts Receivableby 3% (Fig 7.1-40).Q408Q109Q209Q309Q409Q110Q210Urgent Goal•GoodFig. 7.1-40: HFHHN Cash Collections at Point of Service$1,000Amount Collected(in '000's)$800$600$400$200$095%90%85%80%J-10Q109Q209Q309Q409Q110Q210Q310Q410Increased Collections significantly to Date;Rate of Collection IncreasingGoodF-10M-10ER CBC TATA-10M-10J-10GoodJ-10Q208Q308Q408Q109Q209Q309Q409Q110Q210Q310Q410OP Clinics HFMC-F HFH Cashier Collections HFWBHA-10S-10STAT TATHFH HFWBH HFMHHFMH-WC HFWH GoalFig. 7.1-38: Bed Turnaround TimeTurnaround Time(in minutes)65605550All Labs Far Exceed Aggressive GoalHFHS Exceeding Best PracticeDespite Increasing VolumeGood1751507510012550250O-10N-10D-10Q310J-11# of Beds Cleaned(in 000's)45•Good2008 2009 2010 2008 2009 2010TAT # of Beds HCAB Best PracticeQ410F-11Despite the continuous increase in Help Desk call volume,first call resolution (FCR) performance has been at or aboveall benchmarks since Q3 2007 (Fig. 7.1-41). HAP’s ClientServices Division has exceeded its first call resolution goal of92.0% since 2006, never performing below 94.7%. HFHShas sustained 99.9% availability of the patient administrationsystem (registration, scheduling, and billing) since Q4 04and more than 90% of issues are resolved within eight hours.This supports safe, efficient care delivery.Fig. 7.1-41: IT Help Desk First Call ResolutionFCR%80%75%70%65%60%55%7.1b(2) Emergency Preparedness HFHS BUs meet and oftenexceed the requirements of regulatory agencies (Fig. 7.1-42).The number of emergency drills at HFH has been significantlyreduced due to the planning and execution of large disasterdrills, implemented successfully in only a few hospitals in thecountry. In 2007, HFH was named one of five Best-PracticePreparedness hospitals in the U.S. by the CDC based on ourreadiness for response to a community disaster.Fig. 7.1-42: Emergency Preparedness2007 2008 2009 2010 Req’dHFH 10 13 15 5 3Emergency &Community DrillsFire DrillsMaintained Response Rates aboveBenchmarks with Increased VolumeGoodQ107Q207Q307Q407Q108Q208Q308Q408Q109Q209Q309Q409Q110Q210Q310Q410Tickets OpenedFCR HC BenchmkFCR GoalHFMG 47 35 36 33 3HFMH 4 4 6 8 3MFMH-WC 2 2 3 10 3HFWH 2 3 4 3 3HFWBH 3 18 3HFH 88 87 77 66 66HFMG 78 67 52 66 50HFMH 36 36 36 24 24MFMH-WC 12 12 12 12 12HFWH 36 35 36 35 12HFWBH 10 14 127.1c. Strategy Implementation HFHS leads the nation in harmreduction, our top priority (Fig. 7.1-1). We are consistently recognizedfor innovative, high quality patient care (Fig. 7.4-2).Accomplishment of our SOs and SIs is demonstrated by our resultsand the sustainability of our strategic investments to growboth volume and market share. In spite of the local economyand reductions in population, HFHS has invested in our communityby building the new HSWBH and conducting majorrenovations at HFH. For over five years, we have surpassedour aggressive growth goals while remaining financially strong454035302520Tickets Opened(000's)HFHS FCRFCR Industy Benchmk37

and maintaining our A1 stable bond rating. In addition, furtherintegration with HAP drove significant volume to HFHS hospitals.From 2007 to 2010, HFHS led all competitors with 12%IP growth, gaining 10,685 admissions. During the same period,all of SEM grew by only 8,607 admissions. HFHS effectivelycaptured all of these and over 2,000 more, for a total of 99,798admissions in 2010 (7.5a(2)).Consistent with our “can-do” spirit, we set aggressive targetsfor critical measures to force innovation. Fig. 7.1-43 shows arepresentative sample connected with key SOs. Our two areasof red have aggressive performance improvement plans withassigned resources to address (Fig. 2.1-2, 3.1b(1)).Fig. 7.1-43: HFHS Key Dashboard Goal AchievementPILLAR PERFORMANCE MEASURE 00*PeopleServiceQualityGrowthResearch/EducationTotal Employee Turnover (Fig. 7.3-3)Employee Engagement (Fig. 7.3-10)Customer Engagement - % Top Box,Likelihood to Recommend (Fig. 7.2-3,8,10)HCAHPS (Fig. 7.2-5)Harm Prevalence (Fig. 7.1-1)Readmissions (Fig. 7.1-13)Admission Volumes (Fig. 7.5-9)Inpatient Market Share (Fig. 7.5-11)HAP Membership (Fig. 7.5-15)OP Visit Volume (Fig. 7.5-14)NIH-Funded Research Grants/Contracts(7.5a(1))Trainee Satisfaction (7.3-14)YellowYellowYellowRedGreenRedGreenGreenGreenGreenGreenGreenReady for Independent Practice (Fig. 7.3-14) GreenCommunity Benefit (7.4-11)Community GreenVisits to Community Clinics (Fig. 7.4-8)FinanceSystem Operating Net Income (Fig. 7.5-1)Cost per Unit (Fig.7.5-2)Philanthropic Donor Renewal (Fig. 7.4-7)Philanthropic Cash Collected (Fig. 7.5-8)*Green: target achieved; Yellow: within 5%, Red: below targetGreenGreenGreenGreen7.2 Customer-Focused Outcomes7.2a(1) Patient and Stakeholder Satisfaction and 7.2a(2) Patientand Stakeholder Engagement. Consistent with THFE,we strive for excellence in patient satisfaction and engagement.Results here are grouped by work system, combiningsatisfaction and engagement throughout. This reflects our shiftin focus from satisfaction to engagement and our commitmentto compare ourselves to others at a higher level of performance(3.1b(1)). Many of our System results are in the top decile,including Ambulatory, CCS, and HAP. Our community continuesto recognize HFHS above our competitors for best overallquality (Fig 7.2-1). Our community hospitals perform at orabove 75 th %ile for most measures. HFH has improved steadilysince 2002, even though lack of private rooms (Fig.7.2-6) anda more crowded environment account for a significant portionof the difference compared to the other hospitals. We are nowapplying the same approaches used to improve Quality andSafety (6.2b(4)) over the past several years to improve patientengagement and ensure a consistently remarkable experiencethroughout the System. Results are shown by work system dueto space limitations; BU results are available on-site.NRC’s annual market (i.e., current, former, and potential patients)preference survey provides community perception ofHFHS as an integrated system (Fig. 7.2-1). In Wayne County,where 68% of our patients live, HFHS is the preferred healthsystem for “Best Overall Quality” six years in a row.Fig. 7.2-1: Best Overall Quality—System Integration (NRC)Inpatient satisfaction and engagement. Our IP likelihood torecommend mean score approaches the 75 th %ile for all hospitals(Fig. 7.2-2). Consistent with our focus on engagement,only top box likelihood to recommend results are presented forother work systems (Fig. 6.1-1). IP top box likelihood to recommend(Fig. 7.2-3) and satisfaction (Fig. 7.2-4) continue toimprove, as a result of hourly nurse rounding to address issuesin real-time, service excellence assessment and training, andour Service Champion programs.Fig. 7.2-2: IP Likelihood to Recommend (PG)Percent95908580Approaching 75th%ileGood2007 2008 2009 2010 2007 2008 2009 2010HFHCommunity HospitalsSE MI 75th %ileSE MI 90th %ileFig. 7.2-3: IP Top Box Likelihood to Recommend (PG)Top Box Likelihoodto Recommend8075706560HFHHFHimproving,improving,CommunityCommunityApproachingApproaching75th75th%ile%ileGood55Peer Groups Selected on Matching Volumes50'05 '06 '07 '08 '09 '10 '10 '10 '05 '06 '07 '08 '09 '10 '10 '10HFH Community Hospitals 75th %ile 90th %ileFig. 7.2-4: IP Satisfaction (PG)Score90858075GoodHFH improving, Community Exceeds 90th %ile2005 2006 2007 2008 2009 2010HFHCommunity HospitalsSEM 75th %ileGoodSEM 90th %ile38

