GE Healthcare

1. GE Healthcare • Performance Solutions Bending the Execution Curve: Implementing Successful Organizational Change in Hospitals and Healthcare Organizations MUSC 16th Annual Healthcare Leadership Conference Charleston, SC | November 1, 2013

2. Bending the Execution Curve: Implementing Successful Organizational Change in Hospitals and Healthcare Organizations • Organizational Change • Incremental + Transformational • People • Employee & Physician • Leadership Development • Operations / Process • Systems & Structure • Quality (Clinical and Lean/Process) • Service (Patient) • Strategy (i.e., Growth) • Value Based • Continuum of Care • Agenda (Minutes) • Introduction (5) • Vince Joseph (20) • RWJUH – EVP & COO • Dr. Tim Hobbs (20) • CHNw - Chief Physician Executive • Dr. Ninfa Saunders (20) • MCCG & CGHS – President & CEO • Open Discussion (20) • Wrap Up (5)

3. Vince JosephRobert Wood Johnson University HospitalExecutive Vice President & COO

4. Operation: ExcellenceSetting The Pace… Perceptual Acuity Vincent D. Joseph, FACHE Executive Vice President November 1, 2013

5. Japanese Proverb… • “Vision without execution is a daydream. Execution without vision is a nightmare.”

6. Ask Yourself… • Do you have the right people on the bus? • Are they in the right spot? • Do you trust the results will be achieved? • Do you trust you will get the results without damaging the organization? • Can I go into your hospital and ask a Director of Oncology if Finance has goals and what they are?

7. Operation: Excellence… The Formula for Culture-Driven Performance Mission/ Vision Focus and Direction Management Systems Strategic Pillars Leadership Development Leadership Systems RWJUH Values 3-Year Strategic Activation Plan Leadership & Talent Review Quarterly Operating Reviews 1-Year Strategic Activation Plan / Budget Performance Evaluation Goals Setting

8. RWJUH Culture-Driven Performance • Focus & Direction • Well crafted and communicated Mission & Vision • Well defined and integrated Organizational Values • Strategic Imperative linages to Strategy Activation clear • Management Systems • Highly inclusive… Physician and Administrative leadership, plus broadly inclusive of Directors, Managers-Supervisors and Staff • Simple (i.e., templates), Predictable (i.e., Operating Calendar) and Rigorous (e.g., 3-Year, 1-Year, QORs) • A journey… Process, Content and Culture

9. RWJUH Culture-Driven Performance • Leadership Systems • Values Guide development and integration • Goal Setting… Strong strategic and Incentive Compensation (IC) alignment… Proper goal cascading and accountability • Performance Evaluation process… Values and Goals weighting key… Calibration Sessions critical • Talent Playbook activation as rigorous as 3-Year Strategic Plan activation • Leadership Development… Feedback & Coaching on Values, Operating Calendar involvement and leadership • Operating Calendar • The Culture-driven Performance Model in action… Predictable, updated annually, communicated in advance • An entirely new way of doing business

10. 2013 RWJUH Operating Calendar 1ST QUARTER 2ND QUARTER 3 Year Plan Kick-off Mar 22 Leadership & Talent Review Apr 4 Annual Leadership Kickoff Feb 14 Strategic Planning Update Feb 15 Strategic Planning Update May 23 April LLR Mar 13 March QOR Apr 25 Performance Evaluation Feb 21 & Mar 1 Goal Setting Nov 29-Feb 27 May LLR June 12 CULTURE of Kindness February 3 Year Plan Finalized June 27 • Commitment • Understanding • Learning • Trust • Unity • Respect • Empathy QOR Jan 31 June January Strategic Pillars QOR July 25 December • Growth • Financials • Quality • Service Strategic Planning Update Dec 19 July 1 Year Plan Kick-off Aug 1 Mid-Year Check-in Aug 22 November August LLR Oct 11 QOR Oct 24 September October Leadership & Talent Review II Sep 19 Strategic Planning Update Sept 12 1 Year Budget (Aug-Oct) 4TH QUARTER 3RD QUARTER 1 Year Plan Finalized Sept 26

11. RWJUH Financial Highlight… • Through Operation: Excellence we have achieved unprecedented growth in financial success as Recognized by Moody’s with an A2 Rating.

