New And Precise CapStar Health System Case Study

New And Precise CapStar Health System Case Study

CapStar Health System

Case Study

National Institute of Standards and Technology � Technology Administration � Department of Commerce Baldrige National Quality Program 2002

 

 

The CapStar Health System Case Study was prepared for use in the 2002 Malcolm Baldrige National Quality Award Examiner Preparation Course. The CapStar Health System Case Study describes a fictitious not-for-profit health system. There is no con- nection between the fictitious CapStar Health System and any health system, either named CapStar Health System or otherwise. Organizations cited in the case study also are fictitious, with the exception of a few national organizations.

CapStar Health System scored in band 3, showing that the organization demonstrates an effective, systematic approach responsive to the basic requirements of most Items, but deployment in some key Areas to Address is still too early to demonstrate results. In addition, early improvement trends and comparative data in areas of importance to key organizational requirements are evident. If this were an actual Baldrige application with this scoring profile instead of a case study, the CapStar Health System probably would have been evaluated by a group of Examiners, each working independently during the Stage 1—Independent Review. For the 2002 Examiner Preparation Course, the CapStar Health System Case Study was evaluated using the Stage 2—Consensus Review Process, and site visit issues were developed and included as part of the case study scorebook.

National Institute of Standards and Technology � Technology Administration � Department of Commerce Baldrige National Quality Program 2002

CapStar Health System

Case Study

 

 

CONTENTS

2002 Eligibility Certification Form ………………………………………………………… i

Organization Charts ………………………………………………………………………… ix

2002 Application Form ……………………………………………………………………… xi

Organizational Profile ……………………………………………………………………… xii

Glossary of Terms and Abbreviations ……………………………………………………… xvii

Category 1—Leadership

1.1 Organizational Leadership ………………………………………………… 1 1.2 Public Responsibility and Citizenship …………………………………… 4

Category 2—Strategic Planning

2.1 Strategy Development …………………………………………………… 7 2.2 Strategy Deployment ……………………………………………………… 11

Category 3—Focus on Patients, Other Customers, and Markets

3.1 Patient/Customer and Health Care Market Knowledge ………………… 12 3.2 Patient/Customer Relationships and Satisfaction ………………………… 14

Category 4—Information and Analysis

4.1 Measurement and Analysis of Organizational Performance ……………… 17 4.2 Information Management ………………………………………………… 19

Category 5—Staff Focus

5.1 Work Systems……………………………………………………………… 21 5.2 Staff Education, Training, and Development……………………………… 23 5.3 Staff Well-Being and Satisfaction ………………………………………… 25

Category 6—Process Management

6.1 Health Care Service Processes …………………………………………… 27 6.2 Business Processes………………………………………………………… 31 6.3 Support Processes ………………………………………………………… 33

Category 7—Organizational Performance Results

7.1 Patient- and Other Customer-Focused Results …………………………… 35 7.2 Financial and Market Results …………………………………………… 40 7.3 Staff and Work System Results …………………………………………… 43 7.4 Organizational Effectiveness Results……………………………………… 47

 

 

2002 Eligibility Certification Form Page 1of 5 Malcolm Baldrige National Quality Award

1. Applicant

Official Name Headquarters Address_______________________________________________ _______________________________________________

Other Name_______________________________________________ _______________________________________________

Prior Name_______________________________________________ _______________________________________________

2. Highest-Ranking Official

❏ Mr. ❏ Mrs. ❏ Ms. ❏ Dr.

Name Address_______________________________________________ _______________________________________________

Title_______________________________________________ _______________________________________________

Applicant Name_______________________________________________ _______________________________________________

Telephone No. Fax No._______________________________________________ _______________________________________________

E-mail_______________________________________________

3. Eligibility Contact Point

❏ Mr. ❏ Mrs. ❏ Ms. ❏ Dr.

Name Address_______________________________________________ _______________________________________________

Title_______________________________________________ _______________________________________________

Applicant Name Overnight Mailing Address (Do not use a P.O. Box number.)_______________________________________________ _______________________________________________

Telephone No._______________________________________________ _______________________________________________

Fax No._______________________________________________ _______________________________________________

E-mail_______________________________________________

4. Alternate Eligibility Contact Point

❏ Mr. ❏ Mrs. ❏ Ms. ❏ Dr.

Name_______________________________________________

Telephone No. Fax No._______________________________________________ _______________________________________________

5. Applicant Status (Check one.)

Has the applicant officially or legally existed for at least one year, or prior to April 16, 2001? ❏ Yes ❏ No

OMB Clearance #0693-0006—Expiration Date: October 31, 2002 This form may be copied and attached to, or bound with, other application materials.

If you are unable to answer any questions or answer any questions “No,” please contact the Baldrige Program Office at (800) 898-4506 before submitting your form.

i

CapStar Health System, Inc.

N/A

N/A

X

Joe Picardson

President & Chief Executive Officer

CapStar Health System, Inc.

(513) 555-3616

jpicardson@capstar.com

X

Leslie Smith

Health Care Excellence Manager

CapStar Health System, Inc.

(513) 555-4210

(513) 555-4424

lsmith@capstar.com

X

Rupert Manning

(513) 555-4212

1000 Wellness Way

Cincinnati, OH 45202

1000 Wellness Way

Cincinnati, OH 45202

(513) 555-3108

1000 Wellness Way

Cincinnati, OH 45202

same as above

(513) 555-4424

X

 

 

Malcolm Baldrige National Quality Award

2002 Eligibility Certification Form Page 2 of 5

6. Award Category and For-Profit/Not-For-Profit Designation (Check as appropriate.)

❏ Manufacturing (For-Profit Only) ❏ Education ❏ Health Care

❏ Service (For-Profit Only) ❏ For-Profit ❏ For-Profit

❏ Small Business (For-Profit Only) ❏ Not-For-Profit ❏ Not-For-Profit

Criteria being used: (Check one.)

❏ Business ❏ Education ❏ Health Care

(For-profit Education and Health Care organizations may also choose to use the Business Criteria and apply in the Service or Small Business categories.)

7. Industrial Classification

List up to three of the most descriptive three- or four-digit NAICS codes. (See page 19 of this booklet or the PDF version of Baldrige Award Application Forms at www.quality.nist.gov/Award_Application.htm.)

a. _____________ b. _____________ c. _____________

8. Size and Location of Applicant

a. Total number of • employees (business) ________ • faculty/staff (education) ________ • staff (health care) ________

b. For the preceding fiscal year, • Check one financial descriptor: ❏ Sales ❏ Revenues ❏ Budgets

• Check amount: ❏ 0-$1M ❏ $1M-$10M ❏ $10M-$100M ❏ $100M-$500M ❏ $500M-$1B ❏ Over $1B

c. Number of sites: U.S./Territories _______ Overseas _________

d. Percentage of employees: U.S./Territories _______ Overseas _________

e. Percentage of physical assets: U.S./Territories _______ Overseas _________

f. If some activities are performed outside the applicant’s organization (e.g., by an overseas component of the applicant, the parent organization, or its other subunits), will the applicant, if selected for a site visit, make available in the United States sufficient personnel, documentation, and facilities to allow full examination of its operational practices for all major functions of its worldwide operations? ❏ Yes ❏ No ❏ Not Applicable

g. In the event the applicant receives an Award, can the applicant make available sufficient personnel and documentation to share its practices at the Quest for Excellence Conference and at its U.S. facilities? ❏ Yes ❏ No

h. Attach a line and box organization chart for the applicant organization, including the name of the head of each unit or division.