HCAHPS results (Fig. 7.2-5) allow comparisons to competitors ineach market. Our hospitals generally score higher than our immediatecompetitors in each market, growing our market advantage.HFWBH and Providence (new hospitals) have 2010 data only.Fig. 7.2-5: IP Overall Satisfaction Rating (HCAHPS)HFWBH is a beta site for many new initiatives, including24/7 on-demand food services/meals and 100% private rooms.Innovations have resulted in better-than-benchmark patientsatisfaction in all survey areas. HFWBH exceeds 90th percentilefor most key PG questions. Collaborative efforts areunderway to deploy HFWBH best practices System-wide.We perform root cause analyses to prioritize opportunities toimprove service satisfaction. HFH patients in private roomsscore us about 5 points higher, accounting for a significant shiftin %ile ranking. HFH private rooms now achieve 80 th %ileoverall. At HFH, we will move from about 50% private beds to75% over the next five years (Fig. 7.2-6).Fig. 7.2-6: HFH Correlation of Private vs. Non-PrivateRoom Satisfaction (PG)Mean ScorePrivate Beds Score Higher: Building More Private Rooms90Good85807570100%80%60%40%20%0%Q109 Q209 Q309 Q409 Q110 Q210 Q310 Q410Private RoomsNon Private Rooms%ile Rank - Private%ile Rank - Non PrivateSince 2002, HFH IP satisfaction has improved significantly.While not at the 75 th %ile, IP scores are now in the high 80s.We project significant improvement in the next 2 years due toefforts underway (Fig. 7.2-7).Fig. 7.2-7: HFH IP Satisfaction—Long Range (PG)Mean Score85%80%75%70%65%60%55%50%90858075New Hospital (HFWBH) Leads Region; HFHSActively Applying Best Practices System-wideStrong Improvement Since 2002Good%ile Rank2002 2003 2004 2005 2006 2007 2008 2009 2010 2011IPSEM 75th IPProjectionsSEM 90th IPGood2008 2009 2010 MI Avg US AvgHFHS hospitals (blue outline) are adjacent to nearest competitors (red)Emergency Department satisfaction and engagement. Patientschoose EDs based on both quality and convenience. Ourcommunity- based ambulatory EDs are less crowded and oftenmore convenient to access. We are working to replicate theirstrong results throughout the System. ED service improvementsfocus on reducing wait times, more communicationabout delays, and use of volunteers to address patients’ nonclinicalneeds (Figs. 7.2-8, 9). Ambulatory Centers are at the90 th %ile, and SE Leaders are identifying best practices fromambulatory sites that can be adopted at hospital EDs.Fig. 7.2-8: ED Top Box Likelihood to Recommend (PG)Top Box Likelihood toRecommendFig. 7.2-9: ED Satisfaction Overall (PG)Mean Score85807570656055504540Ambulatory Above 90th%ile,Community Hosp. Approach 75th%ileGood'05'06'07'08'09'10'10'10Peer Groups Selected on Matching Volumes'05'06'07'08'09'10'10'10'05'06'07'08'09'10'10'10HFH Community Hospitals Ambulatory 75th %ile 90th %ile959085Ambulatory Exceeds 90th%ileGood8075702005 2006 2007 2008 2009 2010HFH Community Hosps AmbulatorySEM 75th %tile SEM 90th %ileAmbulatory Surgery satisfaction and engagement. (Figs. 7.2-10, 11). Ambulatory surgery top box engagement is strong forambulatory sites and community hospitals. HFH began an SIin 2009, in collaboration with other System departments andSE Leaders, to improve scores through better coordination ofcare before surgery and improved post-op discharge instruc-Fig. 7.2-10: Ambulatory Surgery Top Box Likelihood toRecommend (PG)Ambulatory Exceeds 90th%ile,Regional Approaching 75th%ileTop Box Likelihood toRecommendFig. 7.2-11: Ambulatory Surgery Satisfaction Overall (PG)95Score908595908580757065605550'05'06'07'08'09'10'10'10Peer Groups Selected on Matching Volumes'05'06'07'08'09'10'10'10Good'05'06'07'08'09'10'10'10HFH Community Hospitals Ambulatory 75th %ile 90th %ile80Ambulatory Exceeds 90th%ile752005 2006 2007 2008 2009 2010HFH Com. Hospitals Ambulatory SitesSEM 75th %ile SEM 90th %ile Good39

tions, including wound care at home. These efforts resulted inimproved Q1 2010 scores.Outpatient Medical Practices satisfaction and engagement.OP likelihood to recommend (Fig. 7.2-12) is an important componentof the patient’s overall perception of the System and essentialto drive volume in other areas. Most areas are approachingthe 75 th %ile or higher. Communication is a key customerrequirement and continues to be a focus for improvement, andHFMG OP satisfaction (Fig. 7.2-13) has improved in part dueto Contact Center service improvements (Fig. 7.1-36).Fig. 7.2-12: OP Likelihood to Recommend (PG)Mean ScoreFig. 7.2-13: OP Medical Group Practice Satisfaction—Overall (PG)100 HFMG Approaching 75th%ile Community95Employed Physicians at or Near 90th%ile GoodScoreCommunity Care Services. Satisfaction and engagement withCCS increases engagement with the System as HFHS playsa larger role in the community’s health and well being. CCSis rated highly by our patients (Fig. 7.2-14). The remarkableincrease in overall patient satisfaction from the 21 st %ile to99 th %ile in three years is a result of a focused SI called the PatientEngagement Program. Key elements are being replicatedthroughout the System.Fig. 7.2-14: CCS Patient SatisfactionPercentile RankIn 2008, CCS oncology programs began using PG. The JosephineFord Cancer Center−Downriver, a community basedoncology center, earns consistently high engagement resultsthrough exceptional service, such as offering concurrent therapiesto patients receiving both radiation and chemotherapytreatments (Fig. 7.2-15).401009590858090858075100806040200Approaching 75th %ile or HigherFrom 21st to 99th %ile in 3 YearsGood2007 2008 2009 2010HFMH-CT HFMH-WC HFMGHFWH Nat'l 90%ile Nat'l 90 %ile2005 2006 2007 2008 2009 2010HFMH HFMH-WC HFMGHFWH Nat'l 75%ile Nat'l 90 %ileGood2007 2008 2009 2010CCS %ile RankFig. 7.2-15: OP Oncology Patient Satisfaction—CCS (PG)100PercentHAP. Overall plan satisfaction, as measured by CAHPS, increasedfrom 65% in 2003 to 78% in 2009, better than theNCQA 90 th %ile (Fig.7.2-16). Access to specialty care whenneeded drives overall member satisfaction and was a focus ofHAP’s network-specific referral process improvements. Whileno benchmarks exist, HAP made huge gains from 2003 to 2009in specialty care access satisfaction (Fig. 7.2-17).Fig. 7.2-16: HAP Overall Satisfaction (CAHPS)85%Exceeds 90th %ile and Continues to ImprovePercentHAP was rated “Highest in Member Satisfaction among CommercialHealth Plans in Michigan” for the fourth consecutiveyear according to the J.D. Power and Associates’ 2011 U.S.Member Health Insurance Plan Study (Fig. 7.2-18). The JDPower study measures member satisfaction of 137 health plansin 17 regions throughout the U.S. HAP’s 2011 performance increased,with a score of 769 on a 1,000-point scale, which dramaticallyexceeds the Michigan average score of 696. “Satisfactionamong members in integrated health plans, such as HealthAlliance Plan and Kaiser Foundation Health Plan, averages 741Fig. 7.2-18: US Member Health Plan Study (JD Powers)1,000HAP Highest in Member Satisfaction900Good4 Years in a RowScore (0-,000)75%65%55%800700600500Good2003 2004 2005 2006 2007 2008 2009 2010HAP - CAHPSNCQA 90th %ileFig. 7.2-17: HAP Member Satisfaction with Specialty Access70% Strong Improvement in Access to CareGood60%Score959085807550%40%30%Exceeds 90th% PercentileGood2008 2009 201075th %ile 90th %ile2003 2004 2005 2006 2007 2008 2009 20102008 2009 2010 2011HAP MI Avg.

