Here is what I will be working on when our new Fiscal Year begins in October, 2010. The Goals are arranged along our Pillars of People…..Service…..Quality…..Growth…..Finance…..Academics. I realize there is a lot of detail but I think you can get the gist. In the meantime, I welcome any comments, thoughts or blurts you have.

Mike

• PEOPLE AND SERVICE – Continue focused professional development of all GHS leaders that advances GHS Commitment to Excellence through tighter alignment of vision, mission and goals throughout the GHS management structure, higher levels of consistency in targeted management practices; and expanded connection to purpose (vision and mission) among front line staff.
o Measured by:
• Employee commitment levels consistent with organizational goal.
• Improvement in Tier III and II rankings by current managers.
• Improvement in key employee survey questions related to connection to purpose.
• Q # 61 -Senior management’s actions support this organization’s mission and values.
• Q # 55 – Senior management provides clear direction about where we are going as an organization.
• Q # 17 – The actions of the person I report to supports this organization’s mission and values.
• Q # 53 – I selected this organization as a place to work because its values reflect my own.
• System-wide HCAHPS scores consistent with organizational goal.

• QUALITY – Improve care and outcomes for patients with diabetes in the GHS service area. (Multi-Year Goal – Year Two)
o Measured by:
• Year Two implementation goals completed.
• Partnerships with other community providers strengthened to address diabetes care as well as other chronic diseases through medical homes model. (New Horizon and Free Clinic)
• Interventions developed in year one further refined, for example: create programs that link primary care specialists with our diabetes self-management programs.
• Development and use of standardized diabetes “tool kit” for use across the GHS continuum of care.
• Gross outcomes measures such as utilization rates for GHS Emergency Services and acute inpatient facilities are tracked for targeted populations and baseline data established.

• GROWTH – Advance GHS position as a regional integrated delivery system through strategic alliances and partnerships with other organizations whose missions are consistent with our own.
o Measured by:
• Implement optimal GHS organizational structure that supports a highly integrated delivery system model well positioned to function in the future as an Accountable Care Organization (ACO).
• Develop, assess and move forward on ACO pilot opportunity in collaboration with Blue Cross Blue Shield of South Carolina.
• Continue to explore, assess, and, if appropriate, pursue participation in Accountable Care Organization/Healthcare Innovation Zone demonstration project.
• Address gaps in specialty services employed or highly aligned with GHS (e.g., urology, cancer).

• FINANCE – Ensure strong long-term GHS financial position and our ability to plan and invest in future-focused stategies by achieving targeted operating margin.
o Measured by:
• Implement optimal GHS organizational structure that supports current system-wide volume, payor-mix, and projected revenue AND that supports a highly integrated delivery system model.
• Research and evaluate alternative models for aligning staff and physician incentives that support a highly integrated delivery system model; and develop implementation plan.
• Evaluate and pursue collaborative relationship with Palmetto Health that would advance both organizations’ abilities to achieve shared savings and explore a network alternative to CHS and Novant.
• Achieve 2011 budgeted operating margin.

• ACADEMICS – Advance GHS academics agenda through further strengthening of USC/ GHS relationship as it relates to a four year USC School of Medicine-Greenville, the IAHC and other related program areas (Research, Workforce Development, Total Health).
o Measured by:
• Develop and implement a detailed plan for community engagement/ communications related to workforce development activities at GHS in general and to the USCSOM-Greenville in particular.
• Communicate and advance medical school position among selected national health care affiliation groups including Association of American Medical Colleges (AAMC) and University HealthSystem Consortium (UHC) among others.
• Move forward with the four year medical school application process with the Liaison Committee on Medical Education – achieve preliminary accreditation status by June 2011.

• DIVERSITY – Develop programs and methods that expand the diversity of candidate pools for leadership positions within GHS; and continue to advance GHS supplier diversity activities and results.
o Measured by:
• Higher levels of diversity among candidates for GHS leadership positions.
• Improvements in purchasing statistics compared to 2010 results.

