McKesson Corporation · NYSE:MCK
McKesson — Investor Presentation (May 2008)
42 slides from McKesson's investor presentation, May 13, 2008
Slide 1: Surgeon Satisfaction: What Do Surgeons Want From Your OR?
Surgical Performance Education Webinar Series Surgeon Satisfaction: What Do Surgeons Want From Your OR? Presented by: Marita Parks, RN, MHA, Vice President Kenneth Larson, MD, General Surgeon Sisters of Mercy Health System
Slide 2: Agenda
Agenda About Sisters of Mercy Health System Market Forces What Surgeons Want Finding New Capacity Prioritizing Surgeon Time Creating Culture of Efficiency Surgical Performance Education Webinar Series Copyright 2008, All rights reserved
Slide 3: About Sisters of Mercy Health System
About Sisters of Mercy Health System 9th largest Catholic health system in US based on net patient revenue 18 acute care hospitals in 4 states (MO, AR, KS, OK) 2 heart hospitals (OK, MO) 28,000 co-workers 4,450 medical staff members 1,045 integrated physicians 4,003 licensed beds Total operating rev
Slide 4: Agenda
Agenda About Sisters of Mercy Health System Market Forces What Surgeons Want Finding New Capacity Prioritizing Surgeon Time Creating Culture of Efficiency Surgical Performance Education Webinar Series Copyright 2008, All rights reserved
Slide 5: The Market …
The Market … Source: Advisory Board Futures Database Surgical Performance Education Webinar Series Copyright 2008, All rights reserved
Slide 6: Yet OR Volumes Increasing…
Yet OR Volumes Increasing… Source: Advisory Board 2007 Surgical Performance Education Webinar Series Copyright 2008, All rights reserved
Slide 7: What New ORs Cost…
What New ORs Cost… Expensive option that does not correct underlying problems! Source: Advisory Board 2007 Surgical Performance Education Webinar Series Copyright 2008, All rights reserved
Slide 8: How To Create Flexibility…
How To Create Flexibility… Source: Advisory Board 2007 Surgical Performance Education Webinar Series Copyright 2008, All rights reserved
Slide 9: Agenda
Agenda About Sisters of Mercy Health System Market Forces What Surgeons Want Finding New Capacity Prioritizing Surgeon Time Creating Culture of Efficiency Surgical Performance Education Webinar Series Copyright 2008, All rights reserved
Slide 10: What Surgeons Say…
What Surgeons Say… The New York Times “Young Doctors and Wish Lists: No Weekend Calls, No Beepers” “The surgery lifestyle is so much worse. I want to have a family. And when you work 80 or 90 hours a week, you can’t even take care of yourself.” - Jennifer Boldrick, MD, 31, Dermatologist Source: New
Slide 11: Why Surgeons Build ASCs…
Why Surgeons Build ASCs… Top 3 reasons Source: Jackson 2002 Surgical Performance Education Webinar Series Copyright 2008, All rights reserved
Slide 12: What Matters To Surgeons…
What Matters To Surgeons… Operational efficiency Key operational metrics Access to the operative schedule Strategic priority Preferred times High percentage of on-time starts Reasonable turnover times Timely execution of diagnostic tests & medication orders Skilled staff Highly competent OR staff De
Slide 13: What Surgeons Expect…
What Surgeons Expect… Traditionally, surgeons expect: Autonomy – to care for patients without interference Protection – organizations to shield them from market forces and change Entitlement – freedom from the business side of the practice Problems with this traditional concept Blocks change Subvert
Slide 14: Efficiency
Traditional Approaches Surgeon Wants… Block scheduling On-time starts Quick turnover times Efficiency Dedicated OR teams Flexible anesthesia coverage Instrumentation availability and quality Surgical Performance Education Webinar Series Copyright 2008, All rights reserved
Slide 15: Agenda
Agenda About Sisters of Mercy Health System Market Forces What Surgeons Want Finding New Capacity Prioritizing Surgeon Time Creating Culture of Efficiency Surgical Performance Education Webinar Series Copyright 2008, All rights reserved
Slide 16: Traditional OR Efficiency
Traditional OR Efficiency Source: Advisory Board 2007 Surgical Performance Education Webinar Series Copyright 2008, All rights reserved
Slide 17: New Approaches
