1. No category

Quality and Safety
Patient- and FamilyCentered Care
People
Growth
Finance
System/Community
F Y 2 0 1 3
A N N U A L
R E P O R T
Steven I. Goldstein
President and CEO, Strong Memorial Hospital and Highland Hospital
In its nearly 125-year history, Highland Hospital has grown from a small private residence on Rochester’s South
Avenue to a well-respected community hospital with region-leading specialty services. The past year will be
remembered for how well Highland capitalized on its traditional strengths while preparing for a more complex
and challenging future.
Health care reform is bringing seismic shifts to our industry. Moving from a fee-for-service model to value-based
reimbursement, with its emphasis on proactive disease prevention and management, will place new and greater
demands on everyone from the individual provider in private practice to large academic medical centers like
URMC.
We’ve seen historic partnerships formed over the past year as a result. The Medical Center’s affiliation with
Thompson Health, merger with Pluta Cancer Center and creation of Strong West in the former Lakeside Hospital
brought needed resources to these facilities and ensured continued health care access to their communities, while
expanding the Medical Center’s patient base in Western New York.
In addition to these strategic partnerships, we’ve been working to create an accountable health network that helps
all partners in health care to deliver the most efficient care possible to the community. Highland’s Chief of Medicine
Robert McCann, M.D., has led the introduction of Accountable Health Partners over the past year. He’s brought
together hundreds of community and faculty physicians and hospital administrators to develop a model that
benefits all stakeholders: patients, community physicians, the medical center and its providers, and ultimately, the
community that relies on us for its health care.
More than ever before we will have to think and act as a system. With region-leading services in bariatrics, geriatrics,
orthopaedics and gynecologic oncology, Highland plays an important role in the Medical Center’s goal of building
presence and attracting new patients in upstate New York. As we look forward to Highland’s milestone anniversary,
we will guide it through some of the most dramatic changes in the hospital’s history. Fortunately, throughout its
long history Highland and its people have demonstrated an enduring ability to adapt, innovate and excel.
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Key Facts & Statistics
Table of Contents
Hospital Statistics
261 Beds
14 Operating Rooms
2 da Vinci® Surgical Systems
32 Emergency Department Treatment Areas
9 Emergency Observation Rooms
11 Primary Care Practices
Quality and Safety
4–9
Patient- and Family-Centered Care
10 – 13
People
14 – 17
Growth
18 – 27
Finance
28 – 33
System/Community
34 – 35
A Look Ahead
36 – 37
Appendix: Additional Quality Measures
Patient Statistics
16,095 Adult Discharges
3,045 Births
71,739 Patient Days
39,393 Emergency Department Visits
11,175 OR Cases
141,524 Primary Care Visits
63,673 Family Medicine Visits
12,144 GAMA Visits
Physicians and Employees
2,553 Employees
1,226 Medical Staff Members
Highland Hospital
Mission & Vision
PAT I E N T E X P E R I E N C E
Key Financial Statistics (projected)
$301,228 Million Operating Revenue
$286,028 Million Operating Expenses
5.1 Percent Operating Margin
Quality &
Safety
Patient &
Family
Centered
Care
People
Growth
Finance
System/
Community
I CARE Values
Integrity
Compassion
Accountability
Respect
Excellence
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Our Annual Report is structured around our six Pillars of Excellence –
quality and safety, patient- and family-centered care, people, growth,
finance, and system/community. These are the core service and
operational elements that we believe are critical in delivering on
our Mission and Vision. As you take this opportunity to review the
highlights from our past twelve months, you will see that it is our
strength and dedication to each pillar – built on a strong foundation
of our I CARE Values – that creates a Patient Experience that truly
differentiates Highland Hospital, our employees and physicians in the
community.
Our Mission, Vision and I CARE Values appear on the back cover of
this Annual Report.
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Quality and Safety
National and local rewards and recognition, core quality measures at or above
national benchmarks and an organization-wide focus and participation in quality
makes Highland Hospital the top performer in the region in the new pay-forperformance world of health care.
“Quality is everyone’s job at
Highland Hospital. Across
our hospital and primary
care offices, the quality of
care we provide directly
impacts the health status of
our patients and the overall
cost of care. Our goal is to
provide the highest levels of
safety and quality of care.
As health care data
becomes more transparent
through regulations, we
wholeheartedly agree that
providing information
about the quality of care we
provide makes the public
better consumers and also
helps us identify areas in
need of improvement. I
invite you to explore these
pages and learn more about
how we engage in safety and
quality care 24 hours a day,
7 days a week, throughout
our organization.”
– Sharon Johnson
Director of Quality
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Recognition in Quality
In today’s competitive world of health care, patients and providers
often look for signs of quality when making a choice. A “seal of
approval” given by a independent, nationally renowned organization
is one way to objectively convey hospital quality and assure the
audience that the hospital meets important health care standards and
clinical measures. Some of Highland’s ongoing recognitions include:
•Certification of our Evarts Joint Center, Gynecologic Oncology
and the Geriatric Fracture Center by The Joint Commission
demonstrates the programs’ continued adherence to nationally
recognized patient safety and quality standards.
Five from Highland Receive Local RBJ Awards
Recipients of Rochester Business Journal 2013 Health Care
Achievement Awards were Mary Eileen Callan (Nursing),
Dr. Raymond Mayewski (Management), Dr. Supriya Mohile
(Senior Care), Dr. Roger Oskvig (Physician) and Tamra West
(Innovation); shown in order.
•Highland has the only ICU in Rochester to earn the Gold-Level
Beacon Award and among only three in New York State.
•Our Acute Care for the Elderly (ACE) unit is the only resource
of its kind in the region.
•Highland has been granted Magnet® status since 2011 for
providing the best in nursing care and professionalism in
nursing practice.
New National Honors this Year….
Highland Hospital received Advanced
Certification from The Joint Commission
for Palliative Care by demonstrating
compliance with rigorous national quality
standards, clinical practice guidelines, and
performance measurement activities.
A new national project – The Primary
Care Team: Learning from Effective
Ambulatory Practices (LEAP) –
named Highland Family Medicine
as one of 30 exemplar practices
for its innovative, team approach
to patient care.
Highland Hospital has been listed by U.S. News and World Report
as one of the best hospitals in Western New York for 2013-14. The
regional rankings also recognized Highland for the high quality of its
services in six specialty areas, including Ear, Nose and Throat, Gastroenterology and GI Surgery, Geriatrics, Gynecology, Orthopaedics, and Pulmonology.
Highland Hospital has been designated an
Aetna Institute of Quality ® Orthopedic
Care Facility for total hip and knee
replacement. With this designation Aetna
assists its members in making informed
health care choices and conveys that our Evarts Joint Center has consistently delivered evidence-
based, safe care.
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Quality
is everyone’s job.
Magnet®
Joint Commission Certification
Department of Nursing
Evarts Joint Center
Geriatric Fracture Center
Gynecologic Oncology
Palliative Care
ASGE Quality Recognition
Highland Endoscopy Center
Center of Excellence
Bariatric Surgery Center
Center of Excellence
Radiation Oncology
NICHE Nursing
Accreditation
Acute Care for Elders (ACE) Unit
Center of Excellence
Highland Breast Imaging
Gold-Level Beacon Award
for Excellence
Intensive Care Unit
Designated Stroke
Center
Aetna Institutes
of Quality®
Evarts Joint Center
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Quality and Safety
Quality Counts in Pay-for-Performance
Clinical process of care measures are specific sets
of guidelines in the treatment of common and costly
conditions: Acute Myocardial Infarction (Heart Attack),
Heart Failure, Pneumonia, and the Surgical Care
Improvement Program. These quality measures are
important because research has shown that following these
guidelines leads to significantly better outcomes for our
patients. Shown to the left are the composite quality scores
Highland has achieved over the last two fiscal years.
Part of Highland Hospital’s continuing efforts at improving quality and safety is participation in a national
initiative for public reporting of quality measures promoted by organizations including the Centers for
Medicare & Medicaid Services (CMS) and The Joint Commission.*
See the Finance section of this Annual Report to see how these measures also impact reimbursements.
Heart A(ack (Acute Myocardial Infarc6on) Heart Failure higher is be)er higher is be)er 100 95 90 85 80 100 Highland does not meet the minimum number of cases required for calcula@on of this measure FY1Q12 2Q12 3Q12 4Q12 1Q13 2Q13 3Q13 95 90 85 80 Pneumonia 100 95 95 90 90 85 85 3Q12 4Q12 1Q13 4Q12 1Q13 2Q13 3Q13 higher is be)er 100 FY1Q12 2Q12 3Q12 Surgical Care Improvement Program higher is be)er 80 FY1Q12 2Q12 2Q13 3Q13 Highland Hospital 80 FY1Q12 2Q12 3Q12 4Q12 1Q13 2Q13 3Q13 Top 10% Hospitals *See the Appendix for other quality metrics measured by Highland: Preventable Infections, Nursing Sensitive Indicators, and Readmission Rates
6
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Outcome measures reflect the cumulative impact of
the care we deliver by tracking the health status of a
patient after discharge. Readmission (to the hospital)
and mortality (or survival) rates are examples of outcome
measures. Outcome measures can identify specific
areas of care that may require quality improvement and
further investigation. For example, the performance data
to the right supports the importance of our continued
focus on improving heart failure outcomes. It is clear
that our new Heart Failure and Follow-up Clinics are well
aligned with the needs of our patient population.
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CMS Mortality Measures 30 Day Readmission Rate converted to survival rates; higher is be3er lower is be3er Adjusted Expected Actual Rate Rate S
Baseline Performance Achievement Period Period Threshold NaConal Rate Heart A(ack 20.2% 20.1% 17.9% Heart A(ack 84.23% 86.18% 84.77% Heart Failure 20.2% 22.4% 22.9% Heart Failure 84.98% 85.39% 88.61% Pneumonia 17.4% 16.9% 17.6% Pneumonia 85.63% 86.60% 88.18% The adjusted actual 30 day readmission rate is predicted on the basis of our
hospital’s actual performance with its observed case mix and the estimated
effect we’ve had on readmissions based on discharge-level data. The
expected rate is calculated from average hospital performance with case
mixes similar to Highland and the average hospital effect on readmissions.
During this performance period our adjusted actual readmission rates
were below or very close to expected rates in all three areas. Readmission
rates in two of the three areas were better (lower) than the national rate.
The CMS Value Based Purchasing (VBP) program utilizes the survival
rate (by subtracting the mortality rate from 100%) for patients 65 years of
age or greater. During this performance period we showed improvement
in all three measures (baseline vs. performance period) and exceeded the
achievement threshold (the CMS reimbursement break even point) in one
out of the three areas.
100 Percent
Compliant for Flu
Vaccination
We reached our goal of
100 percent compliance in
this year’s flu vaccination
campaign – demonstrating
that protecting our staff,
their families, patients and
visitors is a priority to everyone
at Highland.
7
Quality and Safety
Clostridium difficile (C. diff) 8
lower is be*er FY1Q12 2Q12 3Q12 4Q12 1Q13 2Q13 3Q13 4Q13 Highland Hospital Highland has had no incidences of VAP during this Ame period Our Palliative Care Program and hospice
services combined with curative medical
treatments can help patients live longer and
spend fewer days in the hospital.