I recently submitted and received approval from our Board for next year’s budget. As part of the communication, I sent the following email to all employees:

Our Board of Trustees met today and approved the Fiscal Year (FY) 2011 budget. About a year ago, I sent a memo to all staff offering context and important details about the FY 2010 budget and I have decided to continue that practice again this year.

Current Environment

I want to begin by reviewing the context in which the FY2011 budget has been developed. At Town Hall Meetings and in other venues, I have talked and written about the impact of current economic conditions on GHS and our operating margin. Here are some of the facts we have discussed:

The United States has experienced the deepest recession since the Great Depression of the 1930s and most signs of recovery this year have been sporadic and sluggish.
Financial and housing markets have seen dramatic declines and have only achieved partial recoveries.
Unemployment across the country continues at levels not seen for nearly three decades.
In our own state, unemployment is nearly 11 percent; and that places South Carolina’s among the very highest unemployment rates in the country. The majority of people in South Carolina receive health care coverage from their employer.
At GHS, we have continued to experience lower than projected inpatient volumes and shifts in payor mix including rising charity care and bad debt. These changes represent a new normal for GHS and we now project flat inpatient volumes and modest growth in outpatient volumes over the next few years.

In FY 2010, GHS management and staff have responded to these challenges by seeking opportunities to improve efficiency and reduce costs and I know that we will continue to face and respond to similar challenges in the coming year.

GHS Strategy and 2011 Goals

Our new fiscal year starts on October 1st and these factors impact strategy, goals, and the budget for the coming year. You may remember that in FY 2009 our Board of Trustees approved changes to our vision and mission statements that reflect the strategic direction that GHS has been following for several years.

GHS Vision: Transform health care for the benefit of the people and communities we serve.

GHS Mission: Heal compassionately. Teach innovatively. Improve constantly.

In 2011, we will move forward with selected strategic initiatives that are key to our long-term strength as an important health resource for our community. These include expanding access to primary care through our physician network, investing in clinical expertise, programs and information technology, and supporting progress on the University of South Carolina School of Medicine – Greenville expansion.

In 2011, our organizational goals relate to the six GHS Pillars of Excellence. These are:

People – We work to transform health care, measured by our annual staff survey.
Service – Patients and families are the focus of everything we do, measured by our patient surveys.
Quality –.We provide right care at the right time and in the right place, measured though CMS All Care Measures, Hand Hygiene and Culture of Safety data.
Growth – We develop our System to meet the needs of our community, measured by net revenue and numbers of new patient visits.
Finance –We responsibly direct our resources to support our mission, measured by our operating margin.
Academics –We educate to transform health care, measured in 2011 by achieving preliminary accreditation of the USCSOM – Greenville.

FY 2011 Budget Development

In developing any budget, leadership must balance the future and strategic priorities of our health system with the current needs of the organization. This year was no exception. In addition to the strategic initiatives described above, we identified two additional budget priorities: 1) minimizing costs to the community while budgeting an operating margin that maintains financial stability; and 2) protecting and growing jobs.

More than ever before, this year’s budget process benefited from the additional input and involvement of our physician leaders/clinical chairs and campus presidents who considered strategic system priorities and helped make tough decisions about a wide range of issues including capital investments, staffing levels, and improved integration of services.

Impact of FY2011 Budget for GHS Employees

For many of the reasons I’ve already described, the FY 2011 budget reflects some difficult decisions which will touch each of us as employees.

The budget I submitted provides for no across-the-board merit increases in 2011. This applies to all eligible employees, physicians, senior leadership and myself. Funds will be made available for market adjustments and to support employee promotions to new positions. It may be worth noting that GHS continues to be market competitive in its employee compensation practices.

We will maintain a comprehensive and competitive benefits program; however, the cost of benefits will rise for employees at a pace that is lower than the national average. For example, insurance premiums will increase an average of 4% and co-pays and deductibles will increase slightly.

In making these decisions a theme emerged around shared sacrifice to protect jobs. I want you to know that the combined effect of these decisions equals nearly 260 positions protected. I understand that these budget decisions will have a personal impact for you and your family. I encourage you to consider the many colleagues whose jobs have been protected as you think about the implications of this budget on your individual situation.

