1. health and fitness

2014
Mission and Values Integration
Annual Report
Submitted to
The Board of Directors Committee on
Values, Ethics, Social Responsibility,
and Pastoral Services
Scope: The Indiana University Health System
April 23, 2015
Values Integration Report 2014
MISSION AND VALUES
The mission of Indiana University Health is to improve the health of our patients and community through
innovation and excellence in care, education, research and service.
IU Health will preserve, strengthen and build upon these values:
• Patient’s total care, including body, mind, and spirit
• Excellence in education for healthcare providers
• Quality of care and respect for life
• Charity, equality, and justice in healthcare
• Leadership in health promotion and wellness
• Excellence in research
• An internal community of mutual trust and respect
BACKGROUND
A key responsibility of the Indiana University Health Board Committee on Values, Ethics, Social
Responsibility, and Pastoral Services is to “Develop strategies for implementation of values identified in
the ‘definitive agreement,’ including means for measuring success and imposing accountability.” This
assignment has been the critical charter for this committee since 1997.
The Wesleyan and medical communities, the cultural and legal stakeholders for IU Health, share core
precepts and common language, though their meanings may differ by context. These undergird the IU
Health Mission and Values. These rules and principles inform all issues of mission, values, and ethics.
Wesleyan “General Rules”
• Do no harm, avoid evil
• Do good of every possible sort
• Love God
Medical Ethics Core Principles
• Nonmaleficence
• Beneficence
• Aim for justice
The Values Committee operates on the premise that mission and values based evaluation precedes
projects. Major decisions about how to invest resources and what leaders to employ are the values
based judgments that precede evaluating the need for a specific project, much less evaluating its
outcomes. Thus, the Committee analyzes both Administration’s choices of projects and key projects’
outcomes.
The Committee seeks both “objective evidence” and “subjective awareness” of how our core mission
and values are being expressed. Thus, “Mission and Values Integration Metrics” were first adopted in
2009. The current metrics were adopted for 2013-14. Over time these core values-centric metrics will
enable an “objective scorecard” summary that will complement narrative assessments and reports.
In 2010, partners outside the Academic Health Center were first incorporated into this report. The 2013
Report was the first to include all hospital entities and system services.
The focus of this report is on core values not directly reviewed by other Board Committees. Thus, the
core values “quality of care and respect for life,” “excellence in education of healthcare providers,” and
“excellence in research” do not receive in-depth treatment in this report.
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Values Integration Report 2014
KEY MISSION STORIES
1. Strategic Planning Process
The system five year strategic planning process was renewed during 2014 resulting in mission-critical focusing
and re-focusing of investments, both people and financial resources. One of the most crucial elements in that
process was the statement of our Value Proposition:
IU Health will be a leader in:
- Managing the health of populations we serve, leveraging all aspects of our tripartite mission;
- Providing care for patients with complex illnesses, while serving as a destination referral center in
select areas.
IU Health will compete on excellence and innovation to drive outcomes and value.
This proposition advances our Mission Statement and recognizes core values that are crucial to our historic and
current identity. We are already seeing new and sustained initiatives based upon this statement.
Population health management as a key strategy is shifting attention toward our insurance plans and primary
care providers as points of investment and expectation. Our primary care providers saw over 52,000
additional patients in 2014. This increase was seen across every IU Health region. A particularly significant
service change was our offering of same day appointments. IUHP, working with Evolent partners in Population
Health, made significant improvements in care of at-risk patients through lowering avoidable hospital
readmissions, avoidable ER visits, and unnecessary post-acute care/Skilled Nursing Facility days. These
improvements more quickly and efficiently connected patients to the most effective provider of care while
avoiding unnecessary cost and risk to those patients.
Our “destination complex care center” value is being refined in several ways. First, we have identified the
need for and processes toward creating a single adult hospital in downtown Indianapolis. A supporting
strategy for this has been furthering “the AHC of the Future” which has focused on space and building needs,
but has also included work toward a unified focus for model of care, patient service, and a coherent integrated
culture.
Our strategic goals will directly address one or both of these priorities. The action closest to completion at the
end of 2014 was reorganizing our “system architecture.” We identified 8 Regional Business Units centered
around hospitals, their outpatient services and practices, and related physicians. Also identified were three
service business units (physician organizations, clinical services, population risk management). Further, we
rationalized various integrated departments and system service units as either Centralized or Coordinated
functions. These designations have clarified accountability, reduced overlapping spheres of authority, and
provided the path to a more efficient organization. Such efficiency of resources will be essential in order to
achieve all elements of our Value Proposition as our mission-centric priorities are expressed.
2. Challenge of Employee Engagement
Our core value of “a community of mutual trust and respect” was demonstrated through our response to
negative findings. Leadership was chagrined by the results of our Spring 2014 Employee Engagement Survey.
When compared to the IU Health 2011 survey and to national benchmarks, our team members reported lower
engagement across all three dimensions measured: peer, manager, and organization. But the most significant
drop was in organizational engagement.
An overall assessment of our employee culture resulted in key interventions by leadership during 2015. The
assessment found the following strengths:
A. Team members are deeply committed to delivering patient care that is high quality and safe.
B. Team members do enjoy collaboration with those on their work teams.
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C. Team members take pride in caring for those with the most severe healthcare challenges and those
who are most vulnerable.
This assessment demonstrated opportunities to build upon:
A. Perceptions of direct manager support and team commitment were positive.
B. The culture valued building upon reputational strengths of “being the brightest and best” and
“being innovative in our approaches.”
Weaknesses were defined around perceptions of senior leader engagement:
A. Changes in the healthcare environment and specifically IU Health’s shift toward increased
efficiency left many confused and with less security.
B. Many team members do not perceive the senior leaders as concerned about work-life balance.
C. Many team members do not perceive that senior leaders are concerned about the challenges they
face in daily work. This was expressed in part by a decrease in perception of senior leaders’
commitment to the organization’s mission and values.