on a 1,000-point scale, compared with 691 among members ofplans where care is not integrated.” Results for additional satisfactionsurveys for HAP members are available on site.7.3 Workforce-Focused Outcomes7.3a(1) Workforce Capability and Capacity. Position timeto-fillimproved through expanded outreach, improved branding,and automation of key hiring process steps (Fig. 7.3-1). InQ1 2010, a one-time backlog of requests increased time-to-fillwhen we closed a small hospital and instituted a temporarySystem-wide hiring freeze in order to maximize internal transferopportunities.Fig. 7.3-1: Time to FillTime to Fill (in days)1501251007550250Improved to Benchmark PerformanceQ109 Q209 Q309 Q409 Q110 Q210 Q310 Q410HFHS75% Lean Benchmark•GoodScoring high on annual employee performance reviews demonstratesworkforce capability to meet System needs. 98%of employees evaluated in 2010 met or exceeded expectations,achieved through our multi-year focus on talent selection, development,and promotion.Recruitment rate is an indicator of hiring activity, whichdetermines whether HR is meeting organization staffing needs.The recruitment rate rose in 2009 to meet staffing requirementsto open HFWBH, but improved in 2010 to achieve Saratoga’s75 th %ile.A drop in our vacancy rate from over 6% in 2008 to 4% in2010 also reduced agency spending by half. These favorableresults were achieved as operations and HR leaders partneredto eliminate agency staff or convert them to employees. 2010results approach 75 th %ile (Fig 7.3-2).Fig. 7.3-2: Vacancy Rate & Agency SpendingVacancy %Vacany Rate Approaches Benchmark; Agency Costs Cut in Half76543210•Good25201510502008 2009 2010Vacancy % HRIC 75% Agency CostsAgency Costs(in millions)In 2010, turnover equaled or beat the Saratoga 75 th %ile for allareas with benchmarks, with significant three-year improvementtrends for hospitals and BHS (Fig. 7.3-3). While nobenchmarks are available, research shows retail and home careservices, key components of CCS, are businesses that typicallyexperience high turnover. Our workforce retention strategieshelp us reduce turnover and retain critical skills and organizationalknowledge. Of our current workforce members, 38%have been promoted or transferred internally.Fig. 7.3-3: Overall Employee TurnoverTotal Turnover %20%15%10%5%0%Turnover Improves to 75th %ile in Areas with ComparisonSystemHospitalsHFMGReducing voluntary turnover for critical-to-fill positions, suchas RNs, most of whom work in our hospitals and HFMG medicalcenters, is a key SI for HRET. Voluntary RN turnover isapproaching the Saratoga best quartile (Fig. 7.3-4).Diversity, Inc. rated HFHS #1 for diversity in health carein 2010, the first year this recognition was available. Our totalscore is a weighted average of four key areas: CEO Commitment,Human Capital, Corporate and Organizational Communications,and Supplier Diversity. In addition, HFHS has receivedmany recognition awards for diversity and workplace culturesuch as: Detroit Free Press—Top Workplaces (2009-2010);Michigan Business & Professional Association—101 Best &Brightest Places to Work, Elite Awards (2008-2010); Institutefor Diversity in Health Management—Best-in-Class Leadership& Governance (2010). Workforce diversity helps us meet patientneeds, build a healthy culture, and reflect our communities.7.3a(2) Workforce Climate. Immunizations protect our employees,patients, and visitors, and support a safe, healthy workenvironment. (Fig. 7.3-5).Participation in wellness programs has increased steadily. In2010, to qualify for HE (5.1b(1)), employees had to completean HRA, which doubled participation in this program. HRALifestyle scores summarize the impact of healthy behaviors onfuture disease rates. HFHS scores have steadily increased andnow surpass the vendor’s book of business (BOB). The 2-pointBHS•GoodCORPHAPCCS2007 20082009 20102009 Saratoga 75th 2009 Saratoga 90thFig. 7.3-4: First Year RN Voluntary Turnover25%RN TO % for 0

increase from 2009 to 2010 translates to about $6M in savings:$1M in avoided health care costs, and $5M in productivity improvement(Fig 7.3-6).Fig. 7.3-6: Workplace Wellness Programs & HRA LifestyleHealth Scores# ProgramsCompletedOur rate of recordable employee injuries falls significantly belowcomparisons. RadicaLogic helps us identify, analyze, andtake proactive action to prevent recurrence (Fig. 7.3-7). Aspart of the No Harm Campaign, and our AHA Safety fellowship,we have actively worked to increase incident reportingfor employee safety events and have achieved a 67% increasein 2010 while decreasing actual harm events.Fig. 7.3-7: MIOSHA—Injury Frequency# Injuries Per 00WorkersEmployee Sharps injuries have declined 30% in the pastyear through BU-level OPRs and targeted improvements inclinical areas with high levels or poor trends.Work-related injury costs declined steadily to 60% less thanthe MI comparison in 2010 due to our Occupational Medicineand Transitional Work Program that keeps injured employeesworking safely while they recover (Fig. 7.3-8).Fig. 7.3-8: Workers Compensation% of PayrollWorkplace Wellness and Lifestyle Scores Increase Rapidly20,0008415,000 Good8210,0005,00015.010.05.00.02.0%1.5%1.0%0.5%0.0%02006 2007 2008 2009 2010System Michigan NationalSteady Decline in Costs; 60% Less Than State•Good2005 2006 2007 2008 2009 2010HFHSMI IndustrySecurity incidents for public order crimes at the Detroitcampus (i.e., weapons, disorderly conduct, trespassing) havebeen cut in half in 7 years, from 659 in 2003 to 324 in 2010,meaning a safer environment for our workforce and patients.Annually during open enrollment, we survey employee satisfactionwith benefits. Satisfaction rose from 96% in 2008 tonearly 100% in 2010 (Fig. 7.3-9).8078762008 2009 2010Succeed HRAOther ProgramsHFHSBOBInjuries are Less Than 1/2 MI AverageLifestyle Score(0-00)•GoodFig. 7.3-9: Benefits SatisfactionEmployees Pay 33% Less then Nat. Avg in Benefit Cost &Give Nearly 100% Satisfaction Rating100%95%90%Good85%80%75%2008 2009 2010Q: I Value the Benefits Provided to Me as an Employee of HFHS% Satisfied7.3a(3) Workforce Engagement. In keeping with our engagementfocus, we adopted the Gallup Q12 in 2008, replacingthe Gantz-Wiley Satisfaction Survey, and administer it toall employees every 18 months. Scores improved in 2010 inCorporate Services and 8 of 9 BUs (Fig. 7.3-10). Managersdeveloped Impact Plans to address opportunities and leveragestrengths. We are currently studying high-performing units andtransferring their practices to units below the 50 th %ile data bysite and manager are AOS.Fig. 7.3-10: Employee EngagementEmployee EngagementScale (0-)From 2008 to 2010, the % of “engaged” employees (thosewho answered “strongly agree”) rose for each of the 12 Gallupitems, and by 5% or better for 8 of 12. Favorable changesreflect the success of our approaches, such as our focus onlearning and development (35% to 45%), communication skills(26% to 31%), and alignment of organizational and workforcegoals (39% to 44%).With our Gallup partner, we developed a metric to compareGallup and Gantz-Wiley overall satisfaction results, whichrose from 60% in 2003 to 80% in 2010 (Fig. 7.3-11).Fig. 7.3-11: Employee Satisfaction% Satisfied4.543.532.590%80%70%60%50%OverallIncreased Engagement for 9/10 EntitiesBHSCCSGoodCORPHAPSteady Improvement Since 2003Ganz-WileyGallup2003 2005 2006 2008 20102010 Volunteer engagement surveys demonstrated high levelsof volunteer engagement and satisfaction in all BUs. Scoresranged from 4.3 to 4.6 on a scale of 1-5 System-wide. Satisfaction(% satisfied or very satisfied) ranged from 78% to 87%.HFHHFMGHFMCTHFMWGoodHFWB2008 2010Gallup 50thGallup 75thHFWYN42

