MALCOLM 2015 BALDRIGE NATIONAL QUALITY AWARD APPLICATION Mid-America Transplant Services 1110 Highlands Plaza Drive East • Suite 100 St. Louis, MO 63110

Illinois

Missouri

Arkansas

0762IÀFH MTS Service Area Table of Contents

(OLJLELOLW\&HUWLÀFDWLRQ)RUP ...... ii Organization Chart ...... x $ZDUG$SSOLFDWLRQ)RUP SDJH$ ...... xii *ORVVDU\RI7HUPVDQG$EEUHYLDWLRQV ...... xiii 2UJDQL]DWLRQDO3URÀOH ...... xix P.1 Organizational Description ...... xix P.2 Organizational Situation ...... xxii Category 1 – Leadership ...... 1 1.1 Senior Leadership ...... 1 1.2 Governance and Societal Responsibilities ...... 4 Category 2 – Strategy ...... 7 2.1 Strategy Development ...... 7 2.2 Strategy Implementation ...... 10 &DWHJRU\²&XVWRPHU)RFXV ...... 12 3.1 Voice of the Customer ...... 12 3.2 Customer Engagement ...... 14 &DWHJRU\²0HDVXUHPHQW$QDO\VLVDQG.QRZOHGJH0DQDJHPHQW ...... 16 4.1 Measurement, Analysis, and Improvement of Organizational Performance ...... 16 4.2 Knowledge Management, Information, and Information Technology ...... 19 &DWHJRU\²:RUNIRUFH ...... 22 5.1 Workforce Environment ...... 22 5.2 Workforce Engagement ...... 25 Category – 6 Operations ...... 29 6.1 Work Processes ...... 29 6.2 Operational Effectiveness ...... 31 Category – 7 Results ...... 34 7.1 Product and Process Results ...... 34 7.2 Customer-Focused Results ...... 40 7.3 Workforce-Focused Results ...... 42 7.4 Leadership and Governance Results ...... 44 7.5 Financial and Market Results ...... 48

Table of Contents • i Organization Chart

Organization Chart • x s m a r r r g o o e t t o r r a a a P n n c i i r

t d d n e n r r t a f o o l A o o p Aftercare Programs s C C Coordinator Coordinator Merry Smith n a r RJ Crunk T Dir, MTS Foundation Transplant Programs Foundatio Vice President, External I I Relations/Executive Director, k n i s n e m a D g d r t A n O

e / o I v r I i F t Karen Brown / A u c Mgr, Grants and A A AA II/Organ Executive Support e A AA/Front Desk x E Executive Admin II y r r e o v t o a c n e i

R d r n o a Services o g C r Coordinator Mgr, Clinical Open Position O Organ Recovery t t n n Updated 4/24/2015 m e e a r e m m o T e e t - r r r a u u d o n c c i t a

o o a d e r r r L n Lead i P P o d o n n r C a a Coordinator o g g o r r Dir, Organ C Coordinator-Team Procurement O O Organ Procurement Organ Procurement Richard Rothweiler r o t n n l a d a a a n g n i t g tI r n m t n a r r r m m s d a i o n o I O r o a a l o i I r O s / e r r t m i o a g p / g t t i g g a a t a e o s p o m c i n r i o o n n r l C R L u e i e e r r g

- e r P a

S t d p t P P o y i m u r l r r s n S c m y i r r i c l p o o l P e e r i p o o o Services o m o a Bill Muren n r p Ron Gegg o r l o i n n m m l a C o S o c Coordinator e n Mgr, Hospital Development P Dir, Hospital Specialist II o o e Procurement F a e Family Liaison e v n r o Donor Program F v D D Family Support Donor Program Donor Program e p o u D e Donor Specialist I S c D Specialist-Regional D Development/Organ Donor Program and D o Development/Organ r Jason Coleman P Procurement Coordinator Program Services d t n n s n t i o o l a r y i i r r l a t t o t i Vice President, Organ Donor i o o t r a a p c t t s m o i u u e p a a l l l a p p u n n a a a F i i i p S

S v v c r d d u t E E y r r e o S r l i r r i o o p o y n o o S o o l Specialist p m i e n n C C a Coordinator Coordinator p S Nicole Kellen o o Senior Family m F Donor Support u Dir, Family and Family Support a D D S Donor Evaluation Donor Evaluation Support Specialist F Family Support and s s e t n n a r o o r i i o t t t o t s i a a a p l c c r i i n a i i o n n c d C u u r e r o p m m o S o i Specialist m m C n Coordinator o o e Dir, Corporate Tammy McLane C C S Communications Communications Communications Senior Corporate Diane Brockmeier t h s t c i s l n a e a e e n c r r r r r a t e d m o o t n u Executive Vice President/COO u t t n a s p m o o i a a i e l e o O s u t l L n n a G e i i i H a y e

c t R c s d d v r i m r r e e u e o n a n i o o c p d D a e u r S n o o E Specialist T Education f u Team Lead e Operations C C m m f Coordinator Coordinator o S a u Senior Human s m t Director, Human H e Angela Schlansker S Human Resources o Staff Development Resources and DMV R C Resources Generalist Community Outreach l k o Dean Kappel r r t President/CEO t e t l n n t s n e C l s o a i a l g t i m C r a n n e i i y

e g u c t r t a e o n o a t c n p u c n a S M o Specialist Materials A e c Accountant M v c Management Anthony Lloyd n A I Accounting Clerk Inventory Control Chief Financial Officer r t r s o r o i r t l t e e a a a r r i n n m n o c a i i o l o t e r d t d u a r r p o s c n o S o C u i

O o o s C d d r C C d n r n o a o a r e a Dan Lunn i l o e c a t Operations i l u L E C Dir, Eye Bank Lead Ocular Coordinator a v c u l r c M e O ME and Coroner e Ocular Customer O R S Ocular Coordinator Relations Specialist Service Coordinator I I t tI s s t i i s g i g b o g o l l a o o l L o n o

n d h n h a c c h e Services e c e L Lead Lab T e T T Robert Bresler b Technologist b Dir, Laboratory Dr. Gary Marklin a a L L Lab Technologist I Chief Medical Officer Lab Technologist II s s s s d d a r r e e r r t m a c c o o t i i d a e o o t t r r c c t t t a v v a s s e e D e i i e r r s a a l l e D R y e e R w w L h n n a a l i i i i l S S S l e e c

a i i c c r d d a l l a m c y v v r r t e e c a i a a t i i a i e e o o c c p p e n l p i i e n i s R R S S o o l a s Reviewer Reviewer Specialist Specialist T n n h e Team Lead i i C C Dir, Quality C u o Coordinator Coordinator c l l Clinical Data Beth Wayant R Research Data e C C H Q Clinical Services Clinical Services Hospital Record Quality Systems T Technical Records d a r t r e a n Linda Martin L l o S e t u Support Services a c m W m n a O T e i

r e I d e T u r Vice President, Tissue and u c A o e s o A o s AA I TWS u r i Dir, Tissue s C Erica Stone Coordinator P T Procurement s Tissue Ocular Procurement i T Tissue Team Lead d t t t s n r i t s r l a o s y r e a l t y p s e i o l s a p c c t p n t a y k n o n e s l a u o l r i n i r a A l a p S e t t o A a S n v s s a e i m i

s c e c r c A g i tw s n m l e i n o n D e e a i e f p e p t t t r n l S m Steve Haven N Dir, PI and IT S i l p r Network a s Specialist e R d s e y o A D P S Data Analyst Performance c u A S p Administrator L S x SSRS Developer B e Business Analyst T E Q I Excellence Analyst R IT Systems Support Reporting Specialist S SQL Applications and r n n r o m o o e i s t i a t n t e a r r i e a c a d n o o i a T n i n t t a n - r v o d r o a a e r T o i r d o L t / n n e D D i i t o a t

a S s a d d e e o e i m n r r r s L l n s C Lead a o i o o o a u u i e e d n D o o o Donation c o r T g Team Lead o C C e H Coordinator Coordinator o H a i D - p - Donor Services o Steve Huckstep r n S n C Specialist/Trainer T I Coordinator-Team I Triage Coordinator In-House Donation Dir, Donor Services In- House Donation xi • Organization Chart *ORVVDU\RI7HUPVDQG$EEUHYLDWLRQV results-oriented survey instruments, training and development programs, and “actionable” management consulting; formerly 24/7 Avatar International LLC and HR Solutions Inc. 24 hours a day/7 days a week BJH 90 DAYS TO SUCCESS Barnes Jewish Hospital (transplant center) Comprehensive approach to teaching the skills an employee needs to be an effective supervisor BOARD QUALIFICATIONS AND AFFILIATION GRID 360 DEGREE REVIEW Grid that illustrates the demographic categories represented on Multi-rater feedback provided by direct reports and peers the Board of Directors

AATB BOARDSOURCE American Association of Tissue Banks Organization that provides knowledge, resources and DVVHVVPHQWWRROVIRUQRQSUR¿WERDUGVWRLQFUHDVHHIIHFWLYH ADA governance systems Americans with Disabilities Act BOD AERO CHARTER Board of Directors St. Louis based corporation that specializes in aircraft management and aircraft charter services BODY SUBSTANCE EXPOSURE HOTLINE Hotline service which provides 24-hour consultation after a AFTERCARE EORRGRUERG\ÀXLGH[SRVXUH Support and bereavement services provided by MTS to Donor Families after donation BONE DONORS RELEASED Metric from scorecards referring to musculoskeletal donors AFTERCARE STAGE released to the tissue processing partner The post-donation stage of the customer life cycle BRAIN DEATH ALLOSOURCE /HJDOGH¿QLWLRQRIGHDWKWKDWUHIHUVWRWKHLUUHYHUVLEOHHQGRI Tissue processing facility partially owned by MTS (customer) all brain activity

ALLOSOURCE TISSUE RECOVERY PARTNERS CANDLELIGHT MEMORIAL MTS, along with three OPOs partnered to form AlloSource. Annual event facilitated by MTS to honor the donors and their gifts AOPO Association of Organ Procurement Organizations CAPA Corrective Action Preventive Action AOS Available On Site CARDIAC CATHETERIZATION Procedure utilized to evaluate potential cardiac donors AP(s) Action Plan(s) CASCADING SCORECARD Tool in the measurement system that cascades results from the AUDIT COMMITTEE topline metrics to the individual level Board committee with the primary purpose of assisting the Board of Directors by providing oversight and making CC UHFRPPHQGDWLRQVLQUHJDUGWRH[WHUQDODXGLWDFWLYLWLHV &RUH&RPSHWHQFLHV+LJKO\HQJDJHGVDWLV¿HGZRUNIRUFHDQG partnering AUTHORIZATION 3HUPLVVLRQRUSRZHUJUDQWHGE\DQDXWKRULW\ ¿UVWSHUVRQRU C&C QH[WRINLQ IRURUJDQDQGRUWLVVXHGRQDWLRQ Capability and Capacity

AVATAR HR SOLUTIONS BEST-IN-CLASS CCP Best-in-Class-top 10% in the Avatar HR Solutions, Inc. Corporate Compliance Program database amongst 260 organizations. CDC AVATAR HR SOLUTIONS Center for Disease Control A company that empowers organizations to increase their employee engagement and customer loyalty by providing

Glossary of Terms and Abbreviations • xiii CEO DART RATE &KLHI([HFXWLYH2I¿FHU Days away, restricted or transferred (OSHA Form 300a)

CFL DATA MALL Center for Life-MTS department responsible for aftercare and 5HSRVLWRU\RISUHGH¿QHGUHSRUWVZKLFKDOORZWKHXVHUWR support for Donor Families post donation. access valuable organizational data for decision-making

CLIA DCD Clinical Laboratory Improvement Amendments Donation after Cardiac Death-type of donation for organ procurement that occurs after cardiac cessation CMS Centers for Medicare and Medicaid Services DEC Donor Evaluation Coordinator CMS CONDITIONS FOR PARTICIPATION Requirements that organ procurement organizations (OPOs), DECADE CLUB hospitals, and organ transplant centers must meet to have their Annual celebration for those tenured employees who are services covered by Medicare celebrating ten or more years of employment

COMMUNITIES WITHIN SERVICE AREA DEPARTMENT SCORECARD Donor families and transplant recipients within the donation Measurement system tool tracked by department service area DEPARTMENT SPOTLIGHTS COMPENSATION COMMITTEE Presentations that highlight departmental and individual %RDUGFRPPLWWHHWKDWSURYLGHVPDQDJHPHQWRIWKHH[HFXWLYH responsibilities compensation program, conducts annual performance evaluation of the CEO and approves recommendations by the DESIGNATED REQUESTOR CEO for his direct reports Employee of key partner hospitals involved with Donor Families during the family interaction process CONFLICTS OF INTEREST COMMITTEE (COI) Board committee that provides oversight and review of board DMV PHPEHUFRQÀLFWVRILQWHUHVW Department of Motor Vehicles

CONVERSION/CONVERSION RATE DOL Percentage of actual donors divided by potential donors Department of Labor

COO DONOR FAMILIES &KLHI2SHUDWLQJ2I¿FHU Families consenting to organ and/or tissue donation

CORE VALUES DONOR HOSPITALS Quality: We do our best, always Partner hospitals within MTS’ DSA where donation may Compassion: We feel and show concern for others occur Integrity: We act according to what is right and wrong Teamwork: We work in harmony with others DONOR MEDAL Innovation: We make meaningful changes to improve Commemorative circular plaque for display at the funeral, family’s home, or at the tombstone CORPORATE GOVERNANCE/NOMINATING COMMITTEE DONOR REGISTRY %RDUGFRPPLWWHHZLWKWKHSXUSRVHRIQRPLQDWLQJTXDOL¿HG Voluntary public registry individuals to serve as board members, committee members, FRPPLWWHHFKDLUVDQGRI¿FHUVRIWKHFRUSRUDWLRQWKLV DONOR SERVICES committee also facilitates the self- evaluation of the board Process owner for facilitation of communications relevant to the donation process on a 24/7 basis CT SCAN Diagnostic tool to assess donor suitability DONORNET Facilitates organ placement and acceptance CUSTOMER LIFE CYCLE 'RQRU)DPLOLHVH[SHULHQFHWKHGRQDWLRQVWDJHLQLWLDOO\ DOR followed by the aftercare stage Department of Revenue

xiv • Glossary of Terms and Abbreviations DPD GRIEF COMPANION PROGRAM Donor Program Development Donor families that are in the early stages of their grief cycle are paired with families further down their grief journey to DPS help provide ongoing support Donor Program Specialist HLA DSA Human Leukocyte Antigen Designated Service Area HONORING THE DONOR EBAA Events, activities, and media messages are used to pay tribute Eye Bank Association of America to the donor for their lifesaving gifts

EEOC HOSPITAL CYCLE TIME Equal Employment Opportunity Commission Time from declaration of death to the transportation of the donor to MTS for ICU management and organ recovery ELT ([HFXWLYH/HDGHUVKLS7HDPFRQVLVWLQJRIWKH&(2DQG&22 HRSA Health Resources and Services Administration EMB (PHUJHQF\0HGLFDO%DQNHPSOR\HHEHQH¿WWRFRYHUH[WHQGHG ICU illnesses Intensive Care Unit

EMR IIP Electronic Medical Record Improvement and Innovation Process

ERP INDIVIDUAL SCORECARDS Emergency Response Plan Measurement system tool tracked at the individual level

EXCELLENCE IN MISSOURI FOUNDATION IT 6WDWHSHUIRUPDQFHH[FHOOHQFHSURJUDP Information Technology

EXECUTIVE COMMITTEE KM Board committee that has the purpose of acting on behalf of Knowledge Management the full Board of Directors between meetings and otherwise as directed by the Board and the bylaws LDS Learning and Development System FDA Food and Drug Administration LIFELOGICS Collaboration of OPOs to develop industry software FLSA applications to capture actionable feedback Fair Labor Standards Act LT FOUR A’s Leadership Team MTS Complaint Resolution Process: Acknowledge, Apologize, Ask, Act LS Leadership System FPA First Person Authorization MAXIMIZING DONATION Increasing consent for donation and clinically managing the FSS donor Family Support Services ME FTE 0HGLFDO([DPLQHU Full-Time Employee MEDICAL ADVISORY BOARD GIFT OF LIFE CMS mandated advisory board that has the primary function Organs and tissues donated by Donor Families to recommend policies relating to the donation, procurement and distribution of organs, tissues and bone.

Glossary of Terms and Abbreviations • xv MEMBER IN GOOD STANDING OSHA &ODVVL¿FDWLRQXWLOL]HGE\8126WRUHÀHFWRUJDQL]DWLRQDOVWDWXV Occupational Safety and Health Administration

MERCER OSR Provides HR consulting services to the Compensation On-Site Requestor Committee to assist with evaluating and establishing the CEO compensation program OWS Organ Work System MISSION :HVDYHOLYHVWKURXJKH[FHOOHQFHLQRUJDQDQGWLVVXHGRQDWLRQ PASSPORT TO EXCELLENCE A quarterly comprehensive 8-hour orientation program MQA Missouri Quality Award PDSA Plan-Do-Study-Act problem-solving methodology MTS Mid-America Transplant Services PEP Performance Evaluation Process NATCO 1DWLRQDO2UJDQL]DWLRQRIWKH7UDQVSODQW&RPPXQLW\ PHONE CONSENT Authorization for donation is secured telephonically primarily NETWORK INTERFACE CONTROLLERS conducted by Donor Services staff Computer cards that connect computers and servers to a network PI Performance Improvement OAC Organ Acquisition Charge - the cost that MTS bills the PMS transplant centers for the procurement of organs; includes all Performance Measurement System direct costs as well as indirect costs PRIORITY MATRIX OD(s) Project management tool that sorts initiatives by urgency and Operational Discussions importance based upon several key factors

OMP PRESS GANEY Operational Management Process 1DWLRQDOFRPSDQ\WKDWSURYLGHVUHVXOWVRULHQWHGVXUYH\ instruments, training and development programs, and OPC actionable management consulting to aid organizations in Organ Procurement Coordinator increasing engagement

OPO PTO Organ Procurement Organization Paid/Personal Time Off

OPTN RFO 2UJDQ3URFXUHPHQWDQG7UDQVSODQWDWLRQ1HWZRUN Rounding for Outcomes

OR RPG Operating Room Research and Planning Group

ORGAN SA(s) Refers to kidneys, lungs, liver, heart, intestine, pancreas Strategic Advantage(s)

ORGAN CONVERSION SAFETY COMMITTEE Percentage of actual organ donors divided by potential organ Safety task force comprised of individuals representing donors multiple departments promoting and addressing safety needs

ORGAN OPERATIONS MEETINGS SAFETY PROGRAM Weekly meetings to review organ donation cases and family Safety program in place across the organization that aids in the refusals prevention of workplace injuries

ORGAN YIELD SC(s) Organs transplanted per donor Strategic Challenge(s)

xvi • Glossary of Terms and Abbreviations SCORECARD SWOT 0HDVXUHPHQWV\VWHPWRROZLWKNH\PHDVXUHVVSHFL¿FWRD Strengths, Weaknesses, Opportunities, Threats analysis as part GH¿QHGVHJPHQWRIWKHRUJDQL]DWLRQ of environmental scanning

SD(s) TISSUE Strategic Discussion(s) Refers to musculoskeletal, skin cardiovascular, and eye

SEROLOGIC DONOR TESTING TISSUE PROCESSORS Donor blood test to assess communicable disease status )DFLOLWLHVWKDWPDQXIDFWXUH¿QDOWUDQVSODQWDEOHWLVVXHIURP donated tissue SERVICE BEHAVIORS (PSOR\HHFRQGXFWJXLGHOLQHVWKDWGH¿QHKRZHPSOR\HHV TISSUE YIELD H[HPSOLI\WKHFRUHYDOXHVLQDSURIHVVLRQDOPDQQHU Tissue procured per donor

SHAREPOINT TOPC A collection of products and software elements that include Tissue Ocular Procurement Coordinators browser-based collaboration functions, process management modules, search modules and a document management TOPLINE SCORECARD platform 3HUIRUPDQFHPHDVXUHPHQWWRROUHÀHFWLQJVWDWXVRINH\ organizational metrics SO(s) Strategic Objective(s) TRAINING AND DEVELOPMENT PLAN Component of the Performance Evaluation Plan SOP(s) Standard Operating Procedure(s) TRANSPLANT CENTER Hospital in which organ transplants occur SLS Sharing LifeSaving Success - directly linked to the MTS TRIGGER mission, this is a plan designed to share organizational Mechanism to notify MTS of an imminent/eligible death to ¿QDQFLDOVXFFHVV initiate the donation process

SQL TRUENORTH Structured Query Language - a standard language used to Electronic software system utilized by MTS Operations for manipulate a relational database system clinical activity as the electronic medical record

STATUS REPORT TWS Monthly activity of organ and tissue donation report provided Tissue Work System to partners and stakeholders UNOS STEWARDSHIP OF THE GIFT 8QLWHG1HWZRUNIRU2UJDQ6KDULQJ In the donation stage of the customer life cycle, trusting that MTS will take the utmost care of the donation in a respectful UPS way Uninterruptible Power Supply

STOPLIGHT REPORT VISION Report given at monthly staff meetings that provides RFO Organs and tissues are always available to those in need IHHGEDFNDQGLGHQWL¿HVLWHPVWKDWKDYHKDGDFWLRQWDNHQDUHLQ progress or cannot be completed V/M Vision/Mission STP Strategic Thinking Process V/M/V Vision/Mission/Values STUDER LEARNING DEVELOPMENT INSTITUTE (LDI) VOC Educational series provided by the Studer Group, an outcomes Voice of the customer EDVHGKHDOWKFDUHFRQVXOWLQJ¿UPGHYRWHGWRWHDFKLQJHYLGHQFH based tools and processes that organizations can immediately VPN use to create and sustain outcomes in service and operational 9LUWXDO3ULYDWH1HWZRUN H[FHOOHQFH

Glossary of Terms and Abbreviations • xvii WF Workforce - includes LT and staff.

WORK SYSTEM SCORECARD Measurement system feedback reporting results of the operational work systems

YIELD Outcomes of donation activities

YTD Year to date

xviii • Glossary of Terms and Abbreviations 2UJDQL]DWLRQDO3URÀOH Figure P.1-1 Vision, Mission,Values Picture Ryan, who is only 16-years-old, an avid baseball player, and a beloved son, grandson, brother, and friend. Organs and tissues are always Following a critical injury during a baseball game, he is now available to those in need n io in the intensive care unit. After evaluating Ryan’s injuries and is V performing lifesaving measures, the doctors have diagnosed We save lives through excellence conclusively that Ryan is brain dead. Machines keep his n sio in organ and tissue donation is organs functioning while a team from Mid-America Transplant M Services (MTS) talks compassionately to Ryan’s family about Compassion: We feel and show concern for others. s donating his organs and tissues. On the most agonizing day of ue Innovation: We make meaningful changes to improve. al WKLVIDPLO\¶VOLIHWKH\¿QGWKHFRXUDJHWRVD\³\HV´ V Integrity: We act according to what is right and wrong. Ryan saved six lives that day, among them: A 3-year-old boy Quality: We do our best, always. from Missouri, who received Ryan’s left kidney, is now excited Teamwork: We work in harmony with others. to go home with his family after being in the hospital since birth; A 56-year-old father, an Amtrak worker from Illinois, circumstances of brain death under which an organ donor must who had been waiting for a liver for four years; A 9-year-old die. Tissue and corneal donation opportunities occur around earthquake victim, who was airlifted to a Florida hospital with RUDSSUR[LPDWHO\WLPHVDQQXDOO\(Figure P.1-3). burns on over 50 percent of her body, received Ryan’s tissue MTS partners with the 122 hospitals located within its that helped keep out infection while her skin regenerated. designated service area to gain access to potential donor The courage and generosity exhibited by Ryan and his family collaborators, a critical control point of the donation family, and by all donor families, are the reasons MTS staff process (Figure 2.1-2). MTS provides ongoing educational members come to work every day to realize the mission of the offerings to donor hospital partners to ensure this introduction organization to save lives through excellence in organ and occurs in a timely manner. Once a referral is made, MTS tissue donation. prescreens the patient for medical eligibility for donation. Patient families are compassionately approached by MTS 32UJDQL]DWLRQDO'HVFULSWLRQ Family Support Services (FSS) staff in the Organ Work 3D2UJDQL]DWLRQDO(QYLURQPHQW System (OWS) and by the Donor Services staff in the Tissue 3D  For more than 40 years, Mid-America Transplant Work System (TWS). During the approach, families are Services (MTS) has served as the regional Organ and Tissue presented with the opportunity for donation or to honor their Procurement Organization (OPO) for 4.7 million people living loved one’s previous decision to become a donor (Figure within a federally-assigned territory inclusive of 84 counties 3.2-1, Availability Phase). MTS clinical staff assists the donor within eastern Missouri, southern Illinois, and northeast hospital partners with the medical management of the donor Arkansas. From its founding goal to assist in the coordination until transportation to the MTS facility occurs and the donated of kidney donations, MTS has grown to become a multi- gifts are recovered (Figure 3.2-1, Recovery Phase). In the IDFHWHGQRWIRUSUR¿WRUJDQL]DWLRQGHGLFDWHGWRVDYLQJOLYHV Organ Work System, recovery is performed by the transplant and enhancing the quality of donated organs and tissues for surgeon assisted by MTS Organ Procurement Coordinators; transplant (Figure P.1-1). Located in St. Louis, MO, MTS is one of the 58 federally designated organizations of its kind in Figurere P.1-2 PartnershipPartnership MoModeldel the United States. MTS’ main service offering is the facilitation of organ and tissue donation, accomplished through the organization’s two work systems: Organ and Tissue (Figure 2.1-2). The MTS delivery of services for both work systems requires the careful coordination of partners, collaborators and suppliers to ensure organs, tissues, and corneas are available for use by the K s e organization’s key customer groups (Figure P.1-2). r y to a S Donor families come from the community at large and are r u o p b p LGHQWL¿HGDVSRWHQWLDOFROODERUDWRUVRQFHDGRQRUKRVSLWDO a l l i l e SDUWQHU QRWL¿HV076RIWKHLUSDWLHQW¶VGHDWK$WWKLVSRLQW o r s

C LIVES assuming the patient is medically suitable for donation, the donor family is presented with the collaborative opportunity SAVED for donation by a member of the MTS workforce. Due to stringent and often limiting criteria governing organ and tissue Partners Customers K rs GRQDWLRQHDFKRSSRUWXQLW\RUUHIHUUDOPXVWEHPD[LPL]HG ey Supplie WRLWVIXOOHVWSRWHQWLDO2IWKHDSSUR[LPDWHO\GHDWKV occurring annually within MTS’ Designated Service Area '6$ DURXQGRUDSSUR[LPDWHO\SDWLHQWVKDYH the opportunity to become organ donors due to the special

2UJDQL]DWLRQDO3URÀOH‡ xix Actively Engaged Population and third highest Overall Figure P.1-3 Finding the Silent Heroes Job Satisfaction in the nation (Figures 7.3-12 & 7.3-14). 4.7 Million People in MTS Service Area • Innovation: Innovation is embedded in the culture of ORGAN 30,000 Deaths Reported MTS beginning at the governance level with a Board of (Approximate) Directors, who are vested in intelligent risk taking, and 1,853 continues through the mission-driven workforce, which is Referrals TISSUE 17,718 OHYHUDJHGWR¿QGPHDQLQJIXOZD\VWRLPSURYH,QUHFHQW \HDUV076KDVEURNHQQHZJURXQGLQWKH¿HOGRIRUJDQ 1 3159 53 212 Eligible and tissue donation, which allows the organization the 4,154 DELOLW\WRIRFXVRQRSHUDWLRQDOHI¿FLHQFLHV Refusals 3D  MTS is a 24-hour business in which many of the

2,196 HPSOR\HHVDUHGHFHQWUDOL]HG7KH:RUNIRUFH3UR¿OH Donors (Figure P.1-4)UHÀHFWVWKHHPSOR\HHSUR¿OHDQGLQFOXGHVMRE type, ethnicity, gender, and tenure. To date, the organization