12. Culture-Driven Performance Overview • Productive Systems & RWJUH’s LEAN-PI Initiative • Lean-PI should be strategically-aligned • Enables strategy activation, but also drives operational improvement with targeted Return On Investment (ROI)

13. LEAN-PI Initiative… Launch and Progress • Lean/Six-Sigma Program started 2010 (partnership with GE) • Actual realized savings of >$15 million in last two years • Dedicated infrastructure lead by senior administration. • Multi-disciplinary approach for project participation and execution. Full engagement of front-line staff. • RWJ Lean/Six-Sigma training institute • Tier-training model • All Senior Administration • Lean-101 education over 1,000 front line staff • >39 Active Facilitators • >30 Active Green Belts • 3 Black Belts • Major Areas of Focus Include: • Quality • Clinical Efficiency • Productivity • Throughput • Supply Chain • Revenue Cycle

14. Culture of Transparency (& Kindness) • Operation: Excellence (O:E) – A Culture of Transparency • O:E created a culture of inclusiveness and two-way communication through engagement of multiple stakeholders • Individuals at all levels of the organization, and across multiple departments, were empowered—and held accountable—with a voice in the change process • This spirit of inclusiveness allowed RWJUH to extend O:E throughout the ranks • When we first started, only senior level vice presidents presented at the quarterly operating review, and when they were finished with their respective areas of responsibility, they left • Today, every assistant vice president and higher, regardless of their pillar, is in the room for the duration of the meeting • Everyone understands what is happening in the business across different sectors and is accountable to their peers • CULTURE of Kindness (CoK) Values • Integration of CoK Values critical to O:E transformation • Values Guide sets expectations for all leaders – the “How” is just as important as the “What” • Values Guide feedback and coaching prepares future leaders

15. ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL - VALUES GUIDE VALUE Outstanding Strong Values Development Needed • Proactively initiates and seeks ownership of new projects, ideas, and/or assignments beyond expectations • Inspires and passionately leads others to reach and exceed goals and objectives in the face of obstacles • Assumes ownership of projects and/or assignments from start to finish • Consistently transfers personal energy and passion into action to accomplish goals and objectives Commitment is establishing ownership and dedication to personal, professional and organizational success with passion and purpose. • Avoids or deflects ownership of projects and/or work assignments • Complacent with ‘good enough’ Commitment • Develops and implements ideas to support others to work more efficiently and overcome challenges and/or barriers • Coaches others to develop reflective listening skills to promote a high level of engagement in the organization • Unaware of others needs and provides information only when asked • Exhibits lack of engagement by ignoring others during discussions and/or meetings • Consistently partners with others and supports those presented with challenges and/or barriers • Consistently demonstrates reflective listening to build a high level engagement with others Understanding is the ability to acknowledge the strengths of others, appreciate their challenges and effectively recognize and support their needs. Understanding • Adapts to new challenges and changes • Displays initiative in continuous learning for personal or professional development • Embraces continuous improvement with innovative ideas and solutions • Leads change and energizes others to adapt to new challenges • Initiates opportunities to develop, coach, and grow self and others • Consistently is a resource for creating and/or implementing innovative ideas and/or solutions to promote continuous improvement • Displays resistance to new challenges and ideas of change • Takes insufficient initiative for personal and professional development • Maintains status quo by resisting innovative ideas or solutions Learning is embracing innovation, challenges and experiences which enhances personal and professional growth. Learning • Has not engendered confidence and/or honesty amongst colleagues and peers • Avoids accepting personal accountability and/or shifts the blame on persons and/or systems • Empowers and delegates work instilling confidence in others abilities to achieve results • Drives accountability throughout the organization by coaching others to own mistakes, behaviors and outcomes and improve on them • Builds confidence with others through honest feedback and timely follow up • Accepts personal accountability for setbacks and/or less successful endeavors Trust is demonstrating honesty and accountability in all interactions to promote a positive environment. Trust

16. ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL – VALUES GUIDE VALUE Outstanding Strong Values Development Needed • Leads cross-functional collaboration throughout the organization to achieve excellence • Commends and shares credit with others and finds opportunities to recognize unique accomplishments • Proactively solicits feedback and information from sources outside the immediate team to drive productivity • Works in silos or isolation from the team or others • Misses opportunities to share credit and celebrate team success • Withholds and/or fails to disclose pertinent information for team performance • Consistently works collaboratively within area of responsibility and occasionally cross-functionally • Acknowledges others efforts and accomplishments • Actively demonstrates open communication between all levels to drive effective team performance Unity is a collaborative practice which creates a sense of togetherness that establishes a high level of teamwork. Unity • Proactively responds and follows up prior to established deadlines, addressing anticipated issues before they become challenges • Manages even the most challenging of situations with tact, composure, professionalism and dignity • Responds to others in a timely manner satisfying their requests, questions or concerns • Maintains a professional demeanor and consistently treats all with dignity (intolerant of gossip and non-productive behaviors) • Slow to react and respond to questions, requests or issues… inconsiderate of timeframes. • Undermines the dignity of others by spreading rumors, and/or speaking negatively about other people (i.e. gossiping). Respect is fostering an environment of integrity by treating others with dignity. Respect • Displays sincere care and compassion in all interactions with patients, families, physicians and coworkers. Puts self in others shoes. • Accessible and approachable to provide care and support even when the workload is heavy • Takes the lead to show compassion and care for the suffering of others and is effective in helping to alleviate their suffering • Identifies and implements new ways to support others providing the access and time needed to achieve the desired outcome • Demonstrates a disregard for care and compassionate by ignoringthe personal or emotional impact of situations • Unavailable or inaccessible to spend time and effort needed to support others Empathy is the sincere awareness of the needs of other people along with the desire and attempt to compassionately support them. Empathy

17. Performance Management • Performance Management Process instituted in 2011 • Leadership & Talent Review Process launched – formal succession planning and identification of next generation leadership • Focus on: • Technical skills • Individual goal results • Culture of Kindness Values • Stresses how something is done is equal to what is done • 9-Block performance chart • Low turnover

18. Operation: ExcellenceSetting The Pace… Thank You! Perceptual Acuity Vincent D. Joseph, FACHE Executive Vice President November 1, 2013

19. Dr. Tim HobbsCommunity Health NetworkChief Physician Executive

20. The Community Way Tim Hobbs, MD, MBA Chief Physician Executive Community Health Network MUSC Annual Healthcare Leadership Conference November 1st, 2013

21. The Community Way

22. Community Health NetworkService Area

23. Community Health NetworkFootprint

24. Accountable Care: Where the Market is Heading… • Current Market Issues: • Payment Reform • Health Care Reform • Downward Pressures on Reimbursement • Payment Model is not Aligned with New Expectations of the Care Models Future Healthcare Delivery And Payment System (Outcomes-Based) Today Transition Future • Emerging Market Trends: • Transitioning Care Delivery from “Sick-Care” to Real Health Care • Focusing on Wellness, and Aligning Resources to Keep People Healthy • From Volumeto Value • Continued Need for Chronic Care Management Current Healthcare Delivery And Payment System (Activity-Based)

25. Building the Foundation for Transforming Care Quality & Patient-Centered Care High-Performing Culture Access, Growth & Innovation Managing Population Health Physician Alignment Affordable Care

