Looking back,

looking back,
moving forward
moving forward
Winona Health
2006 Accomplishments

Winona Health
2006 Accomplishments
Introduction Our Vision
To be a recognized leader in the
revolutionary transformation of
community healthcare.
About this time each year, many of us
are thinking about keeping our New Our Mission
Year’s resolutions. I think, though, that it Devoted to improving the health and
is important to stop and review our past well-being of our family, friends &
accomplishments and celebrate them. I am neighbors.
pleased again this year to share with you Our Cornerstones
Winona Health’s key accomplishments for These cornerstones are the key success
2006. The staff, physicians, volunteers and factors that support our mission and
board members have worked hard and define our strategic planning initiatives.
remained focused—which is not always easy • Collaborative partnerships that
Rachelle H. Schultz
given the competing demands and pressures serve and improve our community
in our rapidly changing environment. • An environment where people can
Our goals focus on ensuring a high quality healthcare experience for realize their full potential
the patients and residents we serve. We must pay attention to every • Excellence and leadership in
interaction that occurs each day, while preparing and positioning clinical care & service
ourselves for the momentous shift in healthcare delivery that hovers • Stewardship of resources that
on the horizon. We have built a solid foundation and are engaging balances mission and healthcare costs
in newer healthcare delivery models to meet the needs of the
consumer—you! Our Values
• Integrity: We do no harm.
Exciting times are ahead in healthcare—more options and involvement • Service: We serve with compassion,
for consumers, incredible advances in medicine, and technology to dignity and respect.
support us in unimagined ways. Winona Health holds a unique position • Loyalty: We build relationships that
with regard to community health systems and has been recognized exceed expectations.
as a role model. Our transformation won’t happen in one month or • Excellence: We improve performance
one year, but over time—another important reason to review our through learning and innovation.
accomplishments in the context of our vision for the future.
We are grateful for the support and involvement of so many community
members at Winona Health. Our commitment is unyielding, and our
partnership with each of you is more important than ever.
Contents
Warm regards, Introduction. . . . . . . . . . . . . . . . . . . . . . . 3
2006 Key Initiatives & Results. . . . . . . . 4
Cornerstone 1: Collaboration. . . . . . . . . 5
Cornerstone 2: People . . . . . . . . . . . . . . 8
Rachelle H. Schultz Cornerstone 3: Care & Service. . . . . . . 10
President/CEO Cornerstone 4: Stewardship. . . . . . . . . 12
2007 Key Initiatives . . . . . . . . . . . . . . . 14
The accomplishments in this publication occurred
in Fiscal Year 2006 (FY06), which began
 October 1, 2005 and ended September 30, 2006.
2006 Key Initiatives & Results
Emergency Department Satisfaction
Goal: Improve the overall quality of Emergency Department
(ED) care and service to increase patient loyalty
Results: Winona Health measures patient satisfaction
in its hospital, senior services and clinic settings. At the
start of Fiscal Year 2006, Community Memorial Hospital’s
ED satisfaction scores were “average” compared to 140
peer hospitals. Winona Health’s staff, especially its ED
physicians and nurses, changed many processes
during the 12-month period—from implementing
bedside registration to having physicians make
follow-up calls to discharged patients. By the end of
the year, the ED was a “top performer” among its peers
in its care and delivery of patient services.
Medicare Average Length of Stay
Goal: Enhance care coordination to ensure optimum
clinical service and resource use.
Results: A team of physicians, nurses, dietitians and
social workers care for patients on Community Memorial
Hospital’s Medical/Surgical floor, including on site
physicians known as hospitalists. Recognizing that most
people prefer being at home over being in a hospital, this
Care Coordination Team begins working with patients on
a post-hospitalization plan as soon as they are admitted.
The team reviews and assesses patient progress and the
best site for their recuperation—home, nursing home,
assisted living or home care. This focus on addressing
patient needs has resulted in a 10% decrease—to
4.4 days—in the average length of stay for CMH patients.