1,958 KDVQRWH[SHULHQFHGDQ\UHGXFWLRQVLQZRUNIRUFH&RQYHUVHO\ as donations increase (Figures 7.1-5 & 7.1-4), so has the need IRUH[SDQVLRQRIERWKFOLQLFDODQGQRQFOLQLFDOVWDIIWRVXSSRUW in the Tissue Work System, recovery is performed by MTS operations. In the past 10 years, the number of employees Tissue and Ocular Procurement Coordinators. MTS acts as a in the organization has nearly doubled (Figure 7.3-4). For responsible steward of the “Gift of Life” by coordinating the the purpose of reporting and comparing data, the workforce placement of donated organs and tissues to its key customer is segmented by work system and department. The OWS groups: local organ transplant centers, tissue processors, and manages the organ donation process; the TWS manages the local corneal transplant centers (Figure 3.2-1, Disposition/ tissue donation process; and the support departments provide Allocation Phase). The donated organs and tissues are used for WKHLQIUDVWUXFWXUHWRPD[LPL]HRUJDQL]DWLRQDOSHUIRUPDQFH the betterment of the organization’s key communities of donor The organization does not utilize the assistance of volunteers. families and transplant patients and their families (Figure P.1- Workforce educational requirements, including applicable 6). FHUWL¿FDWLRQVPD\YDU\E\ZRUNV\VWHPDQGGHSDUWPHQW These requirements are included in all job descriptions. 3D  Simply put, the purpose of MTS is to save and Through various communication methods (Figure 1.1-3), improve lives (Figure P.1-1). MTS’ vision is: Organs and such as regular staff meetings, MTS routinely promotes that Tissues are always available to those in need. The vision every role in the organization contributes to the success of was developed in light of the belief that the organization’s WKHPLVVLRQ$VLGHQWL¿HGLQWKHVWDIIVXUYH\DQGYDOLGDWHG ultimate goal will only be realized when organs and tissue are through repeated survey cycles, the key drivers that engage readily available to patients when they need them. Central MTS employees in achieving the Mission and Vision are to the MTS culture is a strong drive to meet the mission: We contributing to the mission itself: saving lives, followed save lives through excellence in organ and tissue donation. closely by relationships with coworkers and employee %\GH¿QLWLRQWKHPLVVLRQDI¿UPVWKDW076SOD\VDUROHLQWKH EHQH¿WV7KHVHWRSWKUHHHQJDJHPHQWIDFWRUVDUHWKHVDPHIRU lifesaving gift of donation. Whether it is the “literal save” to an all workgroups. organ recipient or a “quality of life save” to a tissue recipient, MTS has no organized bargaining units. All employees at its core, it’s all about saving lives. Values of compassion, require a healthy, safe, and secure work environment. MTS’ innovation, integrity, teamwork and quality serve as a guiding approaches to address these requirements include system-wide force for how the workforce lives the MTS culture on a daily programs targeting risks in particular settings. Many members basis. The vision, mission, and values (V/M/V) of MTS, of the workforce carry out clinical duties in a healthcare validated annually during Strategic Thinking Process (STP) VHWWLQJUDWKHUWKDQSHUIRUPLQJZRUNLQDQRI¿FH+HDOWKDQG (Figure 2.1-1), serve as the foundation for the culture and safety issues related to staff working in healthcare also apply form the basis for how the organization is managed. WR076FOLQLFDOVWDII&RQYHUVHO\W\SLFDORI¿FHUHODWHGVDIHW\ The mission of MTS could not be accomplished without the requirements apply to non-clinical staff. At MTS, such issues organization’s core competencies (CCs) of a mission-driven workforce and innovation. • Mission-Driven Workforce: The work of MTS, by its very Figure P.1-4 :RUNIRUFH3URÀOH (PSOR\HHV

nature, requires a level of care and compassion that can Job Type Gender Leadership Team 13% only be delivered by the “human touch.” Therefore the Male 30% actions and behaviors demonstrated by the MTS staff are Staff 87% Female 70% GLUHFWO\OLQNHGWRFUHDWLQJDSRVLWLYHGRQDWLRQH[SHULHQFH

for the donor family (collaborators), which is essential Ethnicity re u n Te to the accomplishment of the mission and the success of African American 12% <1 year 17% the organization. This CC was recently revalidated by White 83% 1-5 years 46% MTS’ annual workforce engagement survey results, which Other 5% 6-10 years 23% earned MTS national recognition for having the Highest 11+ years 14%

xx ‡2UJDQL]DWLRQDO3URÀOH are addressed through annual training and standard operating Figure P.1-5 Regulatory Environment procedures (SOPs). Due to the 24-hour nature of some work, Mandatory/ VSHFLDOKHDOWKDQGVDIHW\UHTXLUHPHQWVH[LVWIRU³DIWHUKRXUV´ Regulatory Environment staff members that include: reserved parking spots near Voluntary entrance, secured garage parking, and sensor lighting. CAP Safe Laboratory Practices Mandatory 3D  MTS owns a custom-built facility in St. Louis, CLIA Safe Laboratory Practices Mandatory Missouri, which houses a critical care unit with three fully- CMS Billing and Performance Mandatory equipped operating rooms (ORs) where donor management Requirements RFFXUV LQGXVWU\¿UVW 7KHNH\FOLQLFDOWHFKQRORJLHVDQG DHSS Radiation Control Mandatory HTXLSPHQWLQFOXGH[UD\DKRXU+/$ VHURORJ\ODE FDUGLDFFDWKHWHUL]DWLRQFDSDELOLWLHV LQGXVWU\¿UVW D&7 EEOC Employment Practices Mandatory VFDQQHU LQGXVWU\¿UVW DQGLQKRXVHOLYHUDQGNLGQH\ELRSV\ FDA Compliance with FDA Mandatory platform. These innovations have impacted the organ and Requirements tissue procurement practices across the nation. The facility FLSA Employment Practices Mandatory also houses the organization’s eye bank with complete IRS 1RQSURÀW6WDWXV Mandatory processing and distribution services. MTS owns a twin Requirements engine turbo prop plane equipped with medical equipment to transport donors to the MTS facility for organ and tissue UNOS/ Organ Allocation/Operational Voluntary UHFRYHU\ LQGXVWU\¿UVW 8WLOL]LQJWKHODWHVWWHFKQRORJLHV OPTN Oversight MTS provides staff and key partners with collaborative tools, Occupational Health and Safety real-time access to key data, and advanced reporting services OSHA Workplace Safety Mandatory that provide customized analytics and business intelligence. Accreditation 3D  MTS operates under a highly regulated environment AATB Standards for Tissue Banking Voluntary DQGLGHQWL¿HVNH\UHJXODWRU\UHTXLUHPHQWVLQ Figure P.1-5, Accreditation Regulatory Environment. In addition, local environmental and AOPO Standards for Organ Voluntary UHJXODWRU\LQLWLDWLYHVDSSO\IRU¿UHDQGVDQLWDWLRQPHDVXUHV Procurement Accreditation biohazard trash disposal meets all local and state regulations. EBAA Standards for Eye Banking Voluntary P.1b Organizational Relationships Accreditation 3E  Incorporated in the State of Missouri, MTS is a to MTS’ V/M/V, yet is a separate business unit. Intelligent SULYDWHQRWIRUSUR¿W F  RUJDQL]DWLRQ$YROXQWDU\ ULVNVRURSSRUWXQLWLHVWREHQH¿WWKHFRPPXQLW\DWODUJHDQG community-based governance Board of Directors (BOD) sets H[SDQGH[LVWLQJVHUYLFHVDUHH[SORUHGDQGPDQDJHGYLDWKH policy for the organization (Figure 1.1-1) and is composed Improvement and Innovation Process (IIP) (Figure 6.1-2), RIKRVSLWDOH[HFXWLYHVSK\VLFLDQVGRQRUIDPLO\PHPEHUV which provides an “incubator” for testing ideas and intelligent and other disciplines including ethics, law and religion. risks. Separate from MTS’ main service offering, intelligent Representatives from MTS’ top donor hospitals (partners) and ULVNVDUHPDQDJHGWKURXJKWKH,,3XQWLOGH¿QHGHQGGDWHV transplant centers (customers) are appointed, allowing these are reached and a decision is made to integrate into MTS, senior leaders to represent customer and partner requirements. maintain as a separate entity, continue data collection to drive 5HSRUWLQJWRWKHJRYHUQDQFHERDUGWKH&KLHI([HFXWLYH decision making, or to discontinue the intelligent risk. 2I¿FHU &(2 GLUHFWVDOHDGHUVKLSWHDP /7 FRPSRVHGRI WKH&KLHI2SHUDWLQJ2I¿FHU &22 &KLHI0HGLFDO2I¿FHU 3E   MTS’ key market segment is the organization’s &02 &KLHI)LQDQFLDO2I¿FHU &)2 9LFH3UHVLGHQWRI designated service area (DSA), which is assigned by the Organ Donor Program Services, Vice President of Tissue federal government. Local organ transplant centers (Barnes- DQG6XSSRUW6HUYLFHVGLUHFWRUVDQGPDQDJHUV7KLVÀDW Jewish Hospital, Saint Louis University Hospital, St. Louis organizational structure, where leaders are process owners, Children’s Hospital and Cardinal Glennon Children’s enables agility in decision-making and implementation of Hospital), tissue processors (AlloSource, CryoLife, LifeCell, innovative ideas (CC) and process improvements. RTI and VTS) and local corneal transplant centers are MTS’ The BOD evaluates the performance of the CEO through a key customer groups. Donor families collaborate with the GH¿QHGSURFHVVLQFOXGLQJRQJRLQJPRQLWRULQJRISHUIRUPDQFH organization to honor their loved one’s decision to be a donor measures as outlined in the scorecard review process noted or on behalf of their loved one; donor family requirements are in 1.2a(2). The CEO evaluates the performance of the COO; the same regardless of donation type. Figure P.1-6 outlines the COO evaluates the performance of the Vice Presidents MTS’ key customers, partners, and key stakeholders as well and CFO; and the Vice Presidents and CFO evaluate the DVWKHUHTXLUHPHQWVDQGH[SHFWDWLRQVRIWKHRUJDQL]DWLRQ¶V performance of the directors, who, in turn, evaluate managers services and operations for each group. In addition to key and other members of the staff. requirement differences for organ, tissue, and corneal MTS Board of Director’s formed a charitable foundation customers, operations differ in the delivery of services as in late 2013 to support the key communities of donor displayed in Work System Alignment, Figure 2.1-2. families, transplant patients and their families. The work of 3E  MTS recognizes that suppliers, partners and The foundation is complimentary and supportive in nature collaborators play an important role in supporting MTS in

2UJDQL]DWLRQDO3URÀOH‡ xxi achieving its vision, mission and strategic objectives. Key Figure P.1-6 Key Stakeholder Requirements suppliers include Abbott Ambulance, Aero Charter, LifeLogics and St. Louis Cremation. These organizations have made Customers Requirements/Expectations VLJQL¿FDQWEXVLQHVVPRGHODFFRPPRGDWLRQVWRSURYLGH Transplant Centers- • Maximize Donation availability to ensure that the donation process can proceed Organ • Information smoothly. Abbott Ambulance, St. Louis Cremation and Aero • Competence Charter provide air and ground transportation services for Transplant Centers- • Availability staff as well as organ and tissue donors, ensuring that the Corneal • Information LQLWLDWLRQRIWKHGRQDWLRQSURFHVVLVH[SHGLWHG7KLVPLQLPL]HV • Tissue Quality delays that can impact donor families and transplant centers. Tissue Processors • Maximize Donation LifeLogics provides an Electronic Medical Records (EMR) • Information system and provides the platform that allows sequel reporting • Accountability functions, which are a critical part of the PMS (Figure 4.1- 1). Working together with LifeLogics, MTS was able to Partners GHYHORSDFXVWRPH\HPRGXOHIRUXVHLQLWV(057UXH1RUWK Donor Hospitals • Respect / Sensitivity LifeLogics also provides the organization the ability to upload • Involvement tissue donor records to the processors to ensure timely release • Information of tissue. These enhancements provide MTS the ability to • Service Quality scrutinize process performance and enhance competitiveness Collaborators E\H[FHHGLQJFXVWRPHUUHTXLUHPHQWVRIWLVVXHTXDOLW\DQG Organ and Tissue • Compassion availability. Donor Families • Information As MTS’ key partners and main referral source, donor • Stewardship of the Gift hospitals are essential to gaining access to potential donor • Honor the Donor families. Donor Program Development (DPD) staff assist hospitals with the establishment of tailored systems through Suppliers RQJRLQJWUDLQLQJWKDWGH¿QHWULJJHUVWRLQLWLDWHWKHGRQDWLRQ Abbott Ambulance • Accurate Information process (referral) and support the donation decision (Figure Aero Charter • Timely Communication 2.1-2). Once a referral to MTS is made, an MTS staff member Life Logics presents the option of donation to the potential donor family. St. Louis Cremation As collaborators, donor family members provide authorization Stakeholders for donation on behalf of their loved one or honor their loved Communities within • Comply with Legal, Ethical, and one’s documented wish to be an organ and/or tissue donor. Service Area Regulatory Requirements While The primary methods for knowledge sharing and (Including donor families Providing Quality Organs and communication with suppliers, collaborators and partners and transplant patients and Tissues in a Timely Manner are noted in Knowledge Management, Figure 4.2-1; primary their families) methods for customers are noted in Voice of the Customer MTS Workforce • Connection with V/M/V (VOC), Figure 3.1-1. Supplier and partner communication • ([FHOOHQW%HQHÀWV is mainly conducted via two way communication and • Coworkers face-to-face meetings with follow-up communication via MTS Board of • Strategic Planning phone and email. For donor family collaborators, two-way Directors • Administration communication occurs during the authorization process via • Financial Management face-to-face conversations (OWS) and by phone (TWS). • Community and Public Relations Inputs from partners and collaborators, as well as other key stakeholders, feed into the STP (Figure 2.1-1) and help drive performance consistently fall short of the national standards, organizational innovation (CC). CMS could choose to award the DSA to another OPO. Key supply chain requirements for suppliers include timely While OPOs do not compete for organs, the reassignment of communication of information, transportation of donors within potential future designated service areas would be based upon established timeframes and product quality. performance to the standards. P.2 Organizational Situation For the TWS, donor hospitals are required by law to report all deaths to MTS. However, they may contract with another 3D&RPSHWLWLYH(QYLURQPHQW tissue bank at their own discretion for the recovery process. 3D  As the federally designated Organ Procurement MTS maintains tissue recovery contracts with 100% of the Organization (OPO) within its service area, MTS does not 122 donor hospital partners within its service area. MTS have traditional organ procurement competitors. Much like does have a single eye bank competitor for the local corneal a utility company, MTS is a regulated ‘monopoly’ which WUDQVSODQWPDUNHW6LQFHWKHGHFLVLRQWRGHYHORSDQGH[SDQG operates solely within the borders of its federally designated Eye Bank operations was made in 2012, the organization has service area (DSA); no other OPOs may procure organs increased its market share annually. Currently, MTS controls within this boundary. To maintain this designation, however, an estimated 52% of this market (Figure 7.5-15). OPOs must meet national performance standards set by the 076UDQNVWZHQW\HLJKWKDPRQJWKHH[LVWLQJ232VLQ Centers for Medicare and Medicaid Services (CMS). Should WHUPVRISRSXODWLRQOLYLQJZLWKLQWKHLU'6$6LQFHH[SDQVLRQ

xxii ‡2UJDQL]DWLRQDO3URÀOH of the designated service area is not allowed, growth in shown in Strategic Linkages, Figure 2.1-3. donation must come from increases in medically eligible candidates from within the DSA, from increases in the number 3F3HUIRUPDQFH,PSURYHPHQW6\VWHP of families who say “yes” (authorization) to donation or Together with the Board of Directors, the MTS Leadership IURPWKHLGHQWL¿FDWLRQRIQRQKRVSLWDOUHIHUUDOVRXUFHV7KH Team (LT) creates an environment that supports improvement constraints of a limited service area reinforce the importance and innovation (Core Value and CC) through the creation of RIPD[LPL]LQJGRQDWLRQHDFKDQGHYHU\GRQRULQRUGHUWR strategies, systems, and methods for achieving performance achieve the mission of saving lives (Figure P.1-3). Concerted H[FHOOHQFH7KH/HDGHUVKLS6\VWHP /6 (Figure 1.1-1) HIIRUWVWRLQWHJUDWHVWUDWHJLFLPSURYHPHQWLGHDVLGHQWL¿HG is used to set and deploy the V/M/V and culture to the WKURXJKOHDUQLQJHQVXUHEHQH¿FLDOWUHQGVDUHVXVWDLQHGRYHU workforce via the Communication Process (Figure 1.1-3). time and organizational performance results important to the As part of the culture, MTS has embraced the Baldrige PLVVLRQ³PHHW´RU³H[FHHG´UHOHYDQWLQGXVWU\DQGEHQFKPDUN &ULWHULDIRU3HUIRUPDQFH([FHOOHQFHDVWKHRUJDQL]DWLRQ¶V comparisons. business management model for process improvement. The IIP (Figure 6.1-2) is an integral part of the STP (Figure 2.1-1) 3D  While the Affordable Care Act will be a challenge and the OMP (Figure 6.1-1); the IIP serves as a process for for the healthcare industry, the scope of its changes to the OPO improvement, pursuit of strategic opportunities, and making industry is uncertain at this time. As such, the organization resources available to support innovation. Ideas generated has decided to focus on what it can control; utilizing MTS’ in the OMP, STP and/or LDS are prioritized, using the drive and proven ability to innovate (CC) and achieve cost 3ULRULW\0DWUL[WRPDNHGHFLVLRQVDERXWZKLFKRSSRUWXQLWLHV HIIHFWLYHQHVVDQGHI¿FLHQFLHVWRSODFHLWVHOILQDVWURQJ are intelligent risks to be pursued. Improvement teams are ¿QDQFLDOSRVLWLRQ 6$ WRPDQDJHIXWXUHFKDOOHQJHV$VVWDWHG formed to address these strategic opportunities, and the previously, the OWS does not have competitors, and in the Performance Improvement (PI) department leads the analysis TWS there is one local eye bank competitor. A recent cycle and evaluation of projects for mission alignment, impact, and of learning prompted MTS to form a collaborative group resource allocation. All initiatives are presented regularly with four like-minded OPOs with similar business models at Leadership Team (LT) meetings to validate capacity, to position each organization as a leader in the industry. priority, timeline and status of projects and are integrated into 7KLVFROODERUDWLRQWKH/HDGHUVKLSDQG,QQRYDWLRQ1DWLRQDO daily operations through strategic discussions (SD) during &ROODERUDWLYH /,1& LQFOXGHVJURXSSXUFKDVLQJRSWLRQV STP and throughout the year via the OMP. Innovations or best practice sharing, training and development opportunities, improvements driving aligned opportunities are deployed benchmarking and potential innovations. In addition, regular via MTS’ operations; innovations or improvements driving meetings with the single eye bank competitor serve as an intelligent risks that are not aligned with MTS’ two work environmental scan of the eye bank industry and enables systems are deployed via the MTS Incubator. continuous monitoring of opportunities for collaboration and MTS’ performance improvement journey has led to several innovations, including benchmark sharing. ³LQGXVWU\¿UVWV´DQGLQFUHDVLQJO\IDYRUDEOHRUJDQL]DWLRQDO 3D   The Comparative Data Process (Figure 4.1-4), lists results as evidenced in the achievement of record-breaking the organization’s key comparative data sources. The organ organ and tissue donations. These results, however, are not industry has select national benchmarks available through EDVHGRQVDOHVDQGSUR¿WVEXWRQWKHPLVVLRQRIVDYLQJOLYHV multiple sources. However, the lead time before such results which provides a clear focus for organizational processes and become available can be many months. Comparative data is strategies. more limited for tissue operations, in which tissue processors provide monthly feedback for select results in the form of scorecards. Even more challenging is the lack of comparative Figure P.2-1 Strategic Challenges and DQGFRPSHWLWLYHGDWDIRUFRUQHDOWLVVXH1DWLRQDOH\HEDQNLQJ Advantages metrics, which were available several years ago, are no Challenges longer collected or shared due to competition within the eye bank industry. To offset these limitations, MTS is reliant Business • 3RWHQWLDOIRUGLYHUVLÀFDWLRQRIVHUYLFHV on informal sharing through collaboration with other OPOs Operational • 6\VWHPDWLFFXVWRPHUVHUYLFHSURFHVV including AlloSource’s tissue recovery partners. Comparative • Maximizing authorization and yield data from outside the industry is utilized for support metrics 6RFLHWDO • Ensuring organs and tissues are and is obtained from Avatar HR Solutions, the Research and Responsibility available to those in need Planning Group, and the US Department of Labor. :RUNIRUFH • Training and development of key staff 3E6WUDWHJLF&RQWH[W • Retention of key staff Advantages Strategic Challenges and Advantages (Figure P.2-1), SURYLGHVDVXPPDU\WKDWUHÀHFWVWKHFXUUHQWVWUDWHJLFVWDWHRI Business • )LQDQFLDOSRVLWLRQ MTS. Strategic Challenges (SCs) and Advantages (SAs) are Operational • )DFLOLWLHVDQGHTXLSPHQW reviewed annually during Step 4 of the STP (Figure 2.1-1); 6RFLHWDO • 8WLOL]H%DOGULJHFULWHULDWRLPSURYH Steps 5, 6 and 7 ensure appropriate action plans (APs) are Responsibility ZRUNGHVLJQDQGSURFHVVHV linked to organizational success. The alignment of MTS’ :RUNIRUFH • :RUNSODFHFXOWXUHVXSSRUWLQJDKLJKO\ strategic challenges and advantages with strategic objectives is skilled/mission driven staff

2UJDQL]DWLRQDO3URÀOH‡ xxiii Category 1 - Leadership Figure 1.1-1 Leadership System “The thing I take the most pride in is hiring great people and Monitor the Performance 3 trying to provide an environment that is supportive of them. I yPerformance Evaluation Process also think that we are a very innovative organization and that (Figure 5.1-2) starts at the Board of Directors’ level; our Board is always en- yPerformance Measurement System couraging, supportive, and willing to take intelligent risks to do (Figure 4.1-1) things in a different and better way. You have to position your organization a bit on the leading edge.” Operationalize the Strategy 2 Dean F. Kappel, MTS President and CEO since 1986 yStrategic Thinking Process (Figure 2.1-1) yOperational Management Process 1.1 Senior Leadership (Figure 6.1-1)

1.1a Vision, Values, and Mission Organizational by Enabled 1.1-4) (Figure Structure yCommunication Process (Figure 1.1-3) Mid-America Transplant Services’ (MTS) 1.1a(1) yLearning and Development System Leadership Team (LT) provides direction for a fully engaged (Figure 5.2-2) workforce (Figure 1.1-1) that successfully facilitates organ and tissue donation in alignment with the Vision, Mission, and Create the Environment Values (V/M/V) (Figure P.1-1) of the organization. Through yMTS Culture 1 learning and strategic improvement, MTS recognized the yV/M/V (Figure P.1-1) power of an effective mission statement and organized a task yVOC (Figure 3.1-1) force comprised of members of the LT, along with staff from yIIP (Figure 6.1-2) all departments of the organization to collaboratively establish DQGGH¿QHWKH909RI0767KHWDVNIRUFHLQFRUSRUDWHG feedback from the Board of Directors (BOD), which includes demonstratingi bbehaviorsh i consistenti withi h theh organization’si i donor families, partners, customers and stakeholders. Review core values. The LT uses a 360 degree review to provide DQGUDWL¿FDWLRQE\WKH%2'HQVXUHGIXOOXQGHUVWDQGLQJDQG ongoing, systematic feedback to all LT members from peers, concurrence with the V/M/V, which is validated annually direct reports, and external partners pertaining to the leader’s within Step 1 of the Strategic Thinking Process (STP) (Figure individual effectiveness with exhibiting behaviors consistent 2.1-1). During a recent STP session, MTS determined the with the V/M/V. This review process also provides the LT need to re-examine the V/M/V of the organization. This with individual opportunities for improvement and assesses revalidation again incorporated workforce input through the the effectiveness of the LS. The BOD evaluates the Chief use of an internal survey and formation of a staff committee. ([HFXWLYH2I¿FHU¶V &(2 HIIHFWLYHQHVVZLWKRSHUDWLQJWKH The mission statement was validated and remained the organization in alignment with the V/M/V. An example of same; however, the vision and values were updated. These the personal commitment of the LT to the set of beliefs and VWDWHPHQWVZHUHYHWWHGDQGUDWL¿HGE\WKH%2' behaviors that are embedded in the Baldrige business model is The LT deploys the V/M/V and culture to the workforce the commitment of a majority of LT members participating at as well as to customers, stakeholders, partners, and suppliers the state or national level as examiners as part of their personal via multiple communication mechanisms as managed by the development plans. Communication Process (Figure 1.1-3). Examples include: 1.1a(2) The LT’s actions personally demonstrate the highest • Reviewing and emphasizing the V/M/V during Board standards of ethical behavior by promoting the principles meetings, staff meetings, department meetings and via DQGLGHDVUHÀHFWHGLQWKH909DWVWDIIZRUNV\VWHPDQG highlights on the intranet department meetings, as well as regularly through RFO • Incorporating the stories of donor families, recipients, or conversations. Leading by example, the LT adheres to patients waiting for a transplant workplace policies and requires that the workforce follows • Memorial events highlighting the V/M/V of the the same policies including the Code of Professional Conduct, organization; invitations to memorial events are provided &RQÀLFWRI,QWHUHVWDQG'RQRU5HFLSLHQW&RQ¿GHQWLDOLW\ to collaborators, customers, stakeholders, partners, and 7KHZRUNIRUFHUHFHLYHVWUDLQLQJDERXWFRQÀLFWVRILQWHUHVW key suppliers and are attended by all groups and code of conduct expectations. In addition, the workforce • The utilization of a web based annual report outlining annually renews commitment to legal and ethical behavior LQQRYDWLYHUH¿QHPHQWVWRVHUYLFHVDQGKLJKOLJKWLQJ DQGDUHUHTXLUHGWRVLJQDGLVFORVXUHVWDWHPHQW/7FRQÀLFWRI progress towards MTS’ V/M/V which is electronically interest disclosure statements are reviewed by the Corporate provided to customers, stakeholders and key suppliers &RPSOLDQFH2I¿FHU*HQHUDO&RXQVHODQG&RQÀLFWRI,QWHUHVW The LT members serve as role models and demonstrate their Committee of the Board. commitment to the core values by setting the culture via Through the MTS Corporate Compliance Program (CCP) the Leadership System (LS), including daily practice and (Figure 1.1-2), leaders promote an atmosphere that encourages during staff meetings, departmental meetings, and in monthly the workforce to report any questionable behavior. An conversations in Rounding for Outcomes (RFO). Leaders anonymous hotline reporting system is in place to ensure provide personal acknowledgement to the workforce for FRQ¿GHQWLDOLW\/HDUQLQJDQGVWUDWHJLFLPSURYHPHQWUHVXOWHG

Category 1 - Leadership • 1 Figure 1.1-2 Corporate Compliance Program

CommunicationCCo Process (1.1-3), STP (2.1-1), OMP (6.1-1)

Hospital Partners Key Suppliers + Contract Expectation + Contract Expectation +/- Interactions with WF + Vetting Process - 100% Case Review +/- Interactions with WF - 100% Case Surveys - 24-Hour Hotline - 24-Hour Hotline Communities +/- Quarterly Meetings Donor Families - Website Within DSA +/- KM (Figure 4.2-1) + Family House Core Value: Integrity - Donor Family BOD, WF License to Occupy Hotline Annual Review & Transplant Center, Tissue - 24-Hour Hotline Acknowledgement: Processor - Website + Code of Professional + Contract Expectation

Conduct (WF Only) + Physician Code of Professional + Conflict of Interest Conduct + Corporate Compliance + Processor Vetting Training +/- Interactions with WF +/- BOD COI Committee - 24-Hour Hotline - Anonymous Email & - Website Annual Review/Feedback Report Review/Feedback Annual 24-Hour Hotline Background Checks (WF Only)

CommunicationC Process (1.1-3) Legend: “+”= Proactive; “-” = Reactive in an email reporting system being implemented to ensure System (PMS) (Figure 4.1-1) and leadership performance that all key stakeholders groups (Figure P.1-6) have an is monitored via the Performance Evaluation Process (PEP) additional method to report possible violations anonymously. (Figure 5.1-2). The MTS culture, the V/M/V, and the Learning The entire MTS workforce and BOD are trained annually on and Development System (LDS) (Figure 5.2-2) create an the CCP policy. Through learning and strategic improvement, environment amenable to workforce and organizational customers, partners and suppliers are now advised of reporting learning. The commitment to the mission of saving lives, mechanisms via their contracts and during face to face along with the value of innovation (CC), drives MTS to stay meetings, as appropriate. To ensure contracts are consistent on the leading edge of industry knowledge and best practices. with current legal standards, the Executive Leadership Team The opportunity for knowledge and best practice sharing (ELT) requires major contracts with external companies to be is a standing agenda item in the work system meetings and reviewed by legal counsel. Compliance policies are reviewed ensures learning across the organization. Individual training by MTS Quality staff by validating required actions and and development goals are addressed through the ongoing monitoring external reporting sites. PEP. As described in P.1a(2), the MTS culture encourages 1.1a(3) The LT creates a successful organization now and in an environment where employees continuously seek the future and an environment of performance improvement improvement in order to save more lives. through the LS (Figure 1.1-1), which allows a focus on By maintaining a robust Voice of the Customer (VOC) the organization’s key processes to create integrated work process (Figure 3.1.1), the LT creates a workforce culture systems. To ensure sustainability, processes are mapped and that delivers a consistently positive customer experience documented and succession plans are developed, thereby and fosters engagement. Customer satisfaction metrics are creating the environment to accomplish MTS’ lifesaving reviewed in-depth at work system and other Performance mission. Improvement-focused meetings. As appropriate, changes are The organization’s strategy is operationalized via the STP made based on this feedback. (Figure 2.1-1), the Operational Management Process (OMP) The LT creates an environment that encourages and (Figure 6.1-1), and the Communication Process (Figure supports innovation (core value and CC), and intelligent 1.1-3). The STP establishes MTS’ strategic organizational risk-taking [6.2(d)]. Intelligent risk-taking is embedded direction, from which action plans (APs) are developed, in the organization (Figure 6.1-2) starting with the BOD LPSOHPHQWHGDQGPRGL¿HGDVQHHGHGZKLFKFRXOGLQFOXGHD and is initiated in the STP, OMP and/or LDS. Intelligent PDSA (Plan-Do-Study-Act). The OMP is utilized to review, risks are evaluated based on V/M/V alignment and SOs analyze, improve, and prioritize the organization’s internal and DVZHOODV¿QDQFLDOULVN,QWHOOLJHQWULVNVDUHGHSOR\HGYLD external processes; all key strategic and operational decisions WKH076,QFXEDWRUZLWK¿QDQFLDODQGWDUJHWHGUHVRXUFHV are communicated to the workforce and key partners via the until they undergo effectiveness checks and, ultimately, are Communication Process. The organization’s performance is dispositioned. monitored by the LT utilizing the Performance Measurement Organizational goals drive the creation of action plans 2 • Category 1 - Leadership Figure 1.1-3 Communication Process Performance 1.1b(1) The LT communicates with and engages the 1 workforce utilizing the Communication Process (Figure 1.1-3). As MTS has grown, the Communication Process has undergone learning and strategic improvement to stay current StrategicStrattegic OperationalOperattiiona with organizational needs. Through strategic discussions (SDs) Discussions Discussions STP (2.1-1) OMP (6.1-1) and operational discussions (ODs), ideas and information are Key brought into the Improvement and Innovation Process (IIP) Decisions (Figure 6.1-2) and shared via the Communication Process. Key decisions are disseminated to the entire workforce by the LT through various meetings or electronic communications. For example, employee survey feedback about the monthly 2 3 Staff Meetings Work System Meetings staff meetings was vetted through the IIP and resulted in Electronic Means Operations Meetings a new format, meeting schedule, and information sharing Publications Department Meetings mechanisms. Completion of the Communication Process One-Way Two-Way Communication Communication is accomplished through knowledge sharing and feedback, ensuring a closed communication loop both internally and externally. 4 Knowledge Sharing & To promote frank two-way communication with the Feedback workforce, the LT utilizes the Communication Process which Rounding for Outcomes supports an open door policy as well as RFO, the consistent Other Formal & Informal Meetings SUDFWLFHRIDVNLQJVSHFL¿FTXHVWLRQVWRREWDLQDFWLRQDEOH Electronic Means Relationship Management information. Each month, LT members meet (or “round”) KM (Figure 4.2-1) with each of their employees to gain knowledge about VOC (Figure 3.1-1) process effectiveness, available resources, peer recognition, Two-Way Communications DQGQHHGHGFODUL¿FDWLRQRINH\PHVVDJHVDQGGHFLVLRQV 7KLVSUDFWLFHLVDOVREHQH¿FLDOLQEXLOGLQJUHODWLRQVKLSV (APs). Results are monitored with the PMS (Figure 4.1- between leaders and their direct reports and ensuring that 1), and goals not meeting targets result in analysis and PI communication is effective (Figure 7.4-1). Results of RFO are LQWHUYHQWLRQLQFOXGLQJSRVVLEOHPRGL¿FDWLRQRI$3VRUWHVWLQJ reviewed by the CEO and COO to identify common themes. via the PDSA model, as appropriate. Utilizing this systematic To close the communication loop, feedback about rounding approach to monitoring results allows for agility across the is provided at staff meetings via the Stoplight Report (AOS), organization. ZKLFKLGHQWL¿HVVXJJHVWLRQVDFWLRQVLQSURJUHVVRUDFWLRQV The COO, HR, and the members of the LT develop not taken and why. succession plans for their positions to ensure appropriate Local organ transplant centers, tissue processors and local interim leadership is available should a vacancy occur, as well corneal transplant centers are MTS’ key customers. The LT as plans for future leaders to grow within the organization communicates with its customers per the VOC, Figure 3.1-1. VKRXOGDQHHGEHLGHQWL¿HG7KLVSODQLVIRUPHGLQFRQMXQFWLRQ 'XHWRWKHFRQ¿GHQWLDOQDWXUHRIGRQDWLRQVRFLDOPHGLDLV with the personal development goals that are captured in a not used as a vehicle of operational communication with web-based performance management platform. Succession customers. However, capitalizing on technology, MTS created plans are aligned with the annual performance evaluations to and shared Lifesaving Innovations, an interactive website ensure that current and future leaders are receiving needed that provides a behind the scenes look at the state of the art leadership training to support their individual growth and practices and technology that helped the organization save development. The 360 degree feedback review is used to more lives in recent years. Social media is used for internal LGHQWLI\VSHFL¿FLPSURYHPHQWRSSRUWXQLWLHVIRUDOOFXUUHQW DQGH[WHUQDOFRPPXQLFDWLRQIRUEURDGHUQRQFRQ¿GHQWLDO OHDGHUV076KDVDGH¿QHGOHDGHUVKLSFXUULFXOXPWKDWLV messaging that does not incorporate donor information. embedded in the LDS. LT development has included Baldrige In addition, MTS does effectively utilize social media to examiner training at the national and state level, systematic communicate and highlight the customer success stories via leadership development training through Studer Learning Facebook, Instagram, and Twitter reinforcing our common Development Institutes, attendance at state and national mission of saving lives. Baldrige conferences and attendance at nation-wide non- Senior leaders communicate key decisions and needs for industry conferences, such as The Disney Institute. In addition, organizational change utilizing the Communication Process. strategic improvement and learning from manager feedback Members of the LT reinforce high performance and a customer has resulted in the provision of an extensive leadership and business focus in multiple ways (Figure 5.2-1). Personal training and development program for managers in 2015, notes of recognition can be written by any member of the which includes a leadership curriculum designed to optimize LT, including the CEO, to acknowledge special achievement leadership performance and which will provide one-on-one with partner or customer service, or as requested for peer coaching for each manager. recognition through RFO. Through learning and strategic 1.1b Communication and Organizational improvement, the LT established a rewards and recognition

