Winona Health Accomplishments 2005

2005

Accomplishments

Meeting Our Mission Gathering the information displayed in this publication was simply a joy to do and a work of the heart. I have stated on many occasions that Winona Health is a remarkable organization – specifically because of the people who work here. It is their time, talent and hard work that have resulted in these accomplishments.

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I would be remiss if I did not state at the outset that there were far more accomplishments than are listed – we did not have the space to list them all! This publication marks the beginning of a new annual accounting and sharing of accomplishments by Winona Health. We have grown in size and complexity, and it is hard for any one person to know all that is going on inside our organization – but we are committed to sharing our outcomes with all who will listen! Winona Health has a special place in the Winona community. It’s an important place, a place of responsibility and accountability. But we forget to share just what it is that goes on day-to-day inside our organization. And we need to change that. As a community-based healthcare system, our mission is focused on those we serve – residents in Winona and surrounding communities. But not everyone in our service area needs our services each year – or even for many years. I’d like everyone within our service area to be familiar with Winona Health and what we do in order to instill a sense of security: When you are in need, there is a great place to go. That place is Winona Health.

Rachelle Schultz, CEO

I hope you enjoy reading through the accomplishments of 2005 and, in doing so, feel a sense of pride for the work done and the future of healthcare in our community. Warm regards,

Rachelle H. Schultz President/CEO

Community memorial Hospital  lake Winona manor  Watkins manor aditH miller and roger metz manors  Home Care and HospiCe serviCes pHysiCian CliniCs  parkvieW pHarmaCy  Winona HealtH Foundation

Mission: Vision:

Values:

Cornerstones:

Devoted to improving the health and well-being of our family, friends and neighbors

To create an exceptional healthcare organization designed to meet the current and emerging healthcare needs of our community

Integrity, compassion, family, spirituality, excellence, people, environment and communication

 A service environment where people can realize their full potential  Excellence and leadership in clinical care & service  Collaborative partnerships that serve and improve our community  Financial stewardship that balances mission, margin and healthcare costs

People  WH’s employee retention rate was 93.7%, compared to the national average of 83%.

 100% of staff signed off on training for WH’s Service Excellence Standards.

 WH staff developed Role Summaries for all positions.  Targeted efforts to ensure staff understood their work expectations resulted in a 21% increase in this item over the 2003 Employee Pride Survey (64.6% to 85.6%).

 A cross-disciplinary team worked to implement a tobaccofree campus initiative, effective January 1, 2006.

 The WH Intranet was launched and plans were developed to improve its structure and increase usage in order to improve internal communication.

 The second Employee Health Fair was conducted, with 315 employees/volunteers in attendance.

 66% of employees participated in the Employee Pride Survey, exceeding the 60% participation goal; the first Volunteer Pride Survey was conducted with a 39% participation rate.

 A new performance appraisal tool and process was implemented, increasing timely completion of appraisals from 85.12% to 95.12%.

 Computer-based mandatory education was implemented with 98% completion by due date.

 WH staff completed an ICSI Culture of Quality survey, which showed: 

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88% of employees have a clear understanding of WH’s mission, vision and values, compared to the ICSI average of 76% 81% feel encouraged to become involved in the improvement of patient care and service, compared to the ICSI average of 60% 72% agreed our quality goals and strategic plan are clear and well-communicated, compared to the ICSI average of 57% 71% agreed that quality improvement efforts are measured and communicated, compared to the ICSI average of 53%

 Workers’ compensation expenses decreased from about $396,000 in 2002 to $45,000 in 2005. In the same timeframe, lost days ratio decreased from 67 to 10 days, and the medical indemnity ratio improved from 1.38 to 7.70 (good).

Rand Gettler (l), Chief Operating Officer, and Jerry Kouba (r), Environmental Services Manager, congratulate John Matis as he accepts the Sodexho Smile Award.

 The Kronos electronic time and attendance system was built and implementation started.

 Staff implemented a Human Resource Information System with payroll functions, electronic application, workers’ compensation and performance management, and automated data collection.

 WH created an annual Service Excellence Award program, recognizing five staff members for their exemplary customer service. This year’s honorees were Lori Britton, Wendy Helmers, Barb Klink, Bev Spelz and Kris Troska.

 WH staff and volunteers received recognition including: 

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Members of Winona Health’s senior leadership recognize the 2005 Service Award Winners.

 A personal health inventory and workers’ compensation documentation and forms were developed for WHOL for deployment in 2006.