Threats were summarized as focused on failures to respond to team members’ perceptions:
A. Team members feel “overworked and underpaid.”
B. Team members perceive that understaffing makes them more vulnerable to making errors.
C. Team members desire evidence that their concerns have been heard and responded to by
leadership. Failure to do so increases risk of high turnover rates.
Senior leadership embarked on several initiatives in the second half of 2014 and into 2015 that are intended to
shift team member’s perceptions and engagement toward a healthier position.
 “Tier 3” cost centers (very low engagement scores) are receiving focal attention and their leaders have
received focused support in order to increase engagement and preparedness for change.
 Both system and AHC leaders are engaged in culture formation projects.
 Human Resources has recommended pay adjustments for mission critical positions. Staffing
benchmarks are being assessed by all senior leaders to ensure resources are adequate to pursue
preeminent patient care.
Leaders hope that our 2015 employee engagement survey will reflect the positive impact of these initiatives.
We will gather additional data through completing a Physician Engagement Survey and through renewing a
systematic employee Exit Interview data collection process. Leadership recognizes that rebuilding team
member confidence and engagement is a primary missional task.
1. ARE ENTITIES “VALUES—BASED?”
STANDARD:
Evidence that employees are educated and evaluated based upon core mission, values,
and vision of the entity and the system.
METRICS:
Employee Engagement Survey
Processes such as volunteerism and contribution management
STRENGTHS:
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Values, Mission, and Vision are taught in IU Health Essentials (new employee
orientation) and measured in annual appraisals.
o 2,100 new hires completed IU Health Essentials in 2014; 300+ IUHP team
members attended as part of their integration into the system.
o Many entity CEOs personally participate in welcoming new employees and
focusing their attention on mission and values concerns.
98.72% of annual appraisals were completed system-wide.
o WCR, Paoli, Tipton and West had 100% CM completion.
Transformation efforts are clearly values-laden activities grounded in core principles of
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Values Integration Report 2014
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OPPORTUNITIES:
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NEW PRACTICES:
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“respect for people” and the “elimination of waste.”
Key successes include:
o Increasing participation in Lean events and training to over 12% of our
workforce (over 3,500 team members);
o Establishing a process for “spread” in order to share best practices system-wide;
o Launching Strategy Deployment across the system;
o Initiating a partnership with the IU School of Medicine and the Office of
Innovation and Implementation Science to reduce practice variation;
o Utilizing Lean methodology to enhance our incident command system structure
in our system Ebola preparedness;
o Focusing our Transformation efforts on driving performance in quality, safety
and population health measures across the System.
Based on survey results, the Promise of Assurance “was recognized by 85% of the new
team members in the AHC as compared to 80% system-wide.”
Demonstrate positive trends in areas of improvement from 2014 Employee Commitment
Survey (job security, satisfaction with benefits, satisfaction with staffing levels).
Redevelop the Leadership courses and introduce the Senior Leadership course.
Enhance the IU Health Essential’s Promise of Assurance and Assurance in Action exercises
for new employees; putting them in the shoes of patients and families.
East Central Region initiated live rounding practice with mock patients. An Internal
Coach observes and provides immediate feedback. Sessions are recorded for senior
leaders to review.
LaPorte implemented a mentor program in which new employees are assigned a mentor
within their department. Of those that have participated, 100% have stated they have a
better relationship with their team and IU Health.
IUHP “launched ‘What’s Going Well’ online story library, where team members and
providers can submit stories of great care and service which can be shared with the rest
of the organization.”
STANDARD:
Evidence of UMC and IU values heritage – (a) Processes rooted in care for the poor,
social conscience, and holistic care.
METRICS:
Community Benefit Report
(The Values Committee reviewed the preliminary 2014 Community Benefit Summary in
February 2015. The formal report will be published later this year.)
STRENGTHS:
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Increased Charity Care to over $152M.
Most hospital entities and some service lines hosted multiple events and service projects
that benefited the health of their community.
Across the state, 2,252 IU Health team members participated in the Day of Service –the
largest amount in 6 years.
o Team members worked 6,000+ hours to clean and update 19 parks and 2 school
playgrounds; installed 30 pieces of fitness and playground equipment, removed
debris, painted murals, and planted flowers and trees.
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Values Integration Report 2014
2014 Day of Service Review
OPPORTUNITIES:
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Expand access to outpatient Behavioral Health services within the Central and West
Central Regions.
Revise Community Benefit Discount/Charity Care policies and procedures in light of the
Affordable Care Act and approval of HIP 2.0.
NEW PRACTICES: See Section 5, “Charity” below
STANDARD:
Evidence of UMC and IU values heritage – (b) Heritage, mission, and values are
promoted through both internal and external communications in all hospitals
METRICS:
Both ongoing (e.g., websites, public displays) and special event (e.g., anniversaries,
lectures) communications include core values information as appropriate.
STRENGTHS:
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OPPORTUNITIES:
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NEW PRACTICES:
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Entities holding community events display IU Health messages.
System-wide internal communications promote IU Health’s mission and values.
o Most system hospitals/regions have internal communication/public relation teams
in addition to system-wide resources, which aids in promoting IU Health’s Mission
and Values to specific communities/populations.
Ongoing promotion of IU Health Mission and Values via social media for events sponsored
by or in part by IU Health entities.
Continued community education events throughout the state.
IU Health made a gift to the Indiana Conference UMC in support of clergy well-being.
For their Annual Appreciation Celebration, IUHP hosted a canned food drive and collected
over 6,000 canned goods for Gleaners Food Bank.
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Values Integration Report 2014
•
STANDARD:
University created HUG; Helping University by Giving, a new patient assistance fund in
which team member’s donations go to support basic needs of patients outside the
hospital.