Category 1 - Leadership • 3 task force, composed of members representing all areas of 1.2 Governance and Societal Responsibilities the workforce, to explore potential improvements. Financial 1.2a Organizational Governance rewards are in place through the MTS Sharing Lifesaving Success (SLS) plan, a performance based bonus plan 1.2a(1)*RYHUQDQFHRIWKHRUJDQL]DWLRQLVSURYLGHGE\ ensuring alignment and accomplishment of key business and an 18-member BOD that strategically reviews, deploys, customer requirements. The SLS status is reviewed quarterly DQGDFKLHYHV¿VFDODQGPDQDJHPHQWDFFRXQWDELOLW\DQG by the CEO at staff meeting and is a component of MTS’ transparency in operations ensuring that MTS addresses its reward system that reinforces the workforce focus on the responsibility to the community, exhibits ethical behavior, DFFRPSOLVKPHQWRIRUJDQL]DWLRQDOJRDOVZKLFKDUHLGHQWL¿HG practices good citizenship, and protects stakeholder interests. on the Topline Scorecard (Figure 4.1-2). %\XWLOL]LQJD%2'4XDOL¿FDWLRQVDQG$I¿OLDWLRQ*ULG $26  076HQVXUHVWKDWWKH%2'UHSUHVHQWDWLRQLVGLYHUVHUHÀHFWV 1.1b(2) Through the LS (Figure 1.1-1) and the IIP key customers, stakeholders, and partners and is balanced to (Figure 6.1-2), the LT creates a focus on accomplishing promote a diversity of insights and perspectives. Practices the organization’s objectives, improving performance, of the MTS BOD to review and achieve key aspects and fostering innovation, and achieving the V/M/V. Step 1 of accountability of governance include: the LS is creating the environment and is a key part of the • Management is held accountable for operational results by organization’s success. This includes intelligent risk-taking by the evaluation of monthly Status Report and the Topline means of the IIP in which the customer-focused culture drives Scorecard which show strategic objective target progress. the workforce to seek continuous improvement. Intelligent In addition, the Board reviews key work or support risk will be decided based on strategic objectives (SOs) system highlights in an expanded form at quarterly DQG909DOLJQPHQWDVZHOODV¿QDQFLDOULVN,QWHOOLJHQW meetings. risks are deployed via the MTS Incubator – the business • Annual review and approval of strategic plan, budget and development support process that provides initial business topline metrics. LGHDVZLWK¿QDQFLDODQGWDUJHWHGUHVRXUFHV6WHSRIWKH/6 • $FKLHYLQJ¿VFDODFFRXQWDELOLW\E\PRQWKO\UHYLHZRIWKH (Operationalize the Strategy) establishes a focus on actions, ¿QDQFLDOUHSRUWVE\WKH([HFXWLYH&RPPLWWHH)LQDQFLDO which are monitored in Step 3 (Monitor the Performance). reports are reviewed in detail at quarterly board meetings. Cascading scorecards, integrated into work systems, • Maintaining independence and effectiveness in audits is departments, and individual metric levels incorporated into DVVXUHGWKURXJKDQDQQXDOH[WHUQDODXGLW7KHDXGLW¿UP the web-based performance management system are a key is engaged by the board Audit Committee, composed of piece of the PMS and are reviewed monthly at each work independent board members. Audit results are reported to system meeting (Figures 4.1-1 & 4.1-2). Review of the work the committee along with any recommendations. During system scorecards occurs at the top of the agenda for the work a portion of that meeting, management staff is excused system meetings and ensures the ability to recognize the need to facilitate an open and frank conversation between the to modify or implement APs as priorities change. AP progress DXGLW¿UPDQGWKHFRPPLWWHH for all departments is reviewed quarterly at LT meetings. • Transparency of the board and committee operations Systematic reviews of the APs, via one-on-one meetings is accomplished through the availability of minutes, with managers, provide accountability and opportunities presentations, Topline Scorecard, and reports which to ensure that organizational performance is progressing to include quality/regulatory outcomes. As a cycle of plan and ultimately attaining its Vision. PMS also captures improvement, the organization adopted a web-based RWKHUUHVXOWVVXFKDVVXUYH\GDWDDQGPRQWKO\¿QDQFLDO board portal to facilitate ease of communication. results. The ultimate measure for MTS is improvement over • Transparent selection of governance board members time with the key metrics on the Topline Scorecard (Figure is accomplished by actively soliciting nominations 4.1-2). If a key metric is below the target, an appropriate from expanded sources including key members of the SODQZKLFKPD\LQFOXGHD3'6$RUPRGL¿HG$3ZLOOEH community and members of the Medical Advisory Board launched. Through learning and strategic improvement, the in addition to nominations from existing BOD members. Performance Improvement Department initiates this data Recruitment and selection of representatives across analysis to ensure a systematic review is performed when the community ensures the protection of stakeholder metrics are underperforming. For example, the eye bank interests and provides appropriate knowledge and and PI worked collaboratively in 2013 to address ‘two red diversity. Disclosure policies have undergone strategic boxes’ for domestic cornea placement. Several initiatives and improvement and learning. In 2013, as a result of a cycle PDSAs were created to address the gap. APs developed in RIOHDUQLQJDERDUGOHYHO&RQÀLFWVRI,QWHUHVW&RPPLWWHH 2013 continued into 2014, and ultimately resulted in process ZDVHVWDEOLVKHGDQGWKH&RQÀLFWVRI,QWHUHVW3ROLF\ZDV and procedure improvements that provided a record breaking revised. The disclosure statement signed annually by all number of corneas available for vision saving transplants in board members and the LT was revised and expanded. 2014 (Figure 7.1-16). The BOD disclosure statements are now reviewed by the Step 1 of the annual STP helps the organization focus on committee and corporate counsel and are posted in the balancing the needs of customers, partners, and stakeholders. board portal to ensure transparency. Corporate counsel Expectations are validated by periodic surveys and focus reviews the disclosure statements prior to each board groups. Performance metrics in the PMS represent key PHHWLQJWRLGHQWLI\DQ\SRWHQWLDOFRQÀLFWVRILQWHUHVW performance measures of the organization and ensure balance and advises the affected member. This committee also for key customers and stakeholders expectations. 4 • Category 1 - Leadership SURYLGHVRQJRLQJHGXFDWLRQWRWKHERDUGRQFRQÀLFWVRI 1.2b Legal and Ethical Behavior interest issues. 1.2b(1) To date, MTS has not been involved with an • Developing and approving a formal succession plan for adverse event that had societal impact on the organization’s the CEO. Authority has been delegated by the BOD to the services and operations. Historically, national industry CEO to oversee succession plan development for other LT concerns have focused on the safety of the organs and tissues, members. Succession planning for the LT has undergone coupled with fairness in the allocation of organs to recipients. learning and strategic improvement from a fragmented MTS proactively approaches these potential threats through process with few formal inputs to its current system strict adherence to processes addressed through policies and ensuring that succession planning is a component of the procedures. Through strategic improvement and learning, STP (Figure 2.1-1, Step 5) and the LDS (Figure 5.2-2). MTS recognized the need to anticipate adverse events and 1.2a(2) A systematic review process is utilized by the associated concerns from the public. An additional component BOD’s Compensation Committee to conduct a formal, annual was added to the STP (Figure 2.1-1, Step 2) to select a review of the CEO’s performance. The process inputs include potential adverse event in response to the environmental a self-evaluation by the CEO of goal achievement, a review scanning analysis. An AP is developed annually by members of organizational performance metrics (Topline Scorecard), of LT for the purpose of scenario planning. and an online evaluation of the CEO by the entire BOD. These MTS leverages the Organizational Structure (Figure inputs are used by the Compensation Committee to develop 1.1-4) and utilizes the STP (Figure 2.1-1, Step 2) to gather the CEO’s performance review and, in collaboration with the information from a variety of sources to anticipate public CEO, are used to set new goals for the upcoming year. The concerns. As an example, the organization engages the greater Compensation Committee engages an external consulting community through board representation of all stakeholder ¿UP 0HUFHU WRFRQGXFWDVDODU\VXUYH\HYHU\WZR\HDUV communities on both the governing and advisory boards. In conjunction with Mercer, the Compensation Committee Media alerts and position statements are created in response establishes a salary range for the CEO and his direct reports. to national news stories and are distributed to the workforce The feedback from the entire BOD and the assessment of the and the BOD as appropriate. A crisis communication plan has committee is utilized to adjust salary based upon performance. been developed to ensure an appropriate response to public In addition, the CEO participates in the SLS plan with the concerns, if needed. same objectives as the workforce. SLS objectives are reviewed Conservation of natural resources are considered through and approved annually by the Compensation Committee. green building practices, temperature and light conservation, The CEO conducts annual performance evaluations for recycling programs and assurance that the environment is the COO and Executive Director, Foundation, utilizing the protected through effective biohazardous disposal. As an same Performance Evaluation Process (PEP) as are used for example, multiple efforts are made across the organization to evaluations of the LT. The evaluations and recommendations reduce paper usage including the utilization of a board portal for compensation are provided to the Compensation and screen projection of all meeting data. MTS prepares Committee. As part of the PEP process, the CEO provides for impacts and concerns proactively through effective these leaders ongoing feedback, including leadership supply chain management processes, which include a secure effectiveness, and progress towards goal completion in order electronic database, established par levels, and a supplier to drive improvements in performance. vetting process. The BOD completes self-evaluation surveys biennially to determine the level of performance of board members, Figure 1.1-4 Organizational Structure as well as identify opportunities for improvement. The survey includes a self-assessment of their knowledge Level Roles Outcomes and comfort level with key areas of MTS operations; this feedback is utilized to develop an educational agenda • Validate V/M/V • Long-term WDUJHWLQJWKHLULGHQWL¿HGGHYHORSPHQWQHHGV$VDUHVXOWRI 1 • Community/ strategic direction OHDUQLQJDQGVWUDWHJLFLPSURYHPHQWPRGL¿FDWLRQVKDYHEHHQ BOD Partner/Customer • Enhanced community implemented from board survey results. As an example, representation relationships through the survey cycle, board members expressed a desire • Establish • Organizational for more understanding regarding quality initiatives; this accountability sustainability recommendation was incorporated into board meeting agendas as appropriate. Recognizing the need for comparative data in 2 • Create the • Organizational %2'HIIHFWLYHQHVVDVVHVVPHQWWKH&RUSRUDWH*RYHUQDQFH FEEDBACK environment culture Nominating Committee returned to BoardSource as the LeadershipLeadership • Operationalize • Strategic plan provider for the BOD survey. Utilizing this provider, the BOD Team the strategy deployment completed its fourth self-evaluation in 2014. The Corporate • Monitor the • People & performance *RYHUQDQFH1RPLQDWLQJ&RPPLWWHHUHYLHZHGWKHUHVXOWVDQG performance management recommendations and then reported to the full board (full report AOS). The LS (Figure 1.1-1) effectiveness assessment is part of ongoing SDs and is part of the STP Process (Figure 3 • Support and • Maximize donation FEEDBACK 2.1-1). facilitate organ & WorkforceWorkforce tissue donation

Category 1 - Leadership • 5 Due to MTS’ lifesaving mission, all voluntary industry a discussion of key communities to ensure the organization is accreditations possible are sought to help ensure regulatory responsive to their needs and requirements (Figure 2.1-1). and legal compliance (Figure P.1-5), as well as ethical Through the design of its facility, which includes an energy behavior. These voluntary accreditations help MTS ensure management system, MTS contributes to environmental that all processes meet or exceed current standards and assist well-being. The organization continues to explore “green” the organization with proactively identifying any potential opportunities suggested by the workforce; previous staff opportunities for improving processes. Feedback from suggestions resulted in a formalized recycling program for these accreditations is incorporated into the organization’s paper, plastic, and aluminum, as well as a reduction in hand- performance improvement processes. MTS has received full outs for stakeholders by providing data electronically. Societal accreditation from AOPO, AATB, and EBAA, and is one of responsibility extends to the sharing of best practices within only a few Organ Procurement Organizations (OPOs) in the the industry to ensure increases in organ and tissue donation country to have all three accreditations. In addition, MTS spread across the country. As a result of MTS leadership and has monthly internal and external audits scheduled across the demonstrated outcomes, approximately 15% of the OPOs in organization to address regulatory requirements and identify the country have begun their Baldrige journey. potential risks associated with its operations, ensuring the 1.2c(2) 7KH%2'LGHQWL¿HV076¶NH\FRPPXQLWLHVDQG organization remains in a state of readiness. the LT reviews and validates them annually as part of the STP A series of internal and external audits ensures compliance (Figure 2.1-1). MTS’ key communities include donor families, with Key Regulatory and Legal Requirements, as shown transplant patients, and their families within the DSA who in Figure 1.2-1$OODXGLW¿QGLQJVLQFOXGHDGHYLDWLRQIRUP enter into these communities not by choice but through life’s as part of a formal feedback loop and assist MTS with circumstances. proactively addressing issues related to key compliance Supporting and strengthening of key communities is processes, measures, and goals. Additionally, the audits push provided in multiple ways. To support donor families, MTS the organization to exceed regulatory and legal requirements constructed a Donor Memorial Monument and park for donor by serving as methods used for addressing risks associated and recipient families to gather, remember, and honor their with key services and operations (Figures 7.4-4 & 7.4-5). loved ones (Figure P.1-6). In addition, a formal way to honor Audit feedback reports are reviewed by the appropriate work a donor family’s loved one is the Candlelight Memorial, an group and summarized for the LT and the BOD. Should annual event, which is held at the MTS Donor Memorial LPSURYHPHQWVEHLGHQWL¿HGDUHVSRQVHSODQLVGHYHORSHGDQG Monument and park. Mission-driven LT and staff (CC) deployed via the OMP (Figure 6.1-1). actively participate in this and other memorial events hosted 1.2b(2) The Board of Directors and the LT promote an across the organization’s DSA, including in the communities environment that fosters and requires legal and ethical RI6SULQJ¿HOGDQG&DSH*LUDUGHDX0LVVRXULDQG-RQHVERUR behaviors through the CCP (Figure 1.1-2). Furthermore, the Arkansas. RUJDQL]DWLRQ¶VHWKLFDOEHKDYLRUVWDQGDUGVDUHUHÀHFWHGLQLWV MTS created the Center for Life (CFL), an innovative (CC) core value of integrity. To promote and ensure ethical behavior department designed to further the organization’s support of its across the organization, all employees adhere to a Code of key communities (Figure 7.4-11). Through the CFL, MTS has Professional Conduct. improved its services for donor families by addressing their MTS’ fully functioning CCP and policy is consistent with bereavement needs. In support of recipients and their families, industry standards, which provides education, monitoring the BOD has approved funding to assist transplant recipients and investigation of breaches. The program provides two with special needs that either impact their ability to receive anonymous mechanisms (online and telephonic) for the a transplant or endanger the success of a transplant they workforce and other customers, partners, and stakeholders already have received. The MTS BOD, with input from the to report any non-compliance events or occurrences. The workforce and MTS’ local organ transplant centers, evaluated organization provides all employees with annual online CCP an innovative (CC) intelligent risk opportunity to support training on the policy, including a review of the available one of the key communities and established an MTS Family PHWKRGVIRUUHSRUWLQJDQHWKLFDOEUHDFK7KH&&32I¿FHU House. This provides short and intermediate-term housing for is responsible for investigating complaints and reporting transplant recipients and their families from outside the St. to the BOD’s Executive Committee, if appropriate. All the Louis area. The MTS Family House, located in an existing elements of the CCP are reviewed annually by the Corporate apartment building adjacent to the organization’s headquarters *RYHUQDQFH1RPLQDWLQJ&RPPLWWHHDQGKDYHXQGHUJRQH also affords LT and staff the opportunity to interact with multiple cycles of improvement. recipients and their families. An initial three-year lease 1.2c Societal Responsibilities commitment provides the organization with an exit strategy if this intelligent risk does not prove successful. 1.2c(1) The accomplishment of the mission, We save lives In 2013, the MTS Board of Directors established a separate through excellence in organ and tissue donation, is MTS’ IRXQGDWLRQWRFRRUGLQDWHDQGGLUHFWWKHFRPPXQLW\EHQH¿W greatest gift and contribution to society. This can be measured efforts of MTS. This foundation became operational in 2014 by the increase in the number of organs transplanted and the and assumed oversight for the Center for Life activities. This reduction of deaths on the local transplant waiting list, as well organizational change allows MTS to focus on its core service as the increasing number of tissue transplants available due of facilitating organ and tissue donation while ensuring its to increases in tissue donation (Figures 7.1-4, 7.1-5, 7.1-10, key communities’ improvement efforts are accomplished. 7.1-14 through 16). Step 1 of the annual STP session includes ([SDQVLRQRIFRPPXQLW\EHQH¿WLQFOXGHGWKHGLVWULEXWLRQ 6 • Category 1 - Leadership Figure 1.2-1 Key Regulatory and Legal Requirements Key Regulatory and Legal Key Risk Reduction Measures and Goals Figures Requirements Processes Indicators Compliance with organ allocation UNOS/OPTN audits UNOS organ placement Member in good 7.4-5 Internal audits policies standing Compliance with FDA requirements FDA audits FDA approval 7.4-5 Voluntary compliance to meet organ Internal audits AOPO accreditation Full accreditation 7.4-5 donation industry standards QA/Training Voluntary compliance to meet tissue Internal audits AATB Full accreditation 7.4-5 donation industry standards QA/Training EBAA accreditation Compliance with CLIA/CAP CLIA/CAP audit CLIA License 7.4-5 Full accreditation to meet laboratory requirements Compliance Compliance with CMS regulations CMS audit 7.4-5 impacting reimbursement Internal audit Compliance with IRS regulations External Minimal audit adjustments 7.4-4 Financial audits Corporate Compliance Annual training 100% Completion AOS Process (CCP) acknowledgement No Events 7.4-6 Reported hotline issues Compliance with regulations EEOC guidelines Policy Compliance No events or 7.4-5 impacting Human Resources FLSA posted Posting occurrences Safe work place OSHA site audits Full compliance 7.3-7 Safety committee Reportable events No reportable Employee training events Radiation safety (DHSS) Exposure Rate Full compliance 7.3-8 Compliance with DOR requirements DOR audit DOR approval 7.4-5 in early in 2015 of $550,000 in community wellness grants (BOD), customers, front line staff, key partners, and suppliers. as well as $80,000 in nursing scholarships. Future efforts, Through a cycle of learning, STP evolved to include a including potential intelligent risk opportunities, addressing select group of high performing employees to participate in the needs of MTS’ key communities as well as engaging discussions and contribute innovative ideas. the broader community, will fall under the purview of the Both the BOD and the LT focus on a strategic timeframe; foundation. short-term targets and objectives are to be met in one year, and long-term targets and objectives are to be met in three Category 2 - Strategy years. Through learning and strategic improvement MTS has determined that one to three years in their industry “I think the future of MTS continues to be really bright. As long provides a manageable long-term outlook and opportunity to as we’re seeking to innovate and get better by always pushing react to changes within an ever changing industry to ensure the envelope and trying new strategies, we can achieve great RUJDQL]DWLRQDODJLOLW\DVZHOODVÀH[LELOLW\LQRSHUDWLRQV things.” In Step 3 of the STP, focused strategic discussions address the performance projections for the one and three year time Dean F. Kappel, MTS President and CEO horizons established for key metrics. Any transformational change and/or prioritization of 2.1 Strategy Development FKDQJHLQLWLDWLYHVDUHLGHQWL¿HGDQGHYDOXDWHGZLWKLQWKH673 process. MTS capitalizes on its agility achieved through the 2.1a Strategy Development Process Organizational Structure (Figure 1.1-4) to utilize a continuous 2.1a(1) Through learning and strategic improvement, the STP (Figure 2.1-1) that is fully deployed and has seen learning focus of strategic planning evolved from a process based on and strategic improvements. The LT participates in strategic GH¿QLQJDQGDSSURYLQJDFWLRQVWRVXSSRUWWKHEXGJHWWRD discussions (SDs) that take place during quarterly LT meetings Strategic Thinking Process (STP) occurring throughout the and monthly work system meetings, creating consistency year, supported by action plans (APs) and goal achievement. DFURVVWKHHQWLUH673'XULQJWKHVH6'V$3VDUHPRGL¿HG The STP involves Strategic Development, Implementation created, and deployed as needed, and the progress-to-plan is and Discussions, each of which consists of multiple steps monitored and evaluated to drive organizational performance (Figure 2.1-1). Currently, participants in the STP include the when targeted performance measures are lagging or exceeding, Leadership Team (LT), members from the Board of Directors HQVXULQJDJLOLW\DQGRSHUDWLRQDOÀH[LELOLW\7KLVRQJRLQJ cycle of strategy development and deployment has created Category 2 - Strategy • 7 Figureg 2.1-1 Strategicg Thinkingg Process Board of Directors Input

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Strategy Implementation StrategyStS ratet gy IImplementationmpplel menttattioi n 5 Assess & Review 6 Develop 7 Deploy Strategic Plan A. AP proposal Prioritize and cascade Communicate Strategic Direction (Fig. 1.1-3) B. Workforce/Succession Planning organizational goals into APs, C. Financial Impact Monitor/Manage Performance (PMS 4.1-1) ensuring balance Modify APs/PDSAs (OMP 6.1-1) D. Re-validate Performance Projections partners and key stakeholders E. AP Selection Performance Evaluation Process (PEP 5.1-2)

a strategic LT that fosters an environment for innovation SODQVIRULGHQWL¿HGLQQRYDWLYHRSSRUWXQLWLHVDUHGHSOR\HG (CC) to support MTS’ lifesaving mission. The STP process utilizing PDSAs and outcomes are funneled through the undergoes an annual review during the Baldrige application Communication Process (Figure 1.1-3). process to ensure all strategic elements are addressed and that 6WUDWHJLFRSSRUWXQLWLHVDUHLGHQWL¿HGLQ6WHSRIWKH673 WKHPHWKRGVXWLOL]HGUHPDLQDJLOHÀH[LEOHDQGHIIHFWLYHLQ and during ongoing SDs which involve brainstorming and “out responding to changes in the donation environment. of the box” thinking. The SWOT list is reviewed and validated 2.1a(2) The MTS V/M/V (Figure P.1-1) and the IIP through ongoing SDs (Figure 2.1-1, Step 8 of STP). Strategic (Figure 6.1-2) stimulate and incorporate innovation. The opportunities are also discussed during the ongoing IIP, which commitment to the mission of saving lives, along with the includes cost modeling and ROI analysis where appropriate. value of innovation, drives MTS to stay on the leading edge 5LVNVDUHVFRUHGLQWHOOLJHQWULVNLVTXDQWL¿HGDQGEDVHG of industry knowledge and best practices. As part of the IIP, upon alignment with strategic objectives (SOs), approved LQQRYDWLYHVXJJHVWLRQVDQGLGHDVDUHLGHQWL¿HGWKURXJKWKH ideas are prioritized via the priority matrix. Clearly aligned multiple inputs and then vetted. This includes the utilization opportunities are managed by MTS operations; other strategic of Innovation teams, made up of multidisciplinary and diverse opportunities (i.e. Intelligent Risks) are managed through departments and staff. The teams perform data review, and the MTS Incubator, which allows MTS to assume additional utilizing Lean and other Six Sigma tools, they complete business risk while maintaining organizational focus. brainstorming and prioritization sessions. Implementation For the 2015 planning cycle the strategic opportunities LGHQWL¿HGDUHDXWRPDWHGSDUWQHUUHIHUUDOVZRUNIRUFHWUDLQLQJ 8 • Category 2 - Strategy and development, FPA maximization, and relationship During Step 6 (Develop), MTS cascades organizational management to expand our partnership opportunities. goals into APs to accomplish the SOs, address the SCs, 2.1a(3) During Step 2 (Analyze) of STP, MTS evaluates its DQGPDNHD¿QDOGHWHUPLQDWLRQDERXWWKHIHDVLELOLW\RI strategic position. Step 2 also includes extensive review of key accomplishing the SOs during the desired timeframe. performance measurement results, collected on an ongoing Throughout the year, SDs include a review of relevant basis and a comprehensive environmental scan of the donation changes impacting the organization’s ability to execute and transplantation industry, as well as the overall healthcare the strategic plan. MTS’ STP is constantly under review climate of our community. The review includes: through SDs, thereby providing the organization the agility • Key performance measurement results (Figure 4.1-1) necessary to be able to modify previous strategies as needed. • Strengths, Weaknesses, Opportunities, Threats Analysis This constant evaluation, monitored by the Performance (SWOT); Strategic Challenges and Advantages (Figure Measurement System (PMS) (Figure 4.1-1) and facilitated P.2.-1) by the Communication Process (Figure 1.1-3), keeps the • Customer market impacts (Figure 3.1-1) organization focused on executing the strategic plan with • BOD input (comprised of partners, customers, community VXLWDEOHÀH[LELOLW\2UJDQL]DWLRQDOUHVXOWVDUHOLQNHGWRWKH673 members, recipients, donor families) (Figure 1.1-4) (Figure 2.1-1, Step 2), and if AP results are not on target per • Donor family (collaborator) and other key stakeholder the PMS, action is taken to address the gap. feedback and preferences (Figure 4.2-1) 2.1a(4) The MTS key work systems are the Organ Work • Current and proposed changes to regulatory requirements System (OWS) and the Tissue Work System (TWS) (Figure (e.g. UNOS/OPTN, CMS, FDA, AATB, AOPO, EBAA) 2.1-2). Work system decisions are made via Step 8 of the STP. Following analysis of the present situation which includes a Incorporation of organizational knowledge, new technology, review of historical data, Step 3 involves the completion of a product excellence, and agility is also accomplished through performance projection exercise to effectively forecast activity the Operational Management Process (OMP) (Figure 6.1-1). levels for key organizational metrics for the next three years. The decision to outsource a process or manage it internally During Step 4 (Identify) of the annual STP, MTS collects is initiated through the STP. Ongoing analysis of key DQGDQDO\]HVUHOHYDQWGDWDWRDVVLVWLQWKHLGHQWL¿FDWLRQRIWKH supplier and partner strengths and core competencies (CCs) strategic challenges (SCs) and the strategic advantages (SAs) via the OMP provides MTS key information to aid in the utilizing information gleaned from Step 2. This validates the determination of which key processes will be accomplished SOs, and establishes the appropriate goals critical to the future internally or externally. For example, during the annual STP success of the organization. session an SD was held regarding the strategic opportunity Potential blind spots limiting goal achievement or the of moving local donor transportation services in-house. A DFFRPSOLVKPHQWRIWKHRUJDQL]DWLRQV62VDUHLGHQWL¿HGLQ team was formed and the question was vetted through the Step 2 of the STP during the environmental scan with key OMP. Final analysis revealed higher transportation costs customers. An example of learning and strategic improvement and additional resources required if the process was moved is that in 2011 we added the expansion of formal input in-house, which would divert focus from the organization’s from key partners to include additional relevant industry mission. By leveraging the CC of our key supplier, St. Louis data gathered from customer and partner presentations. Cremation, cost savings were recognized. The CEO and Leadership Team gather environmental 076LGHQWL¿HVWKHNH\SHUIRUPDQFHPHDVXUHVRI business information, industry innovations and technological the organization’s success and its challenges through opportunities from industry and non-industry events, such brainstorming in the STP. Within Step 4 of the STP, MTS as conferences hosted by MQA and MBNQA Quest, AOPO, GH¿QHVDQGYDOLGDWHVLWVVWUDWHJLFDGYDQWDJHV 6$V VWUDWHJLF AATB, and EBAA. challenges (SCs), strategic opportunities, current and future

Figure 2.1-2 Work System Alignment

Relationship Management Support Departments Organ Work System

Partner Post- Notification Authorization Clinical Allocation to Donation of Donor Procurement Customer Referral

Tissue Work System Support Departments

Relationship Management

Category 2 - Strategy • 9 core competencies (CCs), SOs and organizational goals based ensuring appropriate balance for organizational needs. The on current performance and the environmental scanning SO of organizational excellence supports the organization by analysis completed in Step 2. During a 2014 LT meeting, creating and maintaining a culture of innovation. The culture, an SD was held with a systematic review of MTS’ strengths enhanced by the mission-driven staff, are empowered to and possible future core competencies which resulted deliver superior service necessary to achieve the second SO of in relationship management being selected. All CCs are maximize customer engagement and satisfaction, which then measured qualitatively to ensure they are based on a strategic OHDGVWRPD[LPL]LQJGRQDWLRQ±WKH¿UVW62076VXSSRUWVLWV assessment of measurable attributes. SOs with organizational goals and resulting APs that leverage 2.1b Strategic Objectives its SAs and CC while tackling its SCs (Figure 2.1-1, Steps 4 & 5) and strategic opportunities. Strategic Linkages, Figure 2.1- Strategic Linkages, Figure 2.1-3, lists key SOs 2.1b(1) 3LGHQWL¿HVWKHFRQQHFWLRQVEHWZHHQ62V6$VDQG6&V and timetables for accomplishing the organization’s goals. As part of the STP, ongoing SDs based on information from Critical to MTS’ sustainability and aligned under the SOs of the PMS (Figure 4.1-1) provides MTS with an opportunity maximizing donation, are the three most important goals to to balance short and long-term challenges within an evolving saving lives: increasing organ conversion, tissue authorization, industry to ensure adaptability to sudden shifts. Strategic and organs and tissues available for transplant. Performance Linkages, Figure 2.1-3, LGHQWL¿HVZKLFK62VDQGJRDOVDUH SURMHFWLRQVUHÀHFWLQJHIIRUWVWRDFFRPSOLVKWKH62VDUH short-term and long-term with complimentary planning established in Step 3 of the STP. horizons. The organization’s strategic objectives consider MTS has minimal planned changes with customers and and balance the needs of all stakeholders by leveraging markets, suppliers and partners. However, enhancements of the organizational structure, work system design and goal current services are the predominant change. For example, prioritization in step 6 of the STP (Figure 2.1-1). Through a key change was a test to increase referrals via a Medical learning and strategic improvement, topline measures include ([DPLQHU¶VRI¿FHDQRQKRVSLWDOVRXUFHWKHUHE\LQFUHDVLQJ metrics measured and monitored across key stakeholders, the number of families offered the option of donation and ensuring balance for the organization. the amount of tissue available to those in need of transplants. MTS created a 2nd cycle PDSA to further increase non- 2.2 Strategy Implementation hospital referrals by expansion of the referral system to 2.2a Action Plan Development and LQFOXGHDZHHNHQG0HGLFDO([DPLQHURI¿FHUHIHUUDOSURFHVVWR Deployment WKUHHODUJHDUHDFRXQWLHV7KH0HGLFDO([DPLQHURI¿FHVQRZ AP development begins in SDs through the STP and represent the second and third highest referral source of eye 2.2a(1) has become a cooperative effort between LT and employees. donors to MTS. Through learning and strategic improvement, MTS has moved 2.1b(2) The MTS SOs are complimentary by nature the organization from a reactive nature where the LT pushed

Figure 2.1-3 Strategic Linkages Strategic 2014 2015* 2017* Challenges/ SO ORGANIZATIONAL GOALS Results (Actual) 1-year 3-year Advantages (short-term) (long-term) (SC/SA) Increase Organ Donors 159 175 180 Operational-SC 7.1-3 Increase Organ Conversion Rate 78% 80% 80% Operational-SC 7.1-19 OWS Increase Local Organs Transplanted 536 592 605 Operational-SC 7.1-5 Increase Tissue Authorization 58% 60% 70% Operational-SC 7.1-20 Increase Age Targeted Bone Donors Released 558 603 795 Operational-SC 7.1-6 TWS Maximize Donation Increase Skin Donors Released 822 850 900 Operational-SC 7.1-7 Increase Domestically Transplanted Corneas 764 798 830 Operational-SC 7.1-8

Sustain Tissue Processor Satisfaction 92% 92% 95% Operational-SC 7.2-2 Sustain Organ Transplant Center Satisfaction 83% 80% 85% Operational-SC 7.2-1 Maximize Satisfaction

Customer Sustain Corneal Transplant Center Satisfaction 88% 88% 90% Operational-SC 7.2-3 Engagement & 7.4-2 Continue the Baldrige Journey N/A Winner N/A Societal-SA Increase Results on Operations 3.96M 4.4M 4.5M Business-SA 7.5-1 *Targets established during 2014 STP sessions and revalidated in Q1 of 2015 Maximize Excellence Organizational