 An electronic employment application was implemented.

Gary Evans, Board Chair – Outstanding Volunteer Fundraiser by the Association of Fundraising Professionals, Upper Mississippi River Valley Chapter John Matis – Sodexho Health Care Services Smile Award Nancy Brown, Sara Gabrick, Rand Gettler, Kathleen Lanik, Mary Reeck, Rachelle Schultz – studied to become MN Council for Quality Evaluators Rachelle Schultz, CEO – named to the MN Council for Quality Panel of Judges

Abbreviations WH – Winona Health EMR – Electronic Medical WHOL – Winona’s Health Record Online WSU – Winona State CMH – Community Memorial University Hospital ICSI – Institute for Clinical LWM – Lake Winona Manor Systems Improvement

Care & Service  Assisted Living satisfaction scores improved from the 79th percentile nationally to the 88th percentile.

 LWM revised its resident satisfaction survey process to facilitate quarterly results, ending the year with an 88% satisfaction rating.

 Hospice increased its average daily census from 4 in 2002 to 20.5 in 2005, improving the quality of life remaining for terminally ill patients.

 CMH’s Emergency Department cared for 17,949 area residents, an increase of 4.3%, while its Department of Behavioral Health’s admissions increased by 19% to 416; nursery admissions by 8.4% to 412; and Dialysis treatments by 12.68% to 6507.

 Dialysis achieved the Renal Network 11 Best Practices and ranked 17 out of 315 facilities nationally for fistula rates.

 CMH’s mortality rate was at 1.55%, compared to a national

 WH’s new Allergy & Asthma Clinic accommodated 293 visits.  A feasibility study was completed for the October 2005 opening of a weekend Urgent Care Clinic.

 Information technology (especially the EMR) was used to improve patient safety and service quality: 

Electronic notes added for use by Physical Therapy

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Sleep study reports received and filed electronically

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Asthma disease management service developed for WHOL

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Electronic orders added in Radiology, reducing paper filing by 85%

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Allergy alerts implemented

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Alerts for patients with antibiotic-resistant bacteria added

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Urgent or critical lab results displayed in red

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benchmark of 2.23%.

 Medicare length of stay was reduced from 4.9 to 4.6 days, indicating improved coordination of patient care and resources.

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 The patient/resident complaint process was evaluated and improved, ensuring uniform reporting and handling of all complaints. Following the first full-year implementation of a new service recovery program, CMH complaints decreased by 19%.

 WH continued to receive staff suggestions for innovations and improvements, with more than 500 opportunity statements submitted and more than 350 implemented.

 New evidence-based pathways were developed consistent with national guidelines for congestive heart failure, preoperative care, pneumonia and preoperative antibiotic use.

 A pharmacist began working with clinicians daily on patient/resident units to ensure appropriate use of medications.

 The Hospitalist program was initiated, ensuring a board-certified Internal Medicine specialist is present in the hospital from 8 a.m. to 6 p.m. daily.

 Collaborative treatment plans with Gundersen Lutheran (Priority

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Automated smoking cessation counseling referral added if patient is a smoker Trigger added to notify Hospice staff before patient admission Automatic wound care referral included if patient meets set criteria Automatic Social Service referral added to address discharge needs

 WH’s focus on patient- and family-centered care resulted in patient and resident inclusion on various teams, including the Breast Health Team.

 KidsHealth, a family web-based resource, was added to the WH website; this and other targeted web efforts lead to a 30% increase in website hits and visitors.

 An educational TV channel and two condition-specific manuals (Congestive Heart Failure and cancer) enhanced patient resources.

 WH collaborated with Project Fine to offer a prenatal class in Spanish attended by 12 families.

 The medical staff evaluated and improved their own credentialing standards to ensure patient quality and safety.

One) and Mayo Clinic (STEMI) improved care of major heart attack patients, with 15 patients transferred under these programs.

 WH purchased a portable decontamination tent with Health Resources and Services Administration (HRSA) Bioterrorism Grant funds, enhancing emergency preparedness.

 WH became a full member of ICSI.  WH voluntarily participated in the Centers for Medicare and Medicaid Services project that defined effective care for three conditions. Compliance scores for all three conditions have improved since the project started: 

Acute Myocardial Infarctions: 94.28 to 100%

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Congestive Heart Failure: 51.85 to 88.57%

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Pneumonia: 63.38 to 89.66%

 LWM has improved its timeliness of CMH patient transfers by 75%.  LWM reduced its bed numbers to 160, opening up more single rooms and adding a second hospice room which has had a 47% occupancy.