New Approaches Finding New Capacity Practice pattern-driven staffing Growth-oriented block scheduling Prioritizing Surgeon Time Surgeon schedule advocate Low-acuity fast tracks Surgeon-specific staffing Flip room strategy Creating a Culture of Efficiency Incentives Case study example Surgical Perfor
Slide 18: Futures: OR As Strategic Asset
Futures: OR As Strategic Asset Strong data infrastructure; data definitions standardized for external benchmarking Team wide alignment with facility goals Prioritized allocations of OR resources based on facility strategic goals Source: Advisory Board 2007 Surgical Performance Education Webinar Seri
Slide 19: How To Find New Capacity…
How To Find New Capacity… Practice Pattern-Driven Staffing Locate demand peaks Study practice patterns of surgeons Change shifts to match demand Stagger shifts so peaks in staffing occur with peaks in demand Assign staff to cover new shifts Use staff preferences to fill later shifts when possible So
Slide 20: Growth-Oriented Block Strategy
Growth-Oriented Block Strategy Block Basics Block Time Management Blocks are a key surgeon draw Expert management of block Demand for blocks usually high times Difficult for new surgeons to Determine strategic growth access procedures based on profitability Incumbents resist reform Allocate percenta
Slide 21: Block Time Effectiveness
Block Time Effectiveness Source: Advisory Board 2007 Surgical Performance Education Webinar Series Copyright 2008, All rights reserved
Slide 22: Agenda
Agenda About Sisters of Mercy Health System Market Forces What Surgeons Want Finding New Capacity Prioritizing Surgeon Time Creating Culture of Efficiency Surgical Performance Education Webinar Series Copyright 2008, All rights reserved
Slide 23: Surgeon Time Constraints
Surgeon Time Constraints Source: Clinical Advisory Board Interviews Surgical Performance Education Webinar Series Copyright 2008, All rights reserved
Slide 24: Prioritizing Surgeon Time: Schedule Advocate
Prioritizing Surgeon Time Schedule Advocate Specialty coordinator who optimizes surgeon schedules on daily basis Cases sometimes get lost due to blocked calendar Coordinator takes charge of wait list – Must be respected by surgeon – Be a self-starter Persistent schedule review results in opportunity
Slide 25: Prioritizing Surgeon Time: Low-Acuity Fast Tracks
Prioritizing Surgeon Time Low-Acuity Fast Tracks Components of Fast-Track Scheduling Select surgeons w/high volumes, fast times Low-acuity patients – Select patients – No comorbidities Limited to one surgeon per day – Preserves procedure balance – Does not overload PACU No residents – Teaching restr
Slide 26: Prioritizing Surgeon Time: Surgeon Specific Staffing
Prioritizing Surgeon Time Surgeon Specific Staffing Advantages of dedicated staffing Nurses familiar w/procedure, supplies, surgeon preference Faster case times Increased surgeon confidence, satisfaction Surgeons vie for dedicated staff Selection criteria for surgeons Standardized supplies Assignmen
Slide 27: Prioritizing Surgeon Time: Flip Room Strategy
Prioritizing Surgeon Time: Flip Room Strategy Flip room criteria Total procedure length less than two hours Turnaround time approximately equal to surgeon-controlled time Case length predictability – minimal variability Equipment – necessary equipment in both rooms Surgical Performance Education Web
Slide 28: Prioritizing Surgeon Time: Flip Room Appropriateness
Prioritizing Surgeon Time Flip Room Appropriateness Appropriateness check Will surgeon increase monthly case load? Will surgeon generate more cases through clinic in free time? Is the surgeon a good steward of hospital resources? Would a new surgeon or other surgeons use this time more appropriately
Slide 29: Agenda
Agenda About Sisters of Mercy Health System Market Forces What Surgeons Want Finding New Capacity Prioritizing Surgeon Time Creating Culture of Efficiency Surgical Performance Education Webinar Series Copyright 2008, All rights reserved
Slide 30: Creating a Culture of Efficiency