ENVIRONMENTAL SUSTAINABILITY
METRICS:
a) System message promulgated.
b) Alignment structures created.
c) Sustainability goals and accountabilities established.
STRENGTHS:
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OPPORTUNITIES:
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NEW PRACTICES:
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Recycle bins located in many public and office areas throughout the AHC.
Shred-it bin contents are recycled after they have been shredded.
East Central Region projected 54 tons of recyclables in 2014. Goal for 2015 is to recycle
30% of all trash, equating to 296 tons.
West’s Green Business Initiative meets regularly with goals of “waste reduction, increased
recycling, and energy/water management.” They achieved recycling 17% of waste and
sustained flat energy expenses. The initiative also focused on reprocessing of equipment,
saving nearly $24,000.00 in new equipment costs.
Strengthen initiatives at most entities to save on water and energy through signage, team
member engagement and involvement, and fixture changes/updates.
System goal to reduce operations costs by 20% or $19.5M by the end of year 2017.
Bedford’s electrical company upgraded electrical transformers resulting in greater
efficiency. Several lights were upgraded to LED, saving money and energy.
The main focus of the Design & Construction/Facilities Affinity Group’s Energy
Conservation & Efficiency Council was Utility Data Collection & Management.
o Found that system-wide, IU Health spends more money on utilities per bed and
square foot than the industry standard.
 Arnett was used as a case study and showed that with utility
modifications to a relatively new hospital, $680,000.00/year was saved.
 Recommendation for 2015 for “Identifying Utility Optimization projects
that generate greater than 24% IRR.”
The Design & Construction/Facilities Affinity Group’s Lifecycle Asset Management team
created a standard to reduce duplicative equipment purchases and decrease
underutilized assets to increase revenue from sales of excess equipment and reduce the
lifecycle cost of assets.
2. PATIENT’S TOTAL CARE – BODY, MIND, SPIRIT
DEFINITION:
Evidence That Patients Experience Care
METRICS:
Patient Experience Survey Results 2014
a) Rating of care inpatient score. Percentile goal of 77.99, result of 73.62 (LEM 1).
b) Rating of care outpatient score. Percentile goal of 80.05, result of 77.05 (LEM 1).
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c) Rating of care MD office patients. Percentile goal of 85.67, result of 82.52 (LEM 1).
STRENGTHS:
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System leaders (LEM 3) for inpatient service scores were Saxony and Blackford.
System leaders (LEM 3) for outpatient service scores were Saxony, Arnett, Morgan, and
Goshen.
System leaders (LEM 3) for MD office visit service scores were West Hospital and the
South Central Region.
From a member of Ball Hospital’s Board of Directors:
“We so often take for granted our health and also our health delivery system. I found
myself, as a result of a recent accident, in a situation where my injury basically halted
my daily activities. It gave me time to reflect on how precious good health is and how
fortunate we are when we are active and free from health issues. My accident
required that I have daily two hour antibiotic infusions for over 30 days. After a couple
of days in the hospital, I was told that Ball has an oncology outpatient unit on the 5th
floor that could accommodate this daily routine. Again, while I knew we have a top
rated hospital, I was not aware of this particular unit. I was so relieved to know that
just a few minutes drive from my home was the outpatient unit. My first visit was
absolutely inspiring. I was greeted warmly by the nurses and my journey began. The
three regular nurses, Barb Ellis, Diane Huber and Doloris Lipscomb were absolutely
phenomenal. As I began to observe them at their daily routine, I was in awe of their
professionalism, their complete mastery of their job, but most of all their complete
dedication to their purpose. These nurses have a special inner being that allows them
to consistently care for a group of ever changing patients with complete empathy and
sincere caring. They all have been doing this work for many years and NEVER did I see
at any time a letdown of their positive outlook and genuine interest in each and every
patient. They all have a unique ability to make each patient feel as if they were the
only one in the room. They build relationships with each and every one that they care
for. I was the fortunate one in that I only had a short term issue and knew that I would
soon be moving on. Most of the patients were very ill and the prognosis in many cases
was bleak………but it was evident that they connected with these angels of mercy and
for the period they were there, they knew someone cared.”
(They had no idea that I was a member of the Board of Directors.)
OPPORTUNITIES:
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NEW PRACTICES:
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Most entities require substantial improved performance towards targets in 2015 and
even more substantial improvement to reach the IU Health Pre-eminence Vision.
AHC received renewed Magnet Hospital designation from ANCC. Received Joint
Commission reaccreditation for Stroke and VAD programs.
Riley initiated pet therapy with the aim to provide additional comfort and support to
patients and their families.
The Child Life Zone opened at Riley through the Teammates for Kids Foundation. “This
therapeutic and recreational play area within the hospital allows our Child Life team to
provide support and therapy services to both inpatient and outpatient families.” The
Zone is also available to families who have wait times between appointments.
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Values Integration Report 2014
The Riley Child Life Zone
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IUHP led the system-wide Primary Care Same Day Appointments campaign, increasing
new primary patients by 14.2% in 7 months.
“Thanks to IU Health. I was skeptical, but this works for everyone. I called at noon
yesterday and had an annual physical completed by 3:45 pm! Same day! That is a
little over 3 hours actually, and my primary care physician called with lab results at
8am this morning. Now that is service and responsiveness! It’s a new day in
healthcare – we’re getting there. My dry cleaner can’t even do that.”
Personal Approach to Healthcare (PATH) was launched through IUHP Primary Care
offices. This approach identifies patients as at-risk or high-risk, better defining their
healthcare needs even before an office visit.
Revenue Cycle Services integrated Tipton, White, and Bloomington into the IU Health
system and introduced new tools for patients to use prior to services, enabling patients
to have better peace of mind about the cost of care before services are provided.