26. Investing In Our Future While Sustaining Current Performance • Cost Restructuring – Huron / Wellspring • Rolling Five Quarter Forecast for Financial Planning • Physician Integration • Information Technology (Community Care Connect) • Organizational Realignment • The Community Way – Studer/ GE partnership • Employee Engagement and Leader Development • Strategy Activation • Process Improvement

27. Organizational Realignment

28. Successful Organizational Change Mechanisms…

29. The Community WayCulture Driven Performance Model Direction and Focus Management System Mission•Vision•Values PATIENTSFIRST |RELATIONSHIPS |INTEGRITY |INNOVATION |DEDICATION |EXCELLENCE Leadership System Network Pillars PEOPLE |SERVICE | QUALITY | FINANCE | GROWTH | COMMUNITY Exceptional Care. Simply Delivered. 3-yr Strategic Plan Talent Development Plan 1-yr Strategy Activation Plan Performance Appraisal Quarterly Strategic Reviews Goal Setting

30. The Community Way2013 Operating Calendar Solid outline = Management System Dotted outline = Leadership System Q1 Q2 MAR APR FEB MAY Annual Kick-off Leadership Performance Appraisal 3-yr Strategic Plan Leadership Development Institute (LDI) Leadership Development Institute (LDI) JAN 5Q Rolling Forecast Goal Setting JUN 1-yr Strategy Activation Plan (‘13) The Community Way PEOPLE | SERVICE | QUALITY | FINANCE | GROWTH | COMMUNITY Exceptional Care. Simply Delivered. Q1 Q4 Q2 Q3 5Q Rolling Forecast Goal Setting Capital Budgeting Staff Engagement Survey Quarterly Strategic Review DEC JUL Physician Engagement Survey Quarterly Strategic Reviews Leadership Development Institute (LDI) 1-yr Strategy Activation Plan (‘14) Labor Standards Update 5Q Rolling Forecast Leadership Development Institute (LDI) Q4 Q3 AUG NOV OCT SEP

31. Employee Engagement and Leader Development… Driving Operational Excellence and Strategic Leader Development Standards of Behavior Purposeful Rounding Monthly Meeting Model LEM/Goals Studer Elements Involvement/Impact GE Elements Talent Development Plans Calibration Sessions Values Guide Staff Manager Director Vice President SVP/EVP Leadership Level

32. Successful Organizational Change Mechanisms… Internal Challenges

33. The Community Way Thank You!

34. Dr. Ninfa SaundersMedical Center Central GeorgiaCentral Georgia Health SystemPresident & CEO

35. Navigating the Tortuous landscapeBeyond Scale: A matter of a masterful execution Ninfa M. Saunders, DHA, MBA, MSN, FACHE President and CEO Medical Center of Central Georgia and Central Georgia Health System Founder, Stratus Healthcare November 1, 2013

36. Define, develop and align services to advance CGHS's System of Care (Care Continuum) Service Strategy S Develop smart growth and partnerships RESULTS IMPERATIVES Deliver outstanding service to every customer every time Results Driven Strategy Supports Value Creation Achieve highest clinical quality and safety by delivering the right care, at the right time, at the right place, at the right cost O Operations Reduce expenses, grow revenue and manage resources Attract, develop and retain valued employees P VALUE People Attract, engage and retain high quality physicians

37. STRATEGY SMART GROWTH BEYOND SCALE

38. Reference: McKinsey & Company, Healthcare Systems and Services Practice, The post-reform health system: Meeting the challenges ahead (2013).

39. You Have More Options Than You Realize Joint Venture–Less Than 50% Equity With Management Rights NonequityCollaborativeArrangements Joint OperatingAgreement ClinicalIntegration Loose Affiliation Total Affiliation ManagementAgreement Joint Venture–Less Than 50% Equity With No Management Rights Joint Venture–50.1% to 99% Equity Merger/CompleteAsset Acquisition Source: Hancock, Daniel, Johnson & Nagle, PC

40. Sg2 Map of Market Accountability Readiness, 2012 Markets Will Develop at Different Speeds Decision Scale Highest Above Average Average Below Average Least Data Not Available Level of Readiness Geographic boundary files obtained from www.dartmouthatlas.org/tools/downloads.aspx#boundaries.Source: Sg2 Analysis, 2012.