 An improved dictation process reduced turnaround time to physicians by five days.

 WH developed a process to review daily, weekly, monthly and quarterly indicator reports to evaluate and improve operational performance.

Winona Health staff simulate a surgery in a newly equipped operating room.

 WH continues to have no adverse health events.  Through the Institutional Review Board, WH began a research project studying pain control in labor and delivery.

 WH hosted 77 nursing students in clinical practicums.

Collaboration  WH’s building project remains on schedule and on budget. Completed in 2005 were the helipad and parking ramp, with the MRI and Surgery Suites set for late 2005 occupancy.

 WH raised $14,000 for Hurricane Katrina relief, $1,300 for Tsunami relief and $19,337 for the Greater Winona Area United Way – its largest local contributor.

 WH and Winona Clinic identified a strategic location for a Women’s

 WH staff volunteered to assist in Hurricane Katrina relief efforts. The

Health Center on the third floor of the new Medical Office Building.

following staff served three-week Red Cross stints: Kathie Johnson, RN; Michael Kycek, RN; Sally Slavicek, Food & Nutrition.

 WH donated almost $26,000 to local nonprofit organizations.  WH and WSU received a three-year $216,000 Minnesota Job Skills Partnership grant to train Lean in Healthcare to 50 WH employees who in turn will train all staff.

 LWM’s nursing director worked with area nursing home colleagues to develop protocols and policies, including an inter-facility admissions document, to provide consistent, effective resident care.

 A local collaborative including WH, local long-term care providers and WSU successfully pursued state legislative action, creating an opportunity to pursue Programs for All-Inclusive Care for the Elderly (PACE). Board members, city officials and Chamber Ambassadors cut the ribbon for the new parking ramp.

 WH staff shared building project news and updates with the community and staff regularly and frequently: 

24 Construction Zone articles in the staff newsletter

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8 news releases sent to local media

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17 radio and television interviews

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4 features in the spring and fall issues of Healthy Connections mailed to 22,000 area households

 The Auxiliary organized Follies, Holiday Happiness, Fantasy of Trees and other events to increase awareness of WH and support its services, donating $59,100 and more than 25,000 volunteer hours.

 The Auxiliary facilitated Advanced Directives classes for 106 residents and held special sessions for Public Health Nursing, LWM, a WSU class, and for the TRW, Home & Community Options and Senior health fairs.

 WH received the following awards: 

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MN Hospital Association’s Innovation in Patient Care Award for the Integrated EMR MN Health and Housing Alliance’s Excellence in Practice Award for LWM’s Make-a-Wish Program

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15 ads in Winona Daily News and Winona Post 9 articles in Winona Daily News and Winona Post

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Hospitals & Health Networks’ Most Wired–Small and Rural

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7 civic group presentations

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Sodexho’s Environmental Services Account of the Year Award

6 employee tours and the first community tour

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MN Council for Quality’s MN Quality Award – Advancement Level

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Many personal tours given by senior leadership

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Malcolm Baldrige National Quality Award – Third Scoring Band

600 staff celebrated the parking ramp opening

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200 community leaders and residents attended the parking ramp dedication 100 attendees enjoyed the parking ramp donors’ banquet

 Four new physicians were recruited to the community: 

Laurel Quinn, MD, Ophthalmology (WH)

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Ehab Michael, MD, Internal Medicine (Winona Clinic)

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Joan Krueger, MD, Pediatrics (Winona Clinic)

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Edward Malone, MD, Family Practice (Family Medicine)

 Family physician Marc Molis, MD, joined the Rushford Clinic staff.  WH recognized the retirement of two long-time local physicians:

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area business leaders.

 WH staff delivered information packets to 30 area businesses and conducted 22 health fair screenings, ergonomic assessments and other services.

 WH staff gave 29 tours, presentations and programs to community groups.

 WH coordinated a Red Cross Blood Drive, which drew 65 participants.

Care Providers of MN’s Community Partnership Award for Winona’s Rural PACE Team

 WH staff made several major presentations: 

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Horace Anderson, MD, 37 years of service, and Bruce Davey, MD, 28 years of service.