Engagement scores in key demographic segments increasedfrom 2008 to 2010 and were similar across segments, demonstratingour effectiveness in engaging diverse segments of theworkforce equally (Fig. 7.3-12).Fig. 7.3-12: Minority EngagementScale (0-)The AMGA survey compares HFMG with similar group practicesacross the U.S. Overall engagement and all 3 key driverssteadily increased since 2004 (Fig. 7.3-13).Fig. 7.3-13: HFMG Physician Engagement% Very SatisfiedWe measure satisfaction of physician trainees at HFH with aninternal survey geared to their unique needs and expectations.From 2004 to 2010, overall satisfaction increased from 71 to 93,and feeling well-trained and ready, from 79 to 93 (Fig. 7.3-14).Fig. 7.3-14: Trainee Satisfaction & Preparation% Agree orStrongly Agree54.543.532.570%60%50%40%30%20%10%0%2004200620082010OverallSatisfactionAll Segments Improve EquallyContinuous Improvement Imporvement Since 20042004HFMG2006Good20082010Time SpentWorkingSatisfied and Well Trained; Nearing 100%100%90% Good80%70%60%50%2004 2006 2008 2009 2010Overall Satisfaction At Completion, Well Trained and ReadyThe Gallup engagement index represents the ratio of “engaged”to “disengaged” employees. For HFHS employees overall,the ratio improved significantly, from 2.9:1 in 2008 to 4.2:1 in2010, surpassing the Gallup health care comparison. Gallup’s“neutralization ratio” is 4.0:1—i.e., it takes four engaged employeesto offset the impact of one disengaged employee. Theratio in Nursing also improved, from 2.5:1 in 2008 to 3.6:1 in2010, also surpassing the Gallup RN comparison (Fig. 7.3-15).HFHS employees can provide financial assistance to other employeesby making financial contributions to Helping Handsor donating CTO hours. Both contributions increased from2004200620082010Leadership &Communication200420062008Quality ofCareAMGA Best PracticeGoodMale Female Non-Minority Minority2008 2010 2008 75th 2010 75th2010Fig. 7.3-15: Overall and Nursing Engagement IndexEngagement Ratio2008 to 2010, with CTO donations doubling, demonstratingemployee engagement (Fig. 7.3-16).7.3a(4) Workforce Development Steady increases in educationhours since 2006 demonstrate HFHS’s commitment todevelopment, despite economic challenges. Satisfaction withofferings also steadily increased to near-perfect levels (KirkpatrickLevel 1 Result: Fig 7.3-17).Fig. 7.3-16: Employees Helping Other EmployeesMonetary ValueEngagement Demonstrated: Increasing Help to Other Employees$175$150 Good(Thousands)$125$100$752008 2009 2010Helping HandsCTO DonationFig. 7.3-17: HFHSU Training Hours and SatisfactionHours (In 000's)Training More Than Triples in 5 Years; Near Perfect Satisfaction300100%25095%20090%150 Good85%1005080%075%2006 2007 2008 2009 2010HoursSatisfactionJust Culture policy and training were deployed in 2009-10to support the No Harm campaign and fosters open communication,safety, and high performance. SL was trained first;training was refined and cascaded to leaders in Corporate Servicesand all BUs engaged in care delivery. Successful learningtransfer was achieved in all BUs (Kirkpatrick Level 2 Result:Fig. 7.3-18).Fig. 7.3-18: Just Culture: Pre and Post TrainingPercent Correct543210100%90%80%70%60%50%GoodBHSEngagement Increases: Surpassing"Neutralization Ratio" for Overall PopulationCCSCORPGood2008 2009 2008 2009HFHS - SystemRN'sGallupU.S. PopulationNeutralizationEvidence of Successful LearningHFHHFMGHFMHHFMH-WCHFWBH% Correct Before Training % Correct After Training% SatisfactionHFWH43

HFHSU trained more than 500 leaders in the 16-hour CrucialConversations workshop; participants scored higher on Gallupengagement, satisfaction, and COS questions than untrainedleaders (Kirkpatrick Level 4 Result: Fig 7.3-19).Fig. 7.3-19: Communication Training for LeadersKirkpatrick Level (0-)Continuing education for physicians and other clinicians includesclassroom and Simulation Center courses, conferences,grand rounds, and morbidity/mortality reviews. Participantsdoubled from 2004 to 2010. Education and on-boarding requirementsto open HFWBH increased the participants in2008-09 compared to 2010 (Fig. 7.3-20).Diversity is a key component of our People strategy. HFHSranks higher than other top U.S. companies (all industries) inthe percent of leadership and professional positions held byAfrican Americans and women (Fig. 7.3-21). Only four othercompanies ranked higher than HFHS in this category.Fig. 7.3-21: Leader and Professional Position Diversity% in Position54.543.53Fig. 7.3-20: CME Activity# Participants(in 000's)604020080%60%40%20%0%African AmericansWomen2007 2008 2009 2010 Avail. in HC By CensusLeader development supports career progression and benchstrength. LA participants are high potentials to fill LEAP positionsin 3-5 years. Our 60% five-year promotion rate demonstrateslearning effectiveness and meets our internal goal tobalance (~50/50) internal promotion with external recruitment(Fig. 7.3-22).Fig. 7.3-22: Leadership Academy Graduate PromotionsLA Graduates(n = )Open Communication Increases EngagementGrand MeanGoodGood2004 2005 2006 2007 2008 2009 2010HFHS Exceeds National BenchmarkGoodOverallSatisfactionOthersTraining Nearly Doubles in 6 YearsWithin - YearsCommitted toQualityLA GradWithin - Years% Promoted 20% 40%Speak Up7.4 Leadership and Governance Outcomes7.4a(1) Leadership.Vision. SL engaged the workforce and key stakeholders indeveloping our new vision (1.1a(1)). SL received input from2,662 employees and 74 trustees/private practice physicians.Of the 3 vision options presented in the voting step, 60% ofeach segment preferred option 2, which formed the basis forour new vision (P.1a(2)).Health Engagement. Living our new vision requires SL to engageour workforce personally in wellness. When SL rolled outHE (1.1b(1), 5.1b(1)), we tested communications effectivenessmultiple times in focus groups and surveys to ensure messagesaddress employee questions and concerns (Fig. 7.4-1).Fig. 7.4-1: SL Communication Results: HECOMMUNICATION PROCESS MEASURESA survey of managers showed 95% of respondents believed theiremployees were aware of HE & 79% understood the program.Focus groups with more than 35 employees at four sites testedmessaging regarding HE and HFHS’s support of wellness. Themajority felt the HE program was a good motivator to focus onone’s health and understood the intentions of the program.OUTCOME MEASURESFor 2010, 86 percent of eligible employees and their spouses orpartners took the actions necessary to qualify for HE, compared toa participation goal of 70 percent.Two key questions in our employment engagement surveydemonstrate deployment of vision and values: Q01: Iknow what is expected of me at work, and Q08: The mission/purpose of my company makes me feel my work is important(Fig 7.3-10). Focus on action and two-way communication aredemonstrated through deployment of a culture of safety planand measured through the culture of safety