If you are unable to answer any questions or answer any questions “No,” please contact the Baldrige Program Office at (800) 898-4506 before submitting your form.

ii

X

X

X

X

X

X

622 6214 6219

4981

12 0

100% 0%

100% 0%

X

 

 

iii

2002 Eligibility Certification Form Page 3 of 5 Malcolm Baldrige National Quality Award

9. Subunits (If the applicant is not a subunit as defined on pages 6-7, please proceed to question 10.)

a. Is the applicant _____ a larger parent or system? (Check all that apply.)

❏ a subsidiary of ❏ a unit of ❏ a school of

❏ a division of ❏ a like organization of ❏ owned by

❏ controlled by ❏ administered by

b. Parent Organization

Name Highest-Ranking Official___________________________________________________________ _____________________________________________________________

Address Name___________________________________________________________ _____________________________________________________________

Title___________________________________________________________ _____________________________________________________________

Number of worldwide employees of the parent ______

c. Is the applicant the only subunit of the parent organization intending to apply? (Check one.)

❏ Yes ❏ No (Briefly explain.) ❏ Do Not Know

d. Name of the official document (e.g., dated Annual Report, press release) supporting the subunit designation.

____________________________________________________________________________________________________________________________________

e. Briefly describe the organizational structure and relationship to the parent.

Attach line and box organization chart(s) showing the relationship of the applicant to the highest management level of the parent, including all intervening levels. Each box within the chart should include the name of the head of the unit or division.

f. Is the applicant’s product or service unique within the parent organization? (Check one.) ❏ Yes ❏ No

If “No,” do other units within the parent provide the same products or services to a different customer base? (Check one.) ❏ Yes ❏ No

If “No,” please provide a brief explanation of how the applicant is distinguishable from the parent and its other subunits (e.g., market/location/name).

If you are unable to answer any questions or answer any questions “No,” please contact the Baldrige Program Office at (800) 898-4506 before submitting your form.

 

 

iv

Malcolm Baldrige National Quality Award

2002 Eligibility Certification Form Page 4 of 5

9. Subunits—continued

g. Business only. Are 50 percent or more of the applicant’s products or services sold or provided to customers outside the applicant’s organization? ❏ Yes ❏ No

h. Business only. Are less than 50 percent of the applicant’s products or services sold or provided to the following? (Please indicate “Yes” or “No” for each part of this question.)

• the parent organization ❏ Yes ❏ No

• other organizations controlled by the applicant or parent ❏ Yes ❏ No

i. Business only. (Check all that apply.)

• Does the applicant have more than 500 employees? ❏ Yes ❏ No

• Do the applicant’s employees make up more than 25 percent of the worldwide employees of the parent? ❏ Yes ❏ No

• Was the applicant independent prior to being acquired—and does it continue to operate independently under its own identity? ❏ Yes ❏ No

j. Business only. Briefly describe the major support functions provided to the applicant by the parent or by other subunits of the parent. (Examples might include human resources, legal, accounting, information technology, etc.)

10. Supplemental Sections (Check one.)

❏ The applicant has: (a) a single performance system that supports all of its product and/or service lines; and (b) products or services that are essentially similar in terms of customers/users, technology, types of employees, and planning.

❏ The applicant has: (a) multiple performance systems that support all of its product and/or service lines; and (b) products or services that are essentially similar in terms of customers/users, technology, types of employees, and planning.

Note: The applicant’s Eligibility Contact Point will be contacted if the second option is checked. Applicants may have two or more diverse product and/or service lines (i.e., in different NAICS codes) with customers, types of employees, technology, planning, and quality systems that are so different that the application report alone does not allow sufficient detail for a fair examination. Such applicants may submit one or more supplemental sections in addition to the application report. The use of supplemental sections must be approved during the Eligibility Certification process and is mandatory once approved.

(Please describe briefly the differences among the multiple performance systems of your organizations in terms of customers, types of employees, technology, planning, and quality systems.)

If you are unable to answer any questions or answer any questions “No,” please contact the Baldrige Program Office at (800) 898-4506 before submitting your form.

X

 

 

v

Malcolm Baldrige National Quality Award

2002 Eligibility Certification Form Page 5 of 5

11. Summary List of Questions

Have each of the questions that follow been answered “Yes”or have the applicable responses been checked? (Answering any of these questions “No” or leaving a response blank means that the applicant is not eligible for the 2002 Malcolm Baldrige National Quality Award.)

• Question 5: Has the applicant officially or legally existed for at least one year, or prior to April 16, 2001?

• Question 6: Have an Award Category and a For-Profit/Not-For-Profit Designation been checked?

• Question 9g: Business only. Are 50 percent or more of the applicant’s products or services sold or provided to customers outside the applicant’s organization?

• Question 9h: Business only. Are less than 50 percent of the applicant’s products or services sold or provided to its parent and other organizations controlled by the applicant or parent? Question 9g and both parts of question 9h should be answered “Yes.”

At least one of the responses to the three questions included in Question 9i must be answered “Yes.”

• Question 9i: Business only.

–– Does the applicant have more than 500 employees?

–– Do the applicant’s employees make up more than 25 percent of the worldwide employees of the parent?

–– Was the applicant independent prior to being acquired—and does the applicant continue to operate independently under its own identity?

12. Self-Certification Statement, Signature of the Highest-Ranking Official

I certify that the answers provided are accurate and that my organization is eligible based on the current requirements for the 2002 Malcolm Baldrige National Quality Award. I understand that at any time during the Award Process cycle, if the information provided was inaccurate, my organization will no longer be eligible for the award and will only be eligible to receive a feedback report.

X Signature

Printed Name

Date

The Malcolm Baldrige National Quality Program is launching a pilot program in 2002 that enables one member of each eligibility applicant’s organization to become a member of the 2002 Board of Examiners. To take advantage of this opportunity, self-certified eligibility applications must be postmarked on or before March 15, 2002.

❏ We are sending _________________________________________________ to serve on the 2002 Board of Examiners.

If you are unable to answer any questions or answer any questions “No,” please contact the Baldrige Program Office at (800) 898-4506 before submitting your form.