 Two Business Forums were held with a combined attendance of 80

Winona Area Chamber of Commerce’s Business Appreciation Award for Technology

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Kathleen Lanik testified in Washington DC at a Congressional Subcommittee hearing on privacy Kim Rock-Stockheimer presented at an International Lymphedema Conference in Glasgow, Scotland Janice Turek, RN, presented WHOL at a national healthcare summit in New York City Bill Gould presented WH’s Workers’ Compensation Management process to a MN Health and Housing Alliance conference and at a workshop for a local chapter of the American Society for Quality William Davis, MD, presented Winona’s EMR at a conference in New York City

 Health Executive magazine published a feature on Rachelle Schultz, and the Journal of the American Health Information Management Association published an article on WH’s EMR.

 WH hosted the Southeastern Health Information Management meeting, attended by 65 people who learned about WH’s EMR and Baldrige journey. Attendees called the meeting “extraordinary.”

Stewardship  Parkview Pharmacy revenue grew 14% in 12 months.  Winona Choice entered into a contract with Medica, introducing a third major health insurance option in Winona and enhancing rate competitiveness for employers and providers.

 WH completed its annual bond rating review and maintained its current Standard & Poors rating.

 An independent audit was completed with a “clean” opinion and no material adjustments made to financial statements, indicating WH’s processes for recording transactions, compiling financial statements and reporting financial information is effective and internal controls are working.

 The Winona Health Foundation developed its mission, vision, values and strategic plan.

 The WH Foundation supported WH:  

Winona Health Physician Clinics improved their financial performance.

 WH’s gain from operations was $2.54 million (4.1% operating margin) versus a budget of $1.69 million, the third consecutive year WH outperformed budget despite:  Charity Care provided to patients increased by more than 300%, totaling $596,000 

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Expenses related to bad debt increased by 86% to $1,892,000 Employee health insurance costs increased by 24%

 Operating expenses were within 2% of budget for the third year in a row.

 Liquidity has improved: 

Cash increased during the fiscal year by more than $5 million

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Cash-to-Debt ratio improved from 84% to 105%

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Days Cash on Hand improved from 153 to 174

 The capital purchasing process was refined to better deploy capital: 

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43% of all requested dollars included a calculation of Return on Investment Dollars deployed were $2.14 million, compared to budget of $2.2 million

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Received gifts from the community of almost $451,000 The Ben and Adith Miller Patient Care Fund assisted 81 Winona residents by paying medical bills of $263,000, a 60% increase over 2004 The Tree of Lights annual appeal raised almost $51,000, a 19% increase over 2004 The Ben and Adith Miller Classic raised $135,000 for the Ben and Adith Miller Patient Care Fund Hugh and Vera Miller and RTP Company donated $25,000 to the Ben and Adith Miller Patient Care Fund on behalf of Kent Gernander, recipient of the Ben and Adith Miller Tribute

 Business software was converted from CPSI to Great Plains (G/L, Human Resources, Payroll), Cerner (Patient Accounting, Materials Management) and Kaufman Hall (Budget, Reporting), while improving key financial indicators.

 WH signed the Attorney General’s agreement to ensure uniform billing practices for patients not covered by Medicare, Medicaid or other insurance.

 The coding and documentation process for complicated pneumonia cases was improved.

 WH received an additional 0.4% reimbursement from Medicare for voluntarily reporting 10 quality measures, resulting in approximately $35,000 annually.

 WH worked with Winona County on mental health issues and received a county stipend to help with 24-hour psychiatric call coverage.

 WH’s investment returns for the 21-month period since consolidating to three investment managers was 20.7%, besting the benchmark of 14%.

 Winona Health Physician Clinics improved their financial performance by 6%.

 Winona Senior Services improved their financial performance by 18%.

 Cost Per Adjusted Discharge (a measure of efficiency) decreased from $6,020 to $5,801 after two years of increases.

The Auxiliary supports Winona Health with gifts of time, talent and treasure.

Looking ahead . . . Winona Health’s Key Initiatives for 2006

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 Emergency Department Satisfaction

Target: 78.9% Goal: Improve the overall quality of Emergency Department care and service to increase patient loyalty.

 Medicare Average Length of Stay

Target: 4.4 days Goal: Enhance care coordination to ensure optimum clinical service and resource use.

 Medical Opportunities for Improvement Target: 10% increase in hospice average daily census Goal: Develop a pathway for end-of-life care to ensure patient-, resident- and family-centered care.

 Operating Margin

Target: 3.5% Goal: Maintain a solid operating margin to balance Winona Health’s mission and costs.

855 Mankato Ave. Winona, MN 55987 winonahealth.org

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