Patients go out of their way for treatment at St. Joe’s
Standards of excellence are part of the routine
When patient access services manager Stephanie Holland, RN, CHAM, heard of a north Georgia couple who had driven well over an hour — past several well-known and much closer facilities — to receive emergency cardiac care at St. Joseph’s Hospital in Atlanta, she was gratified, but not really surprised.
The husband and wife thought of St. Joseph’s, they said, because friends had told them its emergency department (ED) personnel not only provided top-notch clinical care, but also seemed dedicated to making the experience as convenient and nonstressful as possible.
It’s no accident, explains Holland, that the 346-bed tertiary care hospital is one of 17 acute-care facilities designated a magnet hospital by the American Nurses Credentialing Center of the Washington, DC-based American Nurses Association. St. Joseph’s has been part of the Magnet Recognition Program for Excellence in Nursing Services since November 1995. To receive that designation, the hospital met 14 criteria.
At a time when forward-thinking access leaders are stressing the importance of nursing expertise at the point of service, St. Joseph’s appears to be ahead of the trend. Seventy-five percent of the hospital’s employees are nurses, as are the top three access staff members. (See related story, p. 111.)
Although the Catholic Health East (CHE) hospital consistently scores well above the average of the 32 hospitals in the CHE system in several admissions and customer service categories, there is no resting on laurels, says Holland’s boss, Kim Sharkey, RN, MBA, CNAA, director of nursing administration.
"There are 10 standards of excellence [see box, p. 111] that we go over with employees the day they’re hired, and they’re evaluated on those standards every time they have an evaluation," Sharkey says. "We give them an insert that they carry around that includes the standards, the hospital mission, and the customer service policy. At least monthly, we bring up one of the standards at the hospital director-level meeting, then at the staff meeting and in the employee newsletter."
That standard-of-the-month might be, for example, "present a professional image" or "anticipate the needs of the patient," Sharkey says.
In addition to regular surveys by the Nation-al Research Corp. in Lincoln, NE, in which St. Joseph’s results are compared with a national database and with its CHE sister facilities, she notes, the hospital nurtures its customer service with these efforts:
- Individual departments follow up on their own calls and survey cards.
- The Caught by an Angel program places cards throughout the hospital that patients and their families may fill out to give recognition to a particular employee.
Exploring standards of care
To become part of the Magnet Recognition Program for Excellence in Nursing Services, the hospital met 14 criteria, broken into standards of care and standards of professional performance, Sharkey says. The six standards of care are assessment, planning, diagnosis, implementation, identification of outcomes, and evaluation. The eight standards of professional performance are quality of care in administration practice, education, research, collegiality, resource utilization, ethics, performance appraisal, and collaboration.
Volunteers are an integral part of the access department’s customer service initiative, Holland points out, and in late July, their role was changed to further enhance the effort. "Instead of the patient coming [for assistance] to the volunteer behind the desk, we’re now asking the volunteer to go to the patients, to greet them as they come through the door of the main admitting lobby."
To make access staff more easily identifiable to patients, the department implemented a uniform policy on July 1, she says. Access employees are asked to wear khaki pants or skirt, a white blouse or shirt, and a navy sweater or blazer, with a navy tie for men. Although the results have been positive overall, the policy needs fine-tuning, Holland adds.
"[The uniform] is not as recognizable as it should be," she says. "People have translated the policy a little too liberally, with some getting creative and tying on a blue scarf. We’re looking at going to a more tailored look."
A computer conversion in February 1999 lent itself well to the hospital’s customer service ideal, Holland says. St. Joseph’s switched to Last Word, the admission/discharge/transfer system of Seattle-based IDX, which includes an ED module that makes the nurse the patient’s first contact, she adds.
Under that system, the nurse is the first person to interact with the patient, performing a brief triage and setting up a temporary medical records number, Holland explains. "After that, depending on the diagnosis, the patient is either sent to the back for treatment or is waiting in the lobby. At that point, we register the patient, and we do have computers in each of the ED treatment rooms."
In addition to meshing well with EMTALA concerns, she notes, the system allows staff to see the ED census at all times. "We always know who is in what room. We can assign a patient to a room without relying on an erasable board. We can see who’s waiting, who’s triaged."
In the future, electronic communication will be implemented between clinical and registration staff, Holland adds. "We’re looking at how to use an electronic messaging board so that a nurse can notify a registrar that a patient has been upgraded to observation or inpatient status. The floor nurse would be able to access the system and see that."
At present, Holland says, the process is manual, with nurses having to hand a piece of paper to registrars in the admitting area to alert them to such changes. To facilitate that process, the decision was made recently to place a registrar in the ED, Sharkey notes. "[That employee’s] goal is to assist the registrars outside the ED, so instead of those outside walking into the ED to do bedside registration, the one inside will do that."
The ED registrar also will keep track of patients moving out of the ED and being upgraded to inpatient status, and he or she will collect cash payments for co-pays and deductibles, she adds.
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