March 14, 2002

Joe Picardson, MD

X Dr. Mark Worfman

 

 

vi

The following information is needed by the Malcolm Baldrige National Quality Award Program Office to provide the most effective evaluation possible by the Board of Examiners.

1. Site Listing and Descriptors

Please refer to the instructions on page 15 of this booklet or the PDF version of Baldrige Award Application Forms at www.quality.nist.gov/Award_Application.htm to complete this Site Listing and Descriptors form. It is important that the totals for the number of employees, faculty, and staff; percentage of sales, revenues, and budgets; and sites on this form match the totals provided in response to questions 8.a., 8.b., and 8.c. on page 2 of the 2002 Eligibility Certification Form. For example, if you report 600 employees in response to question 8.a., the total number of employees provided in the Site Listing and Descriptors form should be 600.

Provide all the information for each site, except where multiple sites produce similar products or services. For multiple site cases, refer to “c” under item 8, which is titled Size and Location of Applicant. See page 8, 2002 Eligibility Form—Instructions, of this booklet or the PDF version of Baldrige Award Application Forms at www.quality.nist.gov/Award_Application.htm.

Use as many additional copies of this form as needed to include all sites.

2002 Additional Information Needed Form Page 1 of 3 Malcolm Baldrige National Quality Award

Address of Site(s) Percentage ❏ Sales ❏ Revenues ❏ Budgets

Number Employees,

Faculty, and/or Staff

Description of Products, Services, and/or Technologies for each site

X

Excelsion Medical Center 1000 Wellness Way Cincinnati, Ohio

Founders Hospital 1 Faith Hill Road Stoneville, Ohio

Roseleaf Community Hospital 9 Daniel Way Crockett, Kentucky

Hergh Community Hospital 8 Tupelo Avenue Benjamin, Indiana

CapCare Centers (6) (Cincinnati Metropolitan

Service Area)

2212

1161

739

460

88

41.2%

20.8%

14.3%

11.6%

7.3%

General hospital services and tertiary care specialties in cardiac services, oncology, trauma, stroke, sports medicine, and physical rehabilitation; medical student and resident training.

General hospital services, with specialties in women’s care, geriatrics, general and plastic surgery, and behavioral health

General hospital services, including pediatrics, with regional strength in orthopedics and arthritis care

General hospital services, pediatrics, and dialysis

Primary care physician offices with selected specialties, including cardiology, pediatrics, obstetrics/ gynecology, dermatology, and plastic surgery

continued on next page

If you are unable to answer any questions or answer any questions “No,” please contact the Baldrige Program Office at (800) 898-4506 before submitting your form.

 

 

vii

1. Site Listing and Descriptors (continued)

2. Key Business/Organization Factors—List, briefly describe, or identify the following key organization factors:

A. List of key competitors

B. List of key customers/users

2002 Additional Information Needed Form Page 2 of 3 Malcolm Baldrige National Quality Award

Riverport University Hospital Goldenrod Hospital System Zefram Memorial Hospital CNT Integrated Care Veterans Health Administration Outpatient diagnostic and treatment centers (various) River’s Edge Surgical Center, Inc.

Active Inpatients, Outpatients, Home Care Patients, and Families of Patients Potential or Inactive Patients Physicians Payors Employers Community Organizations

Address of Site(s) Percentage ❏ Sales ❏ Revenues ❏ Budgets

Number Employees,

Faculty, and/or Staff

Description of Products, Services, and/or Technologies for each site

X

Galaxia Home Health Care 405 Inverness Drive Cincinnati, Ohio

CapStar Corporate Office 1000 Wellness Way Cincinnati, Ohio

118

203

2.1%

2.7%

Durable medical equipment and IV home services

Corporate administration, financial services, information services, legal, compliance, CapCollege, and regional affiliations

If you are unable to answer any questions or answer any questions “No,” please contact the Baldrige Program Office at (800) 898-4506 before submitting your form.

 

 

viii

C. List of key suppliers

D. Description of the major markets (local, regional, national, and international)

E. The name of the organization’s financial auditor

2002 Additional Information Needed Form Page 3 of 3 Malcolm Baldrige National Quality Award

Beaver and Newton (Medical/Surgical Supplies) Middleton and Green (Office and Other Nonmedical Supplies) South Summit Laboratories Express Pharmaceuticals Twin Scientific Products Stoneyridge Foods Majestic Housekeeping ERCare, Inc. Calmstate Anesthesiology Services InsideYou, Inc. Healthcognizant, Inc. Reliastate Insurance Management System (Insurance Contract Management) Uriwise, Inc. (Dialysis)

Ninety-one percent of CapStar’s patients reside within the 13 counties of the Greater Cincinnati Metropolitan Service Area (MSA). This encompasses five counties in southern Ohio, two counties in southeast Indiana, and six counties in northern Kentucky. Seven of the counties constitute the Primary Service Area, and six counties fall into the Secondary Service Area. The remaining 9 percent of patients come from other areas in the tristate region.

Upper Middle States Accounting, an independent auditor, audited CapStar’s consolidated financial statements in accordance with generally accepted auditing standards.

If you are unable to answer any questions or answer any questions “No,” please contact the Baldrige Program Office at (800) 898-4506 before submitting your form.

 

 

ix

Corporate Staff Organizational Chart

Chief Financial Officer*

Sheila Rikert

Vice President Managed Care

Contracts Sara Dax

Senior Vice President Nursing*

Jessica Troien

Chief Information Officer*

Charles Spocket

Vice President CapStar Medical

Services Joshua Chokatee, MD

Vice President CapStar

Physicians Group Jared Fisher, MD

Director, Galaxia Home Health Care

Emily Diego

Vice President Billing & Collection

Ogden Bailey

Vice President Finance (Vacant)

Vice President Community

Services Jane Tuvek

Residency Program Directors

Process Improvement Office (PIO)

Comptroller Bailey Ulhurn

Hergh Sr. Vice President &

Executive Officer* Paula Janewell

Founders Sr. Vice President &

Executive Officer* George Sulus

Senior Vice President Medical Affairs &

Chief Quality Officer* Mark Worfman, MD

Executive Vice President*

Eileen Kirks

Senior Vice President Human Resources*

Joan Chang

Senior Vice President Strategy & Ventures*

Hugh Scott

* Member of CapStar Executive Leadership Team (ELT)

CapStar Health System, Inc. (CapStar) Board of Directors

Corporate Compliance Officer

(Vacant)

CapStar Charitable Trust

Executive Director Jerri Ryan

President & CEO* Joe Picardson, MD

Excelsion Sr. Vice President &

Executive Officer* William Treskler, MD

Roseleaf Sr. Vice President &

Executive Officer* Robert Siskline

 

 

x

CapStar Corporate Structure

Excelsion Medical Center

Founders Hospital Roseleaf Community

Hospital Hergh Community

Hospital CapStar Medical

Services

CapStar Physicians

Group

CapCare Centers

Galaxia Home Health Care

Healthcognizant, Inc. (Total Health

Centers—planned)

Indicates joint venture with partner

CapCollege CapStar

Charitable Trust

Community Health and Renewal, Inc.