Data Collected: Rochester Central Line Associated Blood Steam 1/1/2012 – 9/30/2012 General Highland Infec5ons (CLABSI) lower is be*er Door-­‐to-­‐doc (minutes) 26 26 3.0 74 137 290 378 1% 1% FY1Q12 2Q12 3Q12 4Q12 1Q13 2Q13 3Q13 4Q13 Highland Hospital CDC Mean Unity per 100 procedures per 1000 line days 2.0 Admit-­‐to-­‐floor (minutes) 1.5 1.0 in ED to floor (minutes) Arrival 0.5 Leave without being seen 0.0 183 FY1Q12 2Q1
FY1Q12 High
Hi
CDC Mean CDC M
ean A more efficient ED - how did
we do it?
(www.medicare.gov/hospitalcompare) 195 5.0 1.6 4.0 1.4 1.2 3.0 1.0 0.8 2.0 0.6 1.0 0.4 0.2 0.0 0.0 2Q12 4Q12 3Q12 1Q13 4Q12 2Q13 1Q13 3Q13 2Q13 4Q13 3Q13 4Q13 FY1Q12 FY1Q12 2Q12 3Q12 Highland Hospital Highland Hospital EMERGENCY DEPARTMENT PATIENT FLOW METRICS 2.5 and release (minutes) Treat per 1,000 venAlator days per 10,000 paAent days lower is be*er lower is be*er 2.0 3.0 2.5 1.5 2.0 1.0 1.5 1.0 0.5 0.5 0.0 0.0 NYS Mean Our Hospital Elder Life Program (HELP)
helps reduce delirium that can make it more
difficult for an older patient to recover from
an illness.
More efficient and targeted patient
transfers from Strong Memorial Hospital
and outlying hospital emergency
departments to Highland for the right care,
at the right time, and at the right place.
Central Line Associated Blood Steam Ven5lator AInfec5ons ssociated (PCLABSI) neumonia Clostridium difficile (C. diff) Events per 100 procedures Our new Heart Failure Follow-up Clinic
provides the crucial consultation and
planning services that have been shown to
reduce the likelihood of a readmission to
the hospital.
H
•Root cause forms and analysis completed on all infection cases. •Enabling real-time incident feedback to clinical leaders.
14 12 10 8 6 4 2 0 FY1Q12
•Intensified efforts to reduce blood culture contamination.
•Comprehensive patient safety programs to engage
staff at the unit level.
89 1.6 1.4 234 1.2 1.0 207 0.8 0.6 467 0.4 0.2 3% 0.0 •By revising our triage and intake
processes.
Nosocom
Site Infec5ons State Surgical NaKonal •By implementing treatment
lower is be*er protocols for stroke, hip fracture,
37 28 5.0 pneumonia and syncope.
154 138 145 96 363 274 N/A Target: 2% 2.0 •By taking part in a hospital-wide
1.0 kaizen focused on patient flow
for ED admissions.
0.0 FY1Q12 2Q12 3Q12 4Q12 1Q13 2Q13 3Q13 4Q13 Highland Hospital 4.0 •By rigorous data tracking
and goal setting for staff and
3.0 providers.
Percent Improved onsite home care agency and
social work collaboration ensures the right
assistance is determined and scheduled
before the patient’s return home.
4Q13 Highland ospital NYS Mean •Alcohol-filled
caps Hfor
IV lines/ports on
units
at higher risk.
•Hospital-wide campaigns for hand hygiene and
environmental cleaning.
per 1000 line days Inpatient Pharmacist bedside consults
ensure patients clearly understand what
has been prescribed for their condition or
recovery before discharge.
FY1Q12 2Q12 3Q12 4Q12 1Q13 3Q13 incidence
of CLABSI
throughout
our 2Q13 hospital:
per 1,000 venAlator days We are working hard together to give
patients a safer and higher quality stay,
a faster transition home, and a reduced
likelihood of readmission. Here are just
some of the improvements that we have
made:
Preventable infections such as C. diff bacteria can
spread easily, particularly in hospitals. Although we can’t
prevent this bacteria from entering our hospital entirely,
we launched a number of initiatives this year to reduce
the risk of new infections:
per 10,000 paAent days Better Collaboration And
More Intervention
lower is be*er 2.0 14 12 1.5 10 8 1.0 6 is another common preventable infection that occurs
CLABSI
4 a patient’s central line. In addition to continuing strict0.5 through
2 guidelines
for IV line insertion, we are equipping our staff
with 0 best-practice tools and techniques to further reduce the0.0 Internal Goal FY1Q12 2Q1
High
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Highland’s 2013 Annual Quality and Safety Poster Contest
At Highland Hospital we are committed to providing Patient- and Family-Centered Care to our community. When there is opportunity for improvement or innovation we know
that Highland staff will take ownership and focus on processes and procedures to achieve excellence. This award program allows us to showcase these efforts and recognize
the innovation and improvements made over the past year at Highland. Here are our 2013 winners:
Patient-Centered
Depression Care:
Improving the Detection
and Treatment of
Depression in Low-Income
and Minority Populations
in Rochester.
Honoring Patient
End-of-Life
Wishes:
Advanced Directive
Kaizen Team.
100% 90% 80% 70% 60% 50% 40% Outcomes Pa-ents with Advance MOLST Present for DNR Physician Signature on Direc-ve Order or DNR/DNI MOLST Baseline April 2012 March 2013 Summary: Accurate documentation and communication of
patient end-of-life issues were not always done reliably. The
goal of this kaizen was to achieve 100 percent compliance in
our electronic medical record system (eRecord) for all patients
regarding advanced directive orders and a completed and signed
Medical Orders for Life-Sustaining Treatments (MOLST) for DNR
(do not resuscitate) Only or DNR/DNI (do not intubate) orders.
The Results: More patients making their own decisions
As a result of this kaizen, our patients now have a much safer
and reliable advance directive process. By expressing their
wishes in advance, patients are unlikely to have life-sustaining
interventions performed by medical staff that is contrary to
their wishes. Advance directives also lift the burden of medical
decision-making from families during a very stressful period,
allowing them to spend meaningful time with their loved ones
without the additional stress of making these difficult choices.
# of pa'ents screened # of pa'ent screens and with posi've PHQ score # of pa'ents enrolled in project Mean first PHQ-­‐9 Mean last PHQ-­‐9 6,252 2700/43% 833/30% 16.01 9.44/41% reduc'on Summary: Depression is a major public health problem in Rochester. The prevalence in the
community is approximately 10 percent and is 30-40 percent at Highland Family Medicine (HFM).
Research has demonstrated that most depression in primary care goes undetected and when
detected, is inadequately treated. The goal of this effort was to reduce the level of depression
in the HFM patient population by 50 percent as measured by a self-administered Patient Health
Questionnaire (PHQ-9). This study was funded by a three-year grant from the Greater Rochester
Health Foundation.
The Results: Continuous healing relationships established
This study showed that depression can be reduced through the coordination of intervention,
medication, and counseling. Lives can be changed as the result of productive interactions
between an informed, motivated patient (their family or caregivers) and a prepared, proactive
practice team (primary care provider, therapist, and depression care manager). A continuous
healing relationship benefits both patients and providers – helping to ensure patients get all the
education and support they need while providers pool their time and talent to improve clinical
quality and outcomes more efficiently.
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Patient- and Family-Centered Care
Highland providers, employees and volunteers have demonstrated a deep
commitment to improving the patient experience. Their efforts yielded groundbreaking changes in the way we work and the way patients perceive our care in
2012-2013, as steadily rising satisfaction scores show.
“Patients and families
are looking for an
experience at a hospital
and not simply a service.
We have made great
progress in patient
satisfaction and will see
continued improvement
by focusing on doing
all the right things,
all the time – every
encounter with a patient
or family member is an
opportunity to further
our progress.”
– Kara Halstead
Director of Organization
Improvement and
Physician Liaison
Patient satisfaction on the rise:
Highland patient satisfaction scores have been trending upward for
several years – now exceeding national averages and heading for
national benchmark levels.
Overall Rating of Hospital
Source: HCAHPS –Scores in Hospital Rating domain only
90%
85%
National Benchmark
80%
73%
75%
70%
74%
69%
77%
68% 68%
66%
66%
National Average
60%
‘11
Q1
‘11
Q2
‘11
Q3
‘11
Q4
‘12
Q1
‘12
Q2
‘12
Q3
‘12
Q4
‘13
Q1
‘13
Q2
‘13
Q3
‘13
Q4
Highland uses Press Ganey patient satisfaction surveys in our
Emergency Department; the latest quarterly results show it is at the
80th percentile, well above its 25th percentile ranking from nearly
three years ago.
Open visitation signals our commitment to patients’ comfort:
Highland became the first hospital in Rochester to offer 24-hour
access to visitors in early 2013. Recognizing the importance of family
and friends to the healing process, the hospital updated its visitation
policy to welcome family and friends at any hour of the day, seven
days a week. Under the new policy, patients also can designate an
advocate to stay with them 24 hours a day.
Quiet campaign lowers voices, raises scores: A quiet
environment helps healing and based on publicly reported
data Highland outranks other local hospitals for quietness. This
achievement was made possible by an ambitious, hospital-wide
campaign to reduce noise. The hospital established quiet times
and dimmed lights on units as a signal to staff and visitors;
posters in hallways and table tents in patient rooms publicized the
campaign. Amenities such as earplugs and TV headsets assisted
patients in getting their rest. Nighttime audits by Highland leaders
were an effective way to measure progress and address areas for
improvement.
ED Pa1ent Sa1sfac1on Results Source: Press Ganey 100 90 80 70 60 50 40 30 20 83.7 85.9 84.0 84.5 86.7 87.4 86.5 85.1 88.9 86.0 86.6 83 88.5 80 69 60 50 25 27 32 58 55 50 37 Na:onal Rank (percen:le) Percentile
rank
– Press
Ganey database
Score (%)
10
73% 75%
72%
65%
FY
73%
Some of the most notable patient experience improvements of
2012-2013:
Score (%) Highland’s very effective “SHHH”
campaign – or Silent Hospitals Help
Healing – has made it the quietest
hospital in Rochester as measured
by HCAHPS scores.
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Perioperative Liaison assists patients, staff: Few experiences
are as stressful for patients and families as surgery; the Highland
Surgery Center partnered with Patient Relations to create a new
Perioperative Liaison role. Highland’s Dottie Haelen ensures ongoing
communication between the Perioperative area and family members
while their loved one is in surgery. Assistance from the Liaison helps
expedite a patient-family visit as soon as possible after procedures.
Introduction of the Perioperative Liaison has improved patient, visitor
and staff satisfaction.
Communications on medications helps patient safety,
satisfaction: Highland continues to head toward the national
benchmark for Communications on Medications thanks to the
efforts of the Inpatient Pharmacy team, Nursing and Social Work.
The pharmacy worked with clinical units to develop a standardized
approach to informing patients about new medications. Social
workers identified at-risk inpatients for pharmacists to visit, where
they explained medications and answered questions.