Medical Opportunities for Improvement
Goal: Develop a pathway for end-of-life care to ensure
patient-, resident- and family-centered care.
Results: Winona Health’s Medical Opportunity for
Improvement centered on ensuring patient-, resident-
and family-centered end-of-life care. Working with other
long-term care providers in the community, Winona
Health staff and volunteers developed and implemented a
process to increase the number of healthcare directives for
long-term care residents. As a result of these efforts, long-
term care residents with healthcare directives increased
from 26% in 2001 to 74% in 2006. As a result of these
directives, more families benefited from hospice services as
the hospice average daily census increased by 10% to 22.
Operating Margin
Goal: Maintain a solid operating margin to balance
Winona Health’s mission and costs.
Results: As a community-owned healthcare system,
Winona Health considers it paramount to provide high
quality healthcare services to everyone in the Winona
region. At the same time, it must be a careful steward
of the community’s resources, ensuring the long-term
viability of the organization. Winona Health uses its
“operating margin” as one measure of whether it has
achieved a balance between its mission to the
community and its costs. This indicator is calculated
by dividing operating income by net revenue. Winona
Health’s FY06 operating margin was 5.6%, 2.5%
better than the median score for Standard & Poor’s
A-rated hospitals.
Cornerstone 1 : Collaboration
Cornerstone 1 : Collaboration
• $32 million building project completed on time and
on budget.
• With completion of the building project, the community’s
major healthcare providers are all located on one campus.
• Twenty-five tours were held for community members,
staff and volunteers during building construction.
• A new surgery area brings state-of-the-art surgical
technology to Winona area residents.
• The remodeled Emergency Department entrance
improves the triage process.

About 1,800 community members attended the building

dedication celebration to see the new facility.

• Winona Health opened two new clinics on the third

floor – Sports & Orthopaedic Specialists and the Eye
Care Center.

Building Project Contractors

Winona Health recognizes and thanks area contractors for their part in
the successful completion of the building project:
Winona Health’s $32 million building project was completed
on time and on budget. All Trades Modern Ready Mix Wapasha
Bauer Electric O’Laughlin Plumbing Construction
• A special unveiling of the Winona Health Foundation Biesanz Stone Otomo Engineering Winona Excavating
donor wall was held on April 5. Dunn Blacktop Services Winona Glass
Flags & Poles Int’l Ralph Scharmer & Sons Replacement
• The new Outpatient Diagnostic Center centralizes
Kendell Doors & River Valley Sweeping Winona Heating &
outpatient surgical procedures, lab tests and imaging
Hardware Ronco Engineering Ventilating
services, so patients have a more convenient healthcare
Kendell Lumber Schwab Company Winona Nursery
experience.
Kimo’s Scherbring Enterprises Winona Rental
• About 1,800 area residents helped dedicate the new Lyle’s Flooring Severson Oil
facility on Sunday, May 21.

Cornerstone 1 : Collaboration
• Seven new providers were recruited to the community • The Winona Health campus became tobacco-free on
in 2006 and two providers recruited in 2005 began January 1, 2006.
working in FY06. Winona Health welcomed the • Community Memorial Hospital’s Emergency Department
following new providers. cared for almost 18,000 patients.
2006:
• Tim Gabrielsen, MD, Orthopaedic Surgery; Winona • Winona Health’s website averaged 4,241 unique visitors
Health Sports & Orthopaedic Specialists per month in FY06, compared to 3,025 per month last
• Laurel Quinn, MD, Ophthalmology; Winona Health year. In addition, its KidsHealth website feature has an
Eye Care Center average of 2,675 unique visitors per month, 400% more
• Laurel Littrell, MD, Radiology; Winona Radiology than the previous year.
• Kevin Quinn, MD, Child/Adolescent Psychiatry;
Winona Health Psychiatric & Counseling Services
• Joel Stevens, PA-C; Winona Health Sports &
Orthopaedic Specialists
• Joy Stevens, PA-C; Winona Health Rushford Clinic
• Aaron Schilling, PA-C; Winona Health Sports &
Orthopaedic Specialists
2005:
• Edward Malone, MD, Family Practice; Family
Medicine of Winona, P.A.
• Ehab Michael, MD, Internal Medicine; Winona Clinic
• Winona Health’s new weekend Urgent Care Clinic treated
almost 2,000 patients in its first year of operations.

