Winona Health Accomplishments 2006

Looking back, moving forward looking back,

moving forward Winona Health 2006 Accomplishments

Winona Health 2006 Accomplishments

Introduction Rachelle H. Schultz

About this time each year, many of us are thinking about keeping our New Year’s resolutions. I think, though, that it is important to stop and review our past accomplishments and celebrate them. I am pleased again this year to share with you Winona Health’s key accomplishments for 2006. The staff, physicians, volunteers and board members have worked hard and remained focused—which is not always easy given the competing demands and pressures in our rapidly changing environment.

Our goals focus on ensuring a high quality healthcare experience for the patients and residents we serve. We must pay attention to every interaction that occurs each day, while preparing and positioning ourselves for the momentous shift in healthcare delivery that hovers on the horizon. We have built a solid foundation and are engaging in newer healthcare delivery models to meet the needs of the consumer—you! Exciting times are ahead in healthcare—more options and involvement for consumers, incredible advances in medicine, and technology to support us in unimagined ways. Winona Health holds a unique position with regard to community health systems and has been recognized as a role model. Our transformation won’t happen in one month or one year, but over time—another important reason to review our accomplishments in the context of our vision for the future.

Our Vision

To be a recognized leader in the revolutionary transformation of community healthcare.

Our Mission

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

Our Cornerstones

These cornerstones are the key success factors that support our mission and define our strategic planning initiatives. • Collaborative partnerships that serve and improve our community • An environment where people can realize their full potential • Excellence and leadership in clinical care & service • Stewardship of resources that balances mission and healthcare costs

Our Values

• Integrity: We do no harm. • Service: We serve with compassion, dignity and respect. • Loyalty: We build relationships that exceed expectations. • Excellence: We improve performance through learning and innovation.

We are grateful for the support and involvement of so many community members at Winona Health. Our commitment is unyielding, and our partnership with each of you is more important than ever. Contents Introduction. . . . . . . . . . . . . . . . . . . . . . . 3 2006 Key Initiatives & Results. . . . . . . . 4 Cornerstone 1: Collaboration. . . . . . . . . 5 Cornerstone 2: People . . . . . . . . . . . . . . 8 Cornerstone 3: Care & Service. . . . . . . 10 Cornerstone 4: Stewardship. . . . . . . . . 12 2007 Key Initiatives . . . . . . . . . . . . . . . 14

Warm regards,

Rachelle H. Schultz President/CEO



The accomplishments in this publication occurred in Fiscal Year 2006 (FY06), which began October 1, 2005 and ended September 30, 2006.

2006 Key Initiatives & Results Emergency Department Satisfaction

Medical Opportunities for Improvement

Results: Winona Health measures patient satisfaction in its hospital, senior services and clinic settings. At the start of Fiscal Year 2006, Community Memorial Hospital’s ED satisfaction scores were “average” compared to 140 peer hospitals. Winona Health’s staff, especially its ED physicians and nurses, changed many processes during the 12-month period—from implementing bedside registration to having physicians make follow-up calls to discharged patients. By the end of the year, the ED was a “top performer” among its peers in its care and delivery of patient services.

Results: Winona Health’s Medical Opportunity for Improvement centered on ensuring patient-, residentand family-centered end-of-life care. Working with other long-term care providers in the community, Winona Health staff and volunteers developed and implemented a process to increase the number of healthcare directives for long-term care residents. As a result of these efforts, longterm care residents with healthcare directives increased from 26% in 2001 to 74% in 2006. As a result of these directives, more families benefited from hospice services as the hospice average daily census increased by 10% to 22.

Medicare Average Length of Stay

Operating Margin

Results: A team of physicians, nurses, dietitians and social workers care for patients on Community Memorial Hospital’s Medical/Surgical floor, including on site physicians known as hospitalists. Recognizing that most people prefer being at home over being in a hospital, this Care Coordination Team begins working with patients on a post-hospitalization plan as soon as they are admitted. The team reviews and assesses patient progress and the best site for their recuperation—home, nursing home, assisted living or home care. This focus on addressing patient needs has resulted in a 10% decrease—to 4.4 days—in the average length of stay for CMH patients.