(CHR)

CapStar Health System, Inc.

 

 

xi

Signature of the Highest-Ranking Official

Date________________

X__________________________________ ❏ Mr. ❏ Mrs. ❏ Ms. ❏ Dr.

Name_____________________________________

Title_____________________________________

Applicant Name_____________________________________

Mailing Address_____________________________________

_____________________________________

_____________________________________

Telephone No._____________________________________

Fax No._____________________________________

OMB Clearance #0693-0006 Expiration Date: October 31, 2002

This form may be copied and attached to, or bound with, other application materials.

Release Statement

We understand that this application will be reviewed by members of the Board of Examiners.

Should our organization be selected for a site visit, we agree to host the site visit and to facilitate an open and unbiased examination. We understand that our organization must pay reasonable costs associated with a site visit. The range of site visit fees is $20,000 – $35,000.

If our organization is selected to receive an Award, we agree to share nonproprietary information on our successful performance excellence strategies with other U.S. organizations.

Applicant Name_____________________________________

Mailing Address_____________________________________

_____________________________________

_____________________________________

Award Category (Check one.) ___ Manufacturing ___ Service ___ Small Business ___ Education ___ Health Care

For small businesses, indicate whether the larger percentage of sales is in service or manufacturing. (Check one.) ___ Service ___ Manufacturing

Criteria being used (Check one.) ___ Business ___ Education ___ Health Care

Official Contact Point

❏ Mr. ❏ Mrs. ❏ Ms. ❏ Dr.

Name_____________________________________

Title_____________________________________

Applicant Name_____________________________________

Mailing Address_____________________________________

_____________________________________ Overnight Mailing Address (Do not use P.O. Box number.)_____________________________________

_____________________________________

_____________________________________

Telephone No._____________________________________

Fax No._____________________________________

Alternate Official Contact Point

❏ Mr. ❏ Mrs. ❏ Ms. ❏ Dr.

Name_____________________________________

Telephone No._____________________________________

Fax No._____________________________________

Application Fees (See page 23 for instructions.)

Enclosed is $________ to cover one application report and ________ supplemental sections.

Make check or money order payable to:

The Malcolm Baldrige National Quality Award

1

2

3

5

6

7

Malcolm Baldrige National Quality Award

2002 Application Form

4

CapStar Health System, Inc.

1000 Wellness Way

Cincinnati, OH 45202

Leslie Smith

Health Care Excellence Manager

CapStar Health System, Inc.

1000 Wellness Way

Cincinnati, OH 45202

same as above

(513) 555-4210

(513) 555-4424

Rupert Manning

(513) 555-4212

(513) 555-4424

X

X

X

X

5,000

May 24, 2002

X

Joe Picardson

President and Chief Executive Officer

CapStar Health System, Inc.

1000 Wellness Way

Cincinnati, OH 45202

(513) 555-3616

(513) 555-3108

 

 

Organizational Profile

P.1 Organizational Description

P1.a Organizational Environment

Based in Cincinnati, Ohio, CapStar Health System, Inc. (CapStar) is a not-for-profit health care system providing services in southern Ohio, northern Kentucky, and south- east Indiana. CapStar is composed of its corporate office, four hospitals, six outpatient centers, and a home care operation. Net patient service revenues were $754 million in 2001. The Operating Units (OUs) of CapStar are Excelsion Medical Center (Excelsion); Founders Hospital (Founders); Roseleaf Community Hospital (Roseleaf); Hergh Community Hospital (Hergh); and CapStar Medical Services (CapStar Medical), which includes the six outpa- tient CapCare Centers (CapCare), CapStar Physician’s Group, Galaxia Home Health Care, and the joint venture with Healthcognizant, Inc. CapStar was founded in 1994 through the merger of Excelsion in downtown Cincinnati and Founders in a northern suburb following a coopera- tive relationship. Both were among the first Ohio members of the Preeminent Hospitals of North America (PHNA) hospital alliance. The alliance enabled independent hospi- tals to jointly develop strategies and gain other advantages such as discount supply purchasing. The two hospitals merged from positions of strength as a proactive move to protect their financial performance and to retain their market shares as Managed Care Organizations (MCOs) sought deep pricing discounts. In addition, a competitor, Riverport University Hospital (RUH), started to reverse its isolationist tendencies by developing relationships with other hospitals in the area. Roseleaf in Kentucky and Hergh in Indiana joined CapStar in 1997 and 1998, respectively. Both were concerned about becoming isolat- ed as other hospitals in the region merged and managed care companies continued to receive pricing concessions from independent hospitals. Hergh was vulnerable since it had a comparatively weak balance sheet and a physical plant that was seriously outdated.

Like many health care organizations, CapStar incurred operating losses in 1999 and 2000. Losses were due to the combined effects of the reduced reimbursement resulting from the Balanced Budget Act (BBA), increased costs of drugs and technology, accelerating costs to recruit staff in several shortage disciplines, and costs associated with the Roseleaf and Hergh mergers. CapStar improved its financial performance in 2001 and 2002 year-to-date (YTD) and has been able to protect its balance sheet. In addition, CapStar has a limited amount of unrestricted assets. As the stock market declined in 2001, investments were moved into conservative investment portfolios, resulting in negligible losses in capital to date.

The CapStar Charitable Trust is the principal fundraising arm of the health system. Its subsidiary, Community Health and Renewal, Inc. (CHR), works with other com- munity-based organizations to provide access to health services and to support neighborhood renewal.

P.1a(1) Main Health Care Services Each hospital offers general medical, surgical, and obstet- rics inpatient services. Roseleaf and Hergh also offer pediatrics because Riverport Children’s Hospital is distant from their service areas. In addition to basic inpatient services, Excelsion, Founders, and Roseleaf specialize in several areas:

Excelsion: trauma, cardiac services, oncology, stroke, sports medicine, physical rehabilitation

Founders: women’s care, geriatrics, plastic and recon- structive surgery, behavioral health services

Roseleaf: orthopedics, arthritis

Hergh has long served as the sole general acute care hos- pital in a rural area of Indiana with a declining popula- tion. The six CapCare Centers are primary care centers for family practitioners and internists in the Cincinnati Metropolitan Service Area (MSA). Several specialists, including allergists, gastroenterologists, and neurologists, rent space in these centers.

CapStar is a teaching organization with resident training programs in internal medicine, general surgery, family practice, emergency medicine, radiology, and orthopedics. It also provides training in association with the Central Ohio School of Public Health for physical therapists, nutritionists, and nurse anesthetists. CapStar purchased 11 physician practices as an offensive strategy to secure influence over primary care services and has reduced sig- nificantly early losses in operating these practices.