survey QuestionsC09: Management shows by their actions that patient safetyis a top priority and C10: I feel encouraged to speak up concerningpatient safety (Fig 7.1-3). All show improvement, withculture of safety scores above the 75 th %ile.Our SO for the Quality & Safety pillar is to be a national leaderin delivering safe, reliable, high quality, and highly coordinatedcare to each individual patient. Recognition serves as oneindicator of our focus on action (Fig. 7.4-2).7.4a(2) Governance & Fiscal accountability. Deloitte &Touche LLP audits HFHS’s fiscal accountability and processesannually. HFHS received unqualified audit reports for thepast ten years with no material weaknesses. Internal Audit Departmentperforms 200 audits annually, sharing results withBU leaders, SL, and the A&CC. Since 2004, Internal Audit hasfound no material weaknesses in the internal control structure.All Insurance Commission Submissions (HAP) have been accepted.There have been no material weaknesses in the OMBA-133 Research audits.Although national best practice benchmarks are not available,HFHS performed significantly better than the Governance Institute(GI) national average for all but 2 questions on the BOTevaluation (1.2a(2), Fig. 7.4-3). The below average scores relatedto new trustee orientation and materials distribution, bothof which were revised for 2011.44

Fig. 7.4-2: Recognition for Quality & SafetyHFHSHFHHAPCOMMUNITY HOSPITALS, AMBULATORYQUALITY AND SAFETY RECOGNITION: SAMPLING, 00-0000: Thomson Top 10 U.S. Systems, Quality and Efficiency00: National Safety Leadership Award, VHA Foundation andthe National Business Group on Health00: MI Quality Leadership (MQC/State Baldrige, highest level)0/00: Healthgrades ED Ranking, Top 5% in the Nation00: AHA/McKesson Quest for Quality Finalist00-00: NRC's Consumer Choice Award for Best OverallQuality for the Detroit/Wayne County area00/00: Thomson Top 100 Hospitals, PI Leaders00-00: Thomson Top 100, CV/Heart Care00: AMA's Bronze Award for stroke care00: Governor's Award for Appropriate Care, Surgical Care, ED00: LeapFrog Group Top 50 Safest Hospitals00: MI AHP' Pinnacle Award for Best Practice: Chronic DiseaseCare, Care Management and Community Outreach.00-0: J.D. Powers, Highest Member Satisfaction00: Consumer Report's Ranking of Best Health Plans (#2)00: U.S. News/NCQA America's Best Health Insurance Plans00: Pinnacle Award for Best Practice: Chronic Disease Careand Clinical Service Improvement00: US News & World Report Ranking of Medicare Program (#1in MI, #24 nationally)00: NCQA Innovation in Multicultural Health Care00: Commonwealth Fund Case Study for Excellence (BHS)00: NCQA Diabetes Physician Recognition Program (HFMG)00: MI AHP Pinnacle Award, Innovations in Diabetes (HFMG)00: NCQA Innovation in Multicultural Health Care (HFMG)0/00: Healthgrades ED Ranking, Top 5% Nationally (HFMH)00: Data Advantage LLC, Top100 Hospitals for Value (HFMH)00: ACS Midas+Platinum Quality Award - Excellence (HFMH)00/00/00: Thomson Top 100, CV Benchmarks (HFMH)00: Leapfrog Group Top 33 Hospitals (HFMH)00/00: Gov.’s Award, App. Care, Surg. Care, ED, CPOE(HFMH)00/00: Gov.'s Award, App. Care, Surg. Care (HFMH-WC)00: BCBS Ctr. of Exc. Award-Bariatric Surgery (HFMH-WC)0/00: Healthgrades ED Ranking, Top 5% Nationally(HFWH)00: Press Ganey's Summit Award, ED, Ambulatory Surgery, &Outpatient Services (HFWH’s Center for Health Services)00/00: Gov.’s Award for App. Care, Surg. Care, ED (HFWH)Key: AHP = Association of Health Plans; App.= Appropriate;Ctr. of Exc. = Center of Excellence; ED–Emergency Dept.;Gov’s = Governor’s (discontinued after 2008)Fig. 7.4-3: BOT 2010 EvaluationGI NATIONALAVERAGEHFHSBOTHFMHBOTHFWHBOTAppropriateness ofBoard Composition50% 84% 82% 90%New Trustee Orientation 83% 80% 70% 88%Focus on Strategyvs. Operations53% 84% 82% 86%Devotion of 20-30% ofAgenda to Quality/Safety64% 76% 86% 98%Timely Meeting Materials 79% 88% 76% 84%Involvement withIdentification of New 65% 80% 88% 92%Trustee CandidatesRole of TrusteeRepresenting System 70% 92% 96% 94%in CommunityTrustee PhilanthropicSupport55% 88% 86% 90%7.4a(3) Organizational accreditation, regulatory, & legalcompliance. All BUs have consistently received full accreditationfor the last decade and fully meet all key regulatoryand legal requirements, achieving 100% of measures andtargets for all processes in Fig. 1.2-1 including all BU accreditationsand licenses; all legal and regulatory complianceprocesses; 100% of risk management trainings and drills/ethicscompliance processes, such as:KEY MEASURES – ALL BUS COMBINEDJoint Commission, DNV, AOA, ACGME, CAPSurvey, CMS conditions of participation, CARF,NCQA, MDCH, CAHPStaff Licensure and Safety, Medical Waste – EPA,MI-OSHA, OSHA, EEOC7.4a(4) Ethical behavior & trust. Employee trust is demonstratedin 7.4a(1) through engagement questions specifically directedat management’s commitment to safety as a priority andemployee willingness to speak up (Fig. 7.1-3) – both scoringabove 75 th %ile. The number of clinical research programsunderway each year is another indicator of patient trust. The IRBhas approved in excess of 500 new research protocols each yearfor the past four years. All SL and managers must disclose alloutside activities and interests with the potential for conflict. In2010, we received 3,000 disclosures requiring the Review Panelto act on 800 responses with substantive disclosures and formulate24 management plans (Fig. 7.4-4). The process will includeprivate physicians and fully integrate research in 2011.Fig. 7.4-4: External Trustee Conflict DisclosuresTrustees Deemed tobe Independent00TOTAL%00TOTALOver the last three years, we have very intentionally encouragedincident reports. SL’s focus on ethical behavior and privacy rights(1.1a(2), 1.2b(1)) and leader/workforce development addressingethical practices (5.2c(1)) have contributed to this effort (Fig. 7.4-5). We consider the increased reporting seen in 2010 a success.100% of compliance incidents are investigated and addressed.Over 3000 vendors have completed HFHS’s mandatory VendorCompliance Policy training (1.1a(2), 6.2a(3)). HFHS wasfeatured in Modern Healthcare as an innovator in this area andshared the policy development and implementation with physicians/healthsystems across the country.Our employees support our communities through the CommunityGiving Campaign. Participation and dollars raised haveincreased each year since 2004 (Fig. 7.4-6).%00TOTAL89 98% 90 100% 93 100%Trustees Disclosing 89 98% 90 100% 93 100%Trustees withPotential Conflicts**Potential Conflictswith EffectiveManagement Plans00-00FullAccreditation100%10 11% 11 12% 8 18%10 100% 11 100% 8 100%Fig. 7.4-5: Reported Incidents through Compliance Line%00 00 00Human resources 83 53 56Privacy 32 101 165Compliance 15 50 136Facility related 6 9 39Safety 5 15 23Total 45