Indianapolis Sleep Center implemented Immediate Follow up & Treat (IFT) to improve
the entire patient experience, resulting in patients needing fewer appointments and
physicians seeing patients sooner.
North was awarded the 2014 Path to Excellence Award by the National Research
Corporation. Adult inpatient ratings placed North above most other National Research
clients.
DEFINITION:
Patient Rights and Ethics
METRICS:
a) Joint Commission findings and action plans from Patient Rights Section.
b) Training provided for ethics committee, ethics consultation committee, staff and
physicians in current ethics issues.
STRENGTHS
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All entities reviewed by accrediting bodies met reaccreditation expectations.
Most entities offer both Clinical Ethics Consultations and Unit Based Ethics conversations
in consultation with the Fairbanks Center for Medical Ethics.
West’s Ethics Committee hosts monthly education/CME events, which shapes the
Committee’s charter, policies, and satisfaction survey process. In addition to unit based
ethics conversations, they provide an ethics consultation meeting 2x per month, meet
monthly as a committee, and provide ethics consult education during Orientation.
Fairbanks Center for Medical Ethics Lecture Series videos are available on-line for all IU
Health team members to view.
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Values Integration Report 2014
OPPORTUNITIES:
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NEW PRACTICES:
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DEFINITION:
Increase system-wide utilization of AHC’s Fairbanks Center for Medical Ethics for ongoing
ethics education and consultation services.
Ensure best practices for ethics committees and consultants, as articulated by the
American Society for Bioethics and Humanities, are instituted throughout the system.
LaPorte participated in reviewing proposed changes to the American Nursing
Association’s Code of Ethics.
Ball Memorial’s Ethics Committee members hosted ethics presentations throughout the
year for community members, educating and encouraging discussion about POST forms,
Advanced Directives, and death and dying.
Bedford hosted a 2-day training, “Respecting Choices,” for staff and physicians.
LaPorte hosted “The Development of the Pharmaceutical Industry and the Creation of
Ethical Dilemmas Between Medicine and Business.”
Joint Commission finding at West resulted in increased intensity of physician education
and audits regarding documenting informed consent.
Care of Dying
METRICS:
a) IU Health Hospice metrics = Increase in patient admissions at some entities.
b) Palliative Care metrics = For a second year, p rograms in AHC, Bloomington, and Ball
increased the number of patients served.
STRENGTHS:
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Average daily cost of care decreased $900 per day for palliative care patients within the
AHC & Ball following a palliative care consult.
Methodist, University, Riley, Ball, and Bloomington have fully dedicated inpatient
Palliative Care teams. Community hospitals without formal Palliative Care teams
collaborate with other IU Health hospitals to provide inpatient Palliative Care or work
with community programs. (Bedford, Morgan)
Most hospitals offer support groups for families of palliative care and hospice patients.
AHC achieved reporting capacity within Cerner documentation that is facilitating
identification of opportunities for improved service and demonstrated results.
Longtime businessman PB first became acquainted with Indiana University Health
LaPorte VNA Services nearly 30 years ago through work projects. So when it came time
for his own Hospice care later in life, he knew exactly where to turn.
In the 1980s, PB served as the Executive Director of the now-named LaPorte Hospital
Foundation. Through his expertise in nonprofit fundraising, he was asked to help grow
the Visiting Nurses Association (VNA) of LaPorte Hospital. He helped organize a twonight phone-a-thon at the former Whirlpool Corporation in LaPorte.
He quickly learned about the highly trained individuals of IU Health LaPorte VNA
Services who have provided compassionate support within the comfort of one’s home
for over two decades. “I was so very impressed with the VNA,” PB recalled of his first
impression of the organization. “If there is any one nonprofit that stands out in my
mind of doing the most to really help people, it was Hospice.”
Nearly two decades later, Paul’s dear friend and business partner of three decades was
diagnosed with stage 4 cancer. After several unsuccessful chemotherapy treatments,
PB’s friend and his family decided to look into Hospice services. VNA staff provided end-
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of-life care for him for a few weeks before he passed. “The compassion, the kindness
and the love that they gave to him, to me and my family struck my heart,” PB
remembered.
Just months later in April 2011, PB himself learned his was suffering from heart failure.
After costly trips in and out of the hospital for care, PB and his family understood from
his healthcare providers that his life expectancy was short. PB was taken home in
February 2012 and placed in the care of Hospice. He soon witnessed first-hand the
caring colleagues of IU Health LaPorte VNA Services provided not just for him but also
his main caregiver, his wife of 51 years.
Hospice staff focused on PB’s quality of life rather than quantity, striving to make his
last days as pain free as possible by managing his symptoms. More importantly,
Hospice helped bring peace to the 80-year-old. “I’ve had such a wonderful life. To be
able to die in the dignity that they afford me is a stabilizing state of mind for me.” “I’ve
had such wonderful care. I can’t think of any other organization in the world that
deserves as much credit as those angels through Hospice,” PB said. “Those people are
on the front line. They treat you like family. They are such compassion souls. They bring
the true meaning of love to your life.”
OPPORTUNITIES:
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NEW PRACTICES:
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Developing resources to meet the increased need for resources in outpatient palliative
care and hospice settings.
Most hospitals educated community members, patients, and their families regarding
Indiana’s Physician Orders for Scope of Treatment (POST).
Methodist created Comfort Care Unit, which focuses on all aspects of end-of-life care.
Bloomington co-sponsored a community event focusing on having end-of-life
conversations with family members.