Close communication
with at-risk patients
about their medications
before they’re discharged
from the hospital is
designed to improve
patient safety and
clinical outcomes, while
reducing preventable
hospital readmissions.
Continued focus on communications with patients: Highland has been
a leader in patient-friendly practices such as bedside shift report, where staff
share updates with each other and the patient; physician/nurse rounding
to anticipate needs and proactively address them; and discharge phone
calls to check on patients’ well being and their satisfaction. As a result,
Communication with Nurses has improved from 76% of patients saying
“Always” in FY11 to 82% in FY13. In the same time period, Communication
with Doctors has improved from 82% “Always” to 84%.
Highland began Pathology Rounding in 2012-2013; Chief of Pathology Julietta Fiscella visits patients
accompanied by Vice Chief of Medicine Bilal Ahmed, M.D., giving patients the opportunity to see their
Laboratory results, ask questions and share concerns. The effort to improve patient-physician communication
earned international recognition in September 2012, when Dr. Fiscella’s abstract was accepted at the
European Association for Communication in Healthcare at St. Andrews University in Scotland.
11
Patient- and Family-Centered Care
Helpful Phone Num
bers
Local telephone
calls
dial “9” then “0” are free of charge. To make a long-d
to reach an outsid
istance call,
e operator.
Patient education
Calling from Outsid
e
Highland Hospit
al
341-6711
Administration
Admitting
341-6278
341-6536
Business Office
Cashier
ext. 16278
Following an update of its patient welcome
video in 2012, Highland sought to improve
the information packet shared with every
inpatient on admission. Marketing and Public
Relations teamed to create a first-of-itskind booklet that puts helpful information
at patients’ fingertips. Streamlining the
design of the packet has reduced printing
and assembly costs by 50% despite the
introduction of full-color, glossy pages.
The new packet has been well received by
patients and staff members.
Chaplain
Ethics Consultation
Services
Food Services
Gift Shop
Highland Foundation
Housekeeping
Library
Nursing Administratio
Parking Questions
Patient Information
Patient Meals
n
341-8040
341-0860
ext. 16761
ext. 16766
341-6766
341-6501
ext. 16870
ext.37951
ext. 10677
341-0677
341-0699
Pharmacy
s
ion Services
Hospital Gui
delines
ext. 16501
ext. 16833
473-2200
Security
Social Work Service
Video Welcome
on Channel 43
ext. 18040
ext. 10860
ext. 18054
341-6833
341-6870
Patient Relations
Telephone & Televis
ext. 10025
dial 0
ext. 37984
ext. 37943
341-8054
341-6761
Medical Records
What You
to Know Du Need
Your Hospital ring
Stay
ext. 16536
341-0025
341-6890
341-6718
473-2200
ext. 10699
ext. 17378
341-6833
341-6718
Services for You
and Your Fami
Inside front and ly
back covers.
Keeping You
Safe
Page 4
ext. 10004
Managing Your
Pain
Page 6
Your Rights as
a Patient
Page 8
Visitation, Insur
& Financial Info ance
Page 10
Preparing to
Go
(Discharge Instru Home
ctions)
Page 11
585.473.2200
www.HighlandH
ospita
l.org
A Typical Day
in the Hospital
Page 12
What Happens During a Day
in the Hospital?
There’s no such thing as a “typical” day at Highland, because
every patient is different and we work around the clock to meet
each patient’s specific needs. But there are some care practices
and patient services that you’re likely to see in the course of
every day.
As a hospital providing 24-hour a day care, we have three
traditional shifts of patient care workers: Day (7 a.m. – 3 p.m.),
Evening (3 p.m. – 11 p.m.) and Night (11 p.m. – 7 a.m.).
*Please note that some staff work longer shifts: 7 a.m. – 7 p.m.
or 7 p.m. – 7 a.m.
Our goal is to deliver the highest-quality clinical care, with great
respect and compassion, always. We welcome patients and
their families as part of the health care team. Communication
between you and your care team is vital
to your well-being; that’s why we
use whiteboards at each patient
bedside to continuously share
important information with
you and your loved ones.
Your whiteboard will be
updated several times
each day with the
Nurse Assessment: A nurse will come to provide any
medications and/or treatments that have been ordered for you
by your physician, as well as complete their assessments and
check your comfort. A nurse or patient care technician may
check your vital signs at this time.
Bathing: Every morning, a patient care technician or nurse will
assist you with washing up. Depending on your condition and
mobility, you may be offered a sponge bath in bed or a shower.
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We CAR E
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names of care team members for each shift, the daily goals for
your care and activity, medications you are taking to control
pain, and more.
Throughout the Day
Visits from Your Care Team: You will be visited each day
by any or all members of your care team, which can include
physicians, nurses, patient care technicians, medical residents,
consulting physicians, physician assistants, nurse practioners
and physical/occupational/speech/respiratory therapists. An
attending physician leads the team and oversees all aspects
of your care during your stay with us. A member of our
Environmental Services Team will visit your room each day to
clean it and empty your waste basket. If you need additional
services at any time of the day please dial ext. 17378
from 8 a.m. – 4:30 p.m.; after these hours
please dial”0”. Below is a listing
of some daily hospital
activities; times are
approximate.
Morning
Morning Shift Report: Shift report will take place at 7 a.m.
or 3 p.m. each day. Nurses leaving their shift meet with nurses
coming on duty to communicate important information about
each patient. They’ll discuss your medical status, your care plan
and any concerns that the nurse coming on shift should watch
for. As often as possible, nurses meet right at your bedside and
invite you to be part of the conversation if you are awake.
Small changes make a big impact on satisfaction: Throughout the year, staff
members initiated creative, thoughtful ways to improve the care and comfort of
patients. Staff on East 5 implemented a photo ID system – each nursing staff member
posts a photo with their first name on patient doors to help families identify the
people caring for their loved ones. East 7 and West 6 staff launched walking programs
to help patients get up and get moving – signs posted around the units tell patients
how far they’ve walked and offer encouragement. The extra exercise improves
patients’ health and their confidence as they prepare for discharge.
Praise for work well done: Meaningful recognition rewards excellence, helps
reinforce organizational goals and inspires everyone to greater achievement. In
2012, Patient Relations designed a comprehensive new recognition program that
includes everyone who can make a positive difference for patients and families: not
only physicians and employees, but also clinical units, supporting departments and
ambulatory sites. The quarterly honorees are prominently featured in employee and
physician communications to highlight their contributions. Highland’s Shining Example
program is an important component of its recognition program; leadership hosts
bi-monthly Shining Examples luncheons for individuals who have been nominated by
patients, families or their peers.
ext. 16718
341-0004
Highland Hosp
1000 South Avenu ital
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Rochester, NY 14620
Patient Admi
ssion
Packet
Calling from Inside
Highland Hospit
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ext. 16711
Breakfast is served between 7:30 a.m. and 9:15 a.m.
Tests, Treatments: You may be transported off your unit
for any tests or treatments that your physician has ordered.
Scheduled tests and treatments typically occur during the day
between 8 a.m. and 5 p.m.
Focus On Outpatient Satisfaction
Midday
Evening
Nighttime
Lunch is served between 11:30 a.m.
and 1:30 p.m.
Quiet Time: All units in the hospital
have set aside quiet times to help
patients get their rest. At 8 p.m., the
entire hospital begins “quiet time” –
lights dim on patient units to signal
the start of quiet time. We partner with
patients and families to help ensure
a quiet environment: we ask staff
and visitors to keep voices low, and
to conduct cell phone conversations
in specified areas on units. To help
patients sleep, we provide sleep masks,
headphones and ear plugs upon
request.
Nighttime Patient Care: Because rest
is so important to recovery, staff will
try to group their care duties (vital sign
checks, assessments, medications) to
minimize interruptions to your sleep at
night.
Midday Nursing Assessment: Most
patients have a nursing assessment
every four hours, so you will see a nurse
several times during the day.
Tests, Treatments: You may also have
scheduled tests or treatments in the
afternoon.
Rounding: Each hour, a member of your health care team
will stop in to check on you. They’ll ask if you are comfortable,
if you need help repositioning in your bed, if you need to use
the bathroom, or have any other requests.
Shift Report typically occurs at 3 pm
or 7 am each day.
Room Cleaning: A member of our Environmental Services
team will visit you in the morning to service your room: this
includes cleaning the bathroom, emptying your trash, cleaning/
sanitizing any areas of your room as necessary. Before leaving,
this team member will ask if you have any other requests.
Environmental Services Check:
A member of our Environmental
Services team will visit your room in
the afternoon to check on the room
condition, clean as needed and ask if
everything is satisfactory.
Dinner is served between 4:45 pm and
6:30 pm
Highland joined the Medical Center’s
implementation of a new outpatient visit
satisfaction process in July 2013. Paper surveys
and the “eSurvey” online tool will enable
Highland to gather and track data on patient
satisfaction with their providers and clinics.
The federal government will begin reporting
on the outpatient experience via “CGCAHPS”
in the near future; the data Highland collects
on outpatient satisfaction now enables the
hospital to proactively identify areas for
improvement and take action.
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The poster, to the right, helps patients at Highland outpatient
clinics understand and participate in the new survey process.
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HCAHPS includes eight “domains” to assess the patient’s perception of their
experience. Hospitals are scored on the percent of patients who say the hospital
“Always” met their expectations in these areas.
alue Based Purchasing took effect in FY12, establishing a national
V
measurement for hospitals’ performance in clinical quality as well as patient
satisfaction. In the first performance year, the VBP score was calculated by
hospitals’ adherence to Clinical Process of Care measures (70% of the score)
and HCAHPS patient survey results (30% of the score.) In FY13, the scoring
formula became more rigorous as clinical outcomes were added.
The latest HCAHPS results show Highland:
•Is above the national average in all HCAHPS domains.
•Has raised its scores in all but one HCAHPS domains since FY2012.
To measure inpatient satisfaction, Highland uses HCAHPS (Hospital Consumer
Assessment of Health Care Providers and Systems) patient survey results.
HCAHPS Results
FY
2011
FY
2012
FY
2013
NationalNational
AverageBenchmark
Overall Rating of Hospital
67%
72%
74%
66%
83%
Communication with Nurses
76%
80%
82%
75%
85%
Responsiveness of Hospital Staff
57%
63%
65%
62%
78%
Communication with Doctors
82%
83%
84%
79%
89%
Pain Management
69%
71%
73%
69%
78%
Communication on Medications
60%
66%
67%
59%
70%
Discharge Information
88%
89%
89%
82%
89%
Cleanliness & Quietness of Hospital
Environment
56%
62%
64%
63%
78%
The chart above shows HCAHPS results for Highland since FY2011. The scores show the percentage of patients who said Highland
“Always” met their expectations in these domains.
13
People
Highland is a great place to work that just keeps getting better. Following a very
positive employee survey in 2011, hospital leadership redoubled efforts around
workplace satisfaction in a two-year campaign that reached every work group and
employee in the organization. The result: improved workplace engagement and
satisfaction as demonstrated in Highland’s exceptional 2013 survey results.