10 • Category 2 - Strategy APs to the staff following the STP, to a proactive nature where per year. Risk assessment including intelligent risks vetting the LT solicits staff participation in SDs to provide input into through the IIP includes cost modeling the potential effects HVWDEOLVKLQJ$3VWKXVHQVXULQJDOLJQPHQWWRLGHQWL¿HG62V RIDFWLRQVYLD¿QDQFLDOVWDWHPHQWVFDVKÀRZSURMHFWLRQVDQG All of the organization’s APs include completion dates and ROI calculations. MTS determines the success of this process results-driven targets. Figure 2.1-3 outlines several of the key WKURXJK¿QDQFLDOEHQFKPDUNLQJDQGE\LWVDELOLW\WRDFFXUDWHO\ short and long-term goals and APs that have been initiated predict revenue, expenses, and topline results; if necessary, for 2015; some goals are complex enough to warrant multiple PRGL¿FDWLRQVDUHPDGHWRDFKLHYHWKHGHVLUHGUHVXOWV APs, while others are maintained through current business 2.2a(4) Workforce plans are captured within Step 5 practices and therefore do not require additional APs. (Assess) of the annual STP and in the Workforce Planning 2.2a(2) Strategy and AP deployment to the workforce, Process (Figure 5.1-1). As a part of these processes, the LT suppliers, and partners occurs in Step 7 of the STP and through performs an analysis of current and future needs and reviews the Communication Process (Figure 1.1-3). For example, St. capacity and capability information along with onboarding and Louis Cremation, as a key supplier, was informed that delivery exit interview data. These discussions determine the workforce time was critical to MTS meeting its goals of patient death needs for the accomplishment of the short and long-term to corneal preservation for 2014 and 2015, the expectation APs. Management one-to-one meetings, RFOs and quarterly was communicated and improvements in delivery times were C&C discussions with management representation from every realized (Figure 7.1-38). MTS sustains key outcomes of APs department provide MTS with the ability to review changing through tracking and monitoring via a customized web-based capacity and capability needs, as well as any potential changes program that aligns goals with individual performance for that could impact the workforce. These ongoing SDs and ODs all members of the workforce towards the accomplishment aid in addressing training and development needs related to of organizational goals, APs, and aligned SOs. The status of workforce capacity or capability while assessing the potential APs is reviewed between members of LT and staff during QHHGIRUPRGL¿FDWLRQLQWKHZRUNIRUFHVKRXOGGHPDQGV routine one-to-one meetings and also in depth during quarterly change. LT meetings. This allows for strategy shifts, resource re- 2.2a(5) Key performance measures for tracking the allocation and also ensures that the outcomes of APs can be achievement of APs and associated organizational goals sustained. Key outcomes of the APs are monitored through the that support the SOs (Figure 2.1-3), are included in the disciplined review of the PMS. In addition, modeling industry PMS Outputs (Figure 4.1-1). Tracking the achievement and best practices in both the OWS and TWS, benchmarking effectiveness of APs is further accomplished through quarterly organizational results to industry high performers, utilizing AP status reviews at LT meetings. AP status is also reviewed the Baldrige feedback reports, and having a mission-driven by managers in their respective monthly one-to-one meetings workforce (CC), coupled with an innovating culture (CC), with their direct managers and with their staff during RFO. IXUWKHUGH¿QHWKHURDGPDSIRU076WRDFFRPSOLVKLWV62V To promote transparency of the ongoing assessment of 2.2a(3) During Step 5 of the STP, APs are reviewed in detail organizational performance, APs are updated monthly and to ensure alignment with the organization’s SOs and resource are housed on a customized web-based program accessible availability. Workforce planning (Step 6) includes a summary to all members of the workforce 24/7. The prior year’s APs of the quarterly capability and capacity (C&C) discussions, are assessed for completion and effectiveness (Figure 7.4-12) ZKLFKSURPSWVWKHLGHQWL¿FDWLRQRIDGHTXDWHFDSDFLW\DQG and are summarized in the Q1 LT meeting. Through ongoing the key learning and development resources needed to SDs, the LT ensures that the measurement system (Figure drive the accomplishment of the APs. Through learning and 4.1-1) covers all key areas of deployment and stakeholder strategic improvement, the Priority Matrix is also utilized requirements. Topline measures cascade throughout to determine resource allocation to balance the achievement departments to individual’s PEP via APs to reinforce of action plans while meeting current obligations. Through alignment and the accountability necessary to accomplish the DGHWDLOHGEXGJHWLQJSURFHVVDQGDIRUHFDVWRI¿QDQFLDOULVN mission of MTS (Figure 4.1-2). LQFOXGLQJDQDVVHVVPHQWRIWKH¿QDQFLDOLPSDFWRIWKH$3V 2.2a(6) Performance projections are included in Strategic DQGRUJDQL]DWLRQDOJRDOV076HQVXUHVWKDWDGHTXDWH¿QDQFLDO Linkages (Figure 2.1-3); initial projections are established resources are available to support ongoing operations and GXULQJ6WHSRIWKH673PRGL¿HGWKURXJKWKHEXGJHWLQJ newly developed APs. Members of the LT participate in the process and re-validated with end of the year outcomes. Past, process of budget creation, review, and validation; the budget present, and projected performance outcomes and benchmarks LVLQLWLDOO\DSSURYHGE\WKH&(2ZLWK¿QDODSSURYDOE\WKH are reviewed through the PMS. After the review, the LT BOD. establishes one, two, and three year projections through ,Q6WHS 6'VRQJRLQJ RIWKH673¿QDQFLDOULVNDQG traditional trending analysis. MTS continues to lead the viability is assessed for current operations and obligations way by promoting knowledge sharing and benchmarking each month. Financial results are affected by allocation of throughout the OPO industry, including partnering with costs through the Centers for Medicare & Medicaid Services RWKHU232VIRUGDWDVKDULQJ7KLVDVVLVWVLQWKHLGHQWL¿FDWLRQ &06 FRVWUHSRUW$FRPSUHKHQVLYH¿QDQFLDOVWDWHPHQW of performance gaps, aids in goal setting for performance analysis is prepared monthly for the LT and the BOD. The improvement, and is critical given the limited number of DQDO\VLVLQFOXGHVYDULRXV¿QDQFLDOVWDWHPHQWV¿QDQFLDO SXEOLFGDWDVRXUFHV,IJDSVLQSHUIRUPDQFHDUHLGHQWL¿HG6'V scorecard metrics, and variances against budget. Additionally, RFFXU3'6$VRU$3VDUHFUHDWHGRUPRGL¿HGDQGUHVRXUFHV <7'¿QDQFLDOVDUHSUHVHQWHGDW%2'PHHWLQJVIRXUWLPHV are allocated to address the opportunities. Through a cycle of

Category 2 - Strategy • 11 learning, a data validation step was added at the beginning of )DFHERRN9LPHR7ZLWWHUDQG,QVWDJUDP*LYHQWKHKLJKO\ each calendar year at the LT meeting to allow MTS to re- regulated nature of the donation and transplant industry, the validate or adjust operational projections established in STP VKDULQJRIFRQ¿GHQWLDOLQIRUPDWLRQDFURVVVRFLDOPHGLDVLWHV against the year-end data. is avoided. As such, MTS focuses social media efforts on E$FWLRQ3ODQ0RGLÀFDWLRQ communication strategies that strengthen the organization’s brand, support business objectives, reinforce company culture Systematic reviews occurring during monthly work system (V/M/V), and celebrate stakeholder successes [3.2b(1)]. The meetings, quarterly LT meetings, and ongoing SDs (Figure primary web-based methodology used by MTS to obtain 2.1-1, Step 8) provide the opportunity to identify performance customer feedback is the online survey. measures that are lagging or exceeding, and modify existing In addition, electronic medical record (EMR) access APs or create new APs as needed. Deployment of APs, SURYLGHVWKH076ZRUNIRUFHZLWKFRQ¿GHQWLDOUHIHUUDO PRGL¿HG$3VDQG3'6$VDUHDFFRPSOLVKHGWKURXJKDFWLRQV information needed in real time to determine donor eligibility that cascade from the work system or department level down and allows tissue processors to release life enhancing tissue to the individual. Ongoing monitoring and discussion of the for transplant. DonorNet, a centralized computer network, APs occurs through LT meetings, the PEP, staff RFOs and links all OPOs, transplant centers, and histocompatibility work system meetings. A 2012 improvement in the web- laboratories throughout the United States and ensures the EDVHGSHUIRUPDQFHPDQDJHPHQWV\VWHPDOORZHGIRUPRGL¿HG LQFUHDVHGHI¿FLHQF\DQGIDLUQHVVRIWKHRUJDQSODFHPHQW APs to be noted and tracked. The ability to effectively track process. DFWLRQVSODQVDQGWKHLUPRGL¿FDWLRQVDIIRUGVWKHRUJDQL]DWLRQ MTS seeks immediate and actionable feedback on the the ability to allocate resources effectively. Through learning quality of services and customer support via a number of VOC and strategic improvement, the PI department populates and listening and learning methods, including surveys, formal and validates the organization’s scorecards and meets with the informal interactions, and meetings (Figure 3.1-1). Learning is appropriate manager to explore the data and develop a PDSA, transferred through the Communication Process. $3RUPRGL¿HG$3LIXQGHUSHUIRUPLQJPHWULFVKDYHEHHQ LGHQWL¿HG 3.1a(2) As the federally designated Organ Procurement Organization (OPO) within its service area, MTS does not have traditional organ procurement competitors or potential Category 3 - Customers customers. Transplant centers exist within the OPO’s Designated Service Area (DSA) and organs are allocated “What stands out most is their (MTS) commitment to their according to UNOS/OPTN through two-way communication. PLVVLRQLVFRPSOHWH7KH\DUHDOZD\VWU\LQJWRÀQGZD\V MTS keeps abreast of potential changes in organ transplant WRLPSURYH7KH\DUHDOZD\VWU\LQJWRÀQGZD\VWRHQVXUH center status. Regulations do not allow OPOs to actively that our working relationship is excellent and they are true pursue transplant centers outside their DSA as potential professionals.” customers. The restriction of operating within a federally Dr. Stuart Sweet, Transplant Center Customer assigned territory eliminates competition and encourages collaborative efforts between OPOs. 3.1 Voice of the Customer The tissue and corneal service lines are part of a relatively 3.1a Customer Listening small and mature competitive marketplace. Relationship management within these small, mature industries allows 3.1a(1) MTS utilizes multiple formal and informal for contact with potential, future, and competitor customers. mechanisms to collect, transfer and utilize customer Listening and interactions occur regularly with potential, LQIRUPDWLRQIRUXVHLQWKHLGHQWL¿FDWLRQRIRSSRUWXQLWLHVIRU former and competitor’s customers via industry conferences improvement and innovation. This systematic Voice of the and webinars as well as survey data, as applicable (Figure Customer (VOC) process (Figure 3.1-1) incorporates methods 3.1-1). These mechanisms allow MTS to obtain actionable for listening, interacting, and observing local organ transplant information on its services, customer support and transactions. centers, tissue processors, and local corneal transplant centers Knowledge sharing and benchmarking with other OPOs for to obtain actionable information throughout the Customer DOOVHUYLFHOLQHVDOORZVIRUWKHLGHQWL¿FDWLRQRIJDSVEHWZHHQ Life Cycle (Figure 3.2-1). The various listening and learning MTS and other high-performing peers. Utilizing feedback methods used for each customer group, as well as methods on the services provided by other OPOs serves as indirect for listening for each phase in the customer life cycle, are also feedback on the level of services provided by MTS. This noted in the VOC process. In addition, learning and strategic actionable information supports operational and strategic improvements have led to a systematic survey process (AOS), decision making and innovation [4.1a(2)]. which incorporates feedback reports providing results to the survey participants and the development of any associated 3.1b Determination of Customer DFWLRQSODQV$QH[WHUQDOFRQVXOWLQJ¿UPDVVLVWVLQVRPH Satisfaction and Engagement surveys by performing formal assessments, which validate 3.1b(1) Local organ transplant center, tissue processor, SUHYLRXV92&¿QGLQJVDQGLQFOXGHLQGXVWU\EHQFKPDUNLQJ and local corneal transplant center satisfaction is determined MTS is able to respond to feedback from these survey through formal survey results (Figure 7.2-1 A-C; 7.2-2 A-B; evaluations through immediate actions, via SDs and the STP and 7.2-3 A-D) personal communication and interaction with as illustrated in the Communication Process (Figure 1.1-3). members of the MTS workforce (Figure 3.1-1). The methods MTS has an established website and social media presence on to determine customer satisfaction are the same for all service

12 • Category 3 - Customers Figure 3.1-1 Voice of the Customer Life Cycle Method Frequency Customers Phase

A = Annual M = Monthly O = Ongoing Q = Quarterly SA = Semi-Annual Authorization Clinical Procurement Disposition/Allocation Donation Post Centers Transplant Local Organ Tissue Processors Centers Transplant Local Corneal Operational Discussions O ••••←→ ←→ ←→ Day to Day Work / Interactions / Department Meetings O ••••←→ ←→ ←→ Strategic Discussions O ••••←→ ←→ ←→ Participation in STP (Figure 2.1-1) O ••••←→ ←→ ←→ Board of Directors Q ••••←→ Medical Advisory Board SA •• ←→ ←→ Allosource Board Meeting Q •• ←→ Transplant Center Meetings SA •••←→ Medical Director Meeting O •• ←→ ←→ ←→

Collect Surveys O ••••←←→←

(Figure 4.1-1 PMS) (Figure Audits, Internal / External O ••••←← Social and Electronic Media e.g. EMR, Facebook, Website, DonorNet O ••••←→ ←→ ←→ Figure 1.1-2 Corporate Compliance Program O ••••←←← Industry Conferences / Webinars O ••••←→ ←→ ←→ Events / Candlelight Memorial / Open House / Receptions O ••••←→ ←→ ←→ Contracts O ••••←→ ←→ CAPA / Deviations O ••••←←← Best Practice Sharing O ••••←→ ←→ ←→ Scorecards / Status Reports / Metrics On-Demand O ••••→←→→ Meetings, Scheduled and Ad Hoc O ••••←→ ←→ ←→ Survey / Processor Feedback O ••••→←→→ 30-Day Graft Function / Adverse Reaction / Processor Feedback Reports Transfer O ←←← (Figure 1.1-3 (Figure • Industry Conferences / Webinars O ••••←→ ←→ ←→ Communication Process) Communication Social and Electronic Media e.g. EMR, Facebook, Website, DonorNet O ••••←→ ←→ ←→ Figure 2.1-1 STP O ••••←→ ←→ ←→ Survey Feedback / Baldrige Feedback / Annual Report A ••••→←→→ Figure 6.1-2 IIP / PDSA / Cross-Functional Innovation Committees O ••••←→ ←→ ←→ CAPA / Deviations / Figure 1.1-2 Corporate Compliance Program O ••••→→→ Change Management / Audit Findings O ••••→→→ Utilize Best Practice Sharing O ••••←→ ←→ ←→ Industry Conferences / Webinars O ••••←→ ←→ ←→ Figure 6.1-1 OMP O ••••←→ ←→ ←→ Legend: ←→ = 2-way communication, ← and → = 1-way communication, in and out, respectively

Category 3 - Customers • 13 lines. Survey data is segmented by multiple dimensions 3.2a(1) MTS relies upon its Voice of the Customer including customer group or market segment, the level of process (VOC) (Figure 3.1-1) to determine customer needs service quality received, and by customer requirements. and requirements for organ and tissue donation services Customer satisfaction data is analyzed and shared via the (Figure P.1-6). Customer requirements are solicited through Communication Process (Figure 1.1-3) through SDs at TWS/ MTS’ formal survey process (AOS) and results are validated 2:6PHHWLQJVDQGWKH¿QGLQJVDUHLQFRUSRUDWHGLQWRWKH673 during the STP (Figure 2.1-1). These requirements serve (Figure 2.1-1, Steps 2 & 8). as critical inputs for the design of work processes and the MTS uses multiple methods, including surveys, to LGHQWL¿FDWLRQRIRSSRUWXQLWLHVIRULPSURYHPHQW%\IRFXVLQJ capture customer dissatisfaction as shown in VOC (Figure SURFHVVLPSURYHPHQWHIIRUWVRQRSHUDWLRQDOHI¿FLHQFLHV 3.1-1). Local organ transplant center, tissue processor, MTS utilizes its drive and proven ability to innovate (CC) its and local corneal transplant center feedback is shared via services to consistently meet and exceed customer needs and the Communication Process with MTS staff and other expectations. stakeholders and customers. It is also reviewed as part MTS focuses on Finding the Silent Heroes, Figure P.1- of the STP (Figure 2.1-1) and SDs occurring at the work 2, and maximizing each donation opportunity to its fullest system meetings to ensure actionable feedback and process potential to meet the needs of its customers. Formal and improvements. A robust deviation and complaint process informal VOC mechanisms ensure revised regulations is part of the corrective action preventative action (CAPA) and opportunities are captured in ODs and SDs, providing system. Dissatisfaction data is trended through the CAPA organizational agility to incorporate applicable changes in process utilizing collected deviation and/or complaint reports meeting and exceeding customer needs and expectations. and the Customer Feedback Process (AOS). This results in Leveraging the robust Communication Process (Figure WKHLGHQWL¿FDWLRQRIURRWFDXVHVDQGDFWLRQDEOHLWHPV7KH 1.1-3), MTS utilizes the VOC, the PMS, and the STP as inputs implementation of the feedback process creates the framework into the Operational Management Process (OMP) (Figure for analysis based upon the services provided at certain 6.1-1) in working with its customers to identify innovative intervals in the Customer Life Cycle (Figure 3.2-1) as it LPSURYHPHQWVDQGUH¿QHPHQWVWRRXUVHUYLFHVZKLFKDUH relates to customer requirements. then tested via the Innovation and Improvement Process MTS measures customer engagement based on the theory (IIP) (Figure 6.1-2). This leads to increases in availability, that relationship strength is correlated with customer loyalty, quality, safety, and ultimately, the number of lives saved and and that loyalty is obtained via those customers that are enhanced. KLJKO\VDWLV¿HG&XVWRPHUVDWLVIDFWLRQRUµHQJDJHPHQW¶DWWKH Service offerings in new markets, new customer highest level is determined via ‘top box’ scores – or scores of opportunities, expansion of relationships with current 5 on a survey measuring satisfaction on a scale from 1 to 5. FXVWRPHUVRUQHZVHUYLFHRIIHULQJVDUHLGHQWL¿HGYLDWKH673 Metrics gathered via the PMS (Figure 4.1-1), are passed the VOC process, or Knowledge Management process (Figure to the OMP (Figure 6.1-1)ZKLFKGULYHVWKHLGHQWL¿FDWLRQRI 4.2-1). Next they are vetted through the OMP, where ODs and actionable information to deliver improvements in meeting SDs occur, and they are dispositioned through the IIP. MTS’ and exceeding customer’s expectations and engagement commitment to innovation (CC) differentiates its services and throughout the Customer Life Cycle. For example, processor creates opportunities to expand and deepen relationships with VDWLVIDFWLRQZLWKWKH076FKDUWUHOHDVHSURFHVVZDVLGHQWL¿HG current customers. Based on MTS strengths and opportunities, as a low scoring metric on a 2013 survey. Analysis and 076LGHQWL¿HVQHZPDUNHWVWRDWWUDFWQHZFXVWRPHUVDQG implementation of APs addressing the gap resulted in creates opportunities for expanding relationships with current regularly scheduled conference calls to address pending customers. Examples of potential new market exploration problems or issues throughout 2014. In 2015, the organization include hand transplantation in the Organ Work System, will validate process improvement efforts through increased procurement of adipose tissue for stem cell therapy in the customer satisfaction scores for chart release, a key customer Tissue Work System, and expansion of a current customer requirement (Figure 7.2-2A). relationships to increase corneal distribution into a new 3.1b(2) Due to designation of its service area by the Centers market. for Medicare and Medicaid Services (CMS), MTS does not 3.2a(2) Local organ transplant centers, tissue processors, have customer competitors in the Organ Work System. MTS and local corneal transplant centers are empowered to seek collaborates to obtain industry benchmarks from other OPOs information and support throughout the Customer Life and tissue banks on customer satisfaction (Figure 4.1-4). Cycle (Figure 3.2-1) as illustrated in MTS’ VOC process Processors provide metrics utilizing industry comparisons (Figure 3.1-1). Customers are able to conduct business with which provides information on key tissue metrics. Saving MTS via inputs as listed in the VOC and by leveraging the Sight, the single eye bank competitor, does not currently Communication Process (Figure 1.1-3). survey its customer groups; customer satisfaction relative The key means of customer support in both work systems to their organization is not available. As a surrogate, MTS LQFOXGHWKHIXO¿OOPHQWRIFXVWRPHUUHTXLUHPHQWV(Figure P.1- collaborates with other eye banks to obtain their customer 6). Key communication mechanisms, including email, phone satisfaction results for similar products. contact, and web site accessibility enable customers to seek 3.2 Customer Engagement information, receive support and conduct business. Methods of customer support do not vary between customers, customer 3.2a Product Offerings and Customer groups or market segments. Support

14 • Category 3 - Customers Key customer support requirements are determined through customers while meeting their requirements, exceeding their the VOC, validated through the survey process (AOS) and expectations and increasing their engagement in every stage deployed to all people involved in customer support via the of the customer life cycle. The robust customer survey process Communication Process. This integrated survey process has (AOS) includes assessments to drive improvements in both undergone learning and strategic improvement. It is managed satisfaction and engagement. by Performance Improvement (PI) and includes an executive MTS utilizes data and information gathered through social summary provided to all internal stakeholders and survey media to help enhance the organization’s brand by raising participants. awareness of donation and transplantation and, ultimately, 3.2a(3) The STP (Figure 2.1-1) determines and validates driving its Vision of organs and tissues are always available to customer group and market segments. Additional information those in need. As a supplement to the environmental scanning gathered from the VOC (Figure.3.1-1) can also be used to analysis performed during step 2 of STP (Figure 2.1-1), MTS identify and anticipate market segments. follows the social media postings of its customers and key Information gathered through the PMS, including the VOC stakeholders to ensure access to the latest developments. data, is integrated within the STP. Knowledge sharing and Moreover, the organization follows all appropriate industry benchmarking with others for all service lines aids in the news sources to identify trending stories or ones gaining LGHQWL¿FDWLRQRIJDSV(Figure 4.1-4). Utilizing feedback on in media exposure, to generate talking points and to create the services provided to customers by other OPOs serves as DSSURSULDWHULVNUHVSRQVHVDVQHFHVVDU\7KLVLQFOXGHV*RRJOH surrogate feedback on the level of services provided by MTS. Alerts to several key words such as organ and/or tissue This actionable information supports operational and strategic donation and transplant. This additional insight may assist in decision making and innovation for both work systems. WKHLGHQWL¿FDWLRQRIQHZVHUYLFHOLQHVDQGPDUNHWVHJPHQWV Information collected in the VOC, along with the analysis including XVivo technology, hand and face transplants, and completed in the PMS, assesses potential business growth 3D organ printing. In addition to environmental scanning opportunities. and crisis communication, MTS is able to supplement organizational strategies to increase share rates and followers 3.2b Customer Relationships WRLWVRZQVRFLDOPHGLDRXWOHWVWKURXJKWKHLGHQWL¿FDWLRQ 3.2b(1) MTS’ mission-driven staff (CC) develops and repurposing and sharing of value added content. In 2014, MTS manages customer relationships as outlined in the VOC initiated a collaborative PDSA with its largest local organ (Figure 3.1-1). Information is collected from customers and transplant center customer and donor hospital partner to test is transferred into the STP and ongoing SDs, where trending, digital advertising strategies for visitors to their facility by analysis and validation take place. Validated information measuring the conversions from social media posts back to the is utilized to improve the level of service provided to MTS website (AOS). current customers. MTS leverages its brand, reputation and 3.2b(2) The MTS mission-driven workforce (CC), is performance to acquire customers and build market share. For dedicated to complaint resolution, resulting in high levels of H[DPSOHRQHRIWKHKLJKO\VDWLV¿HGSULPDU\XVHUVRI076 customer satisfaction (Figures 7.2-1 through 7.2-3D). As the corneal tissue recommended MTS tissue to a local corneal initial step in the Customer Complaint Process (Figure 3.2-2), surgeon who wasn’t using MTS tissue. That surgeon now uses all staff members are trained to utilize the Four A’s of service MTS tissue exclusively. recovery: Acknowledge, Apologize, Ask, and Act. Front- The provision of exceptional service allows MTS to retain line staff members are empowered to implement immediate corrective action at the point of service and utilize additional Figure 3.2-1 Customer Life Cycle

Figure 3.2-2 Customer Complaint Process Referral

ion Receive Customer Complaint at Au n th o o D r Resolve and Provide Feedback - i t z to Customer Utilizing Four A’s s a o t i P o Log Customer Complaint

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Track and Trend Complaints

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i t s n p Review Trends Monthly (OMP 6.1-1) o e Review Annual Trends (STP 2.1-1) s m it e i r o u Identify and Implement n c /A o Improvement ll r oca al P tion Clinic Review With Stakeholders, if AAppropriate (P(PMS 4.1-1)

Category 3 - Customers • 15 resources if needed to quickly resolve customer complaints. as annualized calculations based on year-to-date and/or actual This process allows the MTS workforce to follow-up and performance in achieving the strategic objectives (SOs). provide feedback directly and immediately to successfully Internal targets facilitate the determination of the appropriate resolve their complaint. If front-line staff members or color-coding for all metrics, allowing real-time evaluation managers are not able to resolve the complaint to satisfy the of the organization’s performance. The Communication customer, the complaint is elevated to the executive leadership Process (Figure 1.1-3) deploys and integrates this information for resolution. across the organization. The LT and workforce are able Local organ transplant center, tissue processor, or local to navigate through the different levels of performance corneal transplant center complaints or policy/procedure feedback and access a color-coded scorecard to enhance deviations are routed through the CAPA system for tracking decision-making effectiveness and support continuous and identifying root causes of the deviation utilizing the improvement and innovation (Figure 6.1-2). Through Customer Feedback Process (AOS). Trend analysis of learning and strategic improvement, once the Performance customer complaints is presented at monthly OWS/TWS Improvement (PI) department populates and validates meetings, quarterly at the LT meetings, and is incorporated the organization’s scorecards, they notify the appropriate into the STP for process improvements; and allows the manager to set up a meeting to analyze the data and develop organization to avoid similar complaints in the future. D3'6$$3RUPRGL¿HG$3LIPHWULFVIDOOLQJVKRUWRIWDUJHW KDYHEHHQLGHQWL¿HG0HDVXUHVVXSSRUWLQJWKH62VDQGNH\ Category 4 - Measurement, Analysis, organizational goals are shown in Strategic Linkages, Figure 2.1-3. The key organizational performance measures are and Knowledge Management tracked monthly and found in the Topline Scorecard (Figure 4.1-2) and the Key Financial Measures, short and long term “If MTS is successful making donation happen, hundreds of (Figure 4.1-3). tissue recipients wake up with a chance at a greatly improved 4.1a(2) MTS utilizes the Comparative Data Process (Figure life. That’s a very inspiring thing to be a part of.” 4.1-4) to select and effectively use key comparative data Tom Cycyota, President & CEO, AlloSource, Customer and information to support operational decision making. In the Organ Work System, the national regulatory agencies 4.1 Measurement, Analysis, and Improvement select key performance indicators and establish performance of Organizational Performance threshold levels which must be met by all OPOs in order to maintain designation. Published quarterly, this information 4.1a Performance Measurement is used to identify gaps in performance between MTS and 4.1a(1) MTS uses a Performance Measurement System other high performing peers. More importantly, perhaps, is (PMS), which has undergone several cycles of learning and the use of the OPO Calculator as a gage of organizational strategic improvement, (Figure 4.1-1) to monitor all key SHUIRUPDQFH3URYLGHGE\WKH6FLHQWL¿F5HJLVWU\RI7UDQVSODQW business and daily operational processes. Key performance Recipients (SRTR), this tool allows for the monitoring of local measures are selected, collected, aligned, and integrated in organ donor yield and operational decision making on a case the Strategic Thinking Process (STP) (Figure 2.1-1). The by case basis by comparing observed (actual) results vs. what STP is the mechanism the organization utilizes to select its would be expected based on the national experience (Figure strategic objectives (SOs) and develop goals supported by 7.1-21a). This information is utilized in post-case reviews and aligned action plans (APs). MTS uses the data and information gaps in performance are addressed accordingly. collected from the PMS as an input into the key decision Due to the lack of a national process for comparative making processes -- the STP and the Operational Management tissue data, the selection of key performance indicators and Process (OMP) (Figure 6.1-1) -- to accomplish the mission. the determination of performance thresholds are established Central to the PMS is an electronic system of cascading goals/ by individual tissue processors. Processors track OPO scorecards (Figure 5.1-4)WKDWGH¿QHVWKH7RSOLQH6FRUHFDUG performance on scorecards and are distributed at monthly or with the capability to drill-down through work system and quarterly intervals. This data supports operational decision department level scorecards. This information is readily making as it allows MTS to assess its success in meeting available thru the data mall, a central repository for the PMS, WLVVXHSURFHVVRUUHTXLUHPHQWVDQGSHUPLWVWKHLGHQWL¿FDWLRQRI and is available to the workforce 24/7 through the MTS best practices. For example, while MTS procurement efforts Intranet. met the AlloSource requirement for average useable skin yield Performance measures are used to support daily per donor, an operational decision was made to exceed the organizational decision making through their aggregation processor requirement by increasing skin yield results. MTS and integration into the cascading scorecard system as well contacted the AlloSource liaison, discussed best practices, as in the Performance Evaluation Process (PEP) (Figure and has since implemented a new process for recovering skin 5.1-2). AP progress is tracked utilizing Success Factors, a which has led to sizeable improvements (Figure 7.1-25). web-based performance management system, and action The corneal service industry also lacks a national plans (APs) are reviewed quarterly at LT and individually comparative data process. Instead, MTS collects comparative during Rounding for Outcomes (RFO). Scorecards utilize data from its AlloSource and LINC partners who operate eye DVHULHVRILQWHUQDOWDUJHWV GH¿QHGDVJRDOV WRPHDVXUH banks. While comparative data is limited, the organization RUJDQL]DWLRQDOSHUIRUPDQFHDQGSURMHFWLRQVZKLFKDUHGH¿QHG supplements the limited availability for data by focusing on the Voice of the Customer (VOC) to support operational 16 • Category 4 - Measurement, Analysis, and Knowledge Management Figuregu e 4.1-1 . 1 Performanceeo ace MMeasurementeasu e e t SysteSystem Define Measures PMS Inputs PMS Outputs PMS Integration - STP (Figure 2.1-1) - VOC (Figure 3.1-1) - Cascading Scorecards - STP (Figure 2.1-1) - Comparative Data - KM (Figure 4.2-1) - AP Tracking - OMP (Figure 6.1-1) Process (Figure 4.1-4) - Comparative Data - Financial Performance - PEP (Figure 5.1-2) - IIP (Figure 6.1-2) Process (Figure 4.1-4 ) - PEP (Figure 5.1-2) - Key Customer Reports - LDS (Figure 5.2-2) - Deviations - Key Partner Reports - LS (Figure 1.1-1) - Ad Hoc Reports

decision making. By focusing process improvement efforts Communication Cycle (Figure 1.1-3). RQRSHUDWLRQDOHI¿FLHQFLHV076XWLOL]HVLWVGULYHDQGSURYHQ 4.1b Performance Analysis and Review ability to innovate (CC) its services to distribute the highest quality corneal tissues available. The LT reviews the key organizational performance measures and capabilities during monthly work system meetings as 4.1a(3) MTS collects VOC data through multiple listening, part of ODs and during quarterly Capability & Capacity interaction and observation methods (Figure 3.1-1). The VOC (C&C) meetings. Individual LT members are also responsible data is integrated into the PMS, which drives operational for conducting monthly reviews of work system and and strategic decision making through the OMP and the department scorecards within their scope of responsibilities, as STP, ensuring a more customer-focused culture exists in appropriate, within the OMP (Figure 6.1-1). Competitive and the organization. Key performance indicators for VOC are customer data are inputs into the PMS and are used to help included on Topline, and applicable department scorecards. set performance metrics. Utilizing the PMS, these reviews Data is segmented by multiple dimensions including: customer identify gaps to goals and comparisons as appropriate to group or market segment, the level of service quality received, provide a mechanism to generate steps to bring performance customer requirement, and phase of the customer life cycle. back on track. The PI department is responsible for data VOC data is analyzed and shared via the Communication validation and analysis using a variety of statistical tools, and Process (Figure 1.1-3) through strategic discussions (SDs) works cooperatively with LT members to ensure MTS’ ability at monthly work system meetings. APs to bridge gaps in to meet goals and objectives. Scorecards and data reports are performance are deployed to appropriate members of the stored in a Data Mall on the intranet that is accessible to the workforce [3.1b(1)] as an output of the survey process (AOS). organization. Through learning and strategic improvement, Customer data that supports innovation is managed through 076LGHQWL¿HGWKHQHHGIRUPRUHUREXVWGDWDYLVXDOL]DWLRQ the Improvement and Innovation Process (IIP) (Figure 6.1-2). software to further the organization’s ability to make rapid MTS utilizes data and information gathered through social fact-based decisions. Utilizing statistical software for the real media to help enhance the organization’s brand by raising time visualization and validation of performance data provides awareness of donation and transplantation and, ultimately, a more comprehensive and robust data analysis, ensuring the driving its Vision of organs and tissues are always available integrity of conclusions while providing an infrastructure for to those in need [3.2b(1)]. agile decision making. 4.1a(4) MTS formally reviews the PMS (Figure 4.1-1) MTS reviews progress relative to the SOs, key process DQGPRGL¿HVLWDVDSSURSULDWHGXULQJWKH673HQVXULQJ outcome measures, and APs during SDs and through the OMP the organization is current with accreditation, regulatory, to ensure the organization is on target to meet or exceed the RSHUDWLRQDODQG¿QDQFLDOQHHGVDQGUHTXLUHPHQWV7KH GH¿QHGJRDOVDQGLVSURJUHVVLQJWRZDUGVEHVWLQFODVVLQDOO organization addresses rapid or unexpected changes and their areas. Organizational performance, competitive standing, impact on the PMS during operational discussions (ODs) ¿QDQFLDOKHDOWKDQGFRPSOHWLRQRI62VDQG$3VEHJLQZLWK and SDs and within the monthly work system meetings the Topline Scorecard and cascades to department scorecards. (Figure 6.1-1). The accessibility of the IIP to everyone in the Scorecard reviews also provide a mechanism to rapidly organization, in conjunction with the organizational structure UHVSRQGWRFKDQJHVLGHQWL¿HGWKURXJKWKH673RU203DV (Figure 1.1-4) and ongoing SDs, ensures the organization is well as ensure changes to APs as appropriate, which might agile and able to respond quickly to innovative opportunities include a response to a transformational change in structure or issues that arise (CC). For example, the VOC process or work system. The workforce is provided with updates (Figure 3.1-1)LGHQWL¿HGDFULWHULDFKDQJHE\$OOR6RXUFH on key organizational metrics and APs at various meetings, the primary tissue processor customer, which decreased the providing the opportunity to ask the LT questions regarding number of skin donors that MTS was able to procure for organizational performance and direction. transplant by 50%, thereby negatively impacting the number The BOD reviews the organization’s performance by of lives saved and the Consolidated Results on Operations reviewing the Topline Scorecard and monthly status report. (Figure 7.5-1). Through SDs, MTS completed an ROI and 7KH&(2DQG&22UHSRUWRQJDSVLQSHUIRUPDQFHLGHQWL¿HG LGHQWL¿HGDQDOWHUQDWHWLVVXHSURFHVVRUWKHUHE\PLWLJDWLQJ by “red boxes” as needed; progress is also reported on a large portion of the impact. The PMS metrics were achieving strategic SOs and APs. In addition, the Executive PRGL¿HGWRUHÀHFWWKLVFKDQJHZKLFKZDVVKDUHGWKURXJKWKH &RPPLWWHHUHFHLYHVWKHPRQWKO\¿QDQFLDOVWDWHPHQWVWRUHYLHZ