In late 2013, Riley created the Integrative Medicine and Palliative Care Treatment Team
(IMPACT) to “provide supportive care for children with life threatening and life limiting
disease, and their families, using state of the art medical therapies, coordinated
interdisciplinary care, and evidence based complementary medicine.” One story:
When we were consulted on BD, a 5 yr. old boy with relapsed Diffuse Intrinsic
brainstem Glioma, the primary team was worried that inviting palliative care might
send Stacie, his mom, over the edge. Stacie has lost a previous child to SIDS and was a
single mom. B was her life. She battled with her history of depression and had been
known to threaten to take her own life should B not survive. Since his prognosis was in
fact terminal, we reassured the oncology team that we would be very sensitive to
these concerns but that it was important we get involved. Through our work with B
and Mom we helped Mom to develop a realistic understanding of B’s prognosis and
assisted them with shifting the focus off the impending loss and onto living now and
focusing on what B enjoys. We identified two important things for B, playing on his
swing set, and seeing the new Superman movie. Through a true team effort, we were
able to get a swing set (and assembly) donated to the family AND we were able to get
him a special seat at the Superman movie premiere. Mom accepted hospice care at
home (despite the primary team thinking she would never do that) and Mom
embraced the new focus on quality of life and was still focusing on B’s life and wishes
when she asked the pall bearers at his funeral to wear superhero uniforms. Mom has
gone on to develop a foundation in his honor and has connected with an artist who
will paint pictures of children with cancer in superhero costumes for free.
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DEFINITION:
Spiritual Care
METRICS:
a) AHC chaplaincy staffing standard serves as system benchmark. The AHC exceeds
minimum benchmark. Most entities meet or are close to this benchmark.
b) Education programs offered for staff and community. Present in AHC and all
community hospitals.
c) Performance improvement projects documented. Entities utilizing Cerner n o w
have common documentation methods for spiritual care.
STRENGTHS:
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OPPORTUNITIES:
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NEW PRACTICES:
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DEFINITION:
Riley Chaplains, with support from Social Work, operate the Code Lavender Program,
which “offers an acute response team to clinical care members during times of difficult
patient cases or higher stress levels.”
Spiritual Care leadership is integrated on leadership teams and supports public rituals
which indicate foundational spiritual commitments.
Involvement of community clergy and lay persons as volunteers.
Clinical pastoral education continues to be available at 7 hospital campuses.
The AHC two –day retreat, Gift of CareGiving, completed 14 years of renewing team
members.
The AHC and all community hospitals employ full-time certified chaplains. All critical
access hospitals have clergy available either as volunteers or as part-time employees.
“Sanctuary Moment” distributed weekly via the Daily Matters. (AHC)
Increase staffing to meet minimum benchmarks in all community hospitals.
The Values Grant for Religious and Spiritual Integration in Healthcare will be open to
all IU Health entities in 2015.
Implementation of Spiritual Assessment Documentation in Cerner. Continued work
towards further standardizing documentation.
Ball hosted two sessions of their annual Turner Conference on Faith and Healing entitled
“Self Care Health Care: Mindfulness-Based Stress Reduction,” presented by two team
members of the Buchanan Pastoral Counseling Center. One session was held during the
Medicine Grand Grounds and the second for the public.
LaPorte hosted “The Conversation Project” through the Walther Foundation, which was
attended by community members and clergy.
Bloomington offered “Spirituality and the Doctor/Patient Relationship to first year
medical students.
LaPorte = Excellence in Care to the Caregiver and Colleague Engagement, led by the
Chaplain Director, engages the Care to the Caregiver programing for the facility and all of
our entities.
Behavioral Health
METRICS:
a) Community benefit assessment and interventions.
b) Performance improvement projects documented.
c) Engagement in planning with local and state leaders and with other providers.
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STRENGTHS:
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OPPORTUNITIES:
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NEW PRACTICES:
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Bedford and Paoli utilize Telemedicine and/or outpatient behavioral health providers.
Tipton has two hospital leaders on the Regional Behavioral Health Advisory Board, one as
president.
West participates in the Hendricks County Health Partnership, which has focused on
addressing behavioral health needs in the community. Currently, they are advocating for
a “mental health court” modeled after a diversion-type court in Marion County.
Provide more services through IU Health behavioral healthcare resources rather than
contracting with outside providers to provide service.
Behavioral health identified as an area in high need for many communities surrounding
hospitals. (West Central Region, Bloomington, West)
Strategic capital plan submitted to open a Behavioral Health Division within the West
Central Region. System approval and funding secured. Plans underway in 2015 to activate
a new service enhanced by important collaborations with area behavioral providers.
$202,343.00 was granted by IU Health to multiple organizations in 7 counties to start or
maintain behavioral health services, benefiting 11,000 Hoosiers.
East Central Region has collaborated with Meridian Health Services (MHS) to integrate
primary and behavioral care in the region.
Bloomington partnered with community agencies to address homelessness and saw
arrests and ED visits decrease in that population by 50%.
Morgan transitioned inpatient behavioral health to Meadows Hospital in Bloomington.
3. EXCELLENCE IN EDUCATION FOR HEALTH CARE PROVIDERS
DEFINITION:
See Reports from Education and Research Committee
METRICS:
No System Metric for 2014.
STRENGTHS:
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Values Grant for Education will be promoted system-wide in 2015.
OPPORTUNITIES:
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NEW PRACTICES:
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Revenue Cycle Services is working towards having a Physician Advisor in all regions to
provide physicians with education on CMS updates, reducing the time medical staff
addresses payer issues.
Revised RN scholarships; awarded 33 to IU Health nurses pursuing degrees at varying
levels. (AHC)
Established a system-wide IUH-IUSON RN-BSN cohort.
The Marilyn Cox Nurse Scholarship, with support from the Riley Children’s foundation,
was developed to honor Marilyn’s 25 years of service as Chief Nursing Officer. The award
promotes diversity candidates in nursing school.
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4. QUALITY OF CARE AND RESPECT FOR LIFE
DEFINITION:
See Reports from Quality and Safety Committee
METRICS:
a) Quality and Safety Measurement Panel
Safety Goal of 3 with result of 2 (LEM 2)
Quality Goal of 3 with result of 3 (LEM 3)
b) Population Health Panel Goal of 3 with result of 1 (LEM 1).