Results: As a community-owned healthcare system, Winona Health considers it paramount to provide high quality healthcare services to everyone in the Winona region. At the same time, it must be a careful steward of the community’s resources, ensuring the long-term viability of the organization. Winona Health uses its “operating margin” as one measure of whether it has achieved a balance between its mission to the community and its costs. This indicator is calculated by dividing operating income by net revenue. Winona Health’s FY06 operating margin was 5.6%, 2.5% better than the median score for Standard & Poor’s A-rated hospitals.

Goal: Improve the overall quality of Emergency Department (ED) care and service to increase patient loyalty

Goal: Develop a pathway for end-of-life care to ensure patient-, resident- and family-centered care.

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

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



Cornerstone 1 : Collaboration Cornerstone 1 : Collaboration • $32 million building project completed on time and on budget. • With completion of the building project, the community’s major healthcare providers are all located on one campus. • Twenty-five tours were held for community members, staff and volunteers during building construction. • A new surgery area brings state-of-the-art surgical technology to Winona area residents. • The remodeled Emergency Department entrance improves the triage process.

About 1,800 community members attended the building dedication celebration to see the new facility.

• Winona Health opened two new clinics on the third floor – Sports & Orthopaedic Specialists and the Eye Care Center.

Building Project Contractors Winona Health recognizes and thanks area contractors for their part in the successful completion of the building project:

Winona Health’s $32 million building project was completed on time and on budget.

All Trades Bauer Electric Biesanz Stone Dunn Blacktop Flags & Poles Int’l Kendell Doors & Hardware Kendell Lumber Kimo’s Lyle’s Flooring

• A special unveiling of the Winona Health Foundation donor wall was held on April 5. • The new Outpatient Diagnostic Center centralizes outpatient surgical procedures, lab tests and imaging services, so patients have a more convenient healthcare experience. • About 1,800 area residents helped dedicate the new facility on Sunday, May 21.



Modern Ready Mix O’Laughlin Plumbing Otomo Engineering Services Ralph Scharmer & Sons River Valley Sweeping Ronco Engineering Schwab Company Scherbring Enterprises Severson Oil

Wapasha Construction Winona Excavating Winona Glass Replacement Winona Heating & Ventilating Winona Nursery Winona Rental

Cornerstone 1 : Collaboration • Seven new providers were recruited to the community in 2006 and two providers recruited in 2005 began working in FY06. Winona Health welcomed the following new providers. 2006: • Tim Gabrielsen, MD, Orthopaedic Surgery; Winona Health Sports & Orthopaedic Specialists • Laurel Quinn, MD, Ophthalmology; Winona Health Eye Care Center • Laurel Littrell, MD, Radiology; Winona Radiology • Kevin Quinn, MD, Child/Adolescent Psychiatry; Winona Health Psychiatric & Counseling Services • Joel Stevens, PA-C; Winona Health Sports & Orthopaedic Specialists • Joy Stevens, PA-C; Winona Health Rushford Clinic • Aaron Schilling, PA-C; Winona Health Sports & Orthopaedic Specialists 2005: • Edward Malone, MD, Family Practice; Family Medicine of Winona, P.A. • Ehab Michael, MD, Internal Medicine; Winona Clinic

• The Winona Health campus became tobacco-free on January 1, 2006. • Community Memorial Hospital’s Emergency Department cared for almost 18,000 patients. • Winona Health’s website averaged 4,241 unique visitors per month in FY06, compared to 3,025 per month last year. In addition, its KidsHealth website feature has an average of 2,675 unique visitors per month, 400% more than the previous year.

• Winona Health’s new weekend Urgent Care Clinic treated almost 2,000 patients in its first year of operations.

More visitors used our website’s KidsHealth feature for health education, recipes, health news, games and more. (winonahealth.org/kidshealth)

• Winona Health hosted five focus groups to learn more about the healthcare needs of specific groups, including seniors, local employers, diverse and at-risk populations, school nurses and area ministers. • Winona Health donated more than $27,000 to area nonprofits working on projects to benefit the community’s youth, health and wellness, or economic vitality.