More visitors used our website’s KidsHealth feature for

health education, recipes, health news, games and more.
(winonahealth.org/kidshealth)

• Winona Health hosted five focus groups to learn more

about the healthcare needs of specific groups, including
seniors, local employers, diverse and at-risk populations,
school nurses and area ministers.
• Winona Health donated more than $27,000 to area
nonprofits working on projects to benefit the
community’s youth, health and wellness, or economic
vitality.
Winona Health opened the Urgent Care Clinic in response to
community feedback; almost 2,000 patients have been treated.


• Inpatient and outpatient mental health visits increased lecture at WSU’s sports training and UW—La Crosse’s
by 12%, addressing a key community need. physical therapy programs.
• Winona Health staff contributed $19,426 dollars to the • Lake Winona Manor worked with area nursing homes
Greater Winona Area United Way. In addition, staff on collaborative initiatives, including working with the
members serve on the local United Way Board of county on coordination of emergency/disaster plans.
Directors and several of its committees. • Three hundred Back-to-School packets were distributed
through Winona Health Physician Clinics and its
emergency and outpatient departments. The packets
included school supplies and health tips for children in
elementary school.
• Winona Health staff supported a number of community
events, including the Lion’s Club Toy Drive, Merchant
Bank’s 10 Days of Giving, American Cancer Society’s
Daffodil Sales, Gifts for Winona, the United Way Day of
Caring and a Red Cross Blood Drive.
• Winona Health Speakers’ Bureau placed 58 staff
members in schools and before civic and professional
organizations to discuss their careers or special
healthcare topics.
• Winona Health received editorial coverage in the
following publications:
• Health Executive
magazine – Winona
Health’s technology
advances
• Minnesota Healthcare
News – Electronic
Medical Records
• Healthcare Financial
Management –
Student nurses check the vital signs of baby Emma in the Electronic Medical
Family Birth Center. Records
• Minnesota Physician –
• Winona Health is a site for student nurse practicums; Patient benefits of
in FY06, staff worked with 80 Licensed Practical Nursing Electronic Medical Health Executive magazine
students and 50 Registered Nursing students from Records praised Winona Health for
Minnesota State-Southeast Technical and 55 Registered • Minnesota Medicine – being ahead of the pack in
Nursing students from Winona State University. Retooling Family healthcare IT.
• Collaboration with Winona State University and Medicine
Winona Health benefited Cardiac Rehabilitation • River Valley Business Report – Women in Business
patients, students and outcomes. In addition, • Coulee Region Women – Influential Women
Occupational and Physical Therapy staff members


Cornerstone 2 : People
• The Minnesota Council for Quality recognized Winona
Health for two best practices: The first is Lake Winona
Manor’s mentoring program that pairs new staff
members with veterans staff for a systematic series of
interactions, and the second is the alignment of Winona
Health’s values to its service standards, performance
appraisals and staff recognition.
Imaging Services has acquired overhead lifts, which will
increase patient safety and decrease back injuries among staff.
• Winona Health received a matching grant from the state
of Minnesota and installed overhead lifts in the Imaging
Services department to improve patient and staff safety
in an area at high risk for staff back injuries. No injuries
have occurred since implementation.
• An electronic time and attendance system was
implemented across Winona Health to improve accuracy,
minimize errors and increase efficiency in processing
payroll. This new system allowed for the transition of 1.5
Human Resource employees from payroll processing to
recruiting and orientation.
• The hiring process was evaluated and improved,
resulting in the average time to fill open positions