STRENGTHS:
•
•
•
•
•
Riley, LaPorte, and Stark had the highest results for Safety (LEM 4).
West, Arnett, and Goshen had a result of 5 for Quality (LEM 5).
o All but 1 hospital met LEM 3. (Riley)
U.S. News & World Report’s 2014-15 edition of America’s Best Hospitals lists 4 IU Health
clinical programs among the top 50 national programs. (Neuroscience, Gastroenterology,
Geriatrics, Pulmonology)
Riley was ranked by U.S. News and World Report among the top 50 children’s hospitals in
the nation with 9 out of 10 pediatric specialties ranked within the top 50 in the nation. Six
of these specialty programs rank amongst the top 25 in the nation.
Nursing Magnet Designations: AHC, West, Goshen, and Bloomington.
OPPORTUNITIES:
•
NEW PRACTICES:
•
•
•
•
•
Dissemination of feedback from Patient & Family Advisory Councils.
Over 3,000 Riley team members completed safety and error prevent training; the results
earned Riley the designation of Hospital of the Month for March 2015 by the Children’s
Hospital Solutions for Patient Safety collaborative.
Methodist standardized infant fall work, resulting in 250+ days with no falls.
Electronic risk assessments were standardized throughout the system.
Ball, University and Methodist implemented a pain management pilot. No associated
respiratory events occurred in 400 pain plans.
The AHC established the Ambulatory Professional Practice Council, a shared leadership
forum.
University expanded the Patient Centered Care Steering Team to include multidisciplinary
team members.
A Comment:
“My son, who is now 26, was born with congenital heart defects and had five surgeries
and numerous procedures at Riley when he was a child. As an adult, he started seeing
Dr. Aaron Kay, a new physician board-certified in both pediatric and adult cardiology.
Several months ago, my son had heart constriction – the first time he has ever had
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Values Integration Report 2014
chest pain…I drove him to Methodist and called Dr. Kay, who was in Lafayette
preparing to give a lecture. He instructed us to go to Methodist ER, and he called the
ER to direct my son’s care until he arrived. When he reached the ER, Dr. Kay
coordinated a number of tests, ruling out a heart attack. I was so impressed with Dr.
Kay’s willingness and ability to care for my son in an emergency, even though he was in
another city. It is a godsend for patients like my son to have Dr. Kay, who is so
committed to the highest standards of quality and service.”
5. CHARITY, EQUALITY, AND JUSTICE IN HEALTH CARE
DEFINITION:
Medical Care Regardless of Ability to Pay
(Note: Interim 2014 report received February 2015. Final report in October 2015.)
METRICS:
•
•
•
Charity care = $152M
Subsidized Health Services = $8M (preliminary)
Unreimbursed costs of Medicare and Bad Debt = To be determined mid-2015.
•
Led in working with governor’s office to establish HIP 2.0. Will improve access to
healthcare services for low income Hoosiers and reduce traditional charity care
requirements.
Charity care continues to be more proactively determined for those in need, resulting in
increased charity care and decreased bad debt.
STRENGTHS:
•
OPPORTUNITIES:
•
•
•
NEW PRACTICES:
•
•
Continue to align community benefit accounting and reporting at system level.
Clarify and improve reporting of “subsidized health services.”
Work to establish new definition/guidelines for Charity Care in light of Federal Exchange
Insurance Programs and HIP 2.0.
IUHP provides volunteer physicians in community-based free clinics, in collaboration
with Strength That Cares.
Revenue Cycle Services individual solutions team members, certified by the state as
Navigators, reach out to patients (both on-site and post care) in order to provide
eligibility screening and help patients determine whether they qualify for coverage or
assistance. With the team of Navigators, IU Health is well positioned to enroll patients in
either public assistance or marketplace insurance products. Revenue Cycle Services is also
instrumental in providing opportunities for health care to certain populations of Hoosiers
(e.g. Amish), who may otherwise not have access to affordable care. A division of
Revenue Cycle Services is focused solely on ensuring all patients have access to coverage
for which they qualify. These Navigators are available via phone, appointment, at
registration, and at the bedside to assist in navigating the complicated coverages that
may be available.
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Values Integration Report 2014
DEFINITION:
Access to Healthcare Services
(Note: Interim 2014 report received February 2015. (Final report in October 2015.)
METRICS:
•
Unreimbursed costs of Medicaid, HIP, CHIP (net) = $196M
•
IUHP is the sole participant in the Medicaid State Plan Amendment which
provides faculty physicians with supplemental reimbursement (Upper Payment
Limit or UPL) to improve access and quality to care.
The Academic Health Center and community hospitals have a variety of support
mechanisms for Federally Qualified Health Centers and free clinics.
Availability of special programs for unique communities, such as Amish.
Most hospitals provide various health screenings at no cost during community events.
STRENGTHS:
•
•
•
OPPORTUNITIES:
•
•
•
NEW PRACTICES:
•
•
•
•
System Clinical Services business unit developed to provide better access to outpatient
care and ambulatory services for patients.
Patients can now schedule appointments through My IU Health. Expansion to more
providers is scheduled in 2015.
Decrease new patient appointment lag.
o IUHP has set a goal to have 50% of patients be seen in less than 7 days of making
an appointment, with the majority being same-day or next-day appointments.
White opened a walk-in clinic open evenings and weekends and saw a 70% reduction in
Emergency Department visits. 68% of patients who visited the clinic have been
connected with primary care physicians.
Morgan has partnered with Care Ambulance Service to provide transportation services.
Hamilton, Tippecanoe, and White county community organizations received $118,260 in
grants from IU Health; assisting 5,092 people receive a variety of healthcare services not
otherwise available to them.
IUHP participated in “4 in ’14” where 42 physicians provided free care for 2,800+ patients
at 4 clinics in 2014.