41. An Ever-Changing Landscape in Georgia Source: Developed by Central Georgia Health System and Kaufman Hall

42. STRATUS HEALTHCARE

43. Membership • 29 Hospitals • 14 Health Systems • Approximately 2,000 Physicians • Over 18,700 Employees • Total Annual Expenses in Excess of $2.2 Billion • Over 4,080 Total Beds

44. Membership • Oconee Regional Health Systems • Oconee Regional Medical Center (Milledgeville) • Jasper Memorial Hospital (Monticello) • Putnam General Hospital (Eatonton) • Shepherd Center (Atlanta) • South Georgia Medical Center Health System • South Georgia Medical Center (Valdosta) • Smith Northview Hospital (Valdosta) • Louis Smith Memorial Hospital (Lakeland) • Clinch Memorial Hospital (Homerville) • SGMC-Berrien Campus (Nashville) • Taylor Health Group • Bleckley Memorial Hospital (Cochran) • Taylor Regional Hospital (Hawkinsville) • Tift Regional Health System • Tift Regional Medical Center (Tifton) • Cook Medical Center (Adel) • Upson Regional Medical Center (Thomaston) • Archbold Medical Center • John D. Archbold Memorial Hospital (Thomasville) • Mitchell County Hospital (Camilla) • Grady General Hospital (Cairo) • Brooks County Hospital (Quitman) • Central Georgia Health System • The Medical Center of Central Georgia (Macon) • Central Georgia Rehabilitation Hospital (Macon) • Medical Center of Peach County (Byron) • Coffee Regional Medical Center (Douglas) • Columbus Regional Health System • Columbus Regional Medical Center (Columbus) • Doctors Hospital (Columbus) • Hughston Hospital (Columbus) • Crisp Regional Medical Center (Cordele) • Dodge County Hospital (Eastman) • Houston Healthcare • Houston Medical Center (Warner Robins) • Perry Hospital (Perry)

45. Expand Definition of Servicesto Encompass the Full Continuum of Care Acuity Hospital Acute Care Community-Based Care Ambulatory Procedure Center IP Rehab Physician Clinic Retail Pharmacy SNF Post-Acute Care OP Rehab Urgent Care Center Home Care Diagnostic/ Imaging Center Wellness and Fitness Center Home Value Index: PAA x LOS x Direct Costs x Readmission

47. 5%–10% Can We Do 25% Better for 25% Less? • Incremental Change • Supply chain, standardized order sets, variance reduction, FTE rightsizing • Operational Improvements • Within-unit operational efficiency, LEAN/Six Sigma-style re-engineering • Care Model Redesign • Cross-continuum approach to managing unit cost, utilization and site of care across an entire episode or disease 10%–15% % Cost Reduction 15+%

48. THANK YOU!!!!

49. Open Discussion & Wrap Up

50. Bending the Execution Curve: Implementing Successful Organizational Change in Hospitals and Healthcare Organizations • Organizational Change • Incremental + Transformational • People • Employee & Physician • Leadership Development • Operations / Process • Systems & Structure • Quality (Clinical and Lean/Process) • Service (Patient) • Strategy (i.e., Growth) • Value Based • Continuum of Care • Agenda (Minutes) • Introduction (5) • Vince Joseph (20) • RWJUH – EVP & COO • Dr. Tim Hobbs (20) • CHNw - Chief Physician Executive • Dr. Ninfa Saunders (20) • MCCG & CGHS – President & CEO • Open Discussion (20) • Wrap Up (5)