being six days faster than the national average (41
versus 47 days).
• As part of its ongoing commitment to staff, Winona
Health University was launched to develop staff
educational opportunities. Eighty-four percent of staff
completed a minimum 20 hours of education in FY06.
• Winona Health employee retention rate is 94% versus a
national average of 88%.
• Direct worker’s compensation expenses were decreased
for the fourth straight year; Winona Health’s worker’s
compensation expenses were 0.17% of operating
expenses, compared to the national average of 0.43%.
• More than 1,400 applicants applied for open staff
positions, with 90% of applications submitted electronically
through newly implemented integration of the website
and Human Resources information systems.
Applicants can now apply online for jobs at Winona Health by
visiting winonahealth.org and clicking on “Careers & Volunteering.”
• Crucial Conversations® training was deployed to all
Winona Health directors and managers as a foundation
for leadership development and skill building.
• Four Winona Health staff are now trained Minnesota
Council for Quality evaluators, with special training in
Baldrige quality criteria.
• Living Service Excellence Award recipients for 2006 were:
• Scott Fabian, Materials Management
• Jodie Heim, Lake Winona Manor
• Robin Hoeg, RN, MSN, Inpatient Services
• Dana Marquardt, Human Resources
• Sandy Paetzel, LPN, Medical/Surgical/Pediatrics
• Brett Whyte, MD, Emergency Department
• Many Winona Health staff members continued their
educational training in 2006, including:
• Briana Frisch, Rehab Services, Physical Therapy PhD
and Kinesio Tape Instructor certification
• Stela Hristova, Health Information Management,
Registered Health Information Technician certification
• Christina Friederichs, Physician Clinics, Administrator
in Physician Practice Management certification Living Service Excellence Award recipients were recognized for
• Deb Norton, Karen Resch and Deb Kahoun, outstanding service to the organization. Clockwise from top
left: Brett Whyte, MD; Dana Marquardt; Robin Hoeg, RN, MSN;
Registered Nurses, Critical Care certification
Scott Fabian; Sandy Paetzel, LPN; Jodie Heim
• Marie Gernes, Accounting, Healthcare Financial
Professional certification • Chris Draper, Sherry Hill, Michelle Stark and Jean
• Alicia Lalim, Heidi Ramsey and Doug Haberman, Skime, Senior Services, Hospice and Palliative Care
Rehab Services, Registered Clinical Exercise certification
Physiologist certification • Loretta Boyer, RN, Wound, Ostomy and Continence
• certification

Lean Projects
Fifty-two employees were trained in Lean principles and
completed eight Lean team projects as part of a Minnesota
Job Skills Partnership grant received with Winona State
University. Lean in healthcare refers to eliminating work-
related waste in processes. As a result, the organization
will function more efficiently without extra steps and
tasks that do not add value to the patient experience.
Eventually all Winona Health staff will be trained in Lean
principles. Initial Lean projects included:
Discharge Process
This team’s objective was to recognize, identify and
reduce the wasted time in the discharge process for
patients on the Medical Surgical & Pediatric unit (MSP).
After observing the process, the team determined that it
took an average of 230 minutes from the moment a
physician wrote a discharge order until the hospital bed
was cleaned and ready for the next patient.
The team identified factors that delayed a patient’s
discharge and put an action plan into place to cut out
waste. As a result, the average time was reduced to 162
minutes, saving 68 minutes per discharge.
Supply Management Process
After staff expressed concern about finding supplies in a
timely manner, Lean team members analyzed supply storage
in Lake Winona Manor to encourage faster response to
resident needs. They began by mapping out how staff use
the supply room and determined that it took an average
of 7 minutes 23 seconds to find a particular item.
The team reorganized the supplies and set up a system
for categorizing, labelling and restocking supplies. It then
took staff an average of just 15 seconds to find the item
they were looking for.


Cornerstone 3 : Care & Service
Bruce McFarlin of Buffalo City arrived in the Emergency
Department with chest pain. After the fast action of Winona
Health’s medical team and the air ambulance, he was receiving
balloon angioplasty in La Crosse within 80 minutes. The next
day, McFarlin attended the wedding reception of his niece
Kelsey and her new husband Adam.
• Watkins, Adith Miller and Roger Metz Manors’ average
overall customer satisfaction score in 2006 was 85.4
versus the national peer group score of 81.
• Winona Health Home Care was in the top 8% of
performers in the Home Care Hospitalization Reduction
Study, making it a “best practice” site.
• Transcription services for ICU patients were completed
within seven hours of admission, compared to a
benchmark time of twelve hours. The reduced time-
frame ensured attending physicians had access to
critical information in a more timely manner.
• Patients with abnormal mammograms received results
within 48 hours of testing, thanks to changes in Imaging
Services protocols.
• In FY06, Winona Health provided low-cost prostate
cancer screenings to 122 area men.
• Staff-led efforts to live service excellence, contributed to
a 43% decrease in patient complaints.