“Highland and its people
are building a dynamic
workplace where employees
feel a deep connection to the
hospital’s mission and are
inspired to deliver excellence
in everything they do. We’ve
created unique new training
programs and career paths
to help our people develop
their talents and find great
satisfaction in their work.
Their ideas, energy and
achievements contribute to
Highland’s progress.”
– Kathy Gallucci
Chief Human Resource Officer
Employee satisfaction climbs: The hospital’s
2011 engagement survey placed the hospital
in the 79th percentile, better than the
national health care average and better than
the benchmark among University Hospital
Consortium member hospitals. Highland raised
the bar – and its employee engagement –
with two years’ worth of employee-centered
initiatives around career development, workplace
wellness, pay/benefit information and employee
communications.
The results of these efforts were evident in
Highland’s June 2013 employee engagement
scores. Highland showed impressive gains
at a time when hospitals nationwide are
struggling to maintain employee satisfaction
levels: Highland ranked in the 83rd percentile
in 2013 compared to the 79th percentile in
2011. It achieved a 96% survey participation
rate – more than 20 percentage points higher
than the national average and better than its 88
percent participation in 2011. Employees’ overall
Commitment Indicator Score held steady at 4.36
out of a total score of 5.
The survey showed national benchmark-level
results in key questions that relate to employee
commitment to Highland. Employees responded
positively to questions such as “I am proud to
tell people I work for Highland Hospital,” “I
would recommend this organization as a good
place to work,” and “My work unit provides
high-quality care and service.”
2013 Employee Engagement Survey Results 2011 Highland 2013 Highland NaAonal Healthcare Avg. 4.40 4.30 4.20 4.36 4.36 4.24 4.21 4.10 4.23 4.23 4.22 4.19 4.13 4.09 4.00 4.09 4.05 4.03 4.01 3.96 3.90 3.92 3.80 3.70 Commitment Indicator Employee Manager OrganizaAon Highland’s 2013 employee engagement survey shows the hospital is above the national health care average and the average
among its peer hospitals in the University Hospital Consortium. Highland employees’ “commitment indicator” – their
overall feeling about working at Highland – held steady at 4.36 out of 5, placing the hospital in the 83rd percentile for
350 hospitals nationally. Other domains, above from left, measure how satisfied employees are with their fellow employees,
their immediate manager and the organization. In each domain, Highland employees were well above the national health
care and UHC averages in both 2011 and 2013.
Highland achieved a 96 percent survey participation rate –
compared to the national average of 74 percent – thanks
to communication efforts before the survey and prizes for
participation. Here, Chief Human Resources Officer
Kathy Gallucci surprises an employee with her recognition
for taking the survey.
14
NaAonal UHC Avg. R
Highland’s culture is one of its greatest assets. The hospital has
created a unique and energizing workplace culture with these and
many other initiatives:
New opportunities for professional development: In 2012
Highland implemented a career ladder/career track program that
created opportunities for promotion in six departments –
Environmental Services, Transport, Nutrition Services, Sterile
Processing, the OR and Patient Care Technicians. Nearly 40
employees qualified for promotion under the new career ladder
program. The hospital plans to expand the career opportunities to
other departments in 2013-2014.
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New wellness benefits: Workplace wellness
supports employee satisfaction and productivity
while reducing costs associated with absenteeism. To
help employees proactively address potential health
risks, in January 2013 Highland began offering
biometric screening, left. It is a free annual health
evaluation that gives employees their cholesterol and
blood glucose levels, vital signs and body mass index.
Additional Pay Information/Resources
Tech University
Program
An all-new approach to training: Highland also launched
“Tech University,” an innovative, paid training initiative. Tech U gives
employees with no patient care experience an opportunity to become
a Patient Care Technician (PCT). Highland graduated its first class of
four PCTs in November 2012; six more employees, above, graduated
in June 2013.
To help employees make the most of the
benefits Highland offers, Human Resources
developed “For Your Benefit” in 2012. The
monthly newsletter offers advice on topics such
as health insurance, disability and retirement.
HR also offers regular free education sessions
on financial planning to staff. In January 2013,
employees gained valuable new financialmanagement tools when Highland introduced
electronic pay stubs and W2 forms, giving
employees secure, convenient online access to
their salary information.
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People
Team-based work improvements
Highland departments that identified areas of opportunity in workplace
satisfaction in 2011 focused on making positive changes. Regular visits by
senior leaders at departments’ monthly staff meetings gave employees
the opportunity to raise issues and share feedback. For the past two years,
Highland senior leadership supported department leaders as they worked
with employees to develop and implement action plans for improvement.
By focusing on positive leader-employee communication, work process
improvement and staff empowerment and recognition, several teams made
impressive progress. Their results helped inspire an employee communications
campaign called “Making It Work @ Work.”
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“Making It Work @ Work” launches: This new
employee communications program launched
in March 2013 to showcase Highland’s positive
work culture and give employees wider access to
information. A new Internet page was created to
package an expanded communications portfolio.
The web site includes department success
stories, which profile teams’ progress in improving
workplace satisfaction; I CARE videos, which
feature individual employees describing their work
and how it connects to Highland’s overall mission;
and monthly video news reels that highlight
key achievements at Highland. The launch of
Making It Work @ Work generated significant
web traffic – 486 visits in the first week. The
communications continue to draw staff interest:
for example, I CARE videos that post to Highland’s Facebook
page twice a month reach from 400-650 viewers per video.
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Continuous, open communication: Highland offers many opportunities for
employees to have face-to-face communication with leadership. Senior leaders host
evening and overnight dinner forums each month so staff can come by and enjoy a
meal and conversation. CEO/President Steve Goldstein and VP/COO Cindy Becker hold
Town Hall meetings for physicians and staff three times a year to share organizational
progress and a preview of what’s ahead for Highland.
16
In the past year, staff have had many reasons to celebrate a work culture that is
uniquely Highland. Examples include:
“Art Takes Flight” soars: A good idea – to make Stairwell B more pleasant and
conducive to exercising – blossomed into an inspired art project from September
to December 2012. Two talented local artists spent weeks painting murals in the
hospital’s stairwell. Their creation tells Highland’s story and our I CARE Values in high
style, and surely encourages more staff to skip the elevator and take the stairs.
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Pride Week draws a crowd
A new coffee house gives staff a “buzz”: Employees and visitors waited
patiently for Highland’s new coffee house to open in February 2013. Pre-opening
events kept the anticipation building: more than 100 employees showed up for
a coffee tasting to choose the vendor, below, and some 170 participated in the
contest to name the new shop. An ICU employee came up with a name that fits
the hospital perfectly: “Grand Grounds.”
Pride Week is an annual Highland tradition to recognize individual and
team achievements in quality improvement and the patient experience.
The June 2013 program was more popular than ever, judging by event
attendance as well as Intranet and Facebook traffic. Seven Pride Week
Facebook posts reached 5900 people and generated 178 likes. There were
5300 views of Pride Week Intranet pages, a 303% increase in unique page
views compared to Pride Week 2012.
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Growth
Leading the community in women’s and geriatric health care, marketing centers
of excellence in joint replacement and bariatric surgery, welcoming several
new chiefs to reenergize departments, $15.4 million in facility renovations and
improvements – we’re growing!
“This past year Highland saw
growth in ways that weren’t
always apparent. There were
no cranes, no digging up the
ground and no outward signs
the hospital was growing –
but growth is all around us.
Since 2010 Highland has
recruited more than 60
physicians in specialties such
as orthopaedics, cardiology,
breast surgery, women’s
services, endocrinology and
geriatrics. These physician
recruitments help us with
one of our long-term goals, to
build transfers to Highland
from throughout the region.
We’ve also renovated and
innovated amenities and
technologies around the
hospital to honor Highland’s
commitment to patientand family-centered care
and excellence in health
care – and raised the bar for
health care in the region once
again.”
– Dr. Raymond Mayewski
Chief Medical Director
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Growth at Highland comes from many places – development of our clinical programs and staff, improving the efficiency of our procedures
and processes, renovating and expanding our service locations, and investing in state-of-the-art the technology – allowing us to deliver the
highest level of quality care to our patients. Yet, above all, our growth truly depends on meeting the needs of the population that surrounds
us. It is clear from our year-over-year growth in many key patient volumes that Highland continues to offer the right programs, services and
quality to draw an ever-increasing number of patients through our doors.
Below are just a few key patient volumes demonstrating that Highland continues to deliver true value to patients and physicians in our
community, and beyond.
Key Pa2ent Volumes FY13 Actuals and Percent Change from FY12 Adult Discharges 16,095 -­‐0.5% 3,894 18.0% Medical Observa:on & Short Stay Births Emergency Department Visits OR Cases Adult Pa:ent Days (ALC incl.) Average Length of Stay (ALC excl.) 3,045 3.6% 39,393 2.2% 11,175 3.8% 71,739 2.7% 4.2 5.0% The relatively flat growth in adult discharges was the result of increased surgical activity, offset by a shift in medical patient
volume to outpatient medical observation status. This is primarily the result of pressure from third-party insurers and reduces
reimbursement to the hospital. Highland has added a dedicated Medical Observation Unit to accommodate many of these
patients more efficiently and to ease the volume in our Emergency Department.
Gillian Sullivan RN, BSN, BC, ED
Observation Unit Nurse says goodbye to a
patient as they prepare for discharge.
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Outstanding Clinical Programs Enable Growth
Women’s Health Services
New Highland Women’s Health at South Ave.: A new OB/GYN practice opened
in our Professional Office Building and is well-underway to filling the practice with
new patients.
Orthopaedics
Welcomes a new chief: Catherine Humphrey, M.D., an orthopaedic surgeon is
named Chief of Orthopaedics and brings her expertise in trauma fracture services to
Highland.
Remaining a regional leader: Highland continues to be the regional leader in
No end in sight for growth: Since the Evart Joint Center’s opening in 2005, the
demand for the expertise of our orthopaedic surgeons continues to grow dramatically.
We project 11 percent growth in hip and knee replacements over the next five years
due to double digit growth in the 65 year and older population.
obstetrical
and gynecologic
services. Our physicians perform the
Key Indicators of Gdeliveries
rowth FY12 oncology FY13 highest volume of gynecologic surgical cases in the state and a growing number with
the Rrobotic
da Vinci Surgical System.
Hip: Total eplacements/Revisions 515/62 ®
528/65 to a community in need:
Highland732/65 Breast Imaging at the Anthony Jordan
Knee: TOutreach
otal Replacements/Revisions 692/55 Health Center opened for business offering mammography as well as general X-ray
services to a vulnerable and often under-insured population.
Key Indicators of Growth FY12 FY13 Births 2,938 3,045 Gynecology/Oncology Inpa=ent 540 588 da Vinci® GYN & GYN/ONC Surgeries 529 644 Mammography Screening Exams 8,345 8,544 OB/GYN/Midwifery Clinic Visits 15,343 15,587 Grateful
One of the first
patients to receive
a mammogram at
our new facility at
Anthony Jordan
Health Center.
Prestigeous recognition and reward: The Joint Commission’s Gold Seal of
Approval™ was once again bestowed upon the Evarts Joint Center as well as the new
honor of being recognized by Aetna Institutes of Quality®. Both organizations perform
a thorough review of surgical volumes, quality, and clinical outcomes while also taking
into consideration patient satisfaction survey results.