Fig. 7.4-6: Community GivingAmount Pledged(in Thousands)An indicator of trust is the number of people who volunteer toraise money for HFHS and the donor renewal rate. Donationrenewal rates and philanthropy volunteers have risen dramaticallyover the past four years (Fig. 7.4-7).Fig. 7.4-7: Donor Trust7.4(5) Organizational citizenship & community support.Our Community SO is to be a national leader in communityhealth advocacy and involvement. Our SI to increase supportand utilization of community clinics (CHP) has increased thenumber of participants across the System (Fig 7.4-8).Fig. 7.4-8: Visits to Community ClinicsOther programs address and prevent chronic health conditions.More than 25,000 HAP members have collectivelylost more than 235,000 pounds over two years since HAPteamed up with Weight Watchers® (WW) in 2007. In 2009,HAP conducted a one-year study of 9,243 WW participants.Results include:•••••# of Volunteers# of VisitsMore Employees Pledge, More $ Raised toSupport Community in Difficult Economic Climate$3,50014,000Good$3,00012,000$2,500$2,000$1,50060,00040,00020,0002006 2007 2008 2009 2010$ Pledged # of ParticipantsSchool Based and Community Hospital Clinic VisitsMore than Double; CHASS Continues to IncreaseGood10,0008,0006,000Despite Economy Philanthropy Participation RatesIncrease with Volunteers Tripling in 4 Years2,50060%2,00050%40%1,500Good30%1,00020%50010%00%2006 2007 2008 2009 2010Philanthropy Volunteers Donation Renewal Rate02006 2007 2008 2009 2010CHASS Visits School-Based Visits Community Hospital Clinics21% increase in controlled blood glucose (HbA1c) in peoplewith diabetes; 13% to 27% improvement in total cholesterolamong participants with 6-20% weight loss5% reduction in ER visits42% reduction in cardiovascular inpatient admissions23% reduction in respiratory inpatient admissions14% reduction in use of three or more blood pressure­medications# of ParticipantsRenewal RatesHFHS also recognizes that many of our patients have emergencyat-home needs beyond what they can afford. Each hospitalhas established a Patient Emergency Medical NeedsFund to provide equipment and medications to patients whenthey are discharged from our care. This fund is principally supportedby donations from our workforce. Over the past threeyears, more than $1.1M has been donated to support theseneeds (1.2c(2)), Fig. 2.1-2, Community SI).HFHS actively encourages community volunteerism byour entire workforce and has annually established targets forleadership participation. In 2009, LEAP members accumulatedover 7,480 volunteer hours. In 2010, we spread this expectationto all leaders, setting goals of 10,000 volunteer hours in2010 and 15,000 in 2012. Actual volunteer hours in 2010 exceeded12,000.We support community health by participating in the AHA AnnualHeart Walk. In 2003-10, more than 3,000 HFHS walkersparticipated, raising a total of $2.1M (Fig. 7.4-9). In 2010,HFHS employees raised $341,023, with the CEO and COOamong the top ten fundraisers. HFHS is the top-ranking companyin Michigan, the top ranking health care system in the nation,and the third-ranked company in the nation for donationsfor this AHA event.Fig. 7.4-9: AHA Annual Heart WalkDollars Raised ( '000s)$400$300$200$100$0HFHS is Benchmark: Top Health Care Contributor,3rd Ranked HW Company Donations in the Nation for Contributionswith Over 3000 Walkers per Year Since 2003Good2007 2008 2009 2010Community residents enjoy supporting their communitiesthrough volunteer service at HFHS hospitals (Fig. 7.4-10).Over the past 5 years, volunteer service hours to HFHS haveincreased from 271,684 in 2006 to 487,101 in 2010. This resultreflects expanding our volunteer pool and improving ourreporting process.Fig. 7.4-10: Volunteer Hours# of VolunteerHours600,000500,000400,000300,000200,000Volunteer Hours Double in 4 YearsGood2006 2007 2008 2009 20102010 community benefit initiatives totaled $373M (Fig. 7.4-11).This includes $199M in uncompensated care (Fig. 7.5-3), whichhas increased at a greater rate than all our competitors, up from$132M in 2009. During the most recent three years, communitybenefit consistently represents in excess of 17% of net patientrevenue, with the cost of charity care representing 2.5%.46

Fig. 7.4-11: Community BenefitAmount (in Millions)$400$300$200$100Community Benefit Increases by 40% in 4 Years,Helping Community Throughout Worst Economic CrisisGood2006 2007 2008 2009 2010HFHS is one of the largest employers in SEM and the State.We track both direct and indirect economic impact (wages,employee and vendor consumption) using standard industrymethods. Fig. 7.4-12 shows the financial impact in 2010,Fig. 7.4-12: Economic BenefitHFHS 00 TOTAL IMPACTDirectIndirectTOTALWe are committed to sustaining the environment. In 2010 werecycled more than 2 million pounds of batteries, lamps, electronics,and chemicals. Our measured energy savings from switchingto high efficiency lighting is more than $45,000 per year.HFHS continues to be recognized locally and nationally as aleader in Supplier Diversity (Fig. 7.4-13). The SCM Departmentcontinuously works with staff System-wide to createawareness and advocacy for supplier diversity.Fig. 7.4-13: Supplier Diversity LeadershipMETRO DETROIT$4.08 billion$1.74 billion$5.82 billionHFHS BEST PLACE TO WORK AND DIVERSITY AWARDSCorp Magazine: Diversity Focused Company, 2010Diversity Inc.: #1 Hospital System for Diversity, 2011 & 2010; #10Supplier Diversity in 2009; #8 in 2008Hispanic Business Alliance: Corporation of the Year, 2009Institute for Diversity in Health Management: Best in Class:Leadership & Governance, 2010Intouch Communications: Calidescope of Culture-DiversityResource Guide, 2005; Supplier Diversity 2006Michigan Minority Business Development Council: Corporationof the Year Award Health Care Sector-Supplier Diversity, 2009 &2005; Corporate ONE Award-Supplier Diversity, 2005-2008;Health Care Sector Appreciation Award─Supplier Diversity, 2007Michigan Supplier Diversity Council: Health Care Corporation ofthe Year, 2010Premier Inc.: Diversity Award-Supplier Diversity, 2009 & 2007Community Leadership. As a recipient of the AHA FosterMcGaw Award, HFHS is a recognized leader in communityprograms. Our “can-do spirit” extends beyond programmingto leadership positions in numerous community organizationsas Board members and volunteers.HFHS leaders have served or currently serve in leadershiproles for health care’s top national and state professional organizations,including: Presidents of the AMA, ACC, NationalArab-American Medical Association, Michigan State MedicalSociety, American Academy of Dermatology, U.S. and CanadianAcademy of Pathology, Society of Pediatric Urology, andAmerican College of Chest Physicians; Chancellor, AmericanCollege of Critical Care Medicine; Chair, American Board ofInternal Medicine; and Michigan’s Surgeon General.We have received acclaim for our community leadership, includingthe AHA Grassroots Champion Award, the MichUHCANHealth Care Hero award, and recognitions from multiple mediaand ethnic organizations such as Crain’s Detroit Business HealthCare Hero and B’nai B’rith Great American Traditions Award.Finally, HFHS improves the health of not only our patients andcommunity, but people throughout the nation and across theworld. HFHS researchers engaged in more than 1,700 studieslast year. Neurology pioneered restorative therapy for treatmentof stroke, traumatic brain injury, and neurodegenerative diseases.Radiation oncology developed a gene therapy to increase radiationeffectiveness in prostate cancer. HFHS epidemiologists establishedscreening practices for multiple cancers to reduce racialdisparities in treatment. We collaborate with IHI to document andspread HFHS innovations and