Discussions are under way to sell Galaxia Home Health Care to a third party, since this segment faces lower Medicare funding.

P.1a(2) Purpose, Destiny, and Values Since its founding, CapStar has been devoted to service to people. CapStar’s fervent belief in Purpose, Destiny, and SPIRIT Values (shown in Figure P.1-1); Commitment to Excellence; and Critical Success Factors (CSFs) (Figure P.2-1) is the result of two tragic events that occurred in 1993. Although Excelsion was an adopter of quality man- agement in the late 1980s, these early efforts were not fully productive. Early in 1993, a six-year-old boy hospi- talized for a routine hernia repair died in the operating room due to a medication error. Two months later, the wife of one of the internists on staff died following many years of severe diabetes with multiple complications requiring fre- quent admission to the hospital. Several days following

xii

 

 

xiii

her death, her husband addressed the hospital’s Board and described in detail the problems experienced during her hospitalizations, including charting and medication errors, miscommunications, delays in administering pain medica- tion that caused his wife to suffer unnecessary agony, and staff and physician insensitivity. The retelling of this expe- rience by this well-regarded member of the medical staff had a profound effect on the organization. Both tragic events highlighted the need for Excelsion to explore new ways to become a better health care provider. By the time CapStar was formed, the pursuit of excellence had become pervasive throughout the organization and served as a foundation for the new CapStar system.

P.1a(3) Talent Profile CapStar employs 4981 colleagues in 315 job classifica- tions. The workforce is primarily female (71 percent). Over 90 percent of colleagues are in non-management roles— 41 percent professional, 22 percent technical, 14 percent clerical, and 13 percent service. Forty-one

percent of full-time colleagues are licensed clinicians. Nurses at Excelsion have been represented by Nurses Unity Local 32 since 1981. Local 77 of the Pinewest Engineers Council represents the plant engineering and maintenance staff. There are no other unions at CapStar. CapStar colleagues generally represent the demographic makeup of their respective communities.

CapStar employs 34 FTE hospital-based physicians, including residency program directors and 14 hospitalists (see Glossary) in various administrative/clinical capacities, in addition to the 11 primary care physician practices acquired since 1996. CapStar contracts centrally for radiol- ogists, anesthesiologists, pathologists, and emergency physicians except at Hergh, which continues to contract separately for these services. CapStar provides training for 102 residents in internal medicine, general surgery, family practice, emergency medicine, and orthopedics. There are 711 independent physicians on the active staff of all CapStar hospitals. CapStar has had workforce reductions of 807 FTEs since 1996. These reductions included 484 FTEs affected by the closure of Romland Hospital in 2000. CapStar acquired Romland in 1995 and closed it after five years of losses. Located northwest of Cincinnati in an area that had lost significant population, Romland could no longer exist in the midst of downward pricing from insurers. In each layoff, CapStar offered affected employees job placement and retraining support uncom- mon for the health care industry.

P.1a(4) Facilities, Equipment, and Technology All CapStar facilities (Figure P.1-2) use an extensive array of surgical, diagnostic, and therapeutic equipment. In the past year, CapStar’s systematic technology evaluation method has focused on radiological imaging and medical error elimination technology. As a certified trauma center, CapStar is a part owner with other area trauma centers in a shared air ambulance company, RiverStar Rescue. For over a decade, CapStar has made significant investments in operational, clinical, and financial information systems. All CapStar facilities are connected via the Knowledge Information System (KIS), which is becoming increasing- ly Web based. CapStar has won several “Most Connected Awards” in the past six years. CapStar plans to invest $5–8 million/year in KIS during the next ten years.

P.1a(5) Regulatory Environment Health care is a highly regulated industry focusing on patient and employee safety, compliance, and business processes. CapStar is licensed to operate by the states of Ohio, Kentucky, and Indiana and is subject to numerous state agency regulations dealing with hospital licensure, land use, state charitable agency provisions, trauma center certification, and staff licensure. On the federal level, CapStar is subject to regulations of the Centers for Medicare and Medicaid Services (CMS), Occupational Safety and Health Administration (OSHA), EnvironmentalFigure P.1-1 CapStar Purpose, Destiny, and Values

OUR PURPOSE

“To cherish, preserve, and improve health. We exist to enrich the human experience and fulfill the needs of our patients. We pledge to honor the dignity of every person we serve.”

OUR DESTINY

“To seek out, embrace, and nurture the finest talent, knowledge, and science possible to deliver role model health services to people.”

OUR VALUES

Our Values guide individual and collective work toward achieving our Purpose, our Destiny, and our CSFs. Our SPIRIT Values are a constant reminder of the impor- tance of our work and the vitality of our culture.

Service We excel in surpassing even the unexpressed expectations of our patients and customers.

Pride We celebrate our contribution to society and find in it the energy to excel.

Integrity We make our promises to patients, customers, and each other come true.

Respect We appreciate the talent each of us brings to improving health and extending life.

Innovation We are all explorers and creators of ways to improve how we serve.

Teamwork We learn from each other and work together to achieve our Purpose and to capture our Destiny.

 

 

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Protection Agency, Nuclear Regulatory Agency, and Centers for Disease Control and Prevention. In addition to government regulatory requirements, CapStar participates in numerous accreditation programs, including the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the American College of Surgeons, the College of American Pathologists, and multiple accrediting bodies related to CapStar’s teaching programs.

P.1b Organizational Relationships

P.1b(1) Patient/Customer Segments and Requirements Ninety-one percent of CapStar patients reside within the 13-county MSA that encompasses 5 counties in Ohio, 2 in Indiana, and 6 in Kentucky. Cincinnati is located in Hamilton County. Seven counties constitute the Primary Service Area (PSA), and six counties fall into the Secondary Service Area (SSA). The remaining 9 percent of patients come from other areas in the tristate region. The population of the MSA has increased 8.9 percent since 1990 to 1,979,553. Although the overall population is expected to continue its growth rate, the population has declined slightly in Hamilton County, Ohio, and nearby counties in Kentucky. In addition, 10.2 percent of the overall population is uninsured. CapStar has identified six customer segments as shown in Figure P.1-3.

CapStar did not fully engage in the practice acquisition frenzy of the mid-1990s and acquired only 11 primary care physician practices that staff the six CapCare Centers. Instead of using reserves to buy physician prac- tices, CapStar differentiated itself by systematically inte- grating physicians into the highest levels of leadership and policy-making, developing and deploying industry- leading methods of patient focus, cultivating the potential of the staff, and adopting Compassionate Operational

Excellence (COE) as the operating model. CapStar believes that the best approach to retaining the loyalty of an independent medical staff is to earn it instead of trying to control physicians through ownership. Consequently, CapStar has developed a physician leadership grooming process unique among health care systems and enjoys extensive physician involvement in its key clinical and operational initiatives.