• Winona Health participated in the Center for Medicare/

Medicaid Service’s (CMS) demonstration project and its
most recent scores show its care of Acute Myocardial
Infarction (heart attacks) in the top 10%, Congestive
Heart Failure in the top 20% and Pneumonia in the top
10% of 300 participating hospitals.
• Community Memorial Hospital completed a successful
state and federal survey; of the 468 standards, the
hospital received only three minor citations. In addition,
the surveyors commented on the facility’s superior
quality initiatives.
• Winona Health’s assisted living facilities were inspected
by the State of Minnesota and received no deficiencies.
The surveyor noted that Watkins, Adith Miller and Roger
Metz Manors are doing exceptionally well at medication
administration and staff training. Clients interviewed Elmer, a Watkins Manor resident, presents his catch of the day
were pleased with the activities offered and enjoyed during a fishing outing this summer. Outings like this are an
example of why satisfaction scores for Watkins, Adith Miller
living in the Manors. and Roger Metz Manors were higher this year compared to the
national average for assisted living homes

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• With effective processes in place to ensure patient
safety, Community Memorial Hospital again had no
reportable State of Minnesota adverse events.
• Efforts to improve outcomes as reported in the CMS
Home Health Compare Data resulted in Winona Health
Home Care having eight out of 10 measures equal to or
better than the state average, with five scores equal to
or better than the national average.
• In an effort to improve resident satisfaction, Lake
Winona Manor began serving made-to-order breakfasts
where residents request their food as in a restaurant.
Thanks to a dining program introduced last year, Lake Winona
• Lake Winona Manor redesigned its work model, freeing
Manor residents like Betty enjoy made-to-order breakfasts.
up 2 additional full-time employees to work directly
with residents.
• Microsoft featured Winona Health in its marketing
• Lake Winona Manor staff averaged 2 minutes 45 seconds video at the Health Information Management Society’s
responding to resident call lights, besting their goal by 55%. conference and on its website.