best practices. HFHS research innovationssave hundreds of thousands of lives and millions of dollarseach year nationally. Examples are provided in Fig.7.4-14.Fig. 7.4-14: HFHS Research Innovation ImpactSAMPLE OF INNOVATIONS WITH CLEAR LONG-TERM IMPACTOur sepsis bundle research, developed at HFH, officially became thenational standard of care in 2001 and is estimated to have saved0,000 lives in the US this year alone.Our "hospitalist" randomized controlled trial was the first todemonstrate that the hospitalist model, now a standard practice,reduces the cost of care without compromising quality and safety.First published in 1991, it showed a 1.7-day lower average length ofstay, lower average total charges of $1,681, and significantly lowerlaboratory and pharmacy charges with no difference in mortality orreadmission rates. In the 20 years since, hospitalists have become astandard of care, saving tens of millions of dollars throughreduced length of stay and more efficient patterns of care.SAMPLE OF 00 RESEARCH INNOVATIONSImproving Medical Treatment:First to successfully treat Parkinson’s disease with gene therapy• Achieving lasting, clinically meaningful improvements in 50% ofpatients• Stands to substantially improve the lives of 1 million AmericansExtending hepatitis C treatment for liver transplant patients• Reaching 100% five year survival ratesNew approach to pre-surgical preparation for colonoscopies• Reduces by 50% required liquid media consumption• Enhancing patient comfort and compliancePopulation Health and Wellness:Online program to encourage nutritious eating habits• Daily fruit and vegetable intake increased by 2 servingsGroup wellness programs focusing on pain management• Demonstrated reduced pain levels and stress• Improvement in stress related diseasesPopulation studies of genetics and social/economic conditions asinfluence factors on medical outcome• Genetic factors in African Americans have no impact on Asthmaresponses to medications• African Americans more likely to have recurrence of uterinecancerCancer Treatment and SurvivalStudy of men with cancer diagnosis who opt for “watchful waiting”• Demonstrated significantly worse long-term survival rate thanthose patients that choose radiotherapyA first-ever, long-term study of patients who underwent robotassistedsurgery to remove their cancerous prostates found thatnearly 87 percent of them had no recurrence of the disease afterfive yearsStudy of incorporating exercise in treatment protocols for breastand prostate cancer patients• Those who regularly exercise report measureable better qualityof life and less fatigue.Study of 3,000 patients with large BMI confirmed correlation withlarger tumors and impacted surrounding tissue areas• Potential to improve surgical techniques and reducecomplications47

7.5 Financial and Market Outcomes7.5a(1) Financial performance. In 2001, HFHS experiencedsignificant operating losses, which resulted in an intense focuson right-sizing the organization. We lagged behind competitorsin quality, safety and service, and were unable to make necessaryinvestments in our infrastructure. Consistent with our“Can-do” spirit and commitment to community, we formed abold strategy focused on People, Quality & Safety, and Serviceto drive our Growth, Community, and Finance. We recommittedto our base in Detroit and our academic mission. We committedto relentlessly pursue integration to deliver the best careto our patients and drive growth.Today, HFHS is financially strong. Revenue has increasedeach of the last 8 years and doubled in the last decade reaching$4.08B in 2010. Our integrated System drives growth andprofitability, enabling investment. In the past five years wehave invested over $1B in the System. We remained profitablethroughout the economic downturn that began in 2008.We lead competitors in operating income, debt service coverageand on all fronts in market growth. During the regionaleconomic crisis of the past three years, we have continued toinvest in new infrastructure, jobs, and research and educationand, at the same time, have seen larger increases in uncompensatedcare than most of our competitors.Bond Rating: HFHS’s financial strength is reflected in ourMoody’s bond rating of A1 with a stable outlook for more thanfive years. Our local competitors received ratings of Ba3, A1,and A2, all with negative outlook.One of our local competitors is transitioning to for profit andcomparative data are no longer available for most financialmeasures.Operating Income (Fig. 7.5-1) is earning power from ongoingoperations. In 2010, operating earnings improved 64% over2009. This is notable because 2010 earnings include the costof a 15% increase in uncompensated care and achievementof a group performance award paid out to employees. Whenwe take out increases in uncompensated care since 2007 (Fig.7.5-4) and performance award payouts (dotted line in 7.5-1)the true improvement in operations can be seen. This operatingimprovement was achieved by both increasing revenueFig. 7.5-1: System Operating Net IncomeHigher $150 than Competitors, Improved Operations by 64% this Year$125Operating Income(in millions)$100$75$50$25$0-$25-$502007 2008 2009 2010HFHSCompetitor BGoodCompetitor ACompetitor CHFHS* shows operating income without the cost of uncompensatedcare increases & group performance award employee payouts . This(dashed line) shows our true improvement in operational efficiencyand decreasing costs. Consistent increases in CCS revenuefrom expanding services (Fig. 7.5-16) helped HFHS maintainoperating income in 2009 and 2010 despite the economy andstrategic investments. The 2009 operating decline is associatedwith opening a new hospital.Cost Containment is essential to maintaining operating income.We leverage our integrated System to save money. Systemcost per unit of service, a metric developed in 2009 is acase mix adjusted calculation that includes all System costsand services (Fig. 7.5-2). While no direct comparison exists,we use the Medical Cost Index which HFHS outperformedin 2010 by 4.5%. Hospitals alone contributed $63 of the $91saved. Cost savings from many of our SIs contribute to thisresult. For example, 2010 improvements from the No HarmCampaign are estimated to have saved $4.2M at HFH.Fig. 7.5-2: System Cost per Unit of ServiceDollarsHFHS Reduces Costs by 1.1% While Cost Index 3.4%$9,000•Good$8,750$8,592$8,501$8,500$8,2502009 2010HFHS SystemPredicted benchmarkCCS effectively manages costs and productivity (Fig. 7.1-34)resulting in a competitive income margin for health productsand dialysis compared to competitors (Fig. 7.5-3).Fig. 7.5-3: CCS Income—Margin PercentageU.S. health care providers face challenges to provide care forthe uninsured. The depressed economy in our state and servicearea make our challenges significantly greater. Job andinsurance losses in our community resulted in increased uncompensatedcare from 2006 to 2010 of $95M—almost doublingour contribution (Fig. 7.5-4). Many HFHS initiativesFig. 7.5-4: Uncompensated CareMillionsHFHS Community Commitment Reflected in 90% in 4 Years$280$230$180$130$80$30Confidential2007 2008 2009 2010HFHS SystemCompetitor BCompetitor ACompetitor CGood48