Category 4 - Measurement, Analysis, and Knowledge Management • 17 Figure 4.1-2 2015 Topline Scorecard (March)

2015 Year to Date End of Year Last Year Topline Key Metrics Actual Target % Gap Annualized Projection 2014

Retention Rate 94% 85% 11% 94% 85% 89%

Consolidated Results on Maximize

Excellence $1,188,834 $939,285 27% $4,755,336 $3,757,139 $3, 965,917

Organizational Operations-Overall Organ Referrals 500 414 21% 2,000 1,656 1,831 Organ Conversion 76% 80% -5% 76% 80% 78% Organ Donors 48 43 13% 170 170 159 Organs Transplanted 149 148 1% 596 592 537 Organs Observed vs. Expected 1.01 1.00 1% 1.01 1.00 1.01 Yield Tissue Referrals 4,970 4,350 14.3% 19,880 17,400 17,763 Tissue Authorization Rate 56% 60% -6% 56% 60% 57% Maximize Donation Skin Donors 373 294 27% 1,492 1,175 1,142 Skin Donors Released 231 210 10% 924 850 822 Bone Donors 263 220 20% 1,052 880 977 Age Targeted Bone Donors 144 150 -4% 576 709 558 Released Domestically Distributed 152 200 -24% 608 798 764 Corneas Organ Transplant Center 65% 80% -19% 65% 80% 83% Satisfaction - % Top Box Cornea Transplant Center 88% 88% 89% Satisfaction Processor Satisfaction 92% 92% 92% Maximize Stakeholder Engagement Hospital Partner Case 100% 83% 20% 100% 83% 83% Satisfaction Overall Donor Family 89% 83% 8% 89% 83% 78% Satisfaction - % Top Box WKH¿VFDOKHDOWKRIWKHRUJDQL]DWLRQ thru the analysis of three-year historical organizational trend 4.1c Performance Improvement data and industry trends are utilized to identify gaps and areas of opportunity. This analysis creates short and long-term 4.1c(1) The scorecards and comparative data process within projections that are utilized in the PMS (Figure 4.1-1) and the the PMS (Figure 4.1-1), provide the organization’s workforce PEP (Figure 5.1-2). with tools to monitor organizational performance including A recent PMS improvement involved the incorporation of LGHQWL¿FDWLRQRIEHVWSUDFWLFHV3HUIRUPDQFHUHYLHZGDWDZKLFK key comparative data performance projections, in addition includes evidence of high performance within organizational to their historical data, to provide the organization with units and best practices are shared across the organization additional intelligence for real time utilization. Identifying in SDs via the STP, the OMP and Communication Process. actual best in class performance from comparative Implementation of best practices is accomplished thru the organizations for key measures creates a benchmark and development of action plans and/or PDSAs and ongoing a course of action for improvement efforts, as applicable. monitoring of the PMS for success. For example, the Donor If indicated, APs are created to replicate the best in class Services department authorization rate for 2014 exceeded all performance of these organizations. The collegial nature of the SUHYLRXVUHFRUGV%HVWSUDFWLFHLGHQWL¿FDWLRQLQFOXGHGXVLQJ industry creates an environment for open dialog for sharing PI to monitor monthly gaps in performance at the individual necessary steps to replicate benchmark results demonstrated level and the use of a department trainer to support and retrain by other organizations. struggling individuals. Information on the best practices Reconciliation of differences between projections of was shared at the OWS/TWS and C&C meetings which future performance [4.1(b)] and performance projections contributed to the hire of an organizational wide trainer. [2.2(b)] incorporated into APs occurs through the PMS. The 4.1c(2) The organizations future performance is projected PI department has established a systematic process which includes revalidation of year-end data and a review of future 18 • Category 4 - Measurement, Analysis, and Knowledge Management Figure 4.1-3 Key Financial Measures Figure 4.1-4 Comparative Data Process

Key Financial Measures Results Define Measures & Comparisons Consolidated Results of Operations 7.5-1 STP (Figure 2.1-1) PMS (Figure 4.1-1) Days Cash On-Hand 7.5-10

Days in Accounts Receivable 7.5-5 Short Term Benchmark Scorecard Operating Reserves 7.5-8 - OPTN/SRTR OWS Evaluation Total Assets 7.5-11 - AOPO Criteria - RPG Average OAC Comparison 7.5-13

Long Term - AlloSource Tissue Partners projections. This review may generate PDSAs, APs or TWS - AOPO PRGL¿HG$3VWRDGGUHVVSHUIRUPDQFHJDSV7KLVYDOLGDWLRQ - Cryolife step ensures accuracy and reconciliation of any differences in - EBAA Monitor - Press Ganey performance projections. Performance - RPG PMS (Figure 4.1-1) 4.1c(3) MTS utilizes the systematic review of performance KEY - Avatar HR Solutions data in the OMP (Figure 6.1-1) to identify opportunities in the SUPPORT - AOPO LQSURFHVVDQGRXWFRPHPHDVXUHV7KHVH¿QGLQJVIRUPWKH PROCESSES - BoardSource foundation for the organization’s continuous improvement and - CDC innovation processes. Discussions in the OMP also provide - DHSS - LINC opportunities for identifying possible innovations. Through - US DoL the IIP (Figure 6.1-2), charges align with strategic objectives and a team is formed to focus on a particular opportunity. 4.2 Knowledge Management, Information, The innovation team develops ideas and these ideas are and Information Technology vetted through the Leadership Team (LT) for prioritization and disposition. Approved plans are deployed via the 4.2a Organizational Knowledge Communication Process (Figure 1.1-3). MTS relies on electronic means as well as personal Through cycles of learning and strategic innovation, the communication to manage information and organizational RUJDQL]DWLRQLGHQWL¿HGWKHQHHGIRUDPHWKRGRORJ\WRDGGUHVV knowledge. The organization is able to capitalize on the prioritization of performance improvement and innovation accessible Organizational Structure, Figure 1.1-4, through (CC) opportunities. To ensure a systematic approach, a the Strategic Thinking Proces (STP) (Figure 2.1-1)and the Prioritizy Matrix was developed (Figure 6.1-2). The PI Operational Management Process (OMP) (Figure 6.1-1). department leads the exploration and analysis of proposals. These systems work together to synthesize information PI staff members meet with the requestor/team to generate and turn it into knowledge that can be used to innovate and a business case which is assessed for mission alignment, manage the work systems and processes. impact, and resource allocation. This process generates a score WKDWUHÀHFWVWKHRUGHULQZKLFKWKHLQLWLDWLYHLVLPSOHPHQWHG 4.2a(1) MTS collects information from people, processes, All initiatives are presented at LT meetings through a SD to and the environment via electronic and non-electronic methods validate capacity, priority, timeline, and status of projects. This via the PMS (Figure 4.1-1), which feeds into the OMP where process ensures the transfer of organizational awareness and SDs or ODs occur and information is analyzed and translated knowledge about the status of all initiatives. into actions. The Learning and Development System (LDS) Leadership deploys the priorities and opportunities to (Figure 5.2-2) and the Communication Process (Figure 1.1- members of their respective departments and work groups. 3) demonstrate how job-related knowledge is disseminated. Incorporation of a quarterly initiative and project report at Transfer of workforce knowledge readily occurs due to the staff meetings, utilizing the Communication Process reinforces alignment of the workforce into work systems (OWS/TWS). departmental and work group discussions. APs demonstrating Multidisciplinary meetings within the work systems ensure performance gaps are reported out quarterly, at a minimum, at that consistent messages and information are shared. One-on- the LT meetings to discuss timeline and completion status. one Rounding for Outcomes (RFO) conversations between :KHQDSSURSULDWHSULRULWLHVDQGRSSRUWXQLWLHVDUHLGHQWL¿HG staff and their direct managers occur on a monthly basis to organizational APs are deployed to MTS’ suppliers, partners, HQVXUHWKHRUJDQL]DWLRQEHQH¿WVIURPWKHNQRZOHGJHDVVHWV and collaborators through the OMP (Figure 6.1-1) to ensure of the workforce. Ideas and information gathered through the alignment. This systematic approach ensures organizational systematic deployment of RFO are shared with the workforce alignment and sustainability. For example, given the need for via a Stoplight Report (AOS) at each staff meeting. The timely access to donor information, multiple APs addressed intranet serves as a 24/7 vehicle to disseminate information workforce access to hospital partner EMRs. A project team to a decentralized workforce. MTS reports organizational was created and a formal process for managing user access information through the PMS and analyzes it to create was developed. knowledge using the STP, SDs, and the OMP (Figure 6.1-1). Category 4 - Measurement, Analysis, and Knowledge Management • 19 Figure 4.2-1 Utilize Transfer Collect (Figure 1.1-3 (Figure 4.1-1 PMS) Communication) nutyCneecs/Wbnr O OMP ConferencesIndustry / Webinars CAPA / Deviations / Corporate Compliance Process IIP etPatcSaigO O Best Practic Sharing Change Management / Audit Findings uvyFebc adieFebc nulRpr A Survey Feedback / Baldrige Feedback / Annual Report Os/Saeon nrntO O Strategic Planning Process SOPs / SharePoint / Intranet ConferencesIndustry / Webinars oiladEetoi ei ..ER aeok est O Social and Electronic Media e.g. EMR, Facebook, Website uvyFebc eot A O O O O O O Survey Feedback Reports Meetings, Scheduled and Ad Hoc Best Practice Sharing CAPA / Deviations Contracts ConferencesIndustry / Webinars taei icsin O O Strategic Discussions Operational Discussions uvy O O Audits, Internal / External Surveys ehdFrequency Method Corporate Compliance Process crcrs/Sau eot erc nDmn O Scorecards / Metrics On-Demand / Status Reports upirMeig Q W M in STP Participation True User Meeting North Supplier Meetings AIA O Rounding / PEP QAPI (Figure 6.1-2) Knowledge Management (Figure 6.1-1) /PS rs-ucinlInvtosCmite O / PDSA Cross-Functional Innovations Committees (Figure 5.1-2) (Figure 2.1-1) (Figure 2.1-1) / LDS (Figure 1.1-2) (Figure 5.2-2) (Figure 1.1-2) Q = Quarterly O = Ongoing M = Monthly W = Weekly A = Annual OI O O O O O Collabo-

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20 • Category 4 - Measurement, Analysis, and Knowledge Management As evidenced in the second step of the PMS, a variety of both electronic and non-electronic data is validated through data types is collected from customers via the VOC (Figure 100% chart review by the Quality Systems department to 3.1-1) and all remaining stakeholder groups (Figure 4.2- ensure accuracy. Through learning and strategic improvement, 1), in addition to clinical information captured through the the Quality Systems staff conducts monthly audits, ensuring organization’s EMR (True North). While data from these a systematic approach for existing process evaluation disparate sources are queryable for real-time analysis, the and feedback.Validity, integrity, reliability, currency, and use of business intelligence software (Tableau) allows for FRQ¿GHQWLDOLW\RIHOHFWURQLFGDWDDQGLQIRUPDWLRQDUHHQVXUHG the blending and correlation of data to build new knowledge. through the methods listed in [4.2b(4)]. For example, the FDA For example, analysis of organ authorization rates, donor requires all electronic data systems are validated to ensure data and donor family attributes, and MTS requestor traits were accuracy, integrity and currency. MTS utilizes an independent analyzed and segmented by donor hospital partner to provide contractor to validate operational software. insight into deployment strategies. This ongoing study is still 4.2b(2) MTS has established multiple policies and in the data collection phase (AOS). procedures to ensure the security of sensitive or privileged A variety of mechanisms found in the OMP are utilized to data and information. These policies and procedures outline transfer relevant knowledge to customers, suppliers, partners the physical and technical safeguards for all computers that and collaborators. access electronic protected health information to restrict The PMS serves as the basis for the knowledge assembly to access to authorized users. The organization’s password policy integrate into the following key processes: OMP, STP, and the outlines the appropriate parameters for selecting and securing IIP. These processes involve detailed data analysis developed system-level and user-level passwords. Staff with EMR access in collaboration with the PI staff. Initiatives captured from DUHUHTXLUHGWRVLJQFRQ¿GHQWLDOLW\DJUHHPHQWVDQGDQQXDO,7 the IIP (Figure 6.1-2) are presented at LT meetings to ensure audits performed by Quality Systems verify appropriate access transfer of knowledge and help drive innovation throughout and current users. the organization. Step 4 of the PMS ensures the transfer of MTS oversees the cybersecurity of its information systems organizational awareness and knowledge. by employing an outside vendor who provides monthly port- 4.2a(2) MTS has a number of processes in place to ensure scanning of exterior assets (e.g., VMWare View) to identify that learning is embedded in how the organization operates. and classify potential vulnerabilities. Upon receipt, this report The primary mechanism for this is the LDS (Figure 5.2-2), LVUHYLHZHGDQG¿QGLQJVDUHDGGUHVVHGEDVHGXSRQWKHLUOHYHO which is aligned and integrated with multiple organizational of criticality. Additionally, MTS ensures that the providers processes including the IIP (Figure 6.1-2)6SHFL¿FSURFHVVHV XWLOL]HG HJFORXGVWRUDJHVHUYLFHV DUHFHUWL¿HGDQGWKDW include regular training offerings in response to staff feedback all public, internet facing services are encrypted with SSL and organizational gaps, and personal learning goal for 100% FHUWL¿FDWHVWRVDIHJXDUGWKHVHFXUHWUDQVPLVVLRQRIGDWD of staff. Knowledge sharing is a standing agenda item in work 4.2b(3) Data and information availability is critical to the system meetings and ensures a systematic approach to share ability of the workforce to carry out the mission to save lives QHZNQRZOHGJHRUEHVWSUDFWLFHVLGHQWL¿HGDWH[WHUQDOOHDUQLQJ through excellence in organ and tissue donation. Because events. As an example, the IT Director attended an industry IT PDQ\076HPSOR\HHVZRUNRXWVLGHRIWKHRI¿FHHOHFWURQLF meeting and learned of a new cloud-based scheduling system and hard copy systems are used to ensure staff members that was in use at another OPO. This system was presented have access to critical data and information. In order to at the LT meeting and was later implemented as MTS’ new HQVXUHXVHUIULHQGO\DFFHVVZKLOHNHHSLQJDOOFRQ¿GHQWLDO clinical staff scheduling system. Staff has the ability to initiate data secure, the corporate intranet may only be accessed either of these highly accessible processes, with outcomes remotely via encrypted virtual desktop. Because a majority of shared through the Communication Process (Figure 1.1-3). the MTS staff access and input data from a remote location, 4.2b Data, Information, and Information the TrueNorth clinical database is accessible wherever Technology web access is available. Laptops are issued with password 4.2b(1)076¶SROLFLHVDQGSURFHGXUHVGH¿QLQJWKHSULPDU\ protected, encrypted disk partitions to protect data from work processes systematically address accuracy from the compromise in the event of theft and/or loss. Timeliness of initial referral through the organization’s work systems, to data, both electronic and non-electronic, is crucial due to the the placement of organs and tissues. Clinical information unpredictability and time-dependent processes for donation is entered into True North, which now has several built-in and transplantation. The TrueNorth system creates real-time DFFXUDF\DQGHUURUSURR¿QJFKHFNSRLQWV7KURXJKDTXDOLW\ access to donation activity for the workforce and partners. systems check, MTS realized that opportunities existed to Data not stored in TrueNorth can be obtained through multiple improve data and information input into TrueNorth. Utilizing methods such as telephone, text messaging, faxing, emailing the skills of the in-house SQL developer, the organization and accessing the data mall to gain access as needed. developed a custom error-checking report for TrueNorth MTS provides customers with real-time access to the data entry. Having access to in-house SQL development TrueNorth system for read-only information. For process allows IT solutions to be designed quickly and implemented output summaries and performance information, the partnering in alignment with the organization’s real-time operational process systematically shares relevant information. In needs. For key non-electronic data, MTS ensures accuracy addition, TrueNorth clinical data is uploaded into a national and integrity through manual validation of reports and audits database, DonorNet. This data is utilized by regulatory bodies of critical information. For example, upon case completion, and organizations within the industry for collaboration. Access

Category 4 - Measurement, Analysis, and Knowledge Management • 21 to such critical data has improved turn-around and decision- all network switches, servers, and phones, providing making time for MTS’ partners. Tissue processors can access consistent service of all key computer hardware, software, critical data through a dedicated MTS SharePoint portal and and data. receive real-time data via XML transfer from TrueNorth. The • Intermediate-term: To retain system viability in the face requirements for key suppliers are captured annually through of a power outage, a generator system protects all critical the STP and ongoing SDs. At the present time, there are no computer services listed above as well as the clinical operational requirements for MTS’ suppliers to be linked with procedure rooms, refrigerated and frozen supply and its data information systems. Information and data is made product storage areas, and the Donor Services work areas. available to suppliers via electronic means, conference calls, • Long-term: A full remote disaster recovery site replicates and in-person meetings as appropriate. all key systems from the MTS datacenter in St. Louis, 4.2b(4) The IT Department uses the following systematic Missouri to a remote site, based in Denver, Colorado. In selection process to ensure hardware is reliable, secure and the event of a major power loss or disaster, the remote user friendly: site is powered up and key staff may continue to work via • The hardware exceeds software vendor and network load VPN access. VSHFL¿FDWLRQVIRUWKHVSHFL¿HGDSSOLFDWLRQ V  • The hardware is sourced from a recognized quality Category 5 - Workforce manufacturer and includes appropriate vendor support • Servers, network switches and routers must incorporate “MTS’ Innovations are providing better quality tissue, and that multiple layers of redundancy, including dual power means more vision-saving corneal transplants for my patients.” supplies, Network Interface Controllers, and redundant Dr. Sean Edelstein disk arrays to ensure fault tolerance and uninterrupted Corneal Transplant Surgeon, Customer service • All hardware must include appropriate security features, 5.1 Workforce Environment including disk encryption, port/protocol controls and physical/locking where appropriate 5.1a Workforce Capability and Capacity • End-user testing and acceptance is required prior to 5.1a(1) Workforce capability and capacity is assessed rollout of new laptops, portable scanners or other MTS- through the Workforce Planning Process (Figure 5.1-1). In issued devices recent years, the Workforce Planning Process has experienced The IT Department uses the following selection process to learning and strategic improvement, including the adoption ensure software is reliable, secure and user friendly: of quarterly capability and capacity (C&C) meetings. • The software is sourced from a reputable vendor This innovation enables MTS to have systematic strategic • The software is evaluated to ensure the deployment will discussions (SDs) ensuring the mission-driven workforce(CC) comply with IT security policies can address business, market, and regulatory opportunities. • The software is installed into a virtual test environment Through learning and strategic improvement, the for performance testing and end-user acceptance prior to RUJDQL]DWLRQKDVLGHQWL¿HGWKHVNLOOVDQGFRPSHWHQFLHVWKDW launching to the production network are needed to successfully perform each role within the • The software is built upon industry standard architecture RUJDQL]DWLRQ7REHWWHUGH¿QHFDSDELOLW\WKHQHFHVVDU\VNLOOV to ensure compatibility and usability with existing DUHLGHQWL¿HGLQMREGHVFULSWLRQVDQGWKHFRPSHWHQFLHVDUH systems monitored through the Performance Evaluation Process • 7KHVRIWZDUHPHHWVQHHGVLGHQWL¿HGE\HQGXVHUV (PEP) (Figure 5.1-2). MTS continually evaluates the need In addition to the above criteria, the IT Department monitors for new competencies through multiple input mechanisms, and updates MTS’ systems monthly via staff feedback including the Strategic Thinking Process (Figure 2.1- from surveys and by trending data from the IT Help Desk 1), Rounding for Outcomes (RFO), the Learning and application to identify persistent technology issues to ensure Development System (LDS) (Figure 5.2-2), and Capability optimal performance and data integrity. A global overview and Capacity (C&C) meetings. For example, as a learning of the Information System is a component of the annual and strategic improvement, and as a result of transplant STP (Figure 2.1-1). Regular analysis of help desk data and center feedback, organ clinical staff underwent training feedback from end users has led to the development of more and competency assessments to ensure adequate skills to intuitive, user-friendly software across the organization. assist with kidney dissection and organ biopsies. The need Examples of this are the tissue screening calculator and online IRUWKLVQHZFRPSHWHQF\LVQRZUHÀHFWHGLQDDFWLRQ schedules, developed in collaboration with Donor Services SODQ $3 ,QDGGLWLRQWKHQHHGIRUYDULRXVFHUWL¿FDWLRQV staff and clinical directors to ensure partner and customer is discussed during the Hiring Process (Figure 5.1-3) as a VHUYLFHDQGHI¿FLHQF\IRUVWDII7KHVHWRROVDQGRWKHU¿QGLQJV condition of employment, if applicable, and is included in the have been shared with other OPOs through conference calls job description for the role. After the employee is hired, the and online demonstrations. FHUWL¿FDWLRQUHTXLUHPHQWVDUHGLVFXVVHGGXULQJ5)2VHVVLRQV 4.2b(5) Multiple layers of redundancy are deployed within and documented in the employees’ personal development the MTS IT infrastructure to ensure continued availability of goals. technology resources in the event of an emergency: 076V\VWHPDWLFDOO\DVVHVVHVVWDI¿QJOHYHOVE\VROLFLWLQJ • Short-term: Uninterruptible Power Supplies (UPS) protect feedback through monthly RFOs, ongoing strategic

22 • Category 5 - Workforce

Figure 5.1-1 Workforce Planning Process Figure 5.1-2 Performance Evaluation Process

STP (Figure 2.1-1) RFO SDs C & C LDS (Figure 5.2-2) (1) (2) Goal Setting Quarterly Goal During STP & AP Updates Data Analysis to determine threshold Figure 2.1-1 by department Informa l & l In a te rm ra o c Prioritize & Select Needs to Address F t io n s

Determine Appropriate Action REWARDSREWARDS & RECOGNITIONRECOGNITION

Right Size Workforce s F n PMS | SDs Hire/Reduce/Realign or Train o o i r t m c a al r Communicate the Action (Figure 1.1-3) & te Inf l In (4) orma Annual (3) discussions (SD) at work system meetings, Leadership Team Evaluations With Mid-Year (LT) meetings, Executive Leadership Team (ELT) meetings, LT & Staff Check-Ins C&C discussions, and through the use of forecasting in the Strategic Thinking Process (STP) (Figure 2.1-1). The STP DVVLVWVZLWKSURMHFWLQJSRWHQWLDOVWDI¿QJQHHGVRQHWRWKUHH years into the future, ensuring a right-sized workforce for the donation decision. organization. As an example, in previous years, registered 5.1a(3) MTS organizes and manages its workforce at the nurse (RN) retention was a strategic challenge (SC). During individual, key process, and work system levels as seen in an SD, one of the contributing factors to the high turnover Work System Alignment (Figure 2.1-2) through systematic ZDVLGHQWL¿HGWREHSRRUZRUNOLIHEDODQFHZKLFKZDV cascading of goals/scorecards (Figure 5.1-4). The LT provides VLJQL¿FDQWO\LPSDFWHGE\WKHOHQJWKRIRUJDQGRQRUFDVHV work system oversight and strategic direction through the Analysis of case time indicated that the initial portion of Leadership System (LS) (Figure 1.1-1), which serves as the organ donor evaluation did not require a nursing skill the foundation for key decision making. Key work process set. As a result, MTS created a new position to minimize alignment and systematic cascading of organizational the total case time for the RNs (AOS). Existing workforce goals leverages the core competencies (CCs) of a mission- members had the capability for these jobs and several team driven workforce and innovation, and are paramount in members transitioned to the new positions. This approach was accomplishing the work of the organization. ¿QDQFLDOO\IDYRUDEOHWR076DQGXOWLPDWHO\LPSURYHG51 Systematic cascading of goals/scorecards (Figure 5.1-4) retention (Figure 7.3.2). reinforces a customer and business focus. The reinforcement 5.1a(2) MTS utilizes the Hiring Process (Figure 5.1-3) to of customer and business needs is a priority for MTS and recruit, hire, place, and retain new workforce members. As is managed by the LS, which incorporates approaches for evidenced through a multi-year employee survey process, creating the environment, operationalizing the strategy, and MTS’ mission is a key factor of staff engagement, satisfaction, monitoring the organization’s performance. This approach DQGUHWHQWLRQ7KHUHIRUHKLULQJULJKW¿WWDOHQWIRU076EHJLQV begins with the Hiring Process (Figure 5.1-3), which ensures prior to employment by ensuring that the MTS culture is clear WKHEHVWFDQGLGDWHVDUHKLUHGDQG¿WZLWKWKH076FXOWXUH to all applicants (Figure 5.1-3, Phase 1). As a learning and of a mission-driven and innovative workforce (CCs). The strategic improvement, and as a result of Baldrige feedback, integration of the LDS (Figure 5.2-2) with the LS reinforces 076KDVPRGL¿HGLWVH[WHUQDOUHFUXLWLQJSUDFWLFHV7KHVH the V/M/V and provides training for performing daily tasks PRGL¿FDWLRQVHQVXUHWKDWWKHZRUNIRUFHUHSUHVHQWVWKHGLYHUVH and meeting customer needs. Supported by the Four A’s cultures of the community by utilizing diverse recruiting philosophy, workforce members are empowered to make methods including local community colleges and universities, decisions in the prompt resolution of customer concerns. and social media outlets such as Facebook, Twitter, LinkedIn, These efforts lead to employee satisfaction and competence and Careerbuilder. Donor family members and recipients in the delivery of superior service and allows the organization are also considered for appropriate positions within the to meet and exceed customer satisfaction and to strengthen RUJDQL]DWLRQ7KHVHLQGLYLGXDOVUHÀHFWWKHWKLQNLQJRIWKH loyalty (AOS). organization’s key communities by already possessing a strong The STP (Figure 2.1-1) creates focus, establishes priorities, connection to the MTS mission. As an example, a donor father and sets expectations for the work of the organization while was hired in an effort to increase authorization for donation ongoing performance is monitored through the Performance within the African American community. As a donor father, he Measurement System (PMS) (Figure 4.1-1) and the PEP is able to share his personal experience with potential donor (Figure 5.1-2). Performance expectations are reinforced families with the hope that his story will aid them in their through SDs, RFO, and the PEP. Organizational goal

Category 5 - Workforce • 23 Figure 5.1-3 Hiring Process Figure 5.1-4 Examples of Cascading Goals

Workforce Needs Identified SO:S Maximize Donation Capability and capacity meetings (C & C) STP STP Goal: InIncIncreaserer Local Organs Transplantedlanted Position/Opportunity Posted PROJECTION = 592 CEO/COO Level Applicants - Monitor Progress Identified VP/Director Level - Build relationships w/transplant partners Phase 1 - Develop staff - Initial interview with HR - Review cases - External Candidate: Determine organizational and cultural fit OPC/Frontline Workforce Level - Donor management protocols Phase 2 - Follow allocation processes - Interview with hiring manager/point person to determine a position fit with knowledge, skills, and DEC/Frontline Workforce Level abilities (KSAs) and required certifications - Educate partners

Phase 3 - Peer interview to discuss work related tasks and Workforce Planning Process, MTS manages the needs of the ensure departmental fit with prospective new hire workforce and the organization, ensures continuity, prevents workforce reductions, and considers periods of growth. Phase 4 Additionally, through strategic learning and improvement, - Interview completed with an additional member of LT the Hiring Process (Figure 5.1-3) supports continuity by encouraging promotion from within as well as cross-training for applicable roles, whenever possible. Should a workforce Selection Candidate Not reduction, period of growth, or change in organizational - Manager & HR decide best Selected structure or work system be required, qualitative or candidate - External: notify quantitative information from the PMS (Figure 4.1-1) would - Reference check completed - Internal: provide be utilized to conduct a series of SDs to determine appropriate developmental feedback action. Such action might include recruitment, contingency planning for remaining staff, or potential reassignment or exit strategy for affected staff. 5.1b Workforce Climate Selection Orientation Conditional MTS systematically assesses workplace Packet and 5.1b(1) Offer Made environmental factors to ensure and improve workforce health Sent Training by utilizing a comprehensive wellness program as shown in Workplace Environment (Figure 5.1-5). Components of this UDQJHVDUHHVWDEOLVKHGWRGH¿QHKRZHPSOR\HHVFDQH[FHHG comprehensive wellness program include: exceptional health expectations. Ongoing discussions are supported through a insurance packages, no-cost wellness screenings, annual web-based PEP system that uses measures and targets for APs QRFRVWÀXVKRWVDFFHVVWRDQHPSOR\HHDVVLVWDQFH to create an awareness of how each member of the workforce program, optional hepatitis vaccines, and various other health can exceed expectations and subsequently be rewarded and educational opportunities. These programs encourage through multiple mechanisms, including SLS (Figure 5.2-1). employees to become more proactive in improving their Organizational transparency and accountability are ensured overall health. through the web-based system that allows each member of the To ensure and improve workforce security, MTS maintains workforce to monitor anyone’s progress against goals. a safe facility complete with automatic locking doors and 24/7 video surveillance. MTS badges are required for entry into all 5.1a(4) MTS prepares the workforce for changes in C&C the work areas of the facility with levels of restriction based needs through the Workforce Planning Process (Figure 5.1-1). on job function. To ensure a secure workplace environment, Information about changing C&C requirements and needs, MTS policy requires all visitors to sign in and be escorted by including workforce growth, is gathered through several an MTS employee through the building. Through learning methods including C&C meetings and RFO. Organizational and strategic improvement, MTS now contracts with two changes are conveyed by the LT to the workforce through 6W/RXLVFLW\SROLFHRI¿FHUVWRHYDOXDWHIDFLOLW\VHFXULW\DQG the Communication Process (Figure 1.1-3). Through the the existing Emergency Response Plan (ERP). To ensure