Winona Health opened the Urgent Care Clinic in response to community feedback; almost 2,000 patients have been treated.



• Inpatient and outpatient mental health visits increased by 12%, addressing a key community need.

lecture at WSU’s sports training and UW—La Crosse’s physical therapy programs.

• Winona Health staff contributed $19,426 dollars to the Greater Winona Area United Way. In addition, staff members serve on the local United Way Board of Directors and several of its committees.

• Lake Winona Manor worked with area nursing homes on collaborative initiatives, including working with the county on coordination of emergency/disaster plans. • Three hundred Back-to-School packets were distributed through Winona Health Physician Clinics and its emergency and outpatient departments. The packets included school supplies and health tips for children in elementary school. • Winona Health staff supported a number of community events, including the Lion’s Club Toy Drive, Merchant Bank’s 10 Days of Giving, American Cancer Society’s Daffodil Sales, Gifts for Winona, the United Way Day of Caring and a Red Cross Blood Drive. • Winona Health Speakers’ Bureau placed 58 staff members in schools and before civic and professional organizations to discuss their careers or special healthcare topics. • Winona Health received editorial coverage in the following publications: • Health Executive magazine – Winona Health’s technology advances • Minnesota Healthcare News – Electronic Medical Records • Healthcare Financial Management – Electronic Medical Records • Minnesota Physician – Patient benefits of Electronic Medical Health Executive magazine Records praised Winona Health for being ahead of the pack in • Minnesota Medicine – healthcare IT. Retooling Family Medicine • River Valley Business Report – Women in Business • Coulee Region Women – Influential Women

Student nurses check the vital signs of baby Emma in the Family Birth Center.

• Winona Health is a site for student nurse practicums; in FY06, staff worked with 80 Licensed Practical Nursing students and 50 Registered Nursing students from Minnesota State-Southeast Technical and 55 Registered Nursing students from Winona State University. • Collaboration with Winona State University and Winona Health benefited Cardiac Rehabilitation patients, students and outcomes. In addition, Occupational and Physical Therapy staff members



Cornerstone 2 : People • The Minnesota Council for Quality recognized Winona Health for two best practices: The first is Lake Winona Manor’s mentoring program that pairs new staff members with veterans staff for a systematic series of interactions, and the second is the alignment of Winona Health’s values to its service standards, performance appraisals and staff recognition.

being six days faster than the national average (41 versus 47 days). • As part of its ongoing commitment to staff, Winona Health University was launched to develop staff educational opportunities. Eighty-four percent of staff completed a minimum 20 hours of education in FY06. • Winona Health employee retention rate is 94% versus a national average of 88%. • Direct worker’s compensation expenses were decreased for the fourth straight year; Winona Health’s worker’s compensation expenses were 0.17% of operating expenses, compared to the national average of 0.43%. • More than 1,400 applicants applied for open staff positions, with 90% of applications submitted electronically through newly implemented integration of the website and Human Resources information systems.

Imaging Services has acquired overhead lifts, which will increase patient safety and decrease back injuries among staff.

• Winona Health received a matching grant from the state of Minnesota and installed overhead lifts in the Imaging Services department to improve patient and staff safety in an area at high risk for staff back injuries. No injuries have occurred since implementation.

Applicants can now apply online for jobs at Winona Health by visiting winonahealth.org and clicking on “Careers & Volunteering.”

• An electronic time and attendance system was implemented across Winona Health to improve accuracy, minimize errors and increase efficiency in processing payroll. This new system allowed for the transition of 1.5 Human Resource employees from payroll processing to recruiting and orientation. • The hiring process was evaluated and improved, resulting in the average time to fill open positions

• Crucial Conversations® training was deployed to all Winona Health directors and managers as a foundation for leadership development and skill building. • Four Winona Health staff are now trained Minnesota Council for Quality evaluators, with special training in Baldrige quality criteria.