Key Indicators of Growth FY12 FY13 Hip: Total Replacements/Revisions 515/62 528/65 Knee: Total Replacements/Revisions 692/55 732/65 Doug’s Story
Doug was highly
active – playing
Key Indicators of Glacrosse,
rowth FY12 FY13 2,938 3,045 540 588 529 644 Mammography Screening Exams 8,345 8,544 OB/GYN/Midwifery Clinic Visits 15,343 15,587 running triathlons and leading exercise
classes. ButBirths arthritis threatened to take
away all the things he loved. Watch how
hip resurfacing
put Doug back in the game
Gynecology/Oncology Inpa=ent at: www.joint.urmc.edu
da Vinci® GYN & GYN/ONC Surgeries 19
Growth
Geriatric Health Services
GAMA team has grown: Our Geriatrics and Medicine Associates (GAMA)
practice has welcomed additional providers and staff, including an endocrinologist,
otolaryngologist, geriatrician, diabetes nurse practitioner and case manager. With
more specialists at GAMA, patients can be seen for many of their needs in one
convenient location.
Striving to be a patient-centered medical home: GAMA has received a $100,000
grant to hire a case manager and develop our attending and resident practices into
a PCMH with the goal of achieving NCQA Level 3 certification – better preparing the
group for the pay-for-performance future of health care.
Helping to prevent delirium: Highland introduced the Hospital Elder Life Program
(HELP) to assist in preventing delirium in hospital patients. Volunteers visit with at-risk
patients to help keep them as mentally and physically active as possible.
Addressing cancer in the elderly: Highland opened a Geriatric Oncology Clinic
head by Supriya Mohile, M.D.– one of just a handful of geriatric oncologists
nationwide. She states for “…older patients, cancer impacts their lifestyles much more
dramatically, starting with the day they’re diagnosed.”
Key Indicators of Growth FY12 FY13 GAMA Visits 9,059 12,144 444 436 Key Indicators of Growth FY12 Bariatric Case Volume 634 FY13 What is a Patient-Centered
Medical Home (PCMH)?
647 A model of care in which providers
Geriatric Fracture Center Cases Bariatric Seminar A7endees 20
1,453 Bariatric Surgery Center
Remaining a regional leader: Highland remains the market leader in bariatric
surgeries for Monroe County and continues to expand its market reach to draw
patients from the surrounding counties.
Engaging our patients – past and future: Our Bariatric Facebook page, Monarch
support group and informational seminar attendance continue to grow in size and
reach
across othe
region.
Key Indicators f Growth FY12 FY13 Addressing life after weight loss: The bariatric program has expanded to include
9,059 12,144 the Life After Weight Loss Program. This multidisciplinary program aims to meet the
body contouring
needsCases of patients
who have436 changed their lives through significant
Geriatric Fracture Center 444 weight loss.
GAMA Visits Key Indicators of Growth FY12 FY13 Bariatric Case Volume 634 647 1,453 1,489 Bariatric Seminar A7endees AMA opens the door to better care
This year the American Medical
Association declared that obesity is a
disease that requires medical treatment
and prevention. This change will deliver
patients and providers a new set of
resources to stay healthy.
collaborate effectively to deliver
1,489 preventive care and the right
combination of medical treatment
to patients, keeping them healthy
and reducing the need for
emergency care or hospitalization.
R
Surgery
A growing team of experts: Over the last year our Surgery
Department has added 10 new surgeons with specialties in general,
breast, colorectal, otolaryngology, orthopaedics, plastic and thoracic
surgeries.
The best choice for breast surgery: Highland’s two new breast
surgeons combined with our new surgical suites and dedicated women’s
inpatient unit makes Highland a natural choice for breast surgery.
A new dimension in minimally invasive surgery: Highland surgeons
have begun training and performing single-port robotic surgery using the
da Vinci® Surgical System reducing the required incisions from as many as
six to just one – less than one inch in length.
More on SinglePort Surgeries
In traditional
laparoscopic surgery a
telescopic rod is inserted
through a small incision
in the abdomen and up
to five small incisions
are used as “ports” for
instruments. Singleport surgery leaves little
to no scarring and may
reduce complications
that commonly occur
after more traditional
surgeries. Patients
report less discomfort
and faster recovery
compared with those
undergoing traditional
laparoscopy.
Key Indicators of Growth FY12 FY13 Total Outpa*ent Surgeries 4,927 5.233 Total Inpa*ent Surgeries 5,842 5,942 102 121 da Vinci® General Surgeries E
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Medicine
Cardiology doubles volumes: Office visits have more than doubled since 2008 – from 3,288 office
visits to 7,638 in 2013. New consults have grown from 557 to 1,301 over the same time period.
New heart failure services offer treatment and reduce readmissions: Highland has opened an
eight bed Heart Failure Center as well as a Follow-Up Clinic in the Cardiology Department. Studies have
shown that meeting with a cardiologist within 72 hours after discharge to discuss medications, diet, and
an individualized treatment plan reduces the rate of readmission after heart failure.
Filling a need in endocrinology: Laticia Valle, M.D., has joined Highland’s Department of Medicine
as an attending physician, specializing in endocrinology. This is welcome news to Rochester as there
is a serious shortage of endocrinologists in the city and the surrounding region. A particular focus
will be given to enhancing our gestational diabetes services as well as expanding awareness of our
Diabetes HealthSource programs to more physicians and their patients.
Palliative care growth and recognition: Four physicians and a nurse practitioner have achieved
certification and recertification in hospice and palliative care to enhance the quality of the hospital’s
growing Palliative Care Program. In the true spirit of teamwork, our palliative care team – physicians,
nurses, social workers, pastoral services, pharmacists, physical therapists, and dieticians – also helped
Highland receive Advanced Certification from The Joint Commission for Palliative Care.
The best care in gastroenterology: Gastroenterology services at Highland are performed by the
area’s finest and largest group of experts. Our Highland Endoscopy Center has been recognized for
a second time by the American Society for Gastrointestinal Endoscopy. Recognition is granted for a
three year renewable period.
Key Indicators of Growth Cardiology OP Procedures/Studies Pallia<ve Care Consults FY12 FY13 34,016 38,226 389 416 Why a Focus on Gestational Diabetes?
About 2 to 5 percent of women develop gestational diabetes during their pregnancy.
If untreated, the high levels of sugar circulating in the mother’s blood can put her at
increased risk of blood pressure problems, infections, and other associated complications.
The baby is also at increased risk for cardiac problems, prematurity and stillbirth.
By enhancing our gestational diabetes program we can better ensure a healthy pregnancy
and a healthy start for mother and baby.
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Growth
Neurology
Welcomes a new chief: Dr. Adam Kelly, M.D., a community leader in stroke care and
the Director of Highland’s Stroke Center is named interim Chief of Neurology.
Recognized by the American Heart Association: The hospital has earned the
AHA’s Gold-Plus Award twice in two years. The distinction is the highest honor of its
kind and recognizes Highland’s commitment and success in implementing excellent
care for stroke patients.
New equipment to measure brain waves: New video electroencephalogram (EEG)
monitoring equipment was purchased to better assist in detecting abnormalities in the
electrical activity of the brain.
Neurosurgery
Geriatric neurosurgery: A service well suited to Highland’s patient population.
Older patients can suffer from normal pressure hydrocephalus – fluid buildup on the
brain that creates symptoms that resemble dementia. For patients with this condition,
surgery can relieve the pressure on the brain and relieve symptoms.
Active in the community: Our Neurosurgery and Neurology providers play a key role
in the Stroke Treatment Alliance of Rochester (STAR), a collaborative effort of our four
local hospitals to improve stroke care throughout the community.
Key Indicators of Growth FY12 FY13 Neurosurgeries 846 852 Neurology Consults 510 528 Use the F.A.S.T. Test
Family Medicine/Primary Care
Reaching out to our youth: Our Highland Family Planning Facebook campaign grew
our ‘Likes’ from 91 to 1,142 in just three months. Social media allows us to better
spread the word of our affordable and confidential birth control and reproductive
health services to teens and young adults throughout the community.
Recognized for excellence: Highland Family Medicine is currently working toward
renewal of their NCQA Certification as a Level 3 Patient-Centered Medical Home
and, in late 2012, renewed their recognition status with NCQA’s Diabetes Recognition
Program.
Grants to reduce admissions and emergency department visits: Highland
Family Medicine received a grant entitled “Transforming Primary Care Delivery: A
Community Partnership” and is one of just fifteen practices selected to participate in
this innovative project in its inaugural year.
Commitment to education: We have added a Sports Medicine Fellowship and Deaf
Health Pathway certificate program to the Medical Education component of Family
Medicine. These programs provide additional courses, electives, activities, and projects
over the four years of medical school for those students with interests in serving these
populations.
Did you know?
Rochester has one of the highest percentage of deaf
residents enrolled in higher education. Our Deaf
Health Pathway helps prepare the next generation
of physicians to better serve them.
If you think you or someone you know is having a stroke.
Face: Ask the person to smile. Is the face lopsided?
Arm: Ask the person to raise arms. Does one arm drift down?
Speech: Ask the person to repeat a phrase. Does their speech
sound strange? Can they do it without slurring words?
Time: Don’t waste it. Call 911 now.
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Key Indicators of Growth FY12 FY13 Family Medicine Visits 61,575 63,673 Primary Care Visits 150,193 141,523 R
Radiation Oncology
Welcomes a new chief: Hong Zhang, M.D., Ph.D., brings her skills as a physician,
researcher, and community volunteer to her new role as Highland’s Chief of Radiation
Oncology.
Creating a more accessible and relaxing atmosphere: We recently began a $2
million renovation to our patient entrance, waiting and hallways at our Highland
Hospital location. This project was partially funded by proceeds from the 2013
Highland Hospital Gala, an annual fundraising event.
Upgraded treatment equipment for more precise care: We’ve updated our
linear accelerators at our Highland and Sands Cancer Center locations and are looking
forward to adding new CT simulator capability to these locations in the coming year.
This will allow more highly customized radiation treatments where higher doses are
directed at the tumor while sparing the patient’s normal body structures.
Key Indicators of Growth Radia%on Oncology Procedures New Radia%on Oncology Pa%ents FY12 FY13 28,855 28,301 687 724 E
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Emergency Medicine
New geriatric-friendly emergency department: New protocols and physical
changes have made our Wolk Emergency Department (ED) the first geriatric-friendly
ED in the region with specially trained staff and rooms that increase comfort and help
prevent falls and delirium for our older patients.
Remaining a regional leader: Highland Highland is well ahead of our competition
for timely care in our ED with the shortest process times for: door-to-doc, admit-tofloor and ED-arrival-to-floor.
Upholding patient satisfaction: Our patient satisfaction scores have remained
steady despite remarkable growth in ED volumes. Our steady performance in 2013
was fueled by decreasing the average length of stay, reducing the number of patients
leaving without being seen and our very successful Take a Seat campaign – ED
physicians now sit ‘eye-to-eye’ while discussing a patient’s situation, conveying their
focused attention on the patient.