Commitment to Open Communication

One of my personal commitments relates to open communication. At many Town Hall Meetings, I’ve expressed my belief that GHS employees deserve to hear both good and not-so-good news as long as there’s a sense that leadership is committed to communicating and working together.

These decisions were not made lightly; rather they were made so that we can live up to our vision and mission for GHS and achieve our goals in a tough economic environment.

I encourage you to read the supporting documents on the CEO Corner of GHSNet and to talk with your manager about how these changes will affect you. I plan to talk more about the 2011 budget and organizational goals at the November Town Hall Meetings.

Thank you for the work that you do on behalf of our patients, families and communities. Whether you work directly with patients and their families, or in another setting, each of you plays an important role in making GHS a great place to work, practice medicine and receive health care.

As always, I welcome your feedback, whatever it may be. Feel free to send a note to me via the CEO Corner or directly to my GHS e-mail address: mriordan@ghs.org.

Thank you,
Michael C. Riordan
President and CEO

The last sentence is an important part of most of my communications. It is an invitation to get some feedback. I received about 40 emails from employees and the overwhelming majority were supportive. However, a couple were not and in many ways they were the most important for me to read and respond to. I think it is important to give employees a lot of space to express and process information. The following article I received from a colleague helped me as I responded to employees:

Can’t remember if you get the Crucial Skills e-newsletter, so just thought I’d pass this along….

Our company is going through tough times in the midst of the current financial downturn. We are not downsizing but have been instructed to cut expenses, work more efficiently, and basically do more with less. We have implemented many initiatives—including staffing to workload, reducing overtime, and purchasing more efficiently. All of these initiatives have caused a decrease in employee morale and management is now seen as the enemy.

We have tried to communicate the reasons we are making these changes—including trying to avoid layoffs—yet the anger and overall unhappiness continues. What more can we do?

Signed,
Misunderstood

A Dear Misunderstood,

First of all, let me set your mind at ease that you are normal. And your employees are normal. And that’s the problem.

There’s nothing more normal than resenting those whose decisions create pain or disappointment for you. In fact, that very instinct has been key to the survival of our species for millennia. Evolutionary biologists explain that the human tendency to rationalize our pain by blaming others is inherited from a time when our survival was dependent on being suspicious of those around us. When you and I meet a stranger for the first time, we are hard wired to assess two things: 1) Do they mean me harm? and 2) Are they capable of carrying it out? By perpetually scanning our environment for threats, we live to enjoy another day.

However, in the last couple of hundred years, this tendency became very maladaptive. In complex organizational life, our knee-jerk tendency to assign bad motives to those who inconvenience us creates rampant mistrust, dysfunctional conflict, and as you point out, resentful disengagement. All of that is a long way of saying, welcome to the human race.

It’s also a way of leading to my main point: overcoming this natural tendency requires extraordinarily skillful influence—the kind few leaders practice. Most leaders harbor a naïve hope that a few PowerPoint slides and a perky e-mail or two will overcome this massive genetic inertia toward the negative. Fat chance.

Your only hope—as we describe in Influencer [http://www.bn.com/vitalsmarts]—is to change how you change minds. Here’s how.

1. Discard verbal persuasion. Most of our influence attempts in these circumstances value efficiency over effectiveness. We hope that if we simply reason with people and share logical information they will see the wisdom of our decisions. Give it up. That’s just not going to happen. When you cut costs by reducing people’s overtime, decreasing their discretion and forcing them into unfamiliar tasks, they’re going to want someone to blame. And there is a short list of suspects. You can’t talk them out of conclusions they are hard wired to draw.

2. Create an experience. Your hope lies in engaging your employees in the problem before you present a solution. Before they will appreciate the insoluble tradeoffs you faced as you tried to make humane decisions, you’ll have to put them in the exact emotional and intellectual position you were in and give them the opportunity to mentally appreciate the predicament. And this isn’t the work of a five-minute announcement. You need to set up the problem, involve them in struggling to find solutions, help them confront their simplistic tendencies, then agonize all over again about additional options.