“We recently had a patient that the volunteer urologist suspected of having testicular
cancer. IU (Health) West and Dr. Powell did some additional test and treatment. The
cancer was caught early and treated successfully.”
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Values Integration Report 2014
6. LEADERSHIP IN HEALTH PROMOTION AND WELLNESS
DEFINITION:
Engagement in Communities of Need
(Note: Interim report received February 2015.)
METRICS:
a. Obesity Prevention
• Garden on the Go sold over 300 tons of produce in 19 limited access neighborhoods.
• Annual Day of Service utilized 2,252 volunteers who updated and installed fitness
equipment in community parks and school playgrounds.
• Strong Schools program increased student’s daily physical activity by 28%.
• Walking Groups sponsored by IU Health educated about the health benefits of
walking, with 17% of participants reporting weight loss.
b. Access To Affordable Healthcare
• See Section 5 above.
c. Behavioral Health
• Received $1.2M in strategic funding to expand access to care within Central and West
Central Regions.
d. Pre-K-12 Education
• Kindergarten Countdown assisted 467 underserved children in 10 counties. 21%
increase in Get Ready to Read scores.
• Playworks Indiana (AHC) worked to reduce bullying in low-income elementary schools
in Marion County through transforming recess and classroom engagement.
STRENGTHS:
•
•
•
•
Ticker Survey results demonstrate statewide perception that IU Health has the best
Community Health Program.
3,200+ IU Health team members are part of the Strength That Cares, dedicating more
than 10,000 hours to help improve the health and wellness of the community.
Success of multiple programs within the AHC, West, and Central Regions that introduce
and prepare students for college and education in healthcare fields.
Partnership with Goodwill Industries to hire persons with disabilities. (AHC and Ball)
From North:
“In 2014, IU Health North and Saxony Hospitals joined with St. Vincent Carmel,
Community Health Network, Franciscan St. Francis Health and Riverview Health to
create the Partnership for a Healthy Hamilton County. The mission of the Partnership is
to collaborate across all sectors of the community to advocate for and implement
strategies that help to improve the health of residents where they live, work, play, and
learn.”
OPPORTUNITIES:
•
NEW PRACTICES:
•
•
Expanding access to Behavioral Health, focusing in the Central and West Central Regions.
“Change the Play” with Andrew Luck and Riley expanded, adding a school program and
three summer camps, which reached 4,276 students, 65 schools, and 1,368 families.
North participated in Carmel Clay Public Library’s “1,000 Books to Read before
Kindergarten” program by promoting hand hygiene and overall health.
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Values Integration Report 2014
•
Arnett provided funding for handicapped accessible and adult fitness equipment for
Subaru South Tipp Park, which was completed August, 2014. Adults and children are able
to exercise and have fun in the same space.
Comment:
“…I wish to highlight the successful collaboration with Subaru and the City of Lafayette
to fund the creation of a unique park located in a distressed Lafayette neighborhood.
The park is the first in the region to be certified for safety and the disabled. This is
directly in alignment with community health needs of childhood obesity.”
From West:
"Science Enchantment has been electrifying and uplifting; de-pressurizing the strain of
our rigorous curriculum. Instead of the students depending on ‘YouTube’ to experience
science they have been able to have real-time experiences with the science concepts.
The students get excited when they see the equipment and unleash the curiosity so
necessary for inquiry. With the equipment purchased from the IU Health West grant
we have been able to study convection currents using the hot air balloons; the gas laws
and sound using the vacuum pump and chamber; and atomic structure, molecular
motion, electricity and weather using the van de Graaff. Having equipment and
actually "doing" science engages the staff and students bringing the concepts alive.
There is nothing more satisfying then to see the students enthusiastic about a lesson.
The equipment takes us from the mundane classroom to the stage of a Bill Nye show."
DEFINITION:
Planned Community Benefit Activities
(Note: Interim report for 2014 received February 2015. Final report in August 2015).
METRICS:
a)
b)
c)
d)
e)
Health Professions Education = To Be Determined
Financial Contributions = $12.8M (+67%)
Community Building Activities = $1.9M (+91%)
Community Health Services = $20.6M (-34%) Figures being verified.
Research (community health and clinical) = $21.6M (-70%)
(Note: AHC made a one-time $40M grant to IU in 2013.)
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Values Integration Report 2014
STRENGTHS:
•
•
Connections to most Indiana nursing and allied health education programs.
Most entities host community benefit activities, priorities outlined above.
OPPORTUNITIES:
•
NEW PRACTICES:
•
Continued community benefit activities at community level with focus on needs from
Community Based Needs Assessment.
A comprehensive statewide Community Needs Assessment will be conducted in 2015 per
requirements of the Affordable Care Act.
7. EXCELLENCE IN RESEARCH
DEFINITION:
See Reports from Research and Education Committee
METRICS:
Enroll 1190 additional patients in clinical research trials initiated since 1/1/13.
Results = 4,367 (LEM 5).
STRENGTHS:
•
•
OPPORTUNITIES:
•
•
NEW PRACTICES:
•
Most entities are above the benchmark for new clinical research trails.
Within the AHC, nurses presented at 35 national presentations, published 17 peer review
journal articles and manuscripts, led 23 research projects (completed and in progress),
and led 8 evidence-based projects.
Values Grant for Research will be available to all IU Health system entities in 2015.
The “Grand Challenge” Values Grant will be available in 2015, emphasizing population
health outcomes. This grant will compliment IU Health’s strengths, be community based,
and compromised of multidisciplinary teams and multi-school faculty. Both research and
education must be addressed.
IU Health in collaboration with IUSOM increased clinical trial volumes over 200%, doubled
Phase 1 therapies for cancer, and had a three-fold increase in Phase 1 therapies for other
serious medical conditions.