Key Indicators of Growth FY12 FY13 Emergency Department Visits 38,554 39,393 ED Observa:on Volume 2,193 2,245 Volume includes all three locations.
The soothing sounds and images of nature…
Service from East to West
In addition to our location at our hospital,
Highland also provides radiation oncology
services at the Cancer Center at Park Ridge in
Greece (on the Unity Hospital campus) and at
the Sands Cancer Center in Canandaigua (on
the F.F. Thompson Hospital campus).
A digital cinema window – just one way we are improving the
patient and visitor experience in our ED Observation Unit through
a generous gift from Dr. and Mrs. John M. Bennett.
Medical Observation Unit
New medical observation unit helps get patients home faster: In March 2013,
Highland opened a ten bed Medical Observation Unit on West 6 in response to a
growing number of observation cases. Consolidating these patients in one location
allows us to deliver more efficient and focused care to patients who require shortterm tests or treatment – getting them better and back home faster.
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Growth
Improved Processes Enable Growth
Highland’s Process Improvement strategy concentrates on creating greater efficiencies and reducing waste in every facet of our operations through our people and teamwork.
The success of these efforts will continue to shape the hospital‘s approach to health care and allow us to grow profitably in the future. Our approach includes:
•management and leader training in lean best practices •team kaizen exercises for targeted improvements •technology investments to promote greater efficiency •continuous encouragement of our employees to seek everyday improvements in their personal work environments
Here are just a few of the improvements made over the last year that were powered by teamwork.
TEAMWORK Spurs Efficiency and
Growth in the OR
What they did: Three kaizens ushered in new
strategies to reduce wait times between OR
procedures. These included:
•cross-training staff in Pre-surgical Screening
•streamlining the registration process
•addition of a new barcode scanning
technology for instruments in the Sterile
Processing Department (SPD)
•daily huddles with principles from every
department
The impact: Patients, their families, and
physicians are more satisfied and relaxed
when procedures begin and go as planned.
This kaizen effort resulting in the following
improvements:
•OR first case, on time starts improved by
25 percent
•improved case cart accuracy to 99.3 percent
•decreased flash sterilization rates from
17 to 14.5 percent
•OR case volume exceeded budgets by 2
percent in FY13
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TEAMWORK Improves Delivery and Stock
Levels of Essential Supplies Around the
Hospital
What they did: The Materials Management
Department took steps to focused on the positive
and put in place procedures to establish a more
collaborative atmosphere. These steps included:
•creating an approach to hitting targets called
Laugh (short for Listen, be Accountable, Unite as
one, Group cohesiveness and Help each other)
•establishing daily inventory targets for
consumables (e.g. IV, rubber gloves, swabs, etc.)
in each hospital unit
•cross-training team members to remove
bottlenecks in receiving new supplies
•additional training on our inventory tracking
system
•more leader rounding, group discussions, and
installation of a key metric whiteboard
The impact: A hospital cannot provide quality care and
patient satisfaction without timely delivery of essential
supplies. As a result of this team’s efforts the average
“extra” calls for materials dropped from 250 to just 55
calls per month – an astounding 78 percent reduction.
TEAMWORK Grows Patient and Employee
Pharmacy Use
What they did: A large, visible whiteboard was installed to
allow Care Coordinators to provide up-to-date information
on the patients ready for discharge on the units. This simple
communication vehicle made is easier for Pharmacy Techs to
conduct morning and afternoon rounds inviting these patients
to fill their prescriptions at our in house pharmacy.
The impact: Patients truly appreciate the ease and
convenience of going straight home with the prescriptions
that they need. Patient usage of our pharmacy increased 25
percent from September to November 2012.
In parallel, a broader internal awareness of our pharmacy
services was generated and employee usage also increased
from 12 to 18 percent.
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Adopting a Lean Approach to Health Care
At Highland, we are adopting a lean approach to process improvement across our
organization to create a more cost-effective health care setting, reduce preventable
harm to patients throughout the hospital, and truly differentiate Highland from the
competition.
As we look forward to weaving a culture of lean throughout our organization in the
future, we are proud to share several key accomplishments from FY2013 below.
Educating experts and leaders to develop a lean organization. The initial rollout and ongoing education began
with 10 Lean Experts and over 80 Lean Leaders across the organization. Going forward, these individuals will encourage our entire
workforce to practice the principles of lean in organized kaizen and A3 exercises as well as in everyday work life.
Training for our Lean Experts and Leaders has focused on understanding the basic principles of lean and how to lead change in
a lean culture. These individuals will help us by “leading by example” and through identifying and reducing the amount of nonvalue-added practices performed across the hospital.
Kaizen team addresses inpatient bed availability: A hospital-wide kaizen team worked to improve flow from the
ED to the floor for admitted patients. Improvements were made throughout the admitting process and included:
•Creating an automated electronic communication process for inpatient bed readiness.
•Increasing telemetry capacity on the floors – the ability to monitor the heart rhythm, rate and breathing of a patient from a
remote location permits greater flexibility in admitting of patients with heart conditions.
•Streamlining nursing hand-off for faster and safer patient transitions to the floor.
•Working with Environmental Services to gain efficiencies in the room cleaning process.
•Creating an environment of “trystorming” – where ideas are quickly generated and tested – to streamline staff workflow in
the discharge process.
Thinking lean in a hospital setting involves considering the definition of “Value” from a patient’s perspective and putting in place efficient clinical changes to
provide valuable care. It’s essentially a shift in mindset, moving from viewing “work” as a series of tasks to a process that can be continuously improved on to
achieve the goal of valuable outcomes for patients. When applied rigorously and throughout an entire organization, lean principles can have a dramatic effect
on quality as well as productivity and costs – extremely important as health care moves to a population health management model.
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The Accountable Health
Partner (AHP) Network Growing Collaboration and
Advancing Quality
Our nation’s health care delivery
system must change to address
an unsustainable rise in health
care costs. Health care reform
attempts to “bend the cost curve”
downward by giving providers
incentives to deliver high quality
care that keeps patients healthy
and is also cost effective. This
requires better communication and
collaboration between hospitals,
nursing homes, primary care
practices, and agencies so that
patients get the right level of care
at the right time.
To meet this challenge, the
University of Rochester Medical
Center (URMC) obtained approval
from New York State’s Department
of Health in March 2013 to form
the Accountable Health Partners
(AHP) network. The AHP will unite
community and URMC faculty
physicians, hospitals (including
Highland, Strong Memorial and
F.F. Thompson Hospitals) and other
affiliated providers as true partners
in a coordinated care model. While
there are many more changes yet
to come, a lot of good work is
underway and we look forward
to sharing more about the AHP
network in the coming year.
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Growth
Facility and Technology Improvements Enable Growth
Level 1 and locker room renovations
Many of the best ideas at Highland come directly from our employees as action items from our employee
engagement surveys. Two years ago, employees made important suggestions about how Highland could improve
its workplace and the hospital responded with dozens of improvements. Renovation of the first floor corridors,
men’s and women’s locker rooms are just some of the actions Highland took this year to ‘brightened’ the days of our
employees who work here.
East wing router closet project: Some improvements can’t be readily seen but
can have significant impact of the reliability and performance of the tools that our
staff depend on to deliver the highest quality patient-centered care. This year we
added three new routers to the East Wing that will allow us to support the growing
number of networked computer devices used by our clinicians everyday.
More instruments and better tracking in SPD: The Sterile
Processing Department (SPD) not only added extra instruments
to keep the OR running smoothly but also advanced technology
to better track them. The new bar-code instrument tracking
system is a positive step towards increasing SPD productivity, tray
accuracy, and patient safety – knowing that surgical instruments
are in the right place at the right time.
Cardiology outpatient clinic renovation complete:
To accommodate the increasing volume of Cardiology
patients our waiting room was expanded, exam
rooms were doubled, a consult room and an extra
procedure suite for echocardiograms was built. From an
equipment perspective, a second 3-D echocardiogram
machine was purchased making Highland the only
hospital in the area with two such devices.
800 Total da Vinci® Surgeries Performed 700 765 600 500 545 400 410 300 200 100 631 283 0 FY09 FY10 FY11 FY12 FY13 New da Vinci® Si Surgical System: We have replaced one of our da Vinci®
Surgical Systems with the latest available model. This new robotic platform supports
single-port instrumentation and offers dual consoles for better training and
collaboration. Since its installation many of our surgeons have been trained and are
now performing state-of-the-art surgeries from a single incision in the belly button.
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Gourmet coffee comes to Highland: In February
2013, we opened the Grand Grounds coffee house off
the main lobby much to the delight
of our staff, patients and visitors. The
menu features paninis, specialty soups,
premium salads and a selection of
grab-and-go items such as yogurt and
hummus – even sushi!
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GAMA has a new look and expanded services:
To serve a growing number of patients, Geriatrics
and Medicine Associates (GAMA) has renovated
and expanded its facilities in the Professional Office
Building on the hospital campus. We’ve expanded
our waiting room, added two Ear, Nose and
Throat (ENT) exam rooms and an audiology testing
program.
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Surgical Pre-Testing: Is moving to the main level
of the hospital, providing more convenient
access to patients. Completion in May 2014.
Highland Women’s Health at Culver Rd.: This
new 7,500 square foot clinic will combine our
Community OB/GYN and URMC Midwifery
services as well as house the Rochester
Adolescent Maternity Resource (RAMP) center.
Opening in October 2013.
Radiation Oncology at Highland Hospital:
Completion of our $2 million renovation will
include: a new waiting room that is easier for
patients to access, a central nurses station
that will keep our patients and providers
closer together, and a dedicated CT Scanner.
Completion in Spring of 2014.
Office Annex: To meet our expanding need
for space, a modular office building will
be added to the hospital campus to house
the departments of Social Work, Infection
Prevention and Education. Opening
September 2013.
OR 14 upgrade for second da Vinci®
OR additional storage space
ICU headwall project
New flooring in Radiation Oncology
LINAC upgrade at Highland location
IMPRESSIVE:
More than a dozen
major projects were
completed in FY13
around the hospital
campus and its
satellite locations.
POB Suite 103 and 200 renovations
Nurse recruitment office renovation
West 6 Observation unit
“Art Takes Flight” stairwell project
Hospital fire pump replacement
Main Hospital conference rooms: Renovations
are underway for the Collins, Gleason, and
Calihan conference rooms to create more
modern and flexible meeting spaces. Reopening in November 2013.
West 4 upgrades: A complete remodeling of
West 4 will include all new floors, ceilings,
and wall coverings. These new finishes are
designed with the geriatric population in mind.
Completion in Spring 2014.
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Finance
Healthy margins, patient volumes, donor activity as well as an upgrade in bond rating
enables investments in people, technology, renovations, and equipment.
“It is critical for
Highland Hospital to
continue to generate
positive operating
margins to support
investments in our
infrastructure, upgrades
in clinical equipment
and investments in our
workforce. Highland
has posted a positive
operating margin each
year since 2001 and in
the fiscal year ending
in June 2013 achieved
an operating margin of
5.1 percent. Highland’s
history of strong
financial performance
is due in no small part
to the people who work
here, their teamwork and
dedication to providing
high quality, cost
effective care is crucial to
our success.”