Year(s) Staffed FTE Facility Built Condition Beds Colleagues Excelsion 1925–89 Good 461 2212 Founders 1949–94 Very Good 267 1161 Roseleaf 1993 Excellent 142 739 Hergh 1968 Fair 107 460 CapCare 1995–99 Very Good NA 88 Galaxia NA NA NA 118 Corporate Office NA NA NA 203 Excellent=requires no significant improvements. Very Good=more than adequate for current needs; may require minimum improvements in the future. Good=adequate for current needs; will require significant facility revision to meet future needs. Fair=inadequate to meet contemporary medical delivery; requires extensive to total near-term replacement.

Active Inpatients, Outpatients, Home Care Patients, and Families. Subsegments include age, gender, medical condition, clinic relation- ship, referral source, insurance coverage

Potential or Inactive Patients. No services received within the last three years by CapStar

Physicians. Primary care, specialists, referring physicians, and physician competitors

Payors. Government, managed care, indemnity, billing

Employers. Local busi- nesses/organizations in the communities served

Community Organizations. Local government, schools, churches, tristate civic associations such as Civic Stride, local chapters of heart and diabetes associations

Access to effective 24/7/365 error-free care, compassionate/caring environment, reliable/ consistent information, participation in health care decisions, accommo- dations for visitors

Easy access, compelling reasons to seek care at CapStar vs. elsewhere, accurate answers to inquiries, knowledge of how CapStar is better

Knowledgeable, pleasant colleagues/staff; easy access to technology and facilities; real-time clinical information; input into CapStar policies and decision making; high patient satisfaction

Low costs, quality care, responsiveness, accuracy, range of services

Convenient access; healthy, satisfied employees; quality care at lowest possible cost; wellness and disease prevention information and services

Community health improvement; provision of volunteer support; finan- cial aid and access to health information; support of school-based clinics; violence prevention pro- grams; and economic and development councils

Customer Segments Requirements

Figure P.1-3 Patient/Customer Segments and Requirements

Figure P.1-2 CapStar Facilities

 

 

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P1.b(2) Key Suppliers and Partners CapStar belongs to PHNA, one of the largest national group purchasing organizations. Annually, CapStar spends over $185 million on goods and services. Five nationally known suppliers provide 68 percent of the purchased supplies: Beaver and Newton for general medical/surgical supplies, Middleton and Green for office and other non- medical products, South Summit Laboratories, Express Pharmaceuticals, and Twin Scientific Products. Key serv- ice contracts include Stoneyridge Foods; Majestic Housekeeping; Uriwise, Inc. (for dialysis); Reliastate Insurance Management System (for insurance contract management); and multiple agencies for temporary staff. CapStar continuously seeks to reduce the total number of suppliers.

Key clinical partners include ERCare, Inc., for emergency physician services; Calmstate Anesthesiology Services for anesthesiology services; InsideYou, Inc., for radiologists; and Healthcognizant, Inc., for the ten new ambulatory/ fitness facilities CapStar plans to open in selected popula- tion growth areas of the region. The Veterans Health Administration (VHA) has patient transfer agreements with CapStar and RUH and leases space in four CapCare Centers for Community Based Outpatient Centers.

P.2 Organizational Challenges

P.2a Competitive Environment

P.2a(1) Competitive Position The health care services industry in the region has been in a state of change since the early 1990s when MCOs entered the marketplace. By 1997, MCOs had achieved significant market penetration and clout with over 50 per- cent of the total commercial Medicare and Medicaid mar- ket. WellOhioCare (WOC), the largest MCO, has over 600,000 members and has secured deep pricing discounts from hospitals and physicians. Hospitals that were not in the network lost significant market share. The cumulative effect of WOC’s and the other MCOs’ contracting strategy forced the closure of four hospitals, including Romland.

CapStar is the second largest health care system in the region in terms of staffed beds and net revenue. In 2001, CapStar’s overall market share based on percent of admis- sions was 20 percent in the MSA. Excelsion receives 23 percent of all the patients referred to hospitals in Cincinnati for advanced care from across the region. CapStar’s principal competitors are as follows:

1. RUH (1236 beds) includes Riverport Children’s Hospital and Collin Institute of Psychiatry. RUH is located on the campus of the Exeter School of Medicine (Exeter). RUH and Exeter receive in excess of $110 million per year from government agencies, founda- tions, and corporations to support medical research.

RUH is an organ transplant center and a vigorous com- petitor in oncology services. Riverport Children’s Hospital is a highly regarded and cherished asset in the community and dominates the pediatric marketplace.

2. Goldenrod Hospital System has two hospitals (488 beds). One in downtown Cincinnati serves as a trauma hospital and has strong services in cardiology, neuro- surgery, and burn care. Its other hospital is located in a southern Cincinnati suburb near Kentucky.

3. Zefram Memorial Hospital (404 beds) is located two miles from Founders with strong programs in psychia- try, physical rehabilitation, and geriatrics.

4. CNT Integrated Care has three hospitals (643 beds)— one in Cincinnati, one in a northwestern suburb, and one in Kentucky. CNT is owned and managed by Klingrom Health Management, a national for-profit hospital company.

5. The VHA operates two hospitals and several medical facilities. Veterans who have dual health care benefits are eligible to use CapStar facilities or VHA facilities.

6. Several competitive outpatient diagnostic and treat- ment centers have opened, including eight diagnostic imaging centers and two surgical day centers.

7. River’s Edge Surgical Center, Inc., specializing in short-stay surgery—3 days or less—is opening a new 80-bed hospital in the same service area as Founders (CapStar’s best financial performer). River’s Edge focuses on amenities for surgeons, patients, and fami- lies to make the surgical experience as dignified and as comforting as possible.

P.2a(2) Principal Factors for Success CapStar’s Purpose and Destiny would be promises unkept were it not for the commitment of senior leadership and colleagues who believe in the SPIRIT Values and demon- strate them every day for CapStar patients, customers, and colleagues. CapStar’s success depends upon its ability to achieve its seven CSFs (Figure P.2-1).

P.2b Strategic Challenges

RUH Threat: During the last five years, RUH has become increasingly aggressive in targeting CapStar as its chief competitor. RUH continues its intense pursuit of CapStar’s key physicians. Although CapStar has main- tained physician loyalty, shifts in loyalty are possible. In addition, RUH has expanded its outreach activities to increase its share of patients referred for advanced care, one of Excelsion’s most profitable services. RUH recently announced a new service excellence initiative and a $15 million endowment to establish a Neurodegenerative Disease Institute to recruit world-class talent and to provide services for patients with Alzheimer’s, Parkinson’s, and Multiple Sclerosis. RUH, as the area’s only multi-organ

 

 

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transplant center, has captured the advanced care image in the region. CapStar constantly strives to differentiate its products and services to compete with this image.