24 • Category 5 - Workforce EHQH¿WVLQFOXGLQJDFFLGHQWFDQFHUVKRUWWHUPGLVDELOLW\ Figure 5.1-5 Workplace Environment legal, term-life with a long-term care rider, and cafeteria plans. Factors Measures Results The organizational policies that support the workforce include, a generous paid time off (PTO) plan, emergency Health EAP AOS medical bank (EMB) plan, paid holidays, tuition assistance, Fitbit Wellness Initiative AOS DQGDQRUJDQL]DWLRQZLGHLQFHQWLYHSODQ 6/6 %HQH¿WVZLWK Flu Shots 7.3-5 ¿QDQFLDOLPSDFWVLQFOXGLQJWKH6/6SODQPD\YDU\EDVHG OSHA Compliance 7.3-7 upon staff type, length of service, and performance. In order Wellness Screenings 7.3-5 to meet the needs of a diverse workforce, MTS offers multiple Security Limited access by job function AOS SODQRSWLRQVDQGGLVWLQFWLRQVZLWKLQWKHVHUYLFHVEHQH¿WVDQG ERP AOS policies dependent on workforce demographics, such as: job Training AOS function, FLSA status, tenure, and performance. Accessibility ADA compliant AOS Through learning and strategic improvement, and as a result EEOC compliant AOS RIVWDIIIHHGEDFN076LGHQWL¿HGWKDWWKHNH\ZRUNIRUFH IT resources AOS EHQH¿WVLQFOXGHPHGLFDOLQVXUDQFHRSWLRQV N SODQ workplace security for employees who perform work in and the SLS incentive plan. Employees were asked in 2014, different workplace environments, including at area hospitals, “Compared to similar organizations in the community, I employees are required to review and adhere to that site’s DPVDWLV¿HGZLWKP\EHQH¿WSDFNDJH´RIVWDIIDJUHHG unique security measures. MTS has taken additional measures (Figures 7.3-15)+HDOWKEHQH¿WVDQGWKH N SODQ to ensure the security of our workforce by offering pepper UHYLHZHGDQQXDOO\DUHLGHQWL¿HGE\VWDIIDVRQHRIWKH.H\ spray to all clinical staff and funding a taxi service to transport Workforce Climate Factors (Figures 5.1-6) and are proven employees off site. to be one of the key factors in job satisfaction and retention MTS ensures workplace accessibility by maintaining an (Figures 7.3-14 & 7.3-13). ADA compliant facility with handicap entrance options. 5.2 Workforce Engagement Moreover, MTS is an Equal Opportunity Employer and PDLQWDLQVUHDOLVWLFDQGÀH[LEOHH[SHFWDWLRQVUHJDUGLQJ 5.2a Workforce Engagement and attitudinal accessibility, recognizing the importance of Performance reasonable accommodations. To guarantee technological 5.2a(1) The LS (Figure 1.1-1), PMS (Figure 4.1-1), STP workplace accessibility, all employees are provided IT training (Figure 2.1-1), and V/M/V foster an organizational culture to ensure understanding of the intricate IT systems. characterized by open communication, high performance, and A sample listing of performance measures and the an engaged workforce that provides quality care and service associated improvement goals for workforce health, security, to the customers. As a component of the Communication and workplace accessibility can be found in Workplace Process (Figure 1.1-3), RFO fosters open communication. Environment, Figure 5.1-5, and Workforce Preparedness, The effectiveness of the various communication methods Figure 7.3-6. These performance measures are designed to is validated in (Figure 7.4.-1). The RFO questions include: provide a work environment conducive to supporting the MTS workforce to accomplish the mission. As an example, Figure 5.1-6 Key Workforce Climate Factors the clinical nature of the Organ Procurement Coordinator position may potentially expose staff to radiation from CT and Services X-Ray technologies which is a workplace health concern; the • Wellness program including wellness screenings, flu correlating performance measure is that exposure levels are shots, health coach, Fitbit initiative, and voluntary closely monitored and are well below the maximum allowed smoking cessation program threshold of 5,000 mREM/employee (Figure 7.3-8). • Flexible scheduling 5.1b(2) Focusing on the core competency of a mission- Benefits driven staff, MTS maintains a workforce philosophy of: • Comprehensive medical, dental, and vision insurance “We take care of ‘Our People’ so they can take care of available on a tiered or no cost option to full-time employees RWKHUV´7KHZRUNIRUFHVHUYLFHVEHQH¿WVDQGSROLFLHVDUH validated in the annual employee survey process. MTS has • Low cost option available for dependents many services as a part of their wellness initiative that are • 401K with matching up to 5% DYDLODEOHWRDOOHPSOR\HHVLQFOXGLQJKHDOWKDVVHVVPHQWVÀX • Additional employer 401K contribution of 9% shots, a health coach, voluntary smoking cessation programs, • Optional benefits including cancer, accident, short-term RSWLRQDOÀH[LEOHVFKHGXOLQJ)LWELWFKDOOHQJHDQGDQHPSOR\HH disability, legal, and term life with long-term care rider assistance program also available to family members. • Sharing Lifesaving Success MTS supports its workforce by providing a comprehensive • Employee Assistance Program (EAP) EHQH¿WSDFNDJHWRDOOIXOOWLPHHPSOR\HHVLQFOXGLQJWKUHH Policies medical plan options, as well as dental and vision plans on a • Paid time off tiered cost platform. Employees have the opportunity to select • Emergency medical bank WKHEHVWSODQWRPHHWWKHLUPHGLFDODQG¿QDQFLDOQHHGV076 • Holidays also provides the workforce access to supplemental insurance • Tuition reimbursement

Category 5 - Workforce • 25 “What is working well for you today?” or “What do you need superior customer service (including resolution of complaints) from me?” Through learning and strategic improvement and resulting in customer loyalty and engagement (Figure 7.2-6). Baldrige feedback, a Stoplight Report (AOS) was designed Based on feedback obtained from employee surveys, the LT to communicate progress openly to the entire organization continues to recognize that when staff members understand as a part of staff meeting; this serves as a feedback loop to their connection to the mission (Figure 7.3-11), they are more staff and possible input into the Innovation and Improvement motivated about their work goals and the overall business Process (IIP)(Figure 6.1-2). results. The STP (Figure 2.1-1) and PMS (Figure 4.1-1) provides 5.2a(2) Key drivers of workforce engagement are the foundation for a culture of high performance. The determined through customized surveys developed by Avatar 306HQJDJHVERWKOHDGHUVDQGHPSOR\HHVLQGH¿QLQJKLJK HR Solutions Inc. The employee survey is validated through performance work, which is documented through the PEP. annual staff focus group reviews of engagement elements that Employee performance and success is evaluated based on are included in the survey. As a result of learning and strategic FRPSOHWLRQRI$3VDQGDFKLHYHPHQWRIVSHFL¿FJRDOVWKDW improvement, this staff focus group is representative of all align with the SOs. The LT regularly acknowledges success workforce segments ensuring validation of engagement drivers and subsequently raises standards to drive a high performance for all workforce segments. The survey is administered to staff workforce through the Rewards and Recognition program and includes questions to address each driver of workforce (Figure 5.2-1). Organizational and individual work is also engagement validated in the staff focus group process. All recognized through the SLS plan. RFO also encourages high workforce segments (Figure P.1-4) indicate the overarching performance and achievement of goals through monthly reasons for working at MTS are the mission, relationships with goal review. High performance across the organization is FRZRUNHUVDQGEHQH¿WV further supported by RFO, with the opportunity for all staff to recognize the performance of their peers. 5.2a(3) MTS assesses workforce engagement through the MTS fosters an engaged workforce through V/M/V Workforce Survey Process (AOS). Through learning and (Figure 7.3-11). Through staff feedback, MTS learned how strategic improvement, the survey has gone from an internally powerful the connection to the mission is for the employees. WDEXODWHGTXHVWLRQQDLUHUHJDUGLQJFXOWXUHDQGEHQH¿WV To reinforce MTS’ cultural message, donor families and to an externally developed process that includes national recipients periodically attend staff meetings and share their benchmarks and provides input into the STP (Figure 2.1-1). heartfelt stories. These powerful stories allow MTS to put a The 2014 annual employee survey validated one of MTS’ face to the mission, while motivating, inspiring, and engaging core competencies (CCs) of a mission-driven workforce. the staff. These touching and true testimonies are why the (Figure 7.3-11 & Figure 7.3-12). To assess engagement there 076ZRUNIRUFHZRUNVVRKDUGWRIXO¿OOLWVPLVVLRQ7KH are several formal assessment methods including the annual Communication Process (Figure 1.1-3) and IIP (Figure 6.1-2) survey and RFO; informal assessments include an open door engage the MTS workforce to share ideas and ensures that practice and stay interviews (Figure 4.2-1). These varied WKHRUJDQL]DWLRQEHQH¿WVIURPWKHGLYHUVHLGHDVFXOWXUHDQG interactions enable the organization to assess workforce thinking of the workforce to support the organizational culture. HQJDJHPHQWRQDQRQJRLQJEDVLV076VWUDWL¿HVDQGUHYLHZV The MTS workforce is empowered to make decisions and the survey data by workforce segments to understand how or if take action to achieve individual and organizational success the results differ across workforce groups. MTS’ method and WKURXJKWUDQVSDUHQWFRPPXQLFDWLRQVSHFL¿FDOO\WKH306 measures for assessing workforce engagement do not differ for and the PEP. Leveraging its mission-driven staff (CC), MTS workforce groups and segments. ensures the right staff member is placed in the right job with Workforce retention is measured on the Topline Scorecard the right training, empowering the workforce to provide and has remained consistently high since 2012 (Figure 7.3- 13). MTS has learned that a fully engaged employee will want to remain a team member of MTS, demonstrated by the Figure 5.2-1 Rewards and Recognition numerous years of tenure of some staff members. Absenteeism is not monitored as an organizational metric, but is monitored on a case by case basis. A formal grievance policy has not been created at the advice of legal counsel. When asked on the most recent employee survey, 86% of staff felt the organization does enough to protect their safety. This score is higher than the national norm of 77% (AOS). Productivity Reward/Recognition is monitored through the accomplishment of APs through Given by Staff Given Individual Given by LT Given Organization Wide Departmental the PEP and PMS (Figure 7.4-12)DQGLVPHDVXUHGYLD*URVV  Sharing Lifesaving Success 99Revenue per FTE (AOS). Productivity of the workforce is  Congratulatory slide at staff meeting 9 9 9 acknowledged through the Rewards and Recognition program  Sharing of recipient thank you letters 9 9 9 (Figure 5.2-1).   Personal notes/emails/cards 9 99 5.2a(4) The workforce performance management system supports high performance and engagement of the workforce  Years of service awards/Decade Club 9 9 through its fully deployed PEP (Figure 5.1-2) which has   Peer to peer recognition 9 9 9 undergone learning and strategic improvement. The PEP   Departmental spotlights 9 9 9 consists of several layers that are structured and systematic:

26 • Category 5 - Workforce 1) goal-setting in STP, 2) goal updates, 3) mid-year check-ins, program highlights key organizational elements, such as and 4) annual performance evaluations. Formal and informal an in-depth review of the V/M/V and the organization’s interactions (meetings, on-the-spot coaching, etc.), and performance improvement journey and its intentional use of rewards and recognition occur on an ongoing basis. Utilizing the Baldrige criteria as its business model. The utilization the STP as the foundation, APs are created utilizing staff of a training and development goal in the PEP allows input, to support high performance in the accomplishment of staff and leaders to collaboratively identify training and organizational goals which ultimately drive the achievement development needs based on strengths and opportunities for of the SOs. These goals are aligned with the V/M/V of the the individual and to enhance the organization’s capability organization (a key factor for workforce engagement), and for goal accomplishment. Through RFO, ongoing training cascaded to the workforce with their input included. Managers DQGGHYHORSPHQWQHHGVDUHVHOILGHQWL¿HGE\VWDIIDVZHOODV are able to analyze performance review scores and track goals leaders (Figure 7-3.16). Strategic improvement and learning and AP progress in real-time. The PEP is designed to ensure from manager feedback has resulted in a systematic training transparency across the organization; in turn, each evaluation program for all LT in 2015, which will include a leadership tool includes results on organizational and individual goals, curriculum designed to optimize leadership performance. demonstration of core values, and personal development plans. The priorities of the workforce LDS (Figure 5.2-2) are While staff members indicate the mission, coworkers, and evaluated annually and aligned with the SOs, SCs, APs (short EHQH¿WVDVWKHWKUHHNH\MREVDWLV¿HUV076UHFRJQL]HVWKH and long-term), and goals to ensure support of organizational importance of compensation and Rewards and Recognition needs. As an example, an AP was initiated to implement (Figure 5.2-1). The organization’s compensation system a web-based performance management system. The establishes competitive salary ranges and a merit-based complexity of the software required a two-year AP, including pay increase system to reward staff for achievement of implementation and incorporation of future models of the their goals and demonstration of the core values. MTS has software and a training component. The successful completion a strong commitment to maintaining market-based salaries of this AP resulted in the entire workforce having 24/7 access and works annually with an external consultant to determine to monitor the status of all organizational and individual goals, necessary market adjustments. The organization’s reward and while at the same time promoting transparency across the recognition program includes a program that allows employees organization. to recognize one another; the SLS incentive program designed Organizational performance improvement, organizational to recognize employees’ contributions to MTS’ success; and change, and innovation are driven from the STP through the accomplishment of organizational goals, and various other LS (Figure 1.1-1) and the Organizational Structure (Figure personalized recognition opportunities. 1.1-4) to the employee level where it is reinforced by the The MTS culture and V/M/V reinforces intelligent risk PMS (Figure 4.1-1) and managed through the IIP (Figure taking to achieve innovation. Exploration of innovation is 6.1-2). MTS deploys a systematic leadership curriculum to all managed via the IIP, including use of Innovation Teams. APs LT members which is reviewed annually. New LT members associated with an intelligent risk are evaluated via the PEP are provided with internal training to assist with cultural (Figure 5.1-2) and support innovation (CC/core value). The integration and share organizational knowledge. Additionally, PEP, via the LDS (Figure 5.2-2), evaluates effectiveness, new leaders complete a leadership training session with the LGHQWL¿HVOHDUQLQJDQGGHYHORSPHQWQHHGVDQGVHUYHVDVD Studer group and leadership training that includes coaching, direct input to the PMS (Figure 4.1-1). The information from managing performance, behavioral interviewing, and the PEP is used throughout the year in ongoing SDs. MTS’ developing decision making skills. customer and business focus, and the achievement of APs, are To support ethics and ethical business practices, annual guided by the PMS and reinforced by the PEP. This allows SROLF\WUDLQLQJLQFOXGHVUHYLHZRIWKH&RQÀLFWRI,QWHUHVW the organization to ensure that all goals and targets are closely Policy, Code of Professional Conduct, Corporate Compliance monitored and accountability is achieved. Training, and ongoing procedure compliance. The MTS 5.2b Workforce and Leader Development workforce is educated on the organization’s legal and regulatory requirements through mandatory training. 5.2b(1) MTS’ LDS (Figure 5.2-2) begins with orientating Corporate Compliance Program (CCP) (Figure 1.1-2) training mission-driven staff members, ensuring alignment with the is conducted during new employee orientation and the CCP organizational culture to support the organization’s needs policy competency is assessed annually thereafter; CCP as well as the personal development of the workforce. To training encourages the reporting of suspected breaches of achieve the V/M/V and sustain its CC of a mission-driven policy violations or unethical practices. workforce, MTS focuses on the continual development To perpetuate and improve the customer focus of the of its staff and Leadership Team, beginning with new organization, MTS trains all new employees during orientation employee orientation. As a result of learning and strategic on the organization’s customer complaint philosophy, the Four improvement, new employee orientation is now offered A’s, to ensure superior customer service. MTS utilizes donor in two phases: Introduction and Passport to Excellence. family or recipient volunteers multiple times throughout the During the Introduction phase, new hires are introduced year to reinforce the mission of the organization at all-staff to the MTS culture and complete onboarding activities meetings and events. to create understanding of the organization’s needs. The To ensure the transfer of knowledge from departing or Passport to Excellence is offered quarterly as an extension retiring workforce members, LT members are responsible of new employee orientation. This comprehensive, 8-hour for gathering knowledge and information pertinent to the

Category 5 - Workforce • 27 )LJXUH)LJXUHLearningLearning and DevelDevelopmentopme System

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‡&RXUVH&ULWLTXHV *URZWK'HYHORSPHQW work system and to identify workforce members to receive opportunity to provide feedback about the training they the knowledge sharing. Voluntarily departing members of received and also identify any subsequent training needs of the workforce complete an exit interview questionnaire and interest that will support the mission. Depending on the nature discuss their feedback with the COO. The COO closes the of the training, learning as a result of training is linked to an loop by transferring knowledge from the exit interview; the outcome measured in the goal plan for each employee. As a COO systematically shares this information with the departing result of learning and strategic improvement, and as a result of employee’s manager and HR. Employees who transition staff survey feedback, staff members who attend training off internally complete a survey to capture their knowledge site are asked to share the information they learned at the their which is shared with HR and former/current managers. In the department meeting, work system, or LT meeting to help other event that the information acquired could be used to stimulate team members gain insight from the training. organizational improvement, it would be discussed at the 5.2b(3) At MTS, most job and career-related progression work system C&C meetings and possibly integrated into the involves job enhancement opportunities within the IIP (Figure 6.1-2). Furthermore, exit interview feedback is organization. Due to the organization’s size and structure, aggregated and used for input for further planning at the STP career enhancement is often supported in horizontal and inclusion into the LDS (Figure 5.2-2). To minimize the transitions to different roles. Over half of the workforce is in loss of organizational knowledge, MTS utilizes customer a different position today than originally hired for, and many management software (CRM) to capture relevant customer of those have transitioned multiple times. By supporting and partner information. WKHZRUNIRUFH¶VNQRZOHGJHDQGVNLOOVWKURXJKFHUWL¿FDWLRQV As a component of the LDS (Figure 5.2-2), MTS reinforces courses, and seminars, MTS ensures staff members have new knowledge and on-the-job skills through ongoing diverse skill sets that can be utilized across the organization. competency testing, work system dialogue, bringing in subject This provides the opportunity to increase workforce matter experts for training, and via MTS’ Communication satisfaction and engagement by offering staff members new Process (Figure 1.1-3). Knowledge sharing is also a opportunities. The PEP helps MTS to identify high performers component of the LDS. who can utilize their skills, knowledge, and abilities in various 5.2b(2) Learning and development are critical components ways. to staff success, which in turn drives organizational The LDS prepares the MTS workforce for replacement sustainability and supports the CC of a mission-driven and succession planning. The succession plan is reviewed workforce. Through review and incorporation of Baldrige annually through the STP (Figure 2.1-1, Step 5) DQGPRGL¿HG IHHGEDFN076UH¿QHVWKHHIIHFWLYHQHVVRIWKH/'6(Figure as needed by the HR Director, the COO, and each LT member; 5.2-2). A key MTS staff engagement dimension from the the plan covers a 2 to 12 month time period to provide 2014 employee survey, overall training satisfaction, scored strategy for short-term coverage for each LT position. The LT 85% favorable with MTS staff (Figure 7.3-16). HR evaluates succession plan focuses on the development of current leaders the effectiveness of training by conducting evaluations of positioned to take on additional responsibilities, and emerging internal and external opportunities at the organization, work leaders who could serve as the next generation of MTS system, and department levels, affording the workforce the OHDGHUVKLS7KHLGHQWL¿FDWLRQRIHPHUJLQJOHDGHUVLQFOXGHVD

28 • Category 5 - Workforce review of skill sets required in leadership positions. Through integral inputs into the STP which drives ODs, data analysis, learning and strategic improvement, development needs of real-time decision making, and improvement and innovation LGHQWL¿HGHPHUJLQJOHDGHUVDUHQRZLQFRUSRUDWHGZLWKLQWKH (CC) to ensure customer value. As an example, organ-clinical training and development plan as part of the employee’s operations staff routinely encountered reticence on the part of PEP. MTS consistently applies the succession plan when LT area cardiologists to complete timely cardiac catheterizations members leave the organization. to expedite cardiac evaluation. Delays in the completion of the procedure risked loss of donated organ gifts and created Category 6 - Operations XQQHFHVVDU\GHOD\VIRUWKHWUDQVSODQWFHQWHUV,GHQWL¿FDWLRQ of this issue occurred during SDs and Organ Operations “Organ donation and transplantation is a miracle. I once heard meetings, leading to the development of internal capabilities VRPHRQHGHÀQHDPLUDFOHDVDQHYHQWZKLFKOHDYHV\RXZLWKDQ WKDWUHVXOWHGLQ076EHLQJWKH¿UVW232LQWKHQDWLRQWRKDYH abiding sense of astonishment. It always, each and every time, a cardiac catheterization lab on site. This innovation (CC) strikes you as being astonishing.” was a direct result of MTS’ engaged workforce using the STP, Dr. Joel Cooper, Transplant Surgeon, Customer OMP, IIP, and the Peformance Measurement System (PMS) (Figures 2.1-1, 6.1-1, 6.1-2, & 4.1-1) to assess performance, look for improvements, and deploy appropriate solutions to 6.1 Work Processes meet customer needs. 6.1a Product and Process Design 6.1b Process Management 6.1a(1) MTS’ key service is the facilitation of organ and 6.1b(1) The OMP drives work processes through multiple tissue donation (Figure 2.1-2), a service provided to their inputs including the STP, PMS, staff knowledge, stakeholder customers in collaboration with key partners (Figure P.1- and environmental information as well as outputs from the IIP. 6), which is achieved through key processes and delivery Within the OMP, the PMS (Figure 4.1-1) ensures key metric of their key requirements as outlined in Figure 6.1-3. Key requirements are measured, analyzed, and benchmarked. work processes include Referral Management, Authorization, Operational discussions also include analysis of metrics, and Clinical Procurement. Key work product and process evaluation of current action plans (APs) and process steps, requirements are determined through a variety of listening and validation that current performance is meeting or trending and learning methods via the Voice of the Customer (VOC), to meet targets. As an example, during Organ Operations Figure 3.1-1, including formal and informal surveys, meetings a systematic review of selected organ cases is feedback reports, and informal interactions. The product performed. During these multi-disciplinary reviews, MTS and process requirement analysis and discussion starts in the staff members assess achievement of the hospital process, Strategic Thinking Process (STP) (Figure 2.1-1, Step 8) and authorization process, and the clinical process steps along with continues during the year in ongoing SDs and throughout the stakeholder feedback. This systematic review helps determine Operational Management Process (OMP) (Figure 6.1-1). For if process changes are indicated and provides an opportunity example, it was determined through survey data feedback, that to share learning across the work system. referring physicians from MTS’ donor hospital partners did Key performance measures and in-process measures used not feel prepared for their involvement in organ donor cases. for the control and improvement of work processes are This requirement for information was taken to the Critical outlined in Figure 6.1-3. These in-process measures drive Care Task Force and a tool was developed utilizing their input. increased performance and strict adherence to processes to An information card is now distributed to physicians and ensure maximized outcomes and service. An extensive set nurses caring for potential organ donors to help prepare them of policies and procedures, incorporating key stakeholder for their involvement. LQSXWGH¿QHVWKHZRUNUHTXLUHGWRDFFRPSOLVKWKHNH\ZRUN processes. Deviations to these processes are captured in the 6.1a(2) The OMP (Figure 6.1-1) demonstrates the &$3$GHYLDWLRQV\VWHPDQDO\]HGIRUWUHQGLGHQWL¿FDWLRQ methods used to design and construct key work processes. and resolved. Action plans are deployed and work processes This ensures key requirements driving work processes are DUHPRGL¿HGDVLQGLFDWHG&DSLWDOL]LQJRQ076¶FRUH analyzed, reviewed, and translated into priorities during the competencies -- mission- driven staff and innovation -- is Strategic Thinking Process (STP) and continuing throughout critical to the accomplishment of the key work processes. the year during ongoing strategic discussions (SDs) and Ongoing evaluation of these key work process measures operational discussions (ODs). Figure 6.1-3GH¿QHVWKHNH\ occurs through the PMS to ensure more lives are saved or work processes of the organization: Referral Management, changed. Alignment and integration of performance measures Authorization and Clinical Procurement. These key work begins in the STP and continues through the OMP and the processes drive the organization’s strategic objectives (SOs) partnering process (AOS)to ensure all data and information and ultimately provide organs and tissues for transplant, needs are met to effectively manage performance outcomes. WKHUHE\IXOO¿OOLQJWKHQHHGVDQGUHTXLUHPHQWVRIWKHNH\ Key in-process and outcome measure selection drive and customers and driving organizational sustainability. assess end product quality and performance. Incorporation of organizational knowledge, new technology, product excellence, and agility is also accomplished through 6.1b(2) The OMP (Figure 6.1-1) demonstrates the process the OMP and Step 4 of the Learning and Development used to determine the key work system requirements to System (LDS) (Figure 5.2-2). Both the OMP and the LDS are construct key support processes which include Laboratory Testing, Donor Chart Review and Release Process, Supply

Category 6 - Operations • 29 Figure 6.1-1 Operational Managementg Process

PMS Operational Discussions (Figure 4.1-1) ANALYSIS Staff Improvement

Knowledge A and

L • LT Mtgs

STP ()(RFO) I

G Innovation • ELT Mtgs (Figure 2.1-1) N Process

M • Work System Mtgs G VOC G E • Operations Mtgs IIP N N (Figure 3.1-1) I KM T • Department Mtgs K (Figure 6.1-2) A W • Other Mtgs (Figure 4.2-1) M IT N H IO S M CI EnvironmentalE i t l V DE Information V

KnowledgeK l d FFeedbackdb k LLoop/Analyze/A l and Equipment Management, Financial Management, HR 6.1c Innovation Management Management, IT Management, Process Improvement and Innovation is a core value and CC at MTS and is embedded Quality Compliance Management. Day to day operation of in the culture from the governance level with a Board of the support processes’ ability to meet key business support Directors vested in intelligent risk taking through the mission- requirements is ensured by the OMP. Within the OMP, driven workforce. Innovation is initiated and managed through the PMS (Figure 4.1-1) ensures key metric requirements the IIP (Figure 6.1-2), which is an integral part of the OMP, are measured, analyzed, benchmarked to drive associated LDS and the STP. Innovation discussions can originate in action plans (APs). ODs also include analysis of metrics, the STP, OMP and/or LDS and a business plan is developed. evaluation of current APs and process steps, and validation Plans are prioritized via SDs at LT meetings. An innovation that current performance is meeting or trending to meet team may be formed and is comprised of staff members targets. A Key Support Scorecard is reviewed at OWS/TWS from departments across the organization and is led by PI. to assess performance to projections for meeting key business During Innovation team meetings the team utilizes various requirements. performance improvement tools and data analysis from the 6.1b(3) Improvement of work processes, products (services) PMS to develop new processes to test and implement. Plans and performance is initiated through the OMP (Figure 6.1-1) are assessed for alignment with V/M/V and may be deployed by utilizing the PMS (Figure 4.1-1) and the STP (Figure 2.1- through either Operations or if determined to be Intelligent 1) to identify improvement opportunities. The overarching Risks, they are deployed into the MTS Incubator. Deployment approach to support work process and product improvements and integration of plans include effectiveness checks and is the IIP (Figure 6.1-2). Through learning and strategic re-evaluation as needed. The Communication Process (Figure improvement, enhancements are initiated via a SharePoint PI 1.1-3) is used to report Innovation Team progress to the LT solution, known as the PI Helpdesk, to ensure that changes and staff. and improvements in work processes are systematically Pursuit of a strategic opportunity would be assessed in GRFXPHQWHGDQGDQDO\]HG LQFOXGLQJ¿QDQFLDOLPSDFW 7KLV SDs (Figure 2.1-1, Step 8 ). The Priority Matrix, which is systematic review ensures minimal variability while increasing embedded in the IIP, is used to make decisions about which agility to accomplish the organization’s mission to save VSHFL¿FRSSRUWXQLWLHVDUHGHWHUPLQHGWREHLQWHOOLJHQWULVNV lives through excellence in organ and tissue donation. As an 7KHVFRSHVFKHGXOHDQGQHHGHGUHVRXUFHVLQFOXGLQJ¿QDQFLDO H[DPSOHWKH7:6VWDIIGHYHORSHGD3'6$WRWHVWDPRGL¿HG resources, are validated at the LT meetings via the Priority donor prep procedure to minimize the bone contamination Matrix. Financial and other resources are made available rate, a critical metric to ensure maximizing donation (SO) WKURXJKDUREXVWEXGJHWLQJSURFHVVDQGPXOWLSOH¿QDQFLDO (Figure 7.1-24). Initial results showed improved outcomes, DQDO\VLVWRROVLQFOXGLQJ¿QDQFLDOSURMHFWLRQVDQGSURIRUPD and the rigorous prep practice was incorporated into MTS’ Quarterly C&C meetings assess capability and capacity policies and procedures. Since 2010, MTS has had the UHVRXUFHDYDLODELOLW\7KH6$RI¿QDQFLDOVWDELOLW\SRVLWLRQVWKH lowest contamination rate of all AlloSource partners and the organization to actively pursue innovative ideas and intelligent SUHSSURFHGXUHZDVLGHQWL¿HGDVDEHVWSUDFWLFH076KDV risk taking. trained other OPOs on the procedure. Improvements in work Decisions to discontinue pursuing opportuniites at processes to enhance the mission- driven staff and innovation the approriate time are evaluated through the IIP. The (CCs) are also part of the OMP; staff input and IIP outputs Effectiveness Check and Priority Matrix, key components of may serve as inputs into the OMP ensuring a multifaceted the IIP, allows for a systematic review of current projects as and systematic analysis and discussion of product and process well as proposed projects, and ensures the agility to enhance improvements. support for higher-priority opportunities. As an example,

30 • Category 6 - Operations Figure 6.1-2 Improvement & Innovation Process INPUTS: STP (Figure 2.1-1), OMP (Figure 6.1-1), LDS (Figure 5.2-2) IMPROVEMENT: Generate Business Plan INNOVATION: A Per the Priority Matrix, Initiatives Scored and Intelligent Risk Quantified, Based Upon Alignment with SOs & V/M/V. Approved Ideas Move Forward. Communication Process (Figure 1.1-3) Form Innovation or Project Team Team selection ensures organizational knowledge-sharing Reinforces Knowledge Sharing PI Department Determines Appropriate Tools -PDSA -Stakeholder Impact - Risk Assessment Identify Charge

Submit PI Helpdesk Ticket -Lean/Six Sigma -Project Management D Develop Plan Deploy Plan Aligned Opportunities Intelligent Risks

-Manage via MTS Main -Manage via MTS Incubator (Intelligent Risk)

L Evaluate/Perform Effectiveness Check

Revise Plan - As Needed

I Re-Evaluate and Disposition: Aligned Opportunities Intelligent Risks - Integrate Into MTS Main - Integrate Into MTS Main - Continue Data Collection - Maintain as Separate Entity - Discontinue Initiative - Continue Data Collection - Discontinue Initiative

Annual Review/Feedback Report Ensures Systematic Process Evaluation and Improvement