2006 Awards & Recognition

Winona Health’s Community Memorial The American Association for
Hospital (CMH) received the Premier Respiratory Care presented the 2006
Award for Quality for superior care Quality Respiratory Care Recognition
of Acute Myocardial Infarction (heart Award to Winona Health’s Community
attack) patients. The hospital earned Memorial Hospital.
the award for its high quality, cost efficient treatment of
AMI. The award criteria included clinical process measures
(administering aspirin and beta blockers), clinical quality
outcome measures (for example, readmission rates), and Winona Health was recognized Most
resource utilization factors (cost per case and length of Wired–Small and Rural Hospital for the
stay). Community Memorial Hospital was recognized from fifth consecutive year.
an eligible pool of 400 hospitals.
In addition, Premier highlighted Winona Health’s success in
reducing mortality rates in its February 2006 newsletter. Winona Health continued its quality
A clinical team redefined admission criteria, engaged journey and was recognized by the
physicians, improved documentation and worked with Minnesota Council for Quality with
community resources for appropriate patient placement. a Minnesota Quality Award–
As a result, Winona Health’s inpatient mortality rate Advancement Level.
dropped from 2.3% to 1.21% and continues to be at least
0.5% below its peer group.
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Cornerstone 4 : Stewardship
• Standard and Poor’s raised its rating of Winona Health’s
$19.1 million health revenue bonds to “BBB,” citing a
solid balance sheet, improved operating and excess
margins and good market position.
• Winona Health’s gain from operations was $3.8 million
(5.6% operating margin), outperforming budget for the
fourth consecutive year while funding:
• Charity Care to qualified patients of $624,000
• Write-offs of bad debt totaling $1,636,000
• Start-up of new physician clinics for the community
• Operating expenses were within 2% of budget for the
fourth year in a row.
• Winona Health’s balance sheet remains stable and
compares favorably to similar hospitals:
• Cash-to-Debt ratio: 103%
• Days Cash on Hand: 160
• Debt-to-Capitalization ratio: 29.2%
• Parkview Pharmacy revenue grew 3%, while its
operating margin improved by 100%.
In its 20th year of service to the community, Winona Health’s
Parkview Pharmacy revenue grew 3%.
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Dollars awarded from the
Ben & Adith Miller Patient Care Fund
$600,000
$528,000
$500,000
$400,000
$300,000 $263,000
$200,000
$164,000
$113,000
$87,000
$100,000
$0
2002 2003 2004 2005 2006
In 2006, the Ben & Adith Miller Patient Care Fund nearly
doubled its assistance dollars over the previous year.
• $2.4 million of capital was deployed to fund patient care
and operations, including new equipment for surgery,
lab, cardiac rehabilitation, respiratory care and physician
clinics; information technology; and physical plant
infrastructure upgrades.
• Winona Health’s investment returns for the 36-month
period since consolidating to three investment
managers was 34.7%, besting the benchmark of 26.1%.
• An independent audit was completed with a “clean”
opinion and no material adjustments made to financial
statements, indicating Winona Health’s processes for
recording transactions, compiling financial statements
and reporting financial information is effective and
internal controls are working.
• The Winona Health Foundation awarded $24,100 in
Community Engagement Grants to six local nonprofits
working to improve the community’s health and well-
being. The nonprofits that received the awards include:
• Winona Volunteer Services − $6,500 toward
construction of a kitchen to educate Food Shelf
customers about healthy, whole foods
• Winona Senior High School − $4,500 to purchase
defibulators for the high school and middle school
 • Goodview Elementary School − $600 to engage
children in physical activities
• Project FINE − $5,000 to provide prenatal
education to migrant workers
• Hiawatha Valley Mental Health Center − $4,000 to
provide an on-site day treatment facility for middle-
school-aged children
• Winona Area Public Schools − $3,500 to fund an
ongoing elementary health curriculum
The Ben & Adith Miller Classic raised a record $150,000 toward
the Patient Care Fund.
• The Foundation also awarded $30,000 to three internal
projects under its Quality & Excellence program. The
funding provided pressure-relieving mattresses for
Lake Winona Manor and Community Memorial Hospital,
a ceiling lift system to help in moving patients/residents
and a NuStep exercise machine for use by Lake Winona
Manor residents.
• The Ben & Adith Miller Patient Care Fund provided
$528,000 of assistance to 230 people in 2006, compared
to $263,000 for 81 people in 2005.
• The Ben & Adith Miller Classic, which supports the
Patient Care Fund, raised $150,000 in 2006, a 10%
increase over the previous year.
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• The Winona Health Foundation received $606,494 in
donations from individuals, families and businesses,
allowing it to further its mission of support to Winona Health.
• The Winona Health Foundation inducted 19 members
into its Circle of Visionaries, which refers to people who
have remembered the Foundation with a planned gift.
• The Winona Health Auxiliary gifted $69,100 to Winona
Health for a patient/resident educational television
system, Cardiac Rehab telemetry equipment, and
remodeling of the Watkins Manor kitchen. In addition,
it awarded $15,000 in scholarships to 18 individuals.
• Four Auxiliary volunteers were recognized for contributing
more than 5,000 hours of service to Winona Health: Jan
Wanek, Diane Barge, Lynn Siebenaler, and Jenny Kahl.
• The Winona Health Auxiliary was busy in FY06:
• Conducting its first annual garage sale, which raised
more than $5,000
• Holding its 44th annual Birthday Ball, with proceeds
exceeding $20,000
• Adding three new service points – South Entrance
Information Desk, Boyer Lounge Reception, and
Outpatient Reception
• Orienting 144 new volunteers – 34 more than in the
previous year and five times more than in 2003.
One of the tasks for Auxiliary volunteers, pictured here with
President/CEO Rachelle Schultz, is to arrange and deliver
flowers to patients in the hospital.
Looking ahead :
Key Initiatives for 2007
Ancillary Department Satisfaction
(Laboratory, Imaging, Rehabilitation)
Goal: Improve the overall quality of the Laboratory, Imaging and Rehabilitation
Departments’ care and service to increase patient loyalty.
Target: Three standard deviations above peer mean scores

Employee Health and Well-being

Goal: Decrease employee musculoskeletal incidents related to patient/resident
handling and transfers.
Target: 10% decrease in injuries over 2006

Computerized Provider-Order Entry (CPOE)

Goal: Launch and fully deploy CPOE in a single Winona Health clinical department.
Target: 80% of orders in one department submitted electronically

Operating Margin
Goal: Maintain a solid operating margin to balance Winona Health’s mission
and costs.
Target: 4.0%

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 Community Memorial Hospital ~ Lake Winona Manor ~ Watkins Manor
Adith Miller and Roger Metz Manors ~ Home Care and Hospice Services
Physician Clinics ~ Parkview Pharmacy ~ Winona Health Foundation

winonahealth.org