Managed Care Price Pressure and Increasing Drug Costs: Extensive changes in the health care system in the United States have brought challenges to the relationship between the insurance market and hospitals. CapStar is impacted by the downward price pressures from Medicare, Medicaid, and MCOs despite increases in oper- ating costs due to manpower shortages and steep increases in drug costs. Additionally, the insurance market itself has been in turmoil, with several companies competing for market share. Consequently, it is difficult to establish mutually beneficial, long-term relationships with insurers, who influence where patients seek care. Despite these challenges, CapStar is committed to working with MCOs and other key organizations in promoting and protecting patients’ health, as well as seeking opportunities for developing common goals to ensure quality health care services are delivered to its patients.

River’s Edge Surgical Center: This new hospital threat- ens the profitable ambulatory surgery service of Founders.

Uncompensated Care: Excelsion is adjacent to one of Cincinnati’s most economically depressed neighborhoods. Consequently, it carries a disproportionately high volume of Medicaid and free care. Medicaid reimbursement is the lowest among all insurers. CapStar’s uncompensated care in FY 2000 was $42 million.

Aging Plant: Excelsion is aging and no longer suitable for easy adoption of emerging technology. Extensive facility expansion will cost an estimated $80 million. However, the population has declined 9 percent in the immediate area surrounding the hospital.

Increased Access: CapStar is opening ten Total Health Centers (THCs) in partnership with Healthcognizant, Inc. These centers will house physician offices, fitness facili- ties, rehabilitation services, and counseling/preventive health services. THCs represent CapStar’s primary strate- gy to increase presence in and provide access for higher population growth areas.

Achieving Systemwide Quality, Productivity, and Medical Staff Collaboration: Although CapStar has made measurable progress in service excellence, produc- tivity, and clinical processes, the full advantages of creat- ing CapStar remain to be leveraged. CapStar continues to align once independent physicians from four separate hos- pitals into a collaborative medical staff.

Staffing Shortages: There is a regional and national shortage of therapists, technicians, and nurses, many of whom are approaching retirement age without sufficient numbers of qualified candidates to replace them.

Hergh Performance: The decision to join CapStar in 1998 was controversial and not unanimous within the Hergh community. Consequently, Hergh was a reluctant partner in several CapStar initiatives. Until recently, Hergh’s performance lagged well behind the rest of the system. Since then, the CEO has retired, and Hergh has made progress in catching up with the other OUs.

P.2c Performance Improvement System

The performance improvement system begins with the Executive Leadership Team (ELT) and each Interlocking Committee (IC) responsible for assuring high perform- ance targets are met. This system is mirrored at each OU with a Senior Leadership Team (SLT) and OU-level ICs (Figure 1.1-1). The new service design and improvement processes, the Process Evolution Cycle (PEC) (Figure 6.1-1) and the Process Improvement Cycle (PIC) (Figure 6.1-4), respectively, have been developed and fully deployed to all OUs. Since 1998, the Baldrige framework has been used to design the culture and performance improvement system. CapStar completed a high-level Baldrige self-assessment in 1998 and a more in-depth assessment in 2000. The Baldrige Criteria and Core Values serve as the foundation for the leadership system’s strategy development and are referenced frequently as the Baldrige nomenclature becomes the common language of the organization.

1. Patients First: Why We Exist

2. Physician Distinction: Our Key Partners

3. High Performing Colleagues: Extraordinary Talent, Employer of Choice

4. Compassionate Operational Excellence: Efficient, Effective, Affordable, and Caring

5. Finance and Market Strength: Bottom Line Performance

6. Information Anywhere Anytime: Belief in Knowledge

7. Community Support: Citizenship

Figure P.2-1 CapStar’s Critical Success Factors (CSFs)

 

 

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Glossary of Terms and Abbreviations

ADE Adverse Drug Event

AP Agility Process

AMI Acute Myocardial Infarction

BBA Balanced Budget Act

Board Board of Directors

BSC Balanced Scorecard

CABG Coronary Artery Bypass Graft

CapCare CapCare Centers

CapStar CapStar Health System

CBC Complete Blood Count

CCR Customer Concern and Recovery Process

CHF Congestive Heart Failure

CHR Community Health and Renewal, Inc.

CIO Chief Information Officer

CMS Centers for Medicare and Medicaid Services

CNT CNT Integrated Care

COE Compassionate Operational Excellence

COPD Chronic Obstructive Pulmonary Disease

CQO Chief Quality Officer

C-section Cesarean Section

CSF Critical Success Factor

CT Computerized Tomography

CXR Chest X-Ray

Dialogue Colleagues’ Dialogue

DRG Diagnosis Related Group

ED Emergency Department

EKG Electrocardiogram

ELT Executive Leadership Team

EPI Excellence Performance Institute

EVP Executive Vice President

Excelsion Medical Center Excelsion

Exec Med Executive Medical Staff Team

FMS Finance and Market Strength

Founders Founders General Hospital

FTE Full-Time Equivalent

Galaxia Galaxia Home Health Care

 

 

Gyn/Oncologist Gynecologic Oncologist

Hergh Hergh Community Hospital

HIPAA Health Insurance Portability and Accountability Act

Hospitalist Full-time physician directly employed by CapStar

HPC High Performing Colleagues

HR Human Resources

I2 Inspiring Ideas (CapStar’s suggestion program)

IAA Information Anywhere Anytime

IC Interlocking Committee

ICU Intensive Care Unit

IHIS Integrated Health Information Systems

IT Information Technology

JCAHO Joint Commission on the Accreditation of Healthcare Organizations

KB Knowledge Board

KIS Knowledge Information System

LVEF Left Ventricular Ejection Fraction

MCO Managed Care Organization

MLT Medical Leadership Team

MRI Magnetic Resonance Imaging

MSA Metropolitan Service Area

NB National Benchmark

OB Obstetrics

OKU Ohio/Kentucky University

OR Operating Room

OSHA Occupational Safety and Health Administration

OU Operating Unit

PACT Patient Centered Team

PDA Personal Digital Assistant

PDSA Plan-Do-Study-Act

PDV Purpose, Destiny, and SPIRIT Values

PEC Process Evolution Cycle

PEP Performance Evaluation Plan

PFC Patient Focused Care

PHNA Preeminent Hospitals of North America

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PIC Process Improvement Cycle

PIO Process Improvement Office

POES Physician Order Entry System

PSA Primary Service Area

PT Physical Therapy

RAC Regulatory and Accreditation Committee

RIMS Reliastate Insurance Management System

Roseleaf Roseleaf Community Hospital

RUH Riverport University Hospital

Rx Prescription

S&P Standard and Poor’s

SD Standard Deviation

SLT Senior Leadership Team

SPP Strategic Planning Process

SSA Secondary Service Area

SVP Senior Vice President

TAP Triannual Action Process

THC Total Health Center

VHA Veterans Health Administration

WOC WellOhioCare

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1 Leadership

1.1 Organizational Leadership

Immediately following the creation of the CapStar Health System in 1994, senior administrators, medical staff lead- ers, and members of the newly combined Board of Directors (Board) met in a three-day retreat to establish the fundamental philosophical and operating principles of the new system. Discussion reaffirmed CapStar’s com- mitment to excellence as the region’s preferred advanced care provider that would compete directly with RUH and other community hospitals. CapStar would differentiate itself from other providers by offering only the highest possible compassionate service and clinical excellence in the practice of medicine. To reflect these lofty ideals, the CapStar Purpose and Destiny were established followed by the SPIRIT Values. The Purpose, Destiny, and SPIRIT

Values (PDV), shown in Figure P.1-1, guide the entire organization.