• Living Service Excellence Award recipients for 2006 were: • Scott Fabian, Materials Management • Jodie Heim, Lake Winona Manor • Robin Hoeg, RN, MSN, Inpatient Services • Dana Marquardt, Human Resources • Sandy Paetzel, LPN, Medical/Surgical/Pediatrics • Brett Whyte, MD, Emergency Department • Many Winona Health staff members continued their educational training in 2006, including: • Briana Frisch, Rehab Services, Physical Therapy PhD and Kinesio Tape Instructor certification • Stela Hristova, Health Information Management, Registered Health Information Technician certification • Christina Friederichs, Physician Clinics, Administrator in Physician Practice Management certification • Deb Norton, Karen Resch and Deb Kahoun, Registered Nurses, Critical Care certification • Marie Gernes, Accounting, Healthcare Financial Professional certification • Alicia Lalim, Heidi Ramsey and Doug Haberman, Rehab Services, Registered Clinical Exercise Physiologist certification •

Living Service Excellence Award recipients were recognized for outstanding service to the organization. Clockwise from top left: Brett Whyte, MD; Dana Marquardt; Robin Hoeg, RN, MSN; Scott Fabian; Sandy Paetzel, LPN; Jodie Heim

• Chris Draper, Sherry Hill, Michelle Stark and Jean Skime, Senior Services, Hospice and Palliative Care certification • Loretta Boyer, RN, Wound, Ostomy and Continence certification

Lean Projects

Fifty-two employees were trained in Lean principles and completed eight Lean team projects as part of a Minnesota Job Skills Partnership grant received with Winona State University. Lean in healthcare refers to eliminating workrelated waste in processes. As a result, the organization will function more efficiently without extra steps and tasks that do not add value to the patient experience. Eventually all Winona Health staff will be trained in Lean principles. Initial Lean projects included:

The team identified factors that delayed a patient’s discharge and put an action plan into place to cut out waste. As a result, the average time was reduced to 162 minutes, saving 68 minutes per discharge. Supply Management Process After staff expressed concern about finding supplies in a timely manner, Lean team members analyzed supply storage in Lake Winona Manor to encourage faster response to resident needs. They began by mapping out how staff use the supply room and determined that it took an average of 7 minutes 23 seconds to find a particular item.

Discharge Process This team’s objective was to recognize, identify and reduce the wasted time in the discharge process for patients on the Medical Surgical & Pediatric unit (MSP). After observing the process, the team determined that it took an average of 230 minutes from the moment a physician wrote a discharge order until the hospital bed was cleaned and ready for the next patient.

The team reorganized the supplies and set up a system for categorizing, labelling and restocking supplies. It then took staff an average of just 15 seconds to find the item they were looking for.



Cornerstone 3 : Care & Service • Watkins, Adith Miller and Roger Metz Manors’ average overall customer satisfaction score in 2006 was 85.4 versus the national peer group score of 81. • Winona Health Home Care was in the top 8% of performers in the Home Care Hospitalization Reduction Study, making it a “best practice” site. • Transcription services for ICU patients were completed within seven hours of admission, compared to a benchmark time of twelve hours. The reduced timeframe ensured attending physicians had access to critical information in a more timely manner. • Patients with abnormal mammograms received results within 48 hours of testing, thanks to changes in Imaging Services protocols. Bruce McFarlin of Buffalo City arrived in the Emergency Department with chest pain. After the fast action of Winona Health’s medical team and the air ambulance, he was receiving balloon angioplasty in La Crosse within 80 minutes. The next day, McFarlin attended the wedding reception of his niece Kelsey and her new husband Adam.

• In FY06, Winona Health provided low-cost prostate cancer screenings to 122 area men. • Staff-led efforts to live service excellence, contributed to a 43% decrease in patient complaints.