MTS was approached by Roswell Park Cancer Institute to UHVXOWHGLQSURFHVVHI¿FLHQFLHVDQGVXEVWDQWLDOFRVWVVDYLQJV collaborate with other OPOs in providing tissues for a research These cost savings have impacted the charge structure, project. The scope of the project was systematically evaluated allowing MTS’ organ acquisition costs (OACs) to be among DQGDQDO\]HGIRU¿QDQFLDODQGFDSDFLW\LPSOLFDWLRQVDQG the lowest in the Midwest (Figure 7.5-13)7:6HI¿FLHQFLHV alignment with SOs and mission. During the training period, have allowed increases in donor volume that have not required it was determined the required resources were more than DGGLWLRQDOVWDI¿QJ(Figure 7.3-3). The MTS medical director’s WKHQHJRWLDWHGFRQWUDFWVVSHFL¿HG076PDGHWKHGHFLVLRQ real time involvement with tissue assessments has led to to discontinue pursuit of this opportunity due to capacity reductions in onsite deferrals. resources as well as placing a higher priority on transplantable 2ULJLQDWLQJIURPWKHDQQXDO673VHVVLRQDZHOOGH¿QHG tissue procurements. audit calendar is established each year as part of an AP (Figure 6.2 Operational Effectiveness 2.1-1). Audits are conducted systematically and outcomes drive frequency and sample size, ensuring maximum D3URFHVV(IÀFLHQF\DQG(IIHFWLYHQHVV effectiveness with minimal audit costs. MTS uses an internal Overall costs of the operations, cycle time, productivity, TXDOLW\UHSRUWWRFRPPXQLFDWHDXGLW¿QGLQJVWRWKHZRUN HI¿FLHQF\DQGHIIHFWLYHQHVVIDFWRUVDUHDVVHVVHGWKURXJKWKH system at monthly OWS/TWS meetings. OMP, which includes inputs from the PMS. MTS controls the MTS exceeds industry standards by proactively seeking RYHUDOOFRVWRIRSHUDWLRQVWKURXJKHI¿FLHQF\DQGLQQRYDWLRQ all voluntary accreditations (Figure P.1-5) and participating gained by quarterly Capability and Capacity (C&C) meetings, in accreditation councils. Accreditation inspections assist *URXS3XUFKDVLQJ2UJDQL]DWLRQV,QYHQWRU\&RQWURODQG,,3 the organization with identifying possible gaps in practices SURFHVVPDSSLQJ7KHVHVWUDWHJLHVLQFOXGH¿QDQFLDODQDO\VLV that result in minimizing service errors, rework, and such as an evaluation of budget, cost modeling, and return on defects. Participation on the councils allows for sharing of investment (ROI), along with ongoing SDs (Figure 2.1-1, Step information and best practices to proactively evaluate and 8). An example of cost control is the development of MTS’ improve operations. Input from mission-driven staff members in-house ORs, which incorporated customer feedback and has (CC) during audit preparation meetings ensures that the Category 6 - Operations • 31 Figure 6.1-3 Key Work Processes Key Work Referral Management Authorization Clinical Procurement Process Work System OWS TWS OWS TWS OWS TWS Alignment Key Hospital Hospital Referrals Referrals Organ Donors Tissue Donors Requirements Partner Partner Satisfaction: Satisfaction: OWS TWS (7.1-1A) (7.1-2A) In Process Missed Organ MTS Tissue Organ Tissue Donor Bone No Growth Measures Referrals Approach Rate Conversion Authorization Management Rates (7.1-17) (7.1-18) (7.1-19) (7.1-20) Protocol (7.1-24) Compliance Skin Yield (7.1-22) (7.1-25) Organ Donor Cornea Cases In-house Transplantable (7.1-23) Percentage (7.1-26) Outcome Organ Tissue Local Organ Total Tissue Local Organs Age Targeted Measures Referrals Referrals Donors Donors Transplanted Bone Donors (7.1-1) (7.1-2) (7.1-3) (7.1-4) (7.1-5) Released (7.1-6) Skin Donors Released (7.1-7) Domestically Distributed Corneas by Population (7.1-8) How Determined • Regulatory CMS CMS UAGA VOC (3.1-1) VOC (3.1-1) UNOS/ AATB UNOS/OPTN AATB OPTN EBAA AOPO EBAA UAGA AOPO • Improvement IIP (6.1-2) IIP (6.1-2) IIP (6.1-2) & Innovation KM (4.2-1) KM (4.2-1) VOC (3.1-1) organization’s workforce contributes to process improvement for continued and increased funding of projects and events to opportunities. ensure high levels of customer satisfaction. 7RIXUWKHUPD[LPL]HHI¿FLHQF\DQGFRVWFRQWURO076 6.2b Supply-Chain Management utilizes preventative measures to minimize warranty costs. Preventative maintenance contracts are established to In a non-traditional sense, the supply chain regarding the ensure capital equipment is properly maintained to prevent receipt of the donor referral from MTS’ hospital partners XQSODQQHGFRVWO\UHSDLUV*URXSSXUFKDVLQJDJUHHPHQWVDUH is the most critical supply chain event for the organization utilized to leverage economies of scale in order to negotiate (Figure 2.1-2). The selection of non-traditional suppliers reasonable prices for supplies and maintenance contracts. is pre-determined by the DSA. The ‘donor’ supply chain Additionally, prospective vendors are examined utilizing a PDQDJHPHQWHQWDLOVDVWDQGDUGL]HGLGHQWL¿FDWLRQDQGUHIHUUDO vendor selection process. This process is implemented before process at partner hospitals of all potential donors, ensuring establishing accounts, and new supply requests are evaluated operational needs are met (Figure 7.1-1 & 7.1-2). and approved/denied at the director level via the Supply After the initiation of the referral process, potential donor Requisition Process. suitability is established and the potential donor’s family is MTS employs comprehensive measures to maximize approached for donation (Figure P.1-2). The donor referral HI¿FLHQF\DQGHQVXUHFRVWFRQWUROFDQEHEDODQFHGZLWK system is developed collaboratively with hospital partners customer needs. The work within the OMP, and the core and the donation process begins with the donor entering the value of innovation drives the organization to perform as Organ and/or Tissue Work System. This referral process has HI¿FLHQWO\DVSRVVLEOH7KHFRVWVDYLQJV076UHDOL]HVDOORZV undergone learning and strategic improvement. Hospital

32 • Category 6 - Operations partners initiate the referral; hospital performance is regularly may result in training sessions for staff or changes to policy, if tracked via metrics noted on the hospital Quarterly Dashboard required. The injury reporting process ensures all injuries are report and in the Donor Program Development (DPD) investigated, root cause is determined, and change in-process VFRUHFDUG3RRUO\SHUIRUPLQJKRVSLWDOVDUHLGHQWL¿HGYLD or environment is taken if indicated to ensure recovery. these metrics and subsequent APs are established to ensure This knowledge is shared via the Communication Process, improvement in outcomes. For instance, a donor hospital regular safety updates are communicated to the workforce partner that utilized its staff to approach families for tissue at department and staff meetings. Through learning and donation had very low authorization outcomes. Several strategic improvement, MTS has contracted with two St. Louis collaborative APs were implemented for improvement in FLW\SROLFHRI¿FHUVWRHYDOXDWHWKH6DIHW\3URJUDPLQFOXGLQJ 2010, yielding little to no increase in tissue authorization building security and the existing Emergency Response Plan for the hospital approach. Through a PDSA, an on-site MTS (ERP). As a result, a risk mitigation plan and curriculum to requestor was tested to approach families for tissue donation enhance employee awareness was delivered to all MTS staff. on a single shift at a key hospital, eventually resulting in MTS Recurring workshops offered to all staff include personal coverage of tissue requesting 24/7 at one of the organization’s safety and cybercrime prevention. MTS badges are required largest referral sources, achieving authorization increases of for entry into all the work areas of the facility with levels over 30% at that institution (AOS) and is being replicated at of restriction based upon necessity as determined by job an additional large trauma center. description. Moreover, MTS utilizes a local security company MTS recognizes that collaborative relationships with to provide continuous perimeter and campus security during traditional and key suppliers play an important role in non-business hours including weekends and holidays. enhancing organizational performance (Figure P.1-6). MTS 6.2c(2) MTS has a well-documented, executable disaster manages its traditional supply chain with an online inventory preparedness plan which allows the work systems to continue management system. This system enables the organization to achieve a high level of customer satisfaction. Emergency to manage ordering, purchase orders, purchasing history, preparedness prevention is ensured through regular testing and supply expiration monitoring, which allows MTS to and analysis of the ERP. The plan is a guideline that prepares establish minimum inventory levels that take into account lead MTS staff to respond to safety and operational disruptions times and expiration dates. Through learning and strategic in the event of an emergency. Multiple measures are also improvement suppliers are now selected through a vetting in place to ensure continuity of operations. The design of DQGTXDOL¿FDWLRQSURFHVVXVLQJDYHQGRUDSSURYDOIRUPDQG MTS’ facility ensures all critical services, including Donor an ongoing vendor annual evaluation process. Additionally, Services, IT network, and clinical operations, are continuously a quarantine and release process for critical supplies ensures online and supported by an emergency generator. Routine VWHULOLW\FHUWL¿FDWHVDQGLQYHQWRU\TXDOL¿FDWLRQVPHHWRU testing and preventative maintenance of all critical equipment exceed industry requirements. Suppliers’ performance is optimizes the organization’s ability to respond to any event. measured and evaluated on a variety of levels including Additionally, remote access capabilities allow work to metrics on damaged and returned supplies and delivery times continue uninterrupted in case of a disaster, emergency, or (AOS). Poorly performing suppliers are contacted to resolve weather interruption. IT replication and remote access to recurring issues and if issues persist, are replaced by another phone systems ensures 24/7 remote access for internal and available supplier/supply. external services. The IT systems are replicated at two out- 6.2c Safety and Emergency Preparedness of-state locations, which ensure continuity of operations in 6.2c(1) MTS has established a Safety Program, managed WKHHYHQWRIDVLJQL¿FDQWORFDOGLVDVWHU)RUH[DPSOH076 E\WKH6DIHW\2I¿FHUWKDWXWLOL]HVV\VWHPDWLFSURFHVVHVIRU has provided secure access to internal applications through ensuring a safe operating environment and incorporates the use of virtual desktop. This allows all staff to continue OHDUQLQJDQGVWUDWHJLFLPSURYHPHQW,GHQWL¿FDWLRQRI working wherever an internet connection is available. Also, workforce safety concerns and timely injury reporting in the event of a disaster, an extreme volume of cases, or process allows for a systematic review to identify areas for FULWLFDOVWDI¿QJVKRUWDJHV076KDVDQDJUHHPHQWZLWK prevention and improvement. Injuries are reported and this PXOWLSOHRWKHU232VWRUHFLSURFDWHHPHUJHQF\VWDI¿QJDQG data is monitored to identify potential trends and opportunities facilities on a short-term basis. In the event of a long-term for training on accident prevention (Figure 7.3-7). Accident off site option, MTS is prepared to complete organ and tissue prevention, embedded in the culture of the organization, starts clinical processes at local hospitals, and the Donor Services with new hires and continues with annual training. Prevention department would be operational via remote access. Recovery examples include: OSHA training, Blood Borne Pathogens following an event would be dependent on the incident or Training, the provision of personal protection equipment, event, but MTS’ facility would be re-established at another and staff are provided the hepatitis B vaccine. In addition, location if necessary. In addition, the organization maintains ZRUNIRUFHVDIHW\FRQFHUQVDUHLGHQWL¿HGLQ2'VGHSDUWPHQW EXVLQHVVLQWHUUXSWLRQLQVXUDQFHWRHQVXUHDGHTXDWH¿QDQFLDO meetings, RFO, staff surveys, through monthly quality resources to support continued operations. In the event that audits, walkthroughs of the clinical area, and investigation of MTS continuity contingency plans, including suppliers and injuries. The Safety Program, utilizing the Safety Committee, partners, are deemed ineffective or not available due to analyzes data and recommends needed training sessions, catastrophic circumstances, the highest ranking leadership policy change recommendations, and/or other needed safety member available may make the decision to cease operations enhancements. These learnings and strategic improvements XQWLODOWHUQDWLYHRSWLRQVDUHLGHQWL¿HGE\WKH(/7

Category 6 - Operations • 33 Category 7- Results Fig. 7.1-2A Hospital Partner 7.1 Product and Process Results Satisfaction -- Tissue

7.1a MTS has three key work processes within the work Overall Satisfaction and Engagement Good systems: Referral Management, Authorization, and Clinical 5.0 100% Procurement (Figure 2.1-2)5HIHUUDO0DQDJHPHQWWKH¿UVW key process in both work systems (Figure 6.1-3), is measured 2.5 50% by organ and tissue referrals. The referral process is the %Top Box

Satisfaction 0.0 0% start of collaboration with our hospital partners. Hospital 2012 2013 2014 SDUWQHUVDWLVIDFWLRQZLWKWKHUHIHUUDOSURFHVVLVUHÀHFWHGLQ Figures 7.1-1A & 7.1-2A. Organ referrals (Figure 7.1-1) have experienced a favorable trend for the last 3 years, with 2014 Satisfaction %Top Box referrals reaching organizational best levels. Tissue referrals have increased and are progressing to achieve top quartile Fig. 7.1-3 Local Organ Donors by performance compared to the national benchmark (Figure Population 7.1-2). 2015 APs to Achieve Benchmark Good 40 Fig. 7.1-1 Organ Referrals 20

Growing Partner Engagement Good 2,000 0

Donors/M Pop 2012 2013 2014 2015-Q2 1,000 Donors/M Pop AOPO Top Quartile Referrals 0 Fig. 7.1-4 Total Tissue Donors 2012 2013 2014 2015 YTD

Referrals Internal Target Exceeding Best in Class Performance Good 2,000 Fig. 7.1-1A Hospital Partner Satisfaction - -Organ 1,000 Good Overall Satisfaction and Engagement Donors 5.0 100% 0 2012 2013 2014 2015-Q2 2.5 50% Donors AOPO Best in Class % Top Box

Satisfaction 0.0 0% 2012 2013 2014 2015 last three years exceeding the benchmark, with 2014 resulting in an organizational best and therefore a record number of Satisfaction RPG (Satisfaction) donor families and recipients served. %Top Box RPG (%Top Box) The last key process of both work systems is Clinical Procurement which is measured by local organs transplanted Fig. 7.1-2 Tissue Referrals in the OWS (Figure 7.1-5), and in the TWS the measures are age targeted bone donors released (Figure 7.1-6), skin donors Strong Partner Engagement Good released (Figure 7.1-7), and domestic corneas transplanted 5,000 (Figure 7.1-8). Local organs transplanted are a topline measure directly responsible for increasing lives saved. 2,500 Increases in 2014 in local organs transplanted are a result of MTS improvements in overall organ yield and position MTS above 0 the national top quartile. Age targeted bone donors released 2012 2013 2014 2015-Q2 show a favorable trend, meeting or exceeding the internal target for the last 3 years. Skin donors released, a more Referrals/M Pop AOPO Top Quartile recently added metric, exceeds the internal target for Q4 of DQGVKRZVDEHQH¿FLDOWUHQG$JHWDUJHWHGERQHGRQRUV The key outcome measurement for authorization in the released and skin donors released are not tracked within the OWS is organ donors (Figure 7.1-3) and the authorization industry, but measure MTS’ ability to meet tissue processors outcome measure in the TWS is tissue donors (Figure 7.1-4). requirements. Domestic corneas remain steady with 2015 APs Organ donor numbers remain steady - an innovation team was in place to grow distribution (Figure 7.1-8). formed and 2015 APs were developed to achieve top quartile The two work systems include three service lines which are performance. Tissue donor numbers have increased over the segmented into three customer groups: local organ transplant

34 • Category 7- Results Fig. 7.1-5 Local Organs Transplanted by Fig. 7.1-9 Local Hearts Transplanted Population

Near Top Quartile Performance Good Fourth in the Nation Good 20 150

10 75

0 Hearts TXP/M Pop 0 2012 2013 2014 2015-Q2 2012 2013 2014 2015-Q2

OrgansPop TXP/M MTS OPTN Top Quartile Organs TXP/M Pop OPTN Top Quartile

Fig. 7.1-6 Age Targeted Bone Donors Fig. 7.1-10 Local Lungs Transplanted Released First in the Nation Good

Increasing Bone Donors Released Good 50 700 25 350

0 0 Lungs TXP/M Pop

Bone Donors Released Bone Donors 2012 2013 2014 2015 YTD 2012 2013 2014 2015-Q2 Bone Donors Released MTS OPTN Best In Class AlloSource Best in Class Fig. 7.1-11 Local Livers Transplanted Fig. 7.1-7 Skin Donors Released Eleventh in the Nation Good

Meeting Internal Release Quotas Good 50 400 25 200

0 Livers TXP/M Pop 0 2014-Q3 2014-Q4 2015-Q1 2015-Q2 2012 2013 2014 2015-Q2 Skin Donors Released MTS Internal Target MTS AOPO Top Quartile INTERNAL METRIC INTERNAL

Fig. 7.1-8 Domestically Distributed Fig. 7.1-12 Local Kidneys Transplanted Corneas by Population Second in the Nation Good AP in Place to Grow Distribution Good 90 200

45 100 0

0 KidneysPop TXP/M

Corneas/M Pop Corneas/M 2012 2013 2014 2015-Q2 2012 2013 2014 2015 YTD MTS OPTN Top Quartile Corneas/M Pop AlloSource Best In Class Fig. 7.1-13 Local Pancreata Transplanted centers, tissue processors and local corneal transplant facilities

(Figure P.1-6). The organs transplanted can be segmented Top Quartile Performance Good by organ type: heart, lung, liver, kidney and pancreas and 14 results are shown by organs transplanted per million. (Figures 7.1-9, 7.1-10, 7.1-11, 7.1-12 and 7.1-13) Hearts transplanted 7 show an organizational best outcome for 2014. Local lungs transplanted per million, while decreasing slightly from 2012, still exceed benchmarks and place MTS as the highest lung 0 2012 2013 2014 2015-Q2

allocation program in the nation in 2014. Livers and kidneys Pancreata TXP/M Pop transplanted per million remain steady, meeting or exceeding MTS OPTN Top Quartile benchmark top quartile. Pancreata transplanted per million

Category 7- Results • 35 has increased since 2013 with 2014 showing an organizational DWRIWKHKRVSLWDOVDQLQFUHDVHRIQHDUO\LQWKHODVW best outcome exceeding the benchmark top quartile. Tissue three years. donors can be segmented by bone donors (Figure 7.1-14), skin donors (Figure 7.1-15) and eye donors (Figure 7.1-16). Fig. 7.1-17 Missed Organ Referrals Good Bone donor and skin donor numbers have surpassed a national Exceeding the Benchmark Level comparative top quartile measurement since 2012. Eye donors have seen record breaking growth as well and have 4% far exceeded the top quartile since 2012, with record breaking organizational achievement in 2014. 2%

Fig. 7.1-14 Total Bone Donors 0% Missed Referrals Missed 2012 2013 2014 2015 YTD Record-Breaking Performance Good MTS Hospital Partners 1,500 AlloSource Best in Class

750 Fig. 7.1-18 MTS Tissue Approach Rate

Donors Converting Hospital Partners to MTS Approach Good 0 2012 2013 2014 2015 YTD 100% Donors AOPO Top Quartile 50%

Fig. 7.1-15 Total Skin Donors 0% Approach Rate Approach 2013 2014 2015 YTD

Record-Setting Results Good MTS Hospital Partners 1,500 INTERNAL METRIC

750 The authorization in-process measure for OWS is the

Donors conversion rate (Figure 7.1-19). Conversion is the OWS 0 industry standard measure for authorization. MTS has been a 2012 2013 2014 2015 YTD solid industry performer with top quartile performance within the industry in two of the last three years. The TWS in-process Donors AOPO Top Quartile authorization measure is the authorization rate (Figure 7.1-20). Breakthrough process changes implemented as a result of Fig. 7.1-16 Total Eye Donors innovation committee work in 2014, combined with new job requirements, hiring practices, and workforce development Record Breaking Performance Good have resulted in tissue authorization outcomes exceeding 2,000 industry top quartile.

1,000 Fig. 7.1-19 Organ Conversion

Donors Top Quartile Performance Good 0 100% 2012 2013 2014 2015 YTD Donors AOPO Top Quartile 50%

7.1b(1)076NH\SURFHVVHIIHFWLYHQHVVDQGHI¿FLHQF\ 0% results are noted in Figure 6.1-3 as “in-process measures.” 2012 2013 2014 2015-Q2

7KHUHODWLRQVKLSPDQDJHPHQWHI¿FLHQF\DQGHIIHFWLYHQHVV Rate Conversion Conversion Rate OPTN Top Quartile results for OWS are missed referrals (Figure 7.1-17). Missed referrals have steadily decreased and in 2014 resulted in the least missed referrals in organizational history. For TWS, the Optimizing the gift (yield) (Figure 7.1-21) is demonstrated relationship management in-process measure is the percent in the OWS by the ability of the clinical staff to manage of approaches by MTS (Figure 7.1-18) which shows an the donor’s clinical status to ensure the highest number organizational best for 2014. Donor Program Development of transplantable organs. Yield trending demonstrates staff have worked closely with hospital partners to transition organizational best yield in 2014, exceeding the top quartile the tissue authorization process to MTS Donor Services. In national benchmark. In an industry attempt to normalize the 2014 MTS performed the approach for tissue authorization data, results are adjusted for a pre-determined set of donor characteristics. MTS’ observed performance exceeds expected

36 • Category 7- Results Fig. 7.1-20 Tissue Authorization Fig. 7.1-21 Organ Donor Yield APs in Place to Drive Yield Good Top Quartile Performance Good 100% 4.00

50% 2.00

0% 0.00 Authorization Rate Organs TXP/Donor Organs 2012 2013 2014 2015 YTD 2012 2013 2014 2015-Q2 Authorization Rate AOPO Top Quartile Organs TXP/Donor OPTN Top Quartile performance. MTS’ performance is statistically higher than Fig. 7.1-21A Observed vs Expected by expected for four organ types for 2014 (Figure 7.1-21A). Organ Good Donor Management Protocol Compliance rates (Figure 7.1- 2.00 APs in Place to Drive Yield 22) continues to show 100% compliance and represents the DELOLW\RIWKHFOLQLFDORUJDQVWDIIWRPDQDJHGRQRUVHI¿FLHQWO\ 1.00 and effectively. Organ Donor Cases In-House (Figure 7.1-23) LVWKHSUDFWLFHFKDQJHUHVSRQVLEOHIRUFUHDWLQJVLJQL¿FDQWFRVW VDYLQJVIRU0767KLVLQGXVWU\¿UVWLVDSDUWQHUFXVWRPHU 0.00

VDWLV¿HUIRUWKHGRQRUKRVSLWDOVDQGWKHWUDQVSODQWFHQWHUV Expected : Observed 2012 2013 2014 2015 YTD 076VLJQL¿FDQWO\RXWSHUIRUPVWKHH[WHUQDOEHQFKPDUN Kidneys Heart Liver comparisons with organizational high outcomes for 2014. The Lungs Pancreas Expected 7:6LQSURFHVVPHDVXUHVLQFOXGH%RQH1R*URZWK6NLQ Yield and Cornea Transplantable Percentage. MTS set the Fig. 7.1-22 Donor Management Protocol AlloSource partner benchmark for bone no growth (Figure Compliance 7.1-24) with 2014 as an organizational best. Skin Yield Process Compliance Ensures High Results (Figure 7.1-25) shows favorable trends; APs were developed to address benchmark performance gaps. The cornea 100% transplantable rate (Figure 7.1-26) has remained steady; APs are in place for 2015 to ensure this rate meets or exceeds 50% MTS national average. The key organizational performance indicators for key 0%

support processes are shown in Figure 7.1-27 through Figure 2012 2013 2014 2015 YTD METRIC INTERNAL 7.1-33. Laboratory testing turnaround time (Figure 7.1-27) MTS Internal Target has seen MTS exceeding the organ benchmark both years the laboratory has been operational. Chart Cycle Time - Organ Fig. 7.1-23 Organ Donor Cases In-House (Figure 7.1-28), has seen a steady decrease in the number of Industry Trailblazer days needed for organ charts to be reviewed and uploaded Good to meet regulatory requirements. Chart Release Cycle Time 100% Tissue (Figure 7.1-29)UHÀHFWVDFULWLFDOVWHSLQWKH7:6 process during which charts are completed, quality checked, 50% DQGUHOHDVHGWRWKHSURFHVVRUVIXO¿OOLQJDWLVVXHSURFHVVRU requirement and triggering reimbursement to MTS. A 2013 0% process mapping and LEAN process improvement approach 2012 2013 2014 2015 YTD VLJQL¿FDQWO\LPSURYHGWKH&KDUW&\FOH7LPHGHPRQVWUDWLQJ Eligible% Cases In-House % Eligible Cases In-House DEHQH¿FLDOWUHQGIRUWKHODVW\HDUVZLWK076WLVVXHFKDUW AlloSource Best in Class cycle time meeting or exceeding outperforming the AlloSource partners. Cornea Procurement to Release Time (Figure 7.1-30) Fig. 7.1-24 Bone No-Growth Rates LVDQH\HEDQNHI¿FLHQF\PHDVXUHZKLFKUHÀHFWVWKHDELOLW\RI Best in Class Performance the Eye Bank and Donor Records departments to turnaround Good eye charts in order to offer tissue to corneal surgeons in the 100% shortest time possible. APs put into place in 2014 decreased the release time, providing sight-saving tissue for transplant 50% PRUHHI¿FLHQWO\6WHULOL]HUGRFXPHQWDWLRQDFFXUDF\(Figure 7.1-31) shows the documentation compliance which impacts 0%

clinical equipment availability. Financial Management Growth Bone w/No 2012 2013 2014 2015 YTD >&DWHJRU\D  @GHPRQVWUDWHV076¶VWURQJ¿QDQFLDO position, exhibiting best in class performance for many Bone w/No Growth AlloSource Best in Class

Category 7- Results • 37 measures. HR Management, including the Retention Rate (Figure 7.3-13), has exceeded the AOPO national comparisons Fig. 7.1-29 Chart Release Cycle Time -- for the last 3 years. IT Management (Figure 7.1-32) shows the Tissue ability of the IT department to have server availability 24/7 Releasing More Charts in Less Time in order to support business operations. Process Improvement 50 Good (Figure 7.1-33) is an indicator of PI utilization across the company and shows steady increases in PI department’s use 25 the last 3 years. Quality Compliance Management (Figure Clear P.1-5) highlights MTS’ accreditation results in voluntary and UHTXLUHGFHUWL¿FDWLRQV±SRVLWLRQLQJ076DVRQHRIWKHWRS 0

OPOs in the country meeting or exceeding FDA, UNOS, / Days to Cleared Charts 2012 2013 2014 2015 YTD AOPO, AATB, and EBAA requirements. MTS AlloSource Best In Class Good Fig. 7.1-25 Skin Yield Fig. 7.1-30 Cornea Procurement to Release Times

APs in Place to Drive 2015 Results Good Targeted Improvements Drive Results 6,000 120 3,000 60

0 Time (Hours)

Avg. Skin Yield (cm2)Avg. Skin 0 2012 2013 2014 2015 YTD 2012 2013 2014 2015 YTD

MTS AlloSource Best in Class Release Time INTERNAL METRIC

Fig. 7.1-26 Cornea Transplantable Fig. 7.1-31 Sterilizer Accuracy Percentage Good Consistently High Accuracy Good Benchmark Level Performance 100% 100% 50% 50% Accuracy 0% 0% % Transplantable 2012 2013 2014 2015 YTD 2012 2013 2014 2015 YTD INTERNAL METRIC MTS EBAA National Avg Accuracy Internal Target Good Fig. 7.1-27 Laboratory Turnaround Time Fig. 7.1-32 Server Uptime by Work System

100% Availability Good Turnaround time Ensuring Safe Organs and Tissues 24:00 100% 12:00 50% Uptime Time (hh:mm) 0:00 0% 2014-Q3 2014-Q4 2015-Q1 2015-Q2 2012 2013 2014 2015 YTD MTS Organ MTS Tissue LINC Organ LINC Tissue Uptime Internal Target Figure 7.1-33 PI Helpdesk Tickets Fig. 7.1-28 Chart Release Cycle Time -- Organ Committed to Improvement & Innovation Good 300 259 Process Improvements Drive Compliance 211 134 150 89 83 100% 4943 31 22 27 7 3024 0 3 2 50% 2013 2014 2015 YTD

Ticket Requests Scorecard / Report 0% Data Mining

2012 2013 2014 2015 YTD Procedure or Process Enhancement INTERNAL METRIC

% Completed on Time MTS UNOS/OPTN Survey Change Management

38 • Category 7- Results 7.1b(2) Emergency Preparedness (Figure 7.1-34) lists has seen improvements in 2014, meeting delivery time actions taken to minimize interruptions in the delivery of requirements (Figure 7.1-38). LifeLogics, a key supplier, has MTS’ services. These systems were recently put to the test seen increasing numbers of requests for EMR new features ZLWKWZRHYHQWVFDXVLQJVLJQL¿FDQWSRZHURXWDJHV)RU while decreasing the defects on releases (Figure 7.1-39). instance, during one of the events, power was lost for greater than 12 hours. However, the organization was able to continue Fig. 7.1-37 Abbott Cycle Time Good clinical case activity seamlessly due to the back-up system. Meeting Our Requirements 7.1c Supply Optimization (Figure 7.1-35) via an electronic inventory system has resulted in 100% availability for 2:00 supplies for all in-house cases. Aero Charter, a key supplier, provides air service logistics for donation activity outside of 1:00 the St. Louis metropolitan area. Aero Charter provides 24/7

DFFHVVWRDLUFUDIWZLWKDPLQXWHODXQFKUHTXLUHPHQWDQGDV Time (h:mm) 0:00 demonstrated in Figure 7.1-36 delays due to provider issues 2012 2013 2014 2015 YTD occurred in less than 3% of the 260-plus launches annually. MTS Requirement Abbott INTERNAL METRIC Abbott Ambulance meets requirements 100% of the time (Figure 7.1-37). St. Louis Cremation, another key supplier,

Fig. 7.1-38 St. Louis Cremation Cycle Good Fig. 7.1-35 Supply Optimization Time 100% Compliance Improvement Efforts Drive Compliance Good 3.00 100% 1.50 50% Time (Hours)

Availability 0.00 0% 2013 2014 2015 YTD

2012 2013 2014 2015 YTD MTS Requirement St. Louis Cremation INTERNAL METRIC Availability Internal Target Good Fig. 7.1-36 Aero Charter Delays Good Fig. 7.1-39 Life Logics Change Requests

Few Delays Attributed to Vendor Requests Increasing While Rework Decreasing 100% 80 20% 50% 40 10%

0% Defects 0 0%

2012 2013 2014 2015 YTD Published Features 2012 2013 2014 2015 % of Total Legs Delayed MTS AeroCharter YTD INTERNAL METRIC Features Published Defects

Figure 7.1-34 Emergency Preparedness 2015 Threat Measures Required 2012 2013 2014 YTD Major Power Loss • Monthly 12 12 12 8 key data center and vital equipment running Fire & Tornado • Drills are conducted with all staff to practice responses Semi-Annually2221 including facility evacuation Exposure • Safety/bloodborne pathogen training for applicable staff Annually 1111 Emergency Scenario • Scenario planning Annually1111 • Evaluation and revision of Emergency Response Plan • Cooperative info sharing with local hospitals and other OPOs

Server Crash/ Data • Daily, full back-ups of entire data center Daily 365 365 365 242 Corruption • Weekly archival off-site of disk back-ups with 6-month rotation Weekly 52 52 52 30 schedule Complete Loss of • Key data replicated daily Daily 365 365 365 242 STL Data Center • Power up disaster recovery site in Denver • VPN access provided to all staff

Category 7- Results • 39 7.2 Customer-Focused Results achieving this key customer requirement and Strategic Objective (Figure 7.1 -5). Organ Transplant Center satisfaction 7.2a(1) As the federally designated Organ Procurement can be segmented by position, which includes Transplant Organization (OPO) within its service area, MTS does not Physician, Coordinator, and Administrator (Figure 7.2-1C). have organ procurement competitors. Regardless, maximizing APs in place to increase Transplant Center Satisfaction have customer satisfaction and engagement is an organizational driven satisfaction results in 2015 to organizational best results Strategic Objective, and MTS works closely with its customer for administrator and coordinator satisfaction; physician groups to meet and exceed their requirements. Customer satisfaction remains consistently strong over the last three satisfaction data is gathered through the VOC methods as years. (Full complement of segmentation by customer and listed in Figure 3.1-1 including the customer survey process service line AOS). (AOS), which has undergone multiple cycles of learning Satisfaction levels among MTS’ tissue processors (Figure and strategic improvement [3.2b(2)]. Key measures include 7.2-2) are critical to ensuring organizational success. Overall overall satisfaction, and segmentation by customer group and satisfaction demonstrates near benchmark performance. service line are AOS. &XVWRPHUVDWLVIDFWLRQLQPHHWLQJWKH¿UVWNH\UHTXLUHPHQW Overall satisfaction levels with MTS’ organ transplant ³DFFRXQWDELOLW\´ZKLFKLVGH¿QHGDVHUURUUDWHPLQLPL]DWLRQ centers (Figure 7.2-1) demonstrate benchmark-level is measured utilizing operational metrics reported via tissue performance. processor scorecards (Figures 7.2-2A & 7.2-2B). When Local organ transplant center satisfaction, segmented by segmented by the key customer requirement of “information” key requirement, shows strong performance in ‘competence’ (Figure 7.2-2C), results are consistently high. The third (Figure 7.2-1A) and ‘information’ (Figure 7.2-1B). Customer processor requirement is “maximize donation,” which is tied satisfaction in meeting the third requirement, “maximize to MTS’ tissue donation rates (Figure 7.1-4). Tissue processor donation,” is not measured through surveys. Instead, satisfaction can be segmented by individual processor (Figure operational results are utilized to gage effectiveness in 7.2-2D). Satisfaction by processor has remained strong;

Fig. 7.2-1 Transplant Center Satisfaction - Fig. 7.2-1C Transplant Center -Organ Satisfaction -- Organ Good Overall Satisfaction and Engagement Overall Satisfaction Good 5.0 100% 5.0 2.5 50% 2.5 0.0 0% %Top Box Satisfaction 2013 2014 2015 YTD Satisfaction 0.0 Satisfaction 2013 2014 2015 YTD AlloSource Best in Class (Satisfaction) Administrator Coordinator Physician %Top Box

Fig. 7.2-1A Transplant Center Satisfaction -- Organ Fig. 7.2-2 Tissue Processor Satisfaction Good

Key Requirement: Competence High Levels of Overall Satisfaction Good 5.0 100% 5.0 100% 2.5 50% 2.5 50% 0.0 0% %Top Box Satisfaction %Top Box

Satisfaction 0.0 0% 2013 2014 2015 YTD 2013 2014 2015 YTD Satisfaction Satisfaction %Top Box AlloSource Partner (Satisfaction) %Top Box