Last year, the Board was streamlined from more than 45 to 22 members. Six members of the Board are physicians, consistent with the CapStar commitment to Physician Distinction. For a health care system the size of CapStar, this streamlined Board is designed to provide effective and agile governance. The Board meets quarterly, and its Executive Committee, consisting of twelve members (four physicians and eight community members), meets month- ly. Each Operating Unit (OU) has a local Advisory Committee, appointed by the Board, to serve as a vital communication link between the system’s Board and local needs and interests. One member of the Advisory Committee from each OU serves on the Board.

1.1a Senior Leadership Direction

In 1998, Joe Picardson, CEO of Founders, was promoted to CapStar President and CEO following the retirement of Gene Roddwine, CapStar’s first CEO. Picardson adopted the Baldrige framework as the fundamental method to pro- mote a culture that would enable achievement of CapStar’s PDV and Critical Success Factors (CSFs). Figure 1.1-1 depicts the CapStar leadership system of seven Interlocking Committees (ICs) that support the Executive Leadership Team (ELT). There is one IC for each CSF to assure alignment. At least one ELT member serves on each IC with at least one additional executive who overlaps with another IC to establish the interlocking function. To assure a systematic approach throughout the leadership system, each OU uses an identical IC system in support of its respective Senior Leadership Team (SLT). Each OU deter- mines how often its ICs meet by using the Agility Process (AP) (Area 1.1b[1]).

1.1a(1) The ELT is composed of senior executives at the CapStar level (see Organizational Chart). Each OU is led by its respective SLT, which mirrors the ELT and is tai- lored for the size and unique circumstances of the OU. Every member of the ELT and SLTs is actively engaged in living and deploying the PDV. The CapStar leadership succession process (Item 5.1) emphasizes the selection and grooming of leaders who not merely support deploy- ment of the PDV but who use the PDV as guides to self- assessment and encourage and inspire colleagues accord- ingly. The SPIRIT Values were established over a nine- month period in 1996. Multiple colleague teams drafted the first CapStar Values, which were then presented to the entire workforce for comment. The PDV are revisited annually by the ELT and the OUs. This ensures that the

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C 9

Com passionate

O perational

Excellence

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Physician D

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Info rma

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Figure 1.1-1 Interlocking Committees—CapStar System and OU Levels

*Each OU uses an identical leadership system model of ICs with its respective SLT in the center instead of the ELT. Each OU sets its own meeting frequency using the Agility Process (AP). Example: B3 = COE Committee meets every three weeks during “B” week.

There is one Interlocking Committee (IC) for each CSF: 1. Patients First 2. Physician Distinction 3. High Performing Colleagues (HPC) 4. Compassionate Operational Excellence (COE) 5. Finance and Market Strength (FMS) 6. Information Anywhere Anytime (IAA) 7. Community Support

1

 

 

2

PDV remain relevant and inspiring as the practice of med- icine continues to change and also gives new colleagues the opportunity for input. As a result of this process, the CapStar Values were revised in 1998 to become the SPIRIT Values after input was received from new colleagues at Roseleaf.

Systematic methods used by the ELT/SLTs to reinforce and deploy the PDV throughout all OUs include the following:

• Triannual Colleagues’ Dialogues (Dialogues), held by senior leaders, are round-the-clock forums in each OU that are well attended. Each Dialogue focuses on one or more of the SPIRIT Values, in addition to reviewing and discussing recent operating results tracked in the Balanced Scorecard (BSC) (Figure 2.2-1).

• Each month, a member of the ELT or an SLT writes a column in the CapSpirations newsletter about the PDV, referencing specific examples of how one or more col- leagues supported another colleague or met even the unexpressed needs of a patient or other customer.

• There are more than 100 Knowledge Boards (KBs) posted throughout all OUs. Each KB contains the PDV, the SPIRIT Value of the Month, and recent operating results, including volume, revenue, expenses, and cus- tomer satisfaction data. Approximately one-third of each KB is devoted to specific departmental results, customer feedback, and other information.

• At the beginning of a shift or workday, each colleague logs into the Knowledge Today (KT) e-mail system at his/her personal workstation or at a PC in a Knowledge Information System (KIS) kiosk and receives a brief message from an ELT or SLT member about CapStar or about feedback received from a grateful or concerned customer.

Always present at Dialogues, ELT members are visible and approachable, consistent with the CapStar Open Door Policy. Each quarter, systemwide and OU Inspiration Awards are given by senior leaders to colleagues who demonstrate passionate and effective commitment.

The ELT systematically integrates physicians into the highest levels of leadership and policymaking, consistent with the Physician Distinction CSF and the strategy to uniquely empower and communicate with independent physicians (as opposed to buying physician practices). Physicians hold several key leadership positions, as noted on the CapStar Organizational Chart, and are well repre- sented on each of the systemwide and OU ICs. A key measure of ELT and SLT members’ performance is the

ability to actively and comfortably engage physicians in operational and strategic policies. This is also a key deter- minant of leadership selection. ELT and SLT members seek out physicians for input, engage physicians in discus- sion in the hallways and cafeteria, visit physicians in their offices, and remain open and accessible. Daily interaction with physicians is an expected leadership behavior and key to CapStar’s culture. Issues of medical staff policy and clinically related decisions are addressed by the Executive Medical Staff Team (Exec Med) for CapStar overall and by the respective Medical Leadership Teams (MLTs) for each OU. Each member of the medical staff receives, via KIS, the monthly BSC update. The full med- ical staff meets three times per year—two times by OU and once systemwide—to review organizational perform- ance, provide input on improving performance, and antici- pate and address emerging issues.

CapStar uses a Triannual Action Process (TAP) to develop and rapidly adjust short- and longer-term directions and performance expectations. TAP meetings are held in January, May, and October. Longer-term directions are established at the May TAP meeting when the ELT, SLTs, Exec Med, and MLTs meet in a “Drill Down” process to evaluate thoroughly multiple external and internal trends, issues, and outcomes and to set a one- to four-year organi- zational direction as explained in Item 2.1. Short-term directions and expectations of one year or less are consid- ered at all three TAP meetings, during which all ELT and SLT members report prog

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