help contribute to our community, such as HAP programs forunemployed, registering eligible children for Medicaid in ourSchool Based Programs, and ED counseling for all un- andunder-insured patients. We consider it a System strength thatwe can provide care for our community and still remain financiallystrong.System Net Income (Fig. 7.5-5) represents net income fromoperations plus net income from investments and other nonoperatingactivity. System net income declined in 2008 due tothe impact of the national financial crisis (including negativereturns in the equity and credit markets) and an increase inuncompensated care (Fig. 7.5-4), although our investmentsperformed significantly better than other systems in SEM. Insuranceregulations constrain HAP from owning stock, whichbuffers our investments during down markets but limits ourpotential return. Strong investment strategies have resultedin endowment and pension plans performing in the upper quartilefor the last 5 years.Fig. 7.5-5: System Net IncomeIn Millions$150$100$50$-$(50)$(100)$(150)$(200)$(250)HFHS Less Volatile than CompetitorsGood2007 2008 2009 2010HFHS System Competitor A Competitor B Competitor CDebt service coverage (Fig. 7.5-6) measures the multiple bywhich current interest and principal are covered from currentincome. Despite significant investment and our regional economy,HFHS exceeds Moody’s benchmark and all competitors.This reflects our strong balance sheet and overall financial position.The decline in 2008 represents the additional debt serviceassociated with the bond issue to fund both HFWBH andthe expansions and renovations at HFH. The 2010 dip is dueto our switch to fixed rate bonds to take advantage of marketconditions and increase stability.Fig. 7.5-6: Debt Service CoverageDebt CoverageRate12.510.07.55.02.5Only HFHS Achieves Moody's A1 Stable RatingGood0.02007 2008 2009 2010-2.5HFHS System Competitor A Competitor BCompetitor CMoody'sOur days cash on hand (Fig. 7.5-7) reflect revenue growth,improved collections, operating profitability, and capital funding.Insurance companies carry significantly less cash thanhospitals. Our cash position is at comfortable levels to effectivelymanage capital demands and operations. While weuse Moody’s national benchmark as a comparison, Moody’sFig. 7.5-7: Days Cash on HandDaysrecognizes that as an academic medical center with insuranceoperations in Detroit, our cash levels will be lower. All thesefactors are taken into consideration in our overall bond rating.HFHS launched a seven year philanthropy campaign in2007 and, despite the economy, has succeeded in raising over$167M, surpassing the 2010 goal of $142.8M during the silentphase of the campaign. While cash donations were down 12%in 2009 due to the economy, they have rebounded in 2010 (Fig.7.5-8). The number of donor renewals and philanthropy volunteershas increased every year since 2006 (Fig. 7.4-7).Fig. 7.5-8: Philanthropy: Cash DonationsCash Collected(in million's)7.5a(2) Marketplace performance. HFHS exceeds all competitorsin admission growth (Fig 7.5-9), increasing on average3.0% per year since 2004 vs. SEM’s increase of 0.3%. In2010, HFHS outpaced all competitors, increasing admissionsby 2.6% while SEM lost .9%.Fig. 7.5-9: Admission GrowthPercent Change20017515012510075502508%4%0%-4%-8%$35$30$25$20$15$10HFHS Maintains Cash Balances at Comfortable Levels2004 2005 2006 2007 2008 2009 2010Collected Target 2011 TargetHFHS Leads Market with 3% Despite SEM .9%2004 2005 2006 2007 2008 2009 2010HFHS HospitalsCompetitor BSEMPhilanthropy at Highest Levels Despite SEMGoodGood2007 2008 2009 2010HFHS System Competitor A Competitor BCompetitor CMoody'sCompetitor ACompetitor CGoodDespite a 1.4% decline in the number of births in SEM in2010, HFHS has increased births by 6.5% and market shareby 0.4% (Fig 7.5-10). In the past 2 years, HFHS has increasedbirths by 20% while competitors declined. This is attributedto a successful growth strategy and includes 1,500 births atHFWBH.49

Fig. 7.5-10: Birth GrowthPercent ChangeMarket share is defined by percent of admissions (Fig. 7.5-11). With steady growth since 2004, HFHS now has 17.6%IP Tri-County market share (and 15.0% for SEM). In 2010,we surpassed our closest competitor, which has Tri-Countymarket share of 17.1%.Fig. 7.5-11: IP Market ShareMarket Share %ED Visits and Urgent Care Visits (Figs. 7.5-12, 13). ED visitsoccur at five hospitals and four ambulatory medical centers. Amajority of hospital admissions occur through hospital EDs reflectingthe acuity of patients seen there. The hospital visits arelisted with competitors for their area. Ambulatory competitorinformation is just becoming available (AOS). ED visits haveincreased in both the ambulatory and hospital settings. HFHShas expanded its urgent care sites to direct patients to appropriatecare settings which has resulted in increased visits.Fig. 7.5-12: ED Medical Centers Visits & Urgent Care Visits# of Visits15%10%5%0%-5%-10%Mkt Share Up 3.9% in 6 yrs; Surpassing Closest Competitor in '1018%16%14%12%10%200,000100,0000GoodGood2007 2008 2009 2010System Urgent Care System Ambulatory EDFig. 7.5-13: ED Visits by HospitalHFHS Leads Mkt with 6.5% , SEM 1.4%Good2007 2008 2009 2010HFHS Competitor A Competitor BCompetitor C SEM8%2004 2005 2006 2007 2008 2009 Q1-Q2HFHSCompetitor A2010Competitor CCompetitor B2010 HFHS ED Steady - Urgent Care 10% OP visits remain steady despite shrinking population. Manyaction plans underway to increase visits, including expansionof HFMG ambulatory centers in high growth markets and activerecruitment of physicians.Fig. 7.5-14: HFMG Outpatient Visits# of Visits(in 000's)2,0001,9001,8001,7001,6001,500HFMG Visits Steady in SEMGood2004 2005 2006 2007 2008 2009 2010Preliminary market data available in mid 2010 shows that HAPis maintaining market share at 23.4% (Fig. 7.5-15). This is aremarkable accomplishment because HAP only services SEM,harder hit economically than the rest of the state, versus thestatewide service of the competition. HAP is developing newgrowth initiatives including new insurance products, bettermatched to today’s needs. In addition, successful integrationwith CCS has resulted in reduced HAP admissions (Fig. 7.1-9) and significant cost savings (7.1b(1)) for our sickest andmost expensive patients.Fig. 7.5-15: HAP HMO Membership and Market ShareHAP Membership is Leveling inDeclining HMO MarketMembers (ooo's)60050040030020010002004200520062007200820092010Percent ChangeHAP Maintains Steady MktShare in Hard Hit SEM Market50%40%30%20%10%0%CCS, a significant component of HFHS’s business, has expandedservices in Pharmacy through home delivery initatives,added Dialysis centers and, in the last two years, expandedHHC into the Macomb county region (Fig. 7.5-16). Increasedcoordination among hospitals, HAP, and CCS has also contributedsignificantly to CCS’s growth (7.1a).HAPMkt % Jan-08Mkt % Jan-10Competitor ACompetitor BAll OtherMkt % Jan-09Mkt % Jul-10# of Visits (in thousands)300250200150100500SystemHFHS increased 3.8% vs. SEM at 2.4%GoodHFHCompetitor CHFWBHCompetitor AHFMHHFMH-WCCompetitor DCompetitor EHFWHCompetitor B2008 2009 2010Fig. 7.5-16: CCS Service Volumes400,000Sevice Volumes350,000300,000250,000200,000CCS Increases Volume 20% in 2 YearsGoodQ108Q208Q308Q408Q109Q209Q309Q409Q110Q210Q310Q410Services include: prescriptions, admissions, treatments50