For example, I worked with a large aerospace company that had to make drastic changes in benefits in order to remain competitive. The leaders knew the decisions would be unpopular but wanted to help people understand they did not make the decision exclusively on behalf of shareholder interests. So they gathered groups of opinion leaders from across the company and treated them to the same agonizing set of tradeoffs they had faced. At the end of these three-hour sessions, they asked the group to make a recommendation that satisfied all the criteria the leaders had to address. Every one of the opinion leader sessions ended with a highly split vote about what to do. After a half dozen of these sessions, the story went out through the grapevine that “This was a really tough decision and our leaders did their best to get it right for us and all our stakeholders.” There was hardly a complaint when the tough changes came down—because key employees were not given a lecture, they were given an experience.

If you want to create understanding, you need to create the problem in people’s minds before you present the solution. They need to experience it, own it, play with alternatives, then feel the weight of balancing the tough tradeoffs.

Now let me be clear, I am not suggesting that leaders abdicate decision making. I am not attempting to describe a process for democratic deliberation in organizations that must make fast-paced decisions. The process used at the aerospace company gave employees an opportunity to critique a decision that was already made. If leaders had the time, they might have used this as a consultative process as well as to give them input. But in the end, they would have still made the call.

I applaud your efforts to analyze what you have done well and what you could improve. It is clear that you have a deep concern about the welfare and sentiments of your team. I’m confident that, with continued reflection, you’ll increase your influence for good.

Please feel free to comment on this or any of the other posts.
Thanks,
Mike

You may have heard the term “rounds” or “rounding” when you were in the hospital or watching any of the numerous hospital related soaps or TV series. It typically refers to the time the physicians take to walk around the ward or patient care area and check on their patients. In major teaching hospitals like GHS, the idea of rounding often includes other members of the healthcare team and students or residents.

We have broadened the practice of rounding in a couple of directions. In clinical and patient care areas, we ask our leaders to round on patients and ask questions like: How are we doing managing your pain, are there any staff members that have done an exceptionally good job that you would like to recognize, do you have any questions about your care? What the research shows is regular rounding on patients improves quality by proactively dealing with issues like pain management, safety, and coordination of care and communication. We also see the leaders that have made this a habit (hardwired) consistently have higher patient satisfaction scores.

The next area that we have incorporated rounding is with our own employees. We ask a few simple questions: What is working well, do you want to recognize anyone that has done an exceptional job, do you have the tools and equipment you need to do your job, and are there any systems issues or questions that need to be addressed? I believe that the use of this simple tool is a major reason why our employee engagement scores on the annual survey have been in the top decile nationally for the past 2 years. Also, this is a tool that can be used in any business and industry. I have even used it at home, with slightly modified language, and have gotten a lot of funny and useful answers.

I bring up the rounding tool to provide a context for a meeting I was invited to last week. Every 90 days we block off an entire day to help train our leaders and managers, more than 600 managers that have the responsibility of leading our 10,000 employees. After the meeting, I received an email from a manager who had questions about how to incorporate what was learned at the meeting to her every day role as a leader in one of our practices. That email started an exchange and then an invitation for me to attend her next staff meeting. For me, it was a wonderful meeting that helped connect me to purpose.

I used the rounding questions to get things moving. When I asked what was working well, I heard about new processes, communication, teamwork. That made the next question a natural follow up – anyone they would like to recognize. I really enjoy it when people mention co-workers from other departments, and they mentioned several. This is also where I get my assignment – notes, emails, or calls are sent to the individuals mentioned. I think starting with the first two questions helps employees to think positively and constructively. The next two questions are also related and are the opportunities for improvement or a conversation. No major issues reported out about tools and equipment or system problems. But, the exchange created an atmosphere where the employees’ real concern could emerge. I was in a room with 6 people, 2 of the six had a spouse or significant other that had lost a job and was unemployed for nearly a year and 2 others were single parents. They were afraid about the economy and their jobs. Answering their questions and giving them space to express their concerns or fears was time well spent. My experience is rounding helps surface practical information and when done with patience opens up an opportunity for deeper understanding, engagement, and commitment for all involved. Another important take away for me was the realization that the decisions made by myself and others have an impact on those that work here – I was humbled.