– Len Shute
Chief Financial Officer
Strong Memorial and
Highland Hospitals
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Highland Hospital Pa>ent Volumes Highland’s Patient Volumes
Key Volume Metrics FY2012 FY2013 Hospital Discharges 19,114 19,140 Adult Discharges 16,176 16,095 Births 2,938 3,045 Medical ObservaCon & Short Stay Cases 3,301 3,894 Emergency Department Visits 38,554 39,393 Admissions 5,527 6,042 Treat and Release 28,653 28,982 Fast ER Care 4,374 4,369 Primary Care 150,193 141,523 Family Medicine 61,575 63,673 Gynecology & Obstetrics/Midwifery 15,343 15,587 10,769 11,175 Ambulatory 4,927 5,233 InpaCent 5,842 5,942 69,833 71,739 4.0 4.2 OutpaCent Clinic Visits (selected) OR Cases Adult PaCent Days (ALC incl.) Average Length of Stay (ALC excl.) The success in FY13 was the result of increases in many key volumes metrics. The relatively flat growth in adult
discharges was the result of increased surgical activity, offset by a shift in medical patient volume to outpatient
medical observation status. This is primarily the result of pressure from third-party insurers and reduces reimbursement to the hospital. Highland has added a dedicated Medical Observation Unit to accommodate many of these patients more efficiently and to ease the volume in our Emergency Department.
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Highland’s Value Based Purchasing Scores
What is Value Based Purchasing (VBP)?
In the past, health care providers were paid on a fee-for-service
basis – the more services performed, the more reimbursements
received. Recent reforms enacted in the Affordable Care Act have
begun moving the health care industry to a pay-for-performance
reimbursement model. Over the next several years more and more
incentives will be put in place to encourage providers to keep
people healthy – reducing the amount of tests, procedures and
hospitalizations they’ll need and thereby reducing the overall costs
of health care. The evolving new models continue to pay fees per
procedure or office visit but are making an escalating portion of
these fees subject to quality, outcome, and patient satisfaction
measures.
In place today, the Centers for Medicare & Medicaid Services (CMS)
has set goals for pay-per-performance in four areas of measure:
clinical process of care, patient experience (HCAHPS), outcome
(mortality) and readmission reductions. CMS withholds a portion
of reimbursement from which hospitals can “earn back” funds
with solid performances against these metrics during a designated
performance period. A poor performance and the reimbursement
may be forfeited. A better than average or expected performance
and a hospital can earn back more funds than were withheld.
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VBP DOMAINS Weighted Scores (higher is be0er) Clinical Process of Care 49 37.35 Pa>ent Experience 15.9 16.5 Outcome (mortality) N/A 7.5 64.9 61.35 Total VBP Score READMISSIONS REDUCTION Excess Readmission Ra>o (<1.0 is be0er) Acute Myocardial Infarc>on 1.0041 1.0020 Heart Failure 0.8855 0.8992 Pneumonia 1.0091 1.0266 Weigh+ng of VBP Scores 30% of VBP Scores Weigh+ng points higher that the national average resulting in Highland receiving an addition 16 percent above
our breakeven reimbursement. As a result, Highland was also in ranked #7 in the top 10 reimbursed
hospitals in New York State and the highest among the 15 hospitals in our region.
In the Second Performance Period, a new domain has been added measuring outcomes (mortality)
in addition to continued performance measures around clinical process of care and patient experience.
In the August 2013, Highland Hospital received a preliminary report on its VBP results for the second
performance period. Our preliminary score of 61.35 places us more than 14 points above the national
average and indicates that Highland will recoup approximately 30 percent more than it contributed to
the VBP pool, or an additional $230,000.
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First Second Performance Performance Period Period CMS Area of Measure In the First Performance Period, Highland Hospital’s overall VBP score (64.9) ranked it over 9
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30% 70% 70% n Clinical
Process
of Care
Domain
Weigh+ng of VBP Scores n Outcome
Weigh+ng 30% of VBP Scores n Patient
45% 30% 25% 25% 45% Domain
Experience
Domain
How do we compare at the state and naKonal level? 70 60 50 40 30 20 10 0 64.9 55.46 61.35 46.57 41.16 46.53 First Performance Second Performance Period Period Highland State Na>onal The decrease in Highland’s total VBP score in the
second performance period is due our results in the new
outcome domain. In fact, Highland’s unweighted
scores for both the clinical process of care and
patient experience domains increased in the second
performance period.
We measured favorably in our 30-day mortality rates
for AMI – surpassing both the baseline rate and
achievement threshold. And, although we improved
from our baseline rate, we did not exceed the
achievement threshold in the pneumonia measure.
In the third measure, heart failure, our 30-day
mortality rates did not exceed the baseline rate
or achievement threshold. Our ongoing efforts in
meeting the needs of our pneumonia and heart failure
patients – including the creation of Heart Failure
and Follow-up Clinics – make Highland wellpositioned to improve these results in the future.
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Finance
Key Financial Metrics (000’s omi4ed) Opera&ng Revenue FY2012 FY2013 $290,091 $301,228 Opera&ng Expenses Salaries & Benefits $162,454 $176,416 Supplies & Other Expenses $92,000 $90,849 Interest & Deprecia&on $17,313 $18,763 TOTAL Expenses $271,767 $286,028 Income from Opera&ons $18,324 $15,200 Non-­‐Opera&ng Revenue ($33,827) $22,549 Change in Net Assets ($15,503) $37,749 104.2 124 Days Cash on Hand Recognition
In October 2012, Highland received news that Standard & Poor’s
upgraded the hospital’s bond rating, joining Moody’s in giving
the hospital an “A” level rating.
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$ Millions Highland Hospital Financial Performance
20 18 16 14 12 10 8 6 4 2 0 Highland Hospital Opera1ng Margin (*projected) 6.3% 4.8% 5.0% FY10 FY11 5.1% 4.0% 3.7% FY09 FY12 FY13 FY14* R
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Highland Hospital Capital Expenditures
Improving our financial performance and increasing patient
volume is critical to the health of our hospital. Building a strong
foundation for continued growth is equally important. In pursuit of
this objective, our FY13 capital expenditures included a variety of
growth-enabling improvements.
Capital Expenditures FY2013 Total $15.4 Million $1.9M $0.5M $1.4M $3.1M $1.0M $1.4M $2.9M $3.2M Hospital/Outpa,ent Renova,ons eRecord Medical Equipment Women's Health at Culver Rd. Con,ngency/Strategic Plan IT Radia,on Oncology Equipment Facility Upgrades Going forward, Highland’s proposed FY14 capital budget totals $33 million and will include the following projects, and more:
•New linear accelerator for our Radiation Oncology location at Park Ridge: $3.0M
•Replace da Vinci® Surgical System with updated model: $2.0M
•Completion of Radiation Oncology Unit Renovations: $1.9M
•Patient Care Unit Updates on West 4: $1.5M
•Medical Imaging Equipment and Renovations: $1.0M
•Completion of Highland Women’s Health at Culver Rd.: $1.1M
•Operating room equipment/instruments and patient care equipment/furniture: $2.7M
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The Highland Foundation
Highland Hospital Signature Events
Each gift to Highland is a way that people who have been touched by the highest quality,
compassionate care within our hospital reach out to say “thank you.” The generosity of our
donors helps Highland Hospital continue its efforts to provide best of both worlds.
The Highland Foundation Funds Overview
(Total of each fund as of June 30, 2013)
Total Funds: $8.8 Million The Highland Founda9on Funds Raised 17% 48% n Temporarily Restricted Funds
$4.2 Million
The Hospital has 42 funds that
are designated for specific usage.
Examples include: Nursing
Education Fund, Special Care
Nursery, Family Medicine Fund. $ Thousands 35% 1,400 1,200 1,000 800 600 400 200 0 -­‐200 -­‐400 -­‐600 -­‐800 1200 910 890 600 660 610 930 290 620 (770) FY09 FY10 FY11 Dona8ons FY12 FY13 Investments n Permanently Restricted Funds
$3.1 Million
The Hospital has seven funds
that include a professorship,
endowment and scholarships that
yield interest. Each fund has an
established spending policy to fund
a pre-established initiative. n Unrestricted Funds
$1.5 Million
This fund provides faculty and staff
the opportunity to access funds for
new initiatives and other projects
that have not received a specific
philanthropic designation.
2012 Breast Cancer Education
Event, Tickled Pink
DATE:
October 4, 2012
WHERE:Hyatt Regency Rochester
GUEST:
Keynote speaker,
Marcia Wallace
GUESTS:400 guests
PROCEEDS:Benefitted Highland
Breast Imaging
RAISED: $26,000
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2013 Highland Golf Classic
DATE:
May 20, 2013
WHERE:Greystone Golf Course
EVENT:
10th Anniversary of
womens
mens
tournament
GOLFERS: 171
PROCEEDS:Benefitted Highland
Hospital
RAISED: $53,000
2013 Highland Gala
DATE:
March 16, 2013
WHERE:
Rochester Riverside
Convention Center
EVENT:
A Celebration in the
Irish Tradition
GUESTS:610 guests
PROCEEDS:Benefitted Highland’s
Radiation Oncology
Department
RAISED: $157,000
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System/Community
High-profile advertising campaigns, positive news coverage and participation in
community wellness initiatives are ways Highland connects with the community it
serves. Highland providers, employees and volunteers were active and visible in the
community in 2012-2013.
“Highland is building on
its reputation as a leading
community hospital in
Rochester and throughout
the region. By supporting
community wellness
initiatives and sharing
their knowledge in media
opportunities throughout
the year, our providers
and employees are
advocates for community
health and ambassadors
for Highland.”
– Cindy Becker
Vice President/
Chief Operating Officer
Highland shines in brand campaign: Highland was an important
component of URMC’s 2012 brand campaign. Nearly 50 Highland
physicians, staff members and volunteers participated in TV
commercials for the campaign, which aired during the 2012 Summer
Olympic Games. Highland was featured in a 60-second TV spot that
showcased its leadership in geriatrics, gynecologic oncology and
joint replacement, as well as a 30-second spot about the Evarts Joint
Center. The campaign increased consumer awareness and consumer
preference for Highland (see chart, right).
Highland in the spotlight: Highland Public Relations reached a
variety of audiences through stories it pitched to newspapers, TV
news, radio stations and local magazines. Stories on the hospital’s
physicians, employees, services and growth received more than 180
media placements in 2012-2013. The average number of viewers/
readers reached in each quarter of FY 2012-2013 was approximately
1,240,000.
ealth education in a friendly format: Highland Marketing
H
sponsored senior dinner lectures in 2012 and 2013. The popular
format – a casual dinner plus presentations and Q&A with
Highland providers and caregivers – drew hundreds of enthusiastic
participants to each session. Topics showcased Highland’s leadership
in geriatrics, cardiology and prostate cancer care.