• Winona Health participated in the Center for Medicare/ Medicaid Service’s (CMS) demonstration project and its most recent scores show its care of Acute Myocardial Infarction (heart attacks) in the top 10%, Congestive Heart Failure in the top 20% and Pneumonia in the top 10% of 300 participating hospitals. • Community Memorial Hospital completed a successful state and federal survey; of the 468 standards, the hospital received only three minor citations. In addition, the surveyors commented on the facility’s superior quality initiatives. • Winona Health’s assisted living facilities were inspected by the State of Minnesota and received no deficiencies. The surveyor noted that Watkins, Adith Miller and Roger Metz Manors are doing exceptionally well at medication administration and staff training. Clients interviewed were pleased with the activities offered and enjoyed living in the Manors.

Elmer, a Watkins Manor resident, presents his catch of the day during a fishing outing this summer. Outings like this are an example of why satisfaction scores for Watkins, Adith Miller and Roger Metz Manors were higher this year compared to the national average for assisted living homes

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• With effective processes in place to ensure patient safety, Community Memorial Hospital again had no reportable State of Minnesota adverse events. • Efforts to improve outcomes as reported in the CMS Home Health Compare Data resulted in Winona Health Home Care having eight out of 10 measures equal to or better than the state average, with five scores equal to or better than the national average. • In an effort to improve resident satisfaction, Lake Winona Manor began serving made-to-order breakfasts where residents request their food as in a restaurant. Thanks to a dining program introduced last year, Lake Winona Manor residents like Betty enjoy made-to-order breakfasts.

• Lake Winona Manor redesigned its work model, freeing up 2 additional full-time employees to work directly with residents.

• Microsoft featured Winona Health in its marketing video at the Health Information Management Society’s conference and on its website.

• Lake Winona Manor staff averaged 2 minutes 45 seconds responding to resident call lights, besting their goal by 55%.

2006 Awards & Recognition Winona Health’s Community Memorial Hospital (CMH) received the Premier Award for Quality for superior care of Acute Myocardial Infarction (heart attack) patients. The hospital earned the award for its high quality, cost efficient treatment of AMI. The award criteria included clinical process measures (administering aspirin and beta blockers), clinical quality outcome measures (for example, readmission rates), and resource utilization factors (cost per case and length of stay). Community Memorial Hospital was recognized from an eligible pool of 400 hospitals.

The American Association for Respiratory Care presented the 2006 Quality Respiratory Care Recognition Award to Winona Health’s Community Memorial Hospital.

Winona Health was recognized Most Wired–Small and Rural Hospital for the fifth consecutive year.

In addition, Premier highlighted Winona Health’s success in reducing mortality rates in its February 2006 newsletter. A clinical team redefined admission criteria, engaged physicians, improved documentation and worked with community resources for appropriate patient placement. As a result, Winona Health’s inpatient mortality rate dropped from 2.3% to 1.21% and continues to be at least 0.5% below its peer group.

Winona Health continued its quality journey and was recognized by the Minnesota Council for Quality with a Minnesota Quality Award– Advancement Level.

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Cornerstone 4 : Stewardship • Standard and Poor’s raised its rating of Winona Health’s $19.1 million health revenue bonds to “BBB,” citing a solid balance sheet, improved operating and excess margins and good market position.

Dollars awarded from the Ben & Adith Miller Patient Care Fund $600,000

• Winona Health’s gain from operations was $3.8 million (5.6% operating margin), outperforming budget for the fourth consecutive year while funding: • Charity Care to qualified patients of $624,000 • Write-offs of bad debt totaling $1,636,000 • Start-up of new physician clinics for the community

$528,000

$500,000 $400,000 $263,000

$300,000 $164,000

$200,000 $100,000

• Operating expenses were within 2% of budget for the fourth year in a row.

$87,000

$113,000

2002

2003

$0

• Winona Health’s balance sheet remains stable and compares favorably to similar hospitals: • Cash-to-Debt ratio: 103% • Days Cash on Hand: 160 • Debt-to-Capitalization ratio: 29.2%

2004

2005

2006

In 2006, the Ben & Adith Miller Patient Care Fund nearly doubled its assistance dollars over the previous year.