Fig. 7.2-1B Transplant Center Fig. 7.2-2A Vein Accuracy Rates Satisfaction -- Organ Key Requirement: Accountability Good Key Requirement: Information Good 100% 5.0 100% 2.5 50% 50% Accuracy %Top Box

Satisfaction 0.0 0% 0% 2013 2014 2015 YTD 2012 2013 2014 2015 YTD

Satisfaction %Top Box SV FV Cryolife SV Cryolife FV

40 • Category 7- Results Fig. 7.2-3 Transplant Center Satisfaction Fig. 7.2-2B Heart Valve Accuracy Rates -- Eye Key Requirement: Accountability Overall Satisfaction and Engagement Good Good 100% 5.0 100% 2.5 50% 50% 0.0 0% %Top Box Satisfaction Accuracy 2013-Q4 2014 2015 0% Satisfaction 2012 2013 2014 2015 YTD LINC Best in Class (Satisfaction) Accuracy Cryolife Best in Class %Top Box LINC Best in Class (Engagement) Fig. 7.2-3A Transplant Center Fig. 7.2-2C Tissue Processor Satisfaction Satisfaction -- Eye Good Key Requirement: Information Good Key Requirement: Availability 5.0 100% 5.0 100% 2.5 50% 2.5 50% %Top Box %Top Box

Satisfaction 0.0 0%

Satisfaction 0.0 0% 2013 2014 2015 YTD 2013-Q4 2014 2015 Satisfaction LINC Best in Class (Satisfaction) Satisfaction %Top Box %Top Box

Fig. 7.2-2D Tissue Processor Satisfaction Fig. 7.2-3B Transplant Center Satisfaction -- Eye Good Key Requirement: Information Good Key Requirement: Information 5.0 5.0 100%

2.5 2.5 50% %Top Box

Satisfaction 0.0 0% Satisfaction 0.0 2013-Q4 2014 2015 2013 2014 2015 YTD Satisfaction AlloSource CryoLife RTI LINC Best in Class (Satisfaction) %Top Box

UHVXOWVVKRZEHQH¿FLDOWUHQGVIRUDOOSURFHVVRUVH[FHSW Fig. 7.2-3C Transplant Center 57,$3VDUHLQSODFHIRUWKDWWDUJHWVSHFL¿FDUHDVIRU Satisfaction -- Eye Good improvement. The next survey cycle is scheduled for 2015 Q3. Key Requirement: Quality Full segmented results by customer and service line are AOS. Eye bank metrics are not tracked nationally nor are they 5.0 100% available for the organization’s single corneal transplant 2.5 50% competitor. As a surrogate, MTS utilizes satisfaction of 0.0 0%

customers of other OPOs that provide similar eye banking %Top Box services. Results for meeting local corneal transplant Satisfaction 2013-Q4 2014 2015 center key requirements of “availability,” “information,” Satisfaction LINC Best in Class (Satisfaction) and “quality” as well as overall satisfaction are shown %Top Box in Figures 7.2-3, A, B, & C demonstrate near benchmark levels. Transplant Center Satisfaction – Eye (Figure 7.2- Fig. 7.2-3D Transplant Center 3D) results are segmented by position. Satisfaction for the Satisfaction -- Eye surgery coordinator and transplant physician remain strong Key Requirement: Quality Good for the last 18 months. APs to drive satisfaction have resulted in organizational high results for transplant surgeons. Full 5.0 complement of segmentation by customer and service line 2.5 AOS. To determine dissatisfaction levels with local organ 0.0 transplant centers, tissue processors, and local corneal Satisfaction 2013-Q4 2014 2015 transplant centers, MTS analyzes data obtained through Surgery Coordinator the Customer Complaint Process (Figure 3.2-2). Despite TXP Physician

Category 7- Results • 41 an increase in the number of tissue and eye donors, as well as consistent donor levels for organ donors, the percentage Fig. 7.2-5C Customer Dissatisfaction -- Good of customer complaints for the three customers have Eye demonstrated favorable trends for the past several years Scored as "Poor" or "Very Poor" (Figure 7.2-4). The implementation of a formalized CAPA 10% system provides standardization and allows for the systematic evaluation of complaints regardless of where they occur within 5% the customer life cycle. In addition to complaints, MTS utilizes customer survey 0% Dissatisfaction data to measure dissatisfaction by determining the percentage 2013 2014 2015 YTD of Poor and Very Poor responses (scores of 1 or 2). Results for all service lines - organ, tissue, and eye – remain at or near 0% Dissatisfaction since 2013 (Figures 7.2-5A, B & C). results have demonstrated favorable trends since 2013, with 7.2a(2) To identify levels and trends in customer benchmark level performance in the corneal service line HQJDJHPHQW076FDOFXODWHVWKHSHUFHQWDJHRIYHU\VDWLV¿HG (Figures 7.2-2 & 7.2-3). or top box scores (perfect 5 out of 5) on its customer To assess its performance in building customer relationships, satisfaction scores. This methodology is based upon The MTS analyzes its number of active customers (Figure 7.2-6). Loyalty Effect (Fred Reichheld), which theorizes relationship The organ service line operates in a non-competitive service strength is directly related to customer loyalty and engagement area designated by the federal government, so the number of [3.2]. MTS has maintained consistent levels of engagement local organ transplant centers has not changed in nearly 15 with its local organ transplant centers (Figure 7.2-1). Tissue years. In the tissue service line, MTS maintains contractual processor and local corneal transplant center engagement agreements with its tissue customers. In the corneal service line, results demonstrate an increase in the number of active Good Fig. 7.2-4 Customer Complaints customers. 2015 results are YTD; the organization expects to see the annual increase in active eye customers continue as the Systematic Process Implemented 2012 year progresses (Figure 7.2-6). 10% Fig. 7.2-6 Customer Loyalty Good 5% Sustaining Customer Relationships 20 0% ComplaintsCases / 2013 2014 2015 YTD 10 Organ Tissue Eye 0 Good Fig. 7.2-5A Customer Dissatisfaction -- Customers Active 2012 2013 2014 2015 YTD Organ Organ Tissue Eye Scored as "Poor" or "Very Poor" 10%

5% 7.3 Workforce-Focused Results 0% 7.3a(1) Workforce capability and capacity key measures Dissatisfaction 2013 2014 2015 YTD and results are shown in Figures 7.3-1 through 7.3-4. The PEP ratings (Figures 5.1-2 & 7.3-1) illustrate the average Dissatisfaction performance evaluation score for the MTS workforce, which is measured on a four-point scale. Through the implementation

Fig. 7.2-5B Customer Dissatisfaction -- Good of an outcome-based performance evaluation tool, PEP rating Tissue results indicate that the majority of the workforce “achieve expectations,” therefore meeting the organization’s capability Scored as "Poor" or "Very Poor" needs. MTS maintains adequate capacity for the OWS through 10% evaluation of RN retention (Figure 7.3-2). Within the TWS, evaluation of workforce capacity is assessed at quarterly C&C 5% meetings by ongoing comparison of the number of tissue 0% donors to the number of TOPC staff (Figure 7.3-3) and the Dissatisfaction 2013 2014 2015 YTD ocular coordinators to the number of eye donors (Figure 7.3- 3A). Dissatisfaction ,QFUHDVHLQ:RUNIRUFH*URZWK(Figure 7.3-4) demonstrates JURZLQJVWDI¿QJOHYHOVDQGGLYHUVLW\(Figure 7.3-4A) over the

42 • Category 7- Results DZHOOQHVVSURJUDPZDVLQLWLDWHGLQ>E  @7KH Fig. 7.3-1 PEP Ratings wellness program participation has increased in 2014 (Figure 7.3-5). Staff Consistently Achieves Expectations Good MTS takes great care in ensuring all employees are trained 4.00 upon hire and annually thereafter on proper procedures and safety protocols in each position and department. Workplace 2.00 Preparedness (Figure 7.3-6) demonstrates multiple efforts

Rating deployed to ensure the safety of the workforce. As a result of the organization’s dedication to adherence to safety procedures 0.00 and protocols, MTS monitors its DART rate (Days Away/ 2011 2012 2013 2014 Restricted/Transfer Rate) due to workplace injuries (Figure Rating INTERNAL METRIC 7.3-7). Radiation Exposure rates (Figure 7.3-8) assess the amount Fig. 7.3-2 RN Retention vs Organ Yield of radiation organ clinical staff are exposed to when utilizing Favorable Relationship imaging equipment. MTS policies and procedures ensure that Good employees are safe from radiation exposure. 100% 4.00 Multiple security measures are in place to create the most secure environment for the workforce (Figure 7.3-9). 50% 2.00 The organization has consistently shown commitment to the health and satisfaction of its employees by continuing

RN Retention 0% 0.00 WRRIIHUULFKEHQH¿WSODQVLQPHGLFDOGHQWDOYLVLRQDQGOLIH 2012 2013 2014 2015 FRYHUDJHDVZHOODVDGGLWLRQDOEHQH¿WVDVVKRZQLQ%HQH¿WV YTD Expenditures (Figure 7.3-10). RN Retention Organ Yield Fig. 7.3-4 Workforce Growth Fig. 7.3-3 Tissue Donors per TOPC

Good Expansion of Staff Supporting Mission Good Consistent Staffing Levels Meet Needs 300 300 150 150 0 Avg. Headcount 0 2012 2013 2014 2015 YTD 2012 2013 2014 2015 YTD INTERNAL METRIC INTERNAL METRIC Avg. Headcount AOPO Top Quartile Tissue Donors Donors per TOPC Tissue Tissue Donors per TOPC Fig. 7.3-4A New Hire Diversity Fig. 7.3-3A Eye Donors per OC Good

Benefitting from a Diverse Workforce Good Consistent Staffing Levels Meet Needs 34 100% 800 17 50% 400

0 0% % Diverse New Hires (#) 2012 2013 2014 2015 0 Eye Donors OC Donors per Eye

INTERNAL METRIC YTD 2012 2013 2014 2015 YTD New Hires (MTS) % Ethnically Diverse Eye Donors per OC

Fig. 7.3-5 Wellness Program Participation past three years as services have expanded through intelligent risk taking and innovation utilizing the Workforce Planning Good Process (Figure 5.1-1). Continuing to Encourage Participation 100% 7.3a(2) Workforce climate measures are key to retaining a mission-driven staff (CC) and do not differ by diversity of the workforce or workgroup. Workforce health, safety, and 50% VHFXULW\DVZHOODVHPSOR\HUSURYLGHGVHUYLFHVDQGEHQH¿WV are monitored continuously to ensure effectiveness. Participation 0% In an effort to exhibit concern and care for the employees 2011 2012 2013 2014 as well as engage employees in the topic of personal health, Participation CDC Avg for HCWs

Category 7- Results • 43 Figure 7.3-6 Workplace Preparedness 7.3a(3) Essential to the workforce climate, and a key Measures contributor to employee engagement, is the connection to the Preparations Goal 2012 2013 2014 2015 YTD organization’s mission. Staff members repeatedly indicate Safety Training All Employees 100% 100% 100% 100% an exceptional level of understanding how their individual Fire Alarm Testing Quarterly 4 4 4 3 position contributes to the mission on employee surveys Aero Charter All Applicable 100% 100% 100% 100% exceeding best in class performance (Figure 7.3-11). Safety Training Employees Generators & System Weekly 100% 100% 100% 100% Availability Testing Fig. 7.3-11 Connection to Mission Injury Investigation All Injuries 100% 100% 100% 100% Data/VOIP

(Communication) Testing Real Time 100% 100% 100% 100% Best in Class Performance Good 100% Fig. 7.3-7 DART Rate Good

Committed to a Safe Work Environment 50% 5.00 0% Understanding 2012 2013 2014 2.50 Understanding Avatar Solutions Best in Class

DART Rate 0.00 2012 2013 2014 2015 YTD MTS worked closely with an outside vendor to customize DART Rate US DoL questions assessing workforce engagement, and the organization exceeded external benchmarks. In 2014, Mid- America Transplant Services ranks in the 100th Percentile in

Fig. 7.3-8 Radiation Exposure Good Avatar Solutions’ Engagement database. Well Within Limit of 5,000 mREM/Year Workforce engagement is segmented by work system 5,000.00 (Figures 7.3-12,A,B). MTS continues to have strong organizational retention (Figure 7.3-13). Over the last several years, MTS has focused 2,500.00 on ensuring workforce satisfaction. Overall workforce satisfaction survey results show an increasingly positive 1.87 0.29 0.17 0.03

mREM/Employee trend and favorable comparison to the external benchmark 0.00 (Figure 7.3-14). In 2012 MTS was recognized for having the 2012 2013 2014 2015 YTD third highest overall job satisfaction scores in the country. mREM/Employee DHSS The formal survey provides satisfaction data with national comparisons on multiple dimensions and are segmented by Figure 7.3-9 Security Measures work system and department and are not presented here due to Measures Preparations Goal 2012 2013 2014 2015 VSDFHOLPLWDWLRQV $26 2YHUDOOEHQH¿WVVDWLVIDFWLRQ (Figure YTD 7.3-15) shows exceptional results, outperforming the national Security Alarm Surveillance 24/7 24/7 24/7 24/7 24/7 best-in-class benchmark. Motion-Sensored Lighting 24/7 24/7 24/7 24/7 24/7 DVR-Monitored 24/7 24/7 24/7 24/7 24/7 7.3a(4) MTS supports the training and development of the Security Cameras entire workforce as seen in overall training and development Monitored Panic Buttons (Vendor) 24/7 24/7 24/7 24/7 24/7 satisfaction (Figure 7.3-16) DQG076¶¿QDQFLDOLQYHVWPHQW Security Patrol of Parking Lot in 24/7 NA 24/7 24/7 24/7 the Highlands Complex (Vendor) in Training Expenditures per FTE (Figure 7.3-17). MTS also Badge Access Required measures levels and trends in leader development through the for All Work Areas annual employee survey. Figure 7.3-18 shows leader results Optional Secured Parking 24/7 NA 24/7 24/7 24/7 In Compliance indicating high satisfaction with employer-sponsored training and development. Fig. 7.3-10 Benefits Expenditures 7.4 Leadership and Governance Results 7.4a(1) Figure 7.4-1, Leadership Communication, Good Superior Benefit Package UHÀHFWVVHQLRUOHDGHUFRPPXQLFDWLRQZLWKWKHZRUNIRUFH 100% Communication has exceeded the external Avatar Solutions benchmark since 2010. Segmentation by work system as 50% well as evidence of senior leaders closing the feedback loop on rounding results is AOS. Senior leader commitment to WKH%DOGULJH-RXUQH\DVRQHRIWKHRUJDQL]DWLRQ¶VJRDOVLV % Base Salary 0% 2012 2013 2014 2015 Proj demonstrated in Figure 7.4-2. Direct parallels are evident % Base Salary AOPO Best in Class between MTS’ focus on action through systematic outcome LPSURYHPHQWVH[SHULHQFHGDORQJWKH%DOGULJH-RXUQH\ 44 • Category 7- Results Fig. 7.3-12 Overall Workforce Fig. 7.3-14 Overall Job Satisfaction Engagement Third Highest Nationally Good Best in Class Workforce Engagement Good 100% 100%

50% 50% Satisfaction Satisfaction 0% 0% 2012 2013 2014 2012 2013 2014 Satisfaction Avatar Solutions Best in Class Satisfaction Avatar Solutions Best in Class

Fig. 7.3-12A Workforce Engagement by Fig. 7.3-15 Overall Benefits Satisfaction Work System - OWS Good Good Best in Class Workforce Engagement Good Best in Class Benefits Satisfaction 100% 100% 50% 50% Satisfaction 0% Satisfaction 0% 2012 2013 2014 2012 2013 2014 DPD FSS Satisfaction Avatar Solutions Best in Class Organ Clinical Academic DPD Fig. 7.3-12B Workforce Engagement by Fig. 7.3-16 Overall Training and Work System - TWS Development Satisfaction Good Best in Class Workforce Engagement Good Best in Class Training Satisfaction 100% 100% 50% 50%

Satisfaction 0% 2012 2013 2014 Satisfaction 0% 2012 2013 2014 DPD Donor Services Satisfaction Avatar Solutions Best in Class Tissue Acadmic DPD Fig. 7.3-17 Training Expenditures Fig. 7.3-13 Overall Retention Good Strong Retention Rate Investing in Our People Good $10.0 100% $5.0

50% $K/FTE

Retention $0.0 0% 2012 2013 2014 2015 2012 2013 2014 2015 $K/FTE AlloSource Partner Budget Retention AOPO Industry Average 7.3-18 Leader Development Satisfaction

7.4a(2) MTS Board Self-Assessment (Figure 7.4-3) results Best in Class Performance ZHUHREWDLQHGLQDQG%RDUGVHOIDVVHVVPHQWV Good compare favorably to the benchmark. Full survey data and 100% resultant actions are AOS. 076HQJDJHVLQPXOWLSOHDFWLYLWLHVWRHQVXUH¿VFDO 50% DFFRXQWDELOLW\DVOLVWHGLQVHFWLRQD  $VDQRQSUR¿W Satisfaction organization, an Audit Committee is not a requirement, but 0% was voluntarily established as a best practice in governance 2012 2013 2014 WRH[SDQG¿VFDODFFRXQWDELOLW\([WHUQDO¿QDQFLDODXGLWV MTS Avatar Solutions Best in Class

Category 7- Results • 45 sanctioned by this committee have always achieved the 7.4a(3) MTS views accreditation and regulatory compliance KLJKHVWUDWLQJRI³XQTXDOL¿HG´RSLQLRQ (Figure 7.4-4). as a baseline expectation for performance. The organization has received full accreditation from all voluntary accrediting Fig. 7.4-1 Leader Communication bodies within its industry and has maintained this trend for several years. Additionally, MTS maintains full compliance “Effective in Communicating with Staff” Good with regulatory and legal mandates that have been sustained 100% since the organization’s inception (Figure 7.4-5). 7.4a(4) The nature of MTS’ business requires that the 50% organization lives its core value of integrity, and demonstrates

Favorable social responsibility as indicated by key metrics related to 0% ethical behavior. 100% of the Board of Directors, Leadership 2010 2012 2013 2014 7HDP /7 DQGZRUNIRUFHFRPSOHWHDQQXDOFRQÀLFWVRILQWHUHVW documentation. Ethical behavior is ensured by providing Favorable Avatar Solutions Best in Class annual Corporate Compliance Program (CCP) training to all employees. Currently, 100% of the workforce is CCP trained. Limited corporate compliance issues are noted in Report of Fig. 7.4-3 MTS Board Self Assessment Corporate Compliance Hotline Issues, Figure 7.4-6 which illustrates program effectiveness. Stakeholder (Board of Outperforms National Benchmark Good Directors) requirements show a high level of satisfaction (Figure 7.4-7) based on the BOD evaluation of the CEO’s 100% performance. Employees’ trust in MTS leadership (Figure 7.4-8) has outperformed benchmarks in multiple staff survey 50% cycles. Changes to management processes have contributed to high levels of trust in management. Similarly, trust in 0% leadership (CEO) by the BOD consistently meets or exceeds Mission Financial Strategic CEO the organizational goal of 2.5 on a 3-point scale (Figure 7.4- Followed Oversight Oversight Oversight 9). 2009 2012 2014 7.4a(5) $WUXHPHDVXUHRIVRFLHWDOEHQH¿WLVWKHUHGXFWLRQRI deaths on the local waiting list as MTS increases transplanted Figure 7.4-4 External Financial Audit organs; this dynamic trend has impacted the community living Yea r External Auditor Determination within the designated service area (Figure 7.4-10). 2010 Kerber, Eck & Braeckel Unqualified Opinion To help ensure the success of life saving transplants, MTS 2011 Kerber, Eck & Braeckel Unqualified Opinion is committed to supporting Donor Families, transplant patients 2012 Kerber, Eck & Braeckel Unqualified Opinion 2013 McGladrey, L.L.P. Unqualified Opinion and their families (key communities). In 2013, the MTS 2014 McGladrey, L.L.P. Unqualified Opinion Board of Directors established the Donate Life Foundation, a Excellent Fiscal Accountability supporting 501(c)(3) foundation, to coordinate and direct all FRPPXQLW\EHQH¿WHIIRUWVRI076LQFOXGLQJWKRVHSURYLGHG by the Center for Life. In 2011, the organization created an

Fig 7.4-2 Baldrige Journey 2015 2010 2012 2014 8th MBNQA MBNQA SiteVisit 5th MBNQA 7th MBNQA Application 2x Application Application 45 3rd Site Visit 2003 40 Show Me Challenge 35

30

25 2013 6th MBNQA 20 2011 Application 4th MBNQA 4th Site Visit 15 2008 Application st 2005 1 MBNQA 2nd Site Visit 10 1st MQA Application Application

Organ Donors Per Million Population Organ Donors Per 5

0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 MTS All other DSA’s

46 • Category 7- Results Figure 7.4-5 Regulatory & Legal Compliance Fig. 7.4-9 BOD Trust of CEO Key Measures Measures & Indicators Results High Level of Trust Good AATB Accreditation (3 years) Full Accreditation AOPO Accreditation (3 years) Full Accreditation 3.00 CLIA/CAP (2 years) Full Certification Full Certification 1.50 DHSS (3 years) Full Compliance

DOR No Adverse Findings Trust in CEO 0.00 EBAA Accreditation (3 years) Full Accreditation 2011 2012 2013 2014 Trust in CEO Internal Target EEOC 0 Issues

FDA Approval (2 years) No Adverse Findings Good Fig. 7.4-10 Deaths on Local Waiting List FLSA 0 Issues IRS Compliance 0 Issues Saving More Lives OSHA Full Compliance 100 UNOS/OPTN (3 years) Member in Good Standing Umblemished Performance 50 Deaths Figure 7.4-6 Reported Corporate Compliance Hotline Issues 0 INTERNAL METRIC INTERNAL Yea r Results 2012 2013 2014 2015 YTD 2010 0 Complaints Reported Deaths Internal Target 2011 0 Complaints Reported 2012 1 Complaint Reported endowment of greater than $7 million for the Center for Life 2013 1 Complaint Reported ZLWKDWRWDOHQGRZPHQWRIPLOOLRQUHDOL]HGLQ7KLV 2014 1 ReportedComplaint endowment was created to serve bereavement needs of Donor 2015 YTD 4 Complaints Reported Families and the professionals who serve them. It also aids Commitment to Integrity ZLWKVSHFL¿FQHHGVIRUUHFLSLHQWVDQGWKHLUIDPLOLHVLQFOXGLQJ a recipient grant fund and provides short and intermediate term housing for those awaiting and post-transplant when their Fig. 7.4-7 BOD Requirements of CEO primary residence is located outside the metropolitan area. The

Performing at or above goal of 2.50 Good Donate Life Foundation is one of four in the OPO industry and exceeds the external benchmarks. This is just one more 3.00 example of how MTS is committed to leading the industry in both innovation and service (Figure 7.4-11). 1.50 Fig. 7.4-11 Center for Life / Donate Life Assessment 0.00 Foundation: Principle Balance

2012 2013 2014 Committed Support to Key Communities Good Strategic Planning Financial Management Administration Communication/PR $30

$15 Fig. 7.4-8 Workforce Trust in Leadership $0 Cumulative $M

“My Direct Manager Can Be Trusted” Good 2011 2012 2013 2014 100% Cumulative $M AOPO Foundations

50% 7.4b Results for accomplishing the organizational APs are found in Figure 7.4-12. APs are put in place each year at MTS 0% and success in accomplishing those APs is mission critical in Trust in Leadership 2012 2013 2014 achieving our three main SOs. Trust in Leadership The key metrics for strategy achievement of our Mission Avatar Solutions National Norm include: Figure 7.4-10 Deaths on Local Waiting List, Organ, Tissue and Eye Donors (Figures 7.1-3, 7.1-4, and 7.1-16). Results for building and strengthening our CCs include: Figure 7.3-11 Mission-Driven staff, Figure 7.5-11 Organ

Category 7- Results • 47 Donor Cost Comparison (Innovation – performing In-house 7.5 Financial and Market Results recoveries), and Figure 7.5-12 Average OAC’s - keeping our 7.5a(1)076¶¿QDQFLDOSHUIRUPDQFHLVEHQFKPDUNHG costs the lowest. E\HYDOXDWLQJNH\PHDVXUHVZLWKLQ232¿QDQFLDOVXUYH\V Results for relationship management, our future CC, are conducted by AOPO. MTS utilizes the survey to examine shown in Figures 7.1-1A & 7.1-2A. As an example, results for LWVRYHUDOO¿QDQFLDOFRQGLWLRQ2XUJRDOLVWRDVVHVVZKHWKHU intelligent risk include Figures 7.4-13, A & B. 076¶¿QDQFLDODQGRSHUDWLQJVWDWXVLVLPSURYLQJRYHUWLPH and against benchmarks. MTS also uses budgets to optimize Fig. 7.4-12 Focus on Action: outcomes and continue being a leader in the industry. Accomplishment of APs Consolidated Results of Operations, Figure 7.5-1, demonstrates MTS is in a strong position with good Key to Achieving the Mission Good performance levels compared to budget, with 2014 results of 100% PLOOLRQ076GHPRQVWUDWHVIDYRUDEOH¿QDQFLDOOHYHOVLQ WKHPHDVXUHV*URVV5HYHQXH(Figures 7.5-2,A,B), Operating 50% Margin (Figure 7.5-3), Net Margin (Figure 7.5-4), Days in Accounts Receivable (Figure 7.5-5), Days in Accounts Payable (Figure 7.5-6), and Current Ratio of Assets versus

AP Accomplishment 0% Liabilities (Figure 7.5-7)7KLVSHUIRUPDQFHUHÀHFWV076¶ 2011 2012 2013 2014 METRIC INTERNAL LGHQWL¿HGVWUDWHJLFDGYDQWDJHRISRVVHVVLQJDVWURQJ¿QDQFLDO AP Accomplishment Internal Target position and supports organizational sustainability. Figure 7.5-8, Operating Reserves, includes cash, investments, and accounts receivable. The amount of operating reserves Fig. 7.4-13 Non-Hospital (ME) Referrals is set by BOD policy, and allows MTS to ensure mission attainment and organizational sustainability. MTS sets the Referrals Increasing Exponentially Good standard as the AlloSource best in class performance, and 5,200 MTS Fund Balance (Figure 7.5-9) continues to increase and supports additional investments in innovative strategic risk, 2,600 supporting the establishment of the Foundation in 2013. MTS

Referrals is one of only four OPOs to establish a foundation. The Fund 0 %DODQFHGHPRQVWUDWHV076¶¿QDQFLDOYLDELOLW\DQGVXSSRUWV 2012 2013 2014 2015 YTD the organization’s sustainability. MTS also owns and manages its facility to further growth and cost containment, supporting INTERNAL METRIC St. Louis City St. Louis County FJSC innovation and intelligent risk taking. In 2001, MTS became WKH¿UVW232LQWKHQDWLRQWRRSHUDWHDQLQKRXVHRUJDQ Fig. 7.4-13A Non-Hospital (ME) Referrals recovery suite. In 2010, this innovative practice was adopted Leading to Family Approaches by 3% of all OPOs; in 2013 this had spread to 10% of OPOs. Figures 7.5-10 Days Cash on Hand and Figure 7.5-11 Total Good $VVHWVLQGLFDWHV076¶VXVWDLQDELOLW\DQGVWURQJ¿QDQFLDO 30% Expanding Donation Opportunities management. Performance on both metrics exceed the external EHQFKPDUN076¶VWURQJ¿QDQFLDODQGRSHUDWLQJUHWXUQV 15% demonstrate viability and continue to improve over time. 2YHUDOO¿QDQFLDOSHUIRUPDQFHPHDVXUHPHQWVDUHVLPLODU 0% exceed industry comparisons, and perform well against the % Approached % 2012 2013 2014 2015 YTD budgetary plan.

INTERNAL METRIC St. Louis City St. Louis County FJSC

Fig. 7.4-13B Non-Hospital (ME) Fig. 7.5-1 Consolidated Result of Approaches Leading to Donation Operations Good Efforts Result in Increased Donations Strong Financial Position Good 40% $6

$3 20% $M

$0

% Donations 0% 2012 2013 2014 2015 YTD 2012 2013 2014 2015 YTD INTERNAL METRIC St. Louis City St. Louis County FJSC Total Result AlloSource Best in Class

48 • Category 7- Results Fig. 7.5-2 Total Gross Revenue Fig. 7.5-5 Days in Accounts Receivable Good

Supports Organizational Sustainability Good Exceeds Benchmark Performance $60 80

$30

$M 40 Days

$0 0 2012 2013 2014 2015 YTD 2012 2013 2014 2015 YTD MTS AOPO Top Quartile Days AOPO Top Quartile

Fig. 7.5-2A Gross Revenue - OWS Fig. 7.5-6 Days in Accounts Payable Steady Continued Strong Increasing Organ Revenue Good 80 Performance $40

$20 40 $M Days

$0 0 2012 2013 2014 2015 YTD 2012 2013 2014 2015 YTD

MTS AOPO Top Quartile Days AOPO Industry Average

Fig. 7.5-2B Gross Revenue - TWS Fig. 7.5-7 Current Ratio of Assets vs. Liabilities Increasing Tissue Revenue

16.0 Good Good 20 Strong Financial Position

8.0

$M 10 Ratio 0.0 0 2012 2013 2014 2015 YTD 2012 2013 2014 2015 YTD

Tissue Eye AlloSource Best in Class Ratio AOPO Top Quartile

Fig. 7.5-3 Operating Margin Fig. 7.5-8 Operating Reserves

Strong Operating Margin Good Supports Organizational Sustainability Good 30% $40

15% $20 $M 0%

% of Gross % of Gross Revenue $0 2012 2013 2014 2015 YTD 2012 2013 2014 2015 YTD MTS AOPO Top Quartile MTS AlloSource Best in Class

Fig. 7.5-9 MTS Fund Balance Outperforming External Benchmark Good $120

$60 $M

$0 2012 2013 2014 2015 YTD Transferred to Foundation $M AlloSource Best in Class

Category 7- Results • 49 Fig. 7.5-10 Days Cash on Hand Fig. 7.5-13 Average OAC Comparison – All Organs Good Foundation was Funded in Surpassing Benchmark Performance 2013 Good 800 $45

400 Days

Avg OAC $K Avg OAC $20 0 2012 2013 2014 2015 YTD 2012 2013 2014 2015 YTD MTS AOPO Best in Class MTS OAC Lowest Cost OPO

Fig. 7.5-11 Total Assets Limited by its DSA, increases in tissue donations are SRVVLEOHZLWKLGHQWL¿FDWLRQRIQHZRUH[SDQGHGUHIHUUDO

Outperforming External Benchmark Good sources. Tissue activity levels remain strong. Market Share $140 *URZWK$OOR6RXUFH3DUWQHUV(Figure 7.5-14) shows MTS’ contribution to the total AlloSource tissue volume. APs in place for the last three years have included a focus on growing $70 $M the eye bank. Corneal Surgeon Market Share (Figure 7.5- 15) shows the growth experienced between 2012 and 2015. $0 APs are in place for 2015 include additional strategies to 2012 2013 2014 2015 YTD optimize MTS’ ability to provide corneal tissue in the local MTS LINC Best in Class marketplace. Good Fig. 7.5-12 Organ Donor Cost Fig. 7.5-14 Market Share Growth -- Comparison AlloSource Partners

Dramatic Decrease with In-House Recoveries APs in Place to Drive 2015 Results Good $30 20% $15 10% $K/Donor $0

2012 2013 2014 2015 Share ( % ) Market 0% MTS In-House Hospital Budget 2012 2013 2014 2015 YTD MTS AlloSource Best in Class

7.5a(2)$VDQRQSUR¿WRUJDQL]DWLRQZLWKD'6$WKDWLV Fig. 7.5-15 Corneal Surgeon Market designated by the Centers for Medicaid & Medicare Services, Share MTS does not look to increase market “share” in the typical MTS Market Share Growing Good way other companies do, but looks to improve its own performance within its DSA and track its progress via the 100% measures represented in Section 7.1. Organ Donor Cost Comparison (Figure 7.5-12) 50%

demonstrates the difference in donor costs when donors are Referrals recovered in the traditional hospital setting versus when 0% transferred to the MTS facility for donor care and surgical 2012 2013 2014 2015 Proj recovery. Efforts to contain costs are measured by budget Local Competitor MTS spending trends and Organ Acquisition Charges (OAC). OAC fees that have been charged to the transplant center partners have historically (and continue) to track below the minimum at the strategic direction of the MTS BOD. The comparison data for these charges are compiled from OPOs, typically with geographic proximity, that are most frequently involved with organ sharing activities impacting the local transplant centers, (Figure 7.5-13). Cost containment is an essential area for MTS’ transplant partners to remain competitive in the healthcare payer market.

50 • Category 7- Results