2012 Brand Campaign Results
70%
2012 - March
60%
2012 - November
50%
40%
43%
36%
46%
40%
30%
20%
10%
0%
Familiarity with Highland
Likeliness of Using Highland
ringing Highland into consumer homes: In 2012 Highland
B
launched a community newsletter, AdvancingCARE, that reaches
35,000 homes quarterly plus additional online readers. The
newsletter offers helpful health advice and promotes Highland’s key
services such as gynecologic oncology, joint replacement, geriatrics
and cardiology.
New web system brings added features: Highland and the
Medical Center upgraded the web content management system
in 2012, bringing new capabilities and ease of use to consumers.
New Highland web features, such as video interviews with Highland
experts, increased web traffic and consumer interest.
Social media following grows: Social media such as Facebook
and Twitter are an increasingly important touch point between
Highland and community. Facebook followers have grown from
400 in June 2012 to nearly 4000 – thanks to exposure provided by
Marketing’s brand campaign, and Public Relations’ use of popular
new features such as video clips and photo galleries.
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The Highland Mosaic tells our story in pictures – More than 800
Highland physicians, employees and volunteers contributed their photos
and personal reflections to create The Highland Mosaic – an interactive
online feature that underscores how each individual brings something
unique and important to the organization.
Bringing Life-Saving Screenings Through Outreach
Each year Highland provides valuable health information and preventive screenings
to hundreds of people in our community. The Breast Imaging Center offered free
mammography screenings in October 2012 and February 2013 to hundreds of uninsured and
underinsured women. In August 2012, Highland Cardiology screened student athletes for
hypertropic obstructive cardiomyopathy, a symptomless heart defect, and other potentially
dangerous abnormalities. The session provided screenings and peace of mind to more than
100 athletes and their families.
assionate advocates for a healthy community: Highland
P
people enthusiastically support wellness causes throughout the year;
30 Highland physicians and employees participated in the Ovarian
Cancer 5K in September 2012, contributing toward the event’s
$60,000 fundraising. Highland people took part in the 9000-person
Making Strides the same month, helping to raise $805,000 for
American Cancer Society. In June 2013, the Highland Spin-Outs
team contributed $20,000 to the Tour de Cure bicycle ride for the
American Diabetes Association. Team members are shown above.
Community spirit on display: For the
past several years Highland employees
have consistently met or exceeded the
hospital’s annual United Way fundraising
goal, and 2013 was no exception: Highland
employees donated more than $105,000
to support community health and social
programs.
New services where they’re needed most – In July, Highland began offering X-ray and mammography
services at Anthony Jordan Health Center. People living on the northeast side of Rochester now have
greater access to potentially life-saving diagnostic services.
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A Look Ahead
As proud as we are of our successes in Fiscal Year 2013, Highland Hospital is looking forward with
an equal amount of anticipation. As a companion piece to our Annual Report that reflects on our
past, we have updated Highland Hospital’s Strategic Plan for the future. We invite you to review this
comprehensive document to learn how we will make the next three years as successful as the last.
The 2014 – 2016 Strategic Plan focuses on structured approach to Growth in our
clinical programs that will allow us to navigate an unprecedented time of change
in the health care industry. Without losing sight of our Mission, Vision and I CARE
Values we have framed plans from each clinical program around our Pillars of
Excellence – focusing on the pillar of Growth and setting goals, objectives and
actionable tactics in the remaining the five service and operational pillars to support
growth.
Beyond the future plans for each of the clinical programs, our hospital is also
prepared to take a bold new look at its overall strategy – altering the view of our
world and the world around us as the lines between the two begin to blur.
Our new approach is simple but resolute. Our future depends on being integrated, defined and engaged for growth. Here’s what that means.
•Maximize the potential and
Integration of being a part of the
University of Rochester Medical
Center and Accountable Health
Partnership – these patients and
physicians are part of ‘our’ family.
• Define Highland Hospital as
delivering Excellence in Women’s,
Family & Senior Care – look to
move more University of Rochester
Medical Center services under our
these programs – either directly or
through improved integration – to
provide a better continuum of care to
these populations.
Highland Hospital
Mission & Vision
PAT I E N T E X P E R I E N C E
Quality &
Safety
Patient &
Family
Centered
Care
People
Growth
Finance
System/
Community
I CARE Values
Integrity
Compassion
Accountability
Respect
• Define and continue to build
Services of Excellence – Surgery,
Orthopaedics, Radiation Oncology,
Internal Medicine, Neurology,
Neurosurgery, and Emergency
Medicine – with an emphasis on
supporting the Excellence in Care
strategy as well as providing essential
services to our community.
• Define and expand regional Centers
of Excellence at Highland Hospital –
the Evarts Joint Center, Bariatric
Surgery Center, Geriatric Fracture
Center and Gynecologic Oncology –
to draw patients from the sixteen
county area and beyond.
Excellence
• Effectively target and Engage external audiences to deliver greater volumes and expand
regional reach – move from a traditional marketing approach to a cohesive strategy of
outreach and social marketing tactics to build communities and long-lasting loyalty.
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R
Master Facilities Planning
Looking to the future, growth of clinical programs is an important part of Highland’s
Strategic Plan. But that plan requires space, and the hospital sits on nine acres of land
almost entirely in use.
In FY2014 we will spend $1.0 million towards site analyses and planning studies as
the first steps in our Master Facilities Plan. This plan, pending review and approval
from our Board of Directors, will modernize the hospital so it can continue to
support Highland’s mission of the highest quality, patient-centered care for the next
25 years. It includes:
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•Operating room expansions and upgrades to current health care standards
•Private patient rooms and appropriately sized patient support areas
•Creation of a larger dedicated observation unit
•Hospital storage and support space
•Cafeteria modernization
•PACU, Special Care Nursery and OB Triage reconfiguration
•Required facilities infrastructure updates
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Appendix: Additional Quality Measures
Preventable Infections, Nursing Sensitive Indicators, Readmission Rates
Preventable Infections
Nursing Sensitive Indicators
Ven5lator Associated Pneumonia Ven5lator Associated Pneumonia 2.0 2.0 lower be*er lower is bis e*er 1.5 1.5 1.0 1.0 Highland has had o incidences Highland has had no nincidences of of VAP during this Ame period VAP during this Ame period 0.5 0.5 13 4Q13 4Q13 0.0 0.0 FY1Q12 2Q12 3Q12 3Q12 4Q12 4Q12 1Q13 1Q13 2Q13 2Q13 3Q13 3Q13 4Q13 4Q13 FY1Q12 2Q12 Mean Mean Highland Hospital Highland Hospital team am C Mean Mean 38
5.0 5.0 4.0 4.0 1.6 1.6 1.4 1.4 1.2 1.2 1.0 1.0 0.8 0.8 0.6 0.6 0.4 0.4 0.2 0.2 0.0 0.0 lower be*er lower is bis e*er 8% 6% 1.0 1.0 0.0 0.0 2% 4% FY1Q12 2Q12 3Q12 3Q12 4Q12 4Q12 1Q13 1Q13 2Q13 2Q13 3Q13 3Q13 4Q13 4Q13 FY1Q12 2Q12 Highland Hospital Highland Hospital Target Target lower be*er lower is bis e*er Internal Goal Internal Goal FY1Q12 2Q12 3Q12 Highland Hospital 4Q12 1Q13 2Q13 3Q13 UHC Compare Group Heart Failure lower is be*er 25% 20% Percent Percent Highland Hospital Highland Hospital 0% Nosocomial Pressure Ulcers (bed sores) Nosocomial Pressure Ulcers (bed sores) 5.0 5.0 4.0 4.0 FY1Q12 2Q12 3Q12 3Q12 4Q12 4Q12 1Q13 1Q13 2Q13 2Q13 3Q13 3Q13 4Q13 4Q13 FY1Q12 2Q12 lower is be*er 10% 3.0 3.0 2.0 2.0 Surgical Site Infec5ons Surgical Site Infec5ons per 100 procedures per 100 procedures 13 4Q13 4Q13 Falls with Trauma Falls with Trauma CDC ean CDC MM
ean lower be*er lower is bis e*er Orthopaedic -­‐ Joint Replacements/
Revisions Events Events per 1,000 venAlator days per 1,000 venAlator days ) Readmission Rates
3.0 3.0 2.0 2.0 15% 1.0 1.0 0.0 0.0 5% 10% FY1Q12 2Q12 3Q12 3Q12 4Q12 4Q12 1Q13 1Q13 2Q13 2Q13 3Q13 3Q13 4Q13 4Q13 FY1Q12 2Q12 Highland Hospital Highland Hospital Target Target 0% FY1Q12 2Q12 3Q12 Highland Hospital 4Q12 1Q13 2Q13 3Q13 UHC Compare Group R
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Cindy Becker
Vice President and COO, Highland Hospital
From its beginning to present day, thousands of dedicated people have worked to make Highland Hospital a leading
community hospital in upstate New York. This Annual Report is filled with examples of their latest achievements, and
where these will take Highland in the years to come.
The pace of health care and the complexity of what we do seem to grow with each passing day. Yet time and again, the
people of Highland rise to the challenge and find new ways to distinguish their work and our hospital.
The federal government’s Value Based Purchasing program is one example. Last year Highland finished the first
performance period as the top hospital in the region. This year, the addition of clinical outcomes in the scoring
formula raised the bar; as this report goes to print, Highland has received preliminary VBP results that place it among
the state’s top performers once again.
An energized, committed work force is essential to our continued success. While hospitals around the nation work
to sustain their employee satisfaction levels, Highland is moving ahead. In 2011 Highland ranked above the national
health care benchmark in employee engagement; our 2013 survey results are even better.
Highland continues to evolve and grow as an organization. In the past year we’ve put a great deal of thought and
effort into aligning everyone at Highland around our shared mission and goals to achieve breakthrough gains. We’ve
undergone a dramatic restructuring of the way we set and measure each leader’s goals and the organization’s overall
objectives. Weighted goal-setting has helped us create a structure of shared ownership and accountability and maintain
our focus on reaching clear, measurable outcomes.
Our clinical programs continue to expand their offerings and attract rising numbers of patients to Highland. In the
past year Highland’s chiefs of service have outlined thoughtful and ambitious strategic plans to help Highland grow to
new heights. Highland’s financial performance is among the best for New York state hospitals, many of which regularly
grapple with negative operating margins. Highland is performing well in all aspects of its “portfolio” – quality and
patient safety, patient satisfaction, employee engagement and financial performance.
Highland is just months away from celebrating its 125th anniversary. The hospital has a remarkable history. And
thanks to the providers, employees, volunteers and board members who are guiding its progress, Highland’s best days
are still to come.
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Mission
Commitment to excellence in health care, with patients
and their families at the heart of all we do.
Vision
We deliver Medicine of the Highest Order in a community hospital
where compassion, quality and patient- and family-centered care
are our guiding principles. Our affiliation with a world-class
medical center will allow us to provide the best of both worlds –
state-of-the-art medicine and personalized care.
Values
Integrity
Compassion
Accountability
Respect
Excellence
Production Team:
Robin Montmayeur, Director of Marketing
Barbara Ficarra, Director of Public Relations
Brenda Benedict, Senior Creative Designer
Highland Hospital
1000 South Avenue
Rochester, NY 14620
585.473.2200
www.HighlandHospital.org