• $2.4 million of capital was deployed to fund patient care and operations, including new equipment for surgery, lab, cardiac rehabilitation, respiratory care and physician clinics; information technology; and physical plant infrastructure upgrades.

• Parkview Pharmacy revenue grew 3%, while its operating margin improved by 100%.

• Winona Health’s investment returns for the 36-month period since consolidating to three investment managers was 34.7%, besting the benchmark of 26.1%. • An independent audit was completed with a “clean” opinion and no material adjustments made to financial statements, indicating Winona Health’s processes for recording transactions, compiling financial statements and reporting financial information is effective and internal controls are working. • The Winona Health Foundation awarded $24,100 in Community Engagement Grants to six local nonprofits working to improve the community’s health and wellbeing. The nonprofits that received the awards include: • Winona Volunteer Services − $6,500 toward construction of a kitchen to educate Food Shelf customers about healthy, whole foods • Winona Senior High School − $4,500 to purchase defibulators for the high school and middle school

In its 20th year of service to the community, Winona Health’s Parkview Pharmacy revenue grew 3%.

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• Goodview Elementary School − $600 to engage children in physical activities • Project FINE − $5,000 to provide prenatal education to migrant workers • Hiawatha Valley Mental Health Center − $4,000 to provide an on-site day treatment facility for middleschool-aged children • Winona Area Public Schools − $3,500 to fund an ongoing elementary health curriculum

• The Winona Health Foundation received $606,494 in donations from individuals, families and businesses, allowing it to further its mission of support to Winona Health. • The Winona Health Foundation inducted 19 members into its Circle of Visionaries, which refers to people who have remembered the Foundation with a planned gift. • The Winona Health Auxiliary gifted $69,100 to Winona Health for a patient/resident educational television system, Cardiac Rehab telemetry equipment, and remodeling of the Watkins Manor kitchen. In addition, it awarded $15,000 in scholarships to 18 individuals. • Four Auxiliary volunteers were recognized for contributing more than 5,000 hours of service to Winona Health: Jan Wanek, Diane Barge, Lynn Siebenaler, and Jenny Kahl. • The Winona Health Auxiliary was busy in FY06: • Conducting its first annual garage sale, which raised more than $5,000 • Holding its 44th annual Birthday Ball, with proceeds exceeding $20,000 • Adding three new service points – South Entrance Information Desk, Boyer Lounge Reception, and Outpatient Reception • Orienting 144 new volunteers – 34 more than in the previous year and five times more than in 2003.

The Ben & Adith Miller Classic raised a record $150,000 toward the Patient Care Fund.

• The Foundation also awarded $30,000 to three internal projects under its Quality & Excellence program. The funding provided pressure-relieving mattresses for Lake Winona Manor and Community Memorial Hospital, a ceiling lift system to help in moving patients/residents and a NuStep exercise machine for use by Lake Winona Manor residents. • The Ben & Adith Miller Patient Care Fund provided $528,000 of assistance to 230 people in 2006, compared to $263,000 for 81 people in 2005. • The Ben & Adith Miller Classic, which supports the Patient Care Fund, raised $150,000 in 2006, a 10% increase over the previous year.

One of the tasks for Auxiliary volunteers, pictured here with President/CEO Rachelle Schultz, is to arrange and deliver flowers to patients in the hospital.

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Looking ahead : Key Initiatives for 2007 Ancillary Department Satisfaction (Laboratory, Imaging, Rehabilitation)

Goal: Improve the overall quality of the Laboratory, Imaging and Rehabilitation Departments’ care and service to increase patient loyalty. Target: Three standard deviations above peer mean scores

Employee Health and Well-being

Goal: Decrease employee musculoskeletal incidents related to patient/resident handling and transfers. Target: 10% decrease in injuries over 2006

Computerized Provider-Order Entry (CPOE)

Goal: Launch and fully deploy CPOE in a single Winona Health clinical department. Target: 80% of orders in one department submitted electronically

Operating Margin

Goal: Maintain a solid operating margin to balance Winona Health’s mission and costs. Target: 4.0%

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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 winonahealth.org