8. AN INTERNAL COMMUNITY OF MUTUAL TRUST AND RESPECT
DEFINITION:
Corporate Ethics
METRICS:
a) The Joint Commission compliance = No unresolved notations or issues.
b) TrustLine results = Reports received and considered by Board Committees on a
routine basis.
STRENGTHS:
•
•
Decreased TrustLine calls were a trend in 2014, with exception to AHC entities.
Team members complete Corporate Compliance education annually and upon hire.
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Values Integration Report 2014
OPPORTUNITIES:
•
NEW PRACTICES:
•
DEFINITION:
Decrease the amount of TrustLine calls for 2015 by addressing trends in calls, although we
do not debate as to whether increased or decreased calls are the preferred state.
To keep LaPorte employees connected to the executive work surrounding strategic
pillars, The Scoop, an internal electronic communication that provides highlights of the
weekly Executive Team strategic pillar and operations meeting was launched. It is issued
via email and posted on the organization’s intranet site, Vitals.
Employee Culture
METRICS:
a. Employee commitment:
• 90% participation rate in Commitment Survey throughout system.
• Overall engagement score of 3.95, a decrease from 4.18 in 2011.
o Nationwide, engagement score mean declined from 4.16 to 4.10.
2010
Overall
Engagement
Score
4.18
20%
Action
Planning
Readiness
84
2011
4.18
19%
85
2014
3.95
28%
84
Tier 3
Percentage
b. Professional level minorities: Achieve a 1 percentage point increase by retaining and
recruiting professional level minorities within the AHC, West Central Region, North
Central Region, West, IUHP, and System Services. Result = 0.95%
c. Employee retention (turnover %):
• AHC annual nursing rate = no change at 13.8%
• AHC annual total rate = decreased from 15.05% to 14.8%
• AHC first year nursing rate = decreased from 15.1% to 9.5%
• AHC first year total rate = increased from 13.64% to 21.17%
• System first year rate= 21.32%
• System annual rate = 13.52%
d. Employee volunteerism
• Enrollment in “Strength That Cares” = 3,200
STRENGTHS:
•
•
•
Commitment Survey Top Themes of Strength:
o Team members believe employees assist others with work;
o Team members believe there is collaboration within the work unit;
o Team members believe procedures are being followed properly.
78% of employees responding to the Commitment Survey stated they would recommend
employment with IU Health.
Ball was named as a leader in LGBT Healthcare Equality (for the 3rd year) by the Human
Rights Campaign’s 2014 national survey, Healthcare Equality Index (HEI).
When Tommy Wolfe began his role as Manager, Supply Chain at Riley Hospital in the
fall of 2014, team member engagement was at an all-time low. Through his work with
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Values Integration Report 2014
the Office of Transformation, Tommy has used the framework of leader standard work
for ongoing departmental rounding. This ensures that each team member is given an
opportunity to provide meaningful feedback in a one on one setting. Tommy then used
the transformation tool known as the Kano Model to categorize team member
feedback to create his action plan. Those items categorized as a ‘basic’ need are those
that need immediate action or he risks team member retention. Items categorized as a
‘performer’ are consistent pieces of feedback from the team that will impact overall
team engagement. Items categorized as a ‘delighter’ are personal by nature and may
or may not be feasible for Tommy to accomplish. Using leader standard work and the
Kano Model has allowed Tommy to focus on actions that will impact overall
department engagement and is hopeful that he will see his 2015 team member
engagement survey results impacted as well.
OPPORTUNITIES:
•
•
NEW PRACTICES:
•
•
•
•
•
•
Commitment Survey Top Themes for Development:
o Team members expressed dissatisfaction with job security;
o Team members expressed dissatisfaction with benefits (pay);
o Team members expressed dissatisfaction with staffing levels within the work
unit.
Improving engagement with nurses and other clinical professionals with a focus on those
who do not work day shift.
Benefits campaign launched in August 2014 to better educate team members of benefits
available to them.
To address “systemness,” most IU Health Business Units now have the same IU Health
Plan and Retirement Plan. IUHP, Arnett, Southern Indiana Physicians, and Ball Physician
Group are working towards making this change.
All IU Health employees have the same Attendance Policy and Corrective Action Policy,
which creates fair treatment and consistent application of the policies across the system.
An REI was initiated to identify causes of attrition and create a plan to increase retention
in groups with the highest turnover (24-35 in age, racial or ethnically diverse, and <5 years
service).
Riley’s Chief Nursing Officer hosts “Breakfast with the CNO” where nurses from different
units can discuss issues, give their feedback, and offer ways for improvement.
Volunteer Match is being used to recruit and inform IU Health Employees of volunteer
opportunities, resulting in more accurate tracking of volunteer’s hours.
From Transformation Office:
Participating in a Rapid Improvement Event (RIE) can be good for your career—or even
change its direction. Just ask Jared Doane. Doane had been a patient services assistant
in the Riley at IU Health Emergency Department since 2010 when he joined nine other
team members last April to find ways to improve the cleanliness of rapidly turned
rooms in the hospital’s ED. Doane’s former boss, Estel Stewart, manager of Clinical
Operations for Riley at IU Health, says he noticed an immediate change in Doane
following the RIE. “During the RIE, Jared came up to me and said, ‘I get what we are
trying to do here and it makes a lot of sense,’” explains Stewart. “He told me that the
RIE gave him a sense of purpose. After the RIE, he was a different employee.” Then
Doane received a phone call about a logistics analyst position he had submitted an
application for several weeks earlier. During the interview, Doane spoke of his role in
the RIE and his enthusiasm for the work he had done. He got the job, and now is
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Values Integration Report 2014
settling into his new role at IU Health. “The RIE helped prepare me for my new
position,” says Doane. “The experience I gained at the RIE has heightened my
confidence to a level it’s never been at before. To have so many people tell you what a
wonderful job you are doing is a pretty good feeling.”
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