2012 Highlights

Well, we have closed the books on 2012 and what a year it was! We have a whole lot to be proud of. I want to use this post to talk, in some detail, about our success and how we got there as well as discuss the goals for 2013.


Vision
Let's start with a refresher. We have a vision and a mission that drives our organization. Our vision is, "To create a world where all children can reach their maximum potential." For me, this means that every child deserves our absolute best to ensure they achieve all that is possible, regardless of how sick or challenged they may be. And we, as clinicians, are often the people that give them, and their parents, the tools to help on that journey. It may not come in conventional ways, but we must never stop looking for ways to innovate and give hope.

Mission
Our mission is that "we are going to be the preeminent provider for specialized health care services for children." There are two phrases in here that we selected deliberately but that we have a lot of feedback on and that is forcing us to review this.

First is, “preeminent” - people say what does it mean? To me, it means the best of the best. We are going to set the bar high and everyone else is going to be learning from us on how to get there. We are going to do this not just as the biggest, but by looking for innovation and examining what the families’ needs are, not just with clinical success. The second is, “specialized healthcare services.” We are not serving the "typical" rehab child anymore. Most of our children have habilitation needs - children with autism or with developmental delays - we are helping them achieve goals for the first time not as "rehabbing" them to regain a skill they had before. Although people continue to tell me that no one knows what those words mean, our efforts to clarify may be muddying the waters. Something we are actively looking at.

Four Pillars

We do all of this by breaking our annual corporate goals into four pillars that drive all of our work. Those pillars are Quality, Employee and Community Engagement, Service Excellence and Profitable Growth. The six corporate goals then fit into these categories, and then they cascade down to each of your individuals E 3 goals to help us achieve the corporate goals each year. Each of the corporate goals has metrics under them: threshold, target and maximum. The threshold is what we need to accomplish just to get through the year. Target helps us take a breath and say we did better than we thought, and then aspiration is just that - the goal we aspire to achieve in a year.

In 2012, we achieved five of our six corporate goals. Four at the aspiration level, one at target and one not at all. It is important to discuss how we achieved them as much as what was achieved.

Quality - We achieved the aspirational goal for our Quality goal in 2012. The Quality goal is measured by our Quality Report Card, which is located on the intranet LINK http://mtapsp10/Pages/Hospital-Announcements.aspx. We achieved the aspirational goal by achieving six out of seven of our quality goals established.

Goal #1
Flu vaccine - In 2010, the JCAHO, the federal agency that accredits us, said that hospitals must vaccinate 90 percent of all employees by 2020. Many hospitals instituted policies that said you can't work at the hospital if you aren’t vaccinated. Others did what we did which was to say that for new employees we would make it a condition of employment, therefore, telling people, right upfront it wasn't negotiable on a go forward basis. By achieving this goal early, we have demonstrated to JCAHO our achievement of their aspirational goal eight years early. I couldn't be prouder of achieving this goal.

Goal #2
WeeFim Score Change – We use a tool, WeeFim (Functional independent measure, Wee is for kids) to measure an effectiveness score. We use the tool to measure children’s functioning on admission and on discharge and the change score is measured against similar facilities. We achieved better than benchmark.

151,000 people die each year in hospitals from things that could have been prevented and even more acquire new illnesses in the hospital due to things the hospital or their staff did. The remaining four goals on our report card related to these issues, or preventing these issues: hand washing, blood stream infections, medical errors, and sentimental events (patient death).

Goal #3
Hand washing - I know this one seems like a "no brainer" but when you think about the fact that one nurse on a 12 hour shift might have to wash her hands hundreds of times on a busy day, you start to see how hard it can be. Every time you touch a child, you need to make sure you wash first. This is to reduce the spread of germs from one to the next. We have a very aggressive secret shopper program who observe what staff are doing and then calculate the percentage of times we achieve the hand washing goal. In 95 percent of the cases, we achieve our goal! We will continue to strive for 100 percent, but this is a great accomplishment. When JCAHO comes, they will be observing every interaction our children have with staff and they will track whether or not we accomplished this in 100 percent of the cases.

Goal #4
Medication errors - Of course we would like to say we have ZERO medication errors but the team of Pharmacy, Physicians and Nursing has driven the number to an astoundingly small number that we are almost there! Over 400,000 doses given on the inpatient unit, we only had 20 errors, and none caused harm to the patient! This is a phenomenal rate, and one we are so proud of.

Goal #5
Blood stream infection rate - We have been consistently working to drive down our blood stream infection rate. This is something that they call a “high risk, low volume” situation for us because we have very few children who could even get a blood stream infection because we virtually have no chance to cause an infection, except for children who are receiving a special type of nutrition through a TPN process. This means we don't do it very often, which means we are at greater risk for something going wrong. The children on TPN, are very, very fragile medically, and getting this blood stream infection could prevent them from getting a needed transplant or other life saving intervention. It is further complicated by the fact that the child could have picked up the infection in the sending hospital but it doesn't appear until the child gets to us. While we did not achieve our goal in this area for this year, we have redoubled our efforts to examine every opportunity to improve on this, including sharing our best practices with the referring hospital and partnering with them to keep the child infection free because we are both committed to the whole child - not just when they are within our care.