Creating a Culture of Efficiency Find ways to motivate staff Bonuses based on: – Expense per case – Patient and surgeon satisfaction scores – Team performance goals Send staff home early when case load completed Turn surgeons into allies First case start times Room turnover times Effective managemen
Slide 31: First Case Start Times Example
Creating A Culture of Efficiency First Case Start Times Example Percent of Cases Starting On Time 100% 87% 90% 80% 77% 70% 67% 67% 65% 65% 63% 61% 60% 59% 58% 57% 59% 60% 53% 50% 43% 44% 42% 40% 40% 37% 36% 37% 32% 32% 32% 28% 30% 23% 20% 10% 0% 6 06 06 06 07 06 06 06 6 6 6 06 06 l-0 -0 -0 -0 p- - n
Slide 32: Reasons for Delays
Creating A Culture of Efficiency Reasons for Delays Incomplete Patient Month Surgeon Anesthesia Staff Other Testing Delay Jan-06 36% 20% 5% 0% 37% 2% Feb-06 38% 14% 4% 7% 34% 3% Mar-06 40% 7% 1% 4% 29% 18% Apr-06 45% 15% 1% 3% 25% 10% May-06 51% 17% 5% 3% 15% 9% Jun-06 40% 13% 7% 8% 28% 4% Jul-06 21
Slide 33: First Case Start Times
Creating A Culture of Efficiency First Case Start Times Goal Improve the first case start time percentage to a specified target – benchmark 75% Monitor daily and track progress Routinely report progress to surgeons – post graphs Celebrate successes Surgical Performance Education Webinar Series Copyr
Slide 34: Average Case Turn Around Time Example
Creating A Culture of Efficiency Average Case Turn Around Time Example Average Case Turn Around Time (minutes) 32.0 30.0 28.0 26.0 24.0 Benchmark 22.0 20.0 18.0 06 6 06 07 06 06 06 6 6 6 06 06 l-0 -0 -0 -0 p- - n- n- b- - g- r- ov ec ay ar ct Ju Ju Ja Fe Ap Se Au O M N D M Benchmark 20 – 25 minutes
Slide 35: Case Study: OR Turnover Times
Case Study: OR Turnover Times Goal Achieve and maintain an average turnover time of 25 minutes (Mercy best practice benchmark) Decrease the amount of time from the patient into the room to the start of the procedure Monitor progress Report progress to surgeons – post graphs Celebrate successes Surgi
Slide 36: Total Cases & Add Ons
Creating A Culture of Efficiency: Total Cases & Add Ons Total Cases & Add On Cases - Main OR 800 700 600 500 400 300 200 100 0 06 r-0 6 6 06 6 06 06 06 6 6 6 7 07 eb- a pr-0 y- un-0 J ul- g- p- ct-0 ov -0 ec -0 an-0 eb- F M A Ma J Au Se O N D J F Total Add On Cases Total Cases 32.9% avg. add-on case
Slide 37: Case Study: Room Utilization
Case Study: Room Utilization 7:00-12:00 M-F 12:01-17:00 M-F Totals M-F 07:00 - 17:00 Turnover Wk Month Time Days Case In Room Case In Room Turnover Total In Room Minutes Available Room Utilization (Min.) Volume Min. Volume Min. Minutes Min.+ T/O Min. 7:00 - 17:00 (M-F) 7:00 - 17:00 (M-F) Jan-06 21 2
Slide 38: Sustainability: Balanced Scorecard Approach
Sustainability: Balanced Scorecard Approach Internal Processes Vision Learning Financial & & Performance Strategy Growth Customer Satisfaction “The balanced scorecard is like the dials in an airplane cockpit: it gives managers complex information at a glance.” Robert S. Kaplan Surgical Performance E
Slide 39: Building a Balanced Scorecard
Building a Balanced Scorecard FINANCIAL CUSTOMER SATISFACTION PERFORMANCE • Effective resource utilization • Enhance patient experience • Improved cash flow & AR • Reinforce staff morale • Long term viability • Increase physician satisfaction INTERNAL PROCESSES LEARNING AND GROWTH • Streamline proce
Slide 40: Summary
Summary Key Learnings To Create A Surgeon-Friendly OR Focus on Surgeons Schedule flexibility Skilled staff Flip room strategy Focus on Staff Metric targets and management Behavioral changes Incentive structures Surgical Performance Education Webinar Series Copyright 2008, All rights reserved
Slide 41: Questions?
Questions? Marita Parks, RN, MHA, Vice President Kenneth Larson, MD, General Surgeon For more information: Trish Crescitelli Director, Marketing, Surgical Solutions McKesson Trish.Crescitelli@mckesson.com Surgical Performance Education Webinar Series Copyright 2008, All rights reserved
Slide 42: Surgeon Satisfaction
Surgeon Satisfaction What Do Surgeons Want from Your OR? To obtain CEUs, please complete and submit the survey at http://www.zoomerang.com/Survey/?p=WEB227P87GCZV4 Archived webinars available on the McKesson web site www.mckesson.com/events or www.ormanager.com Contact Trish Crescitelli at trish.cre