Goal #6
Sentinel Events - This means an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. The goal is to have none of these types of events. We had no sentinel events this year, and therefore, achieved our goal.

Goal #7
Reduction of trach decanulations - Nursing and Respiratory on LTC Mountainside did a great job of making considerable reductions, exceeding our goal. By working together they identified opportunities for both product improvement, (we ordered different trach ties) as well as examined how we transferred kids from their bed to their strollers or chairs, when we examined the data, it revealed this is when they occurred most frequently.

Reducing Cost Per Unit
Under profitable growth was reducing our costs per unit of service by 10 percent. We reduced our cost per unit by over 5 percent, which is a great accomplishment but below our goal. The cost per unit means we need to reduce what it costs us to see a child in all settings. This can happen by eliminating waste - meaning stop doing things that take time, but don't add any value. It also happens by increasing the number of children we are seeing and spending the same amount of money. An easy way to think about this is through all of the automation we have done. When we automate a process that used to take people hours to do, that allows those people to do other things at the same cost we were spending before. We need to be focused on this because we know that neither the government nor insurance companies are going to pay us anymore to provide services and in order to keep giving raises, doing more training, buy new equipment, we have to figure out how to live within a smaller budget, even though our expenses are going up. I often say I would rather be ready when the cuts come, then scrambling to figure it out. We are definitely doing the work now to be ready.

We achieved the aspirational goal under profitable growth for our combined operating margin. We measure this by combining the Hospital and the Foundations profit margins. It is important to look at these two numbers because we set up our processes very differently as a non profit hospital than a for profit, due to our charitable commitments. The work that we do in the hospital allows the Foundation to go out and inspire donors make us their charity of choice. The Foundation's ability to raise funds is directly related to how we care for our patients, the programs we offer and how we operate. Due to the success in eliminating waste from our hospital functions through the 100 Day Work Out process and an exceptional fund raising year by the Foundation, especially due to team Children’s Miracle Network Hospitals team, we made a 3.8 percent profit. This has allowed us to continue to expand our services and continue programs that we otherwise wouldn't have, including opening in Egg Harbor Township and soon to open Newark in the Summer. Our continued focus on the 100 Day Work Out process and on our path to Excellence will help us during the uncertainty of healthcare reform.

Profitable Growth
The second Quality goal besides the report card was achieving the aspirational goal of serving 20,495 children. We were able to reduce our neurodevelopmental wait list from 2,500 to 270 children waiting for an appointment today. This is an amazing accomplishment that was done by every part of the outpatient team working together. The physicians made dramatic changes to their schedules, we hired more docs, streamlined our authorizations, improved scheduling and it has resulted in improvements in this goal of improving access and profitability for the organization. This was truly transformational!

Employee Engagement
We achieved the target goal in our employee engagement. We ranked in the 88th percentile of all Children's Hospitals who take the same survey. While we are very proud of this score, increasing 2 percent over last year, you have told us there is still work to be done. We have been doing so many good things but you have told us that you want understand our direction and progress in a more uniform way. So we will be expanding our 100 Day Work Out process, focused on improving quality and eliminating waste into a process which we have named Operation:Excellence. This is adapted from GE's process they used to achieve great success. I will be telling you more about it during the employee meetings in June. Our effort is to address the direct feedback that you don't have context for the decisions that we make or how the work you are doing day to day fits in to our overall strategic goals.

Service Excellence
We achieved our aspirational goal of our net Promoter Score with Press Ganey. This is the score that the federal government looks at to determine the level of satisfaction of your customers. They look at one question - "Would you recommend this service to others?" They then apply a formula that subtracts your 1’s and 2’s from your 5’s and divides by your total number of surveys. The federal government says you need to be at minimum of 50%; we had an average of 80.3% which is an exceptional score! It also means there are still people who are not sure they would recommend us. For us, in examining the data, this comes from people giving us 4's instead of 5's. We will continue to pursue how to move those scores. While we are doing well, we know that the federal government will increase their score, and again, we want to be ahead of the curve.

So what does all of this mean? We should be very proud that our hard work paid off and we are achieving the goals that we set for ourselves. All of the goals are focused on preparing us for the future. A future where quality and price is going to decide whether we will get to even treat the child. We must be the provider with the highest quality and lowest cost in order to continue the excellent work and relationships we have with our children.

I look forward to sharing the goals with you for 2013 at the employee meetings in the coming months. Thank you for your continued dedication and hard work. It is an honor to work with each of you.

Please feel free to comment or ask questions below.

Amy