Balanced approach yields huge quality turnaround
Burning focus’ of board, management key factor
How does a hospital boost its patient satisfaction levels from the 22nd to the 87th peer percentile in just a few short years? "Hard work" is the easy answer, but according to the quality team at Memorial Medical Center in Johnstown, PA, it took a concerted effort by the entire staff, led by a focus on quality on the part of the hospital board and top management. The result was the recent naming of Memorial as the winner of the South Bend, IN-based Press, Ganey Associates’ Success Story contest, which drew more than 130 entries. The journey, say the key players, began at a very difficult time in the hospital’s history.
"Two or three years ago, we had run into some significant fiscal issues. We had been losing some $2 million a month from operations," says Steven E. Tucker, president of Memorial. "This was part of the driving force for change. We reassessed the situation as a board and staff and adopted a balanced strategic approach of service excellence, clinical excellence, and fiscal soundness."
Problems were mounting; quality suffered
At the time, in addition to the fiscal problems and the aforementioned low patient satisfaction scores, admissions also were declining. Two years later, Memorial is averaging a positive cash flow of $400,000 per month; admissions are up 9% over last year, and patient satisfaction now is consistently in the top 11th to 12th percentile.
"Some of the biggest changes had to happen in the administration," says Tucker. "But we also honestly listened to employees, physicians, patients. We ran employee retreats by department for 50 to 60 employees, where we spent three to four hours brainstorming. Then, we implemented the suggested changes; everybody was encouraged to look at improvement."
In the face of pressing financial problems, a good deal of "cutting and slashing" had to be done immediately, says Tucker. "Then we embarked on our pursuit of service excellence, with the goal of very satisfied employees, patients and physicians," he recalls. "We committed to a cultural change and a real focus on patients — not just lip service. Not a single board meeting goes by where we don’t talk about it."
The improvement process was given a major overhaul, says Suzanne D. Ross, MSN, director of performance improvement resources. "Every department was doing its own thing in little silos and had been measuring the same things for 20 years," she observes. "We created a council for performance improvement, where people from every department in the organization come together each month."
Departments report their activities on a rotating basis, Ross explains. "When you hear what other departments are doing, it can sometimes become a wow’ moment when you realize that idea can work with your department, or perhaps you are facing a similar situation and can help another department. It has created a lot of interdisciplinary teams."
The process is employee-driven, Ross emphasizes. "Being a leader means getting employees motivated. Seeing what they can get done has had a huge impact on the morale of the organization."
All of the elements of excellence being emphasized at Memorial impact each other, according to Anthony J. Campagna, director of laboratory and patient registry. "Many of the things we work on and present deal with all of those elements," he says. "We benchmark the industry for best clinical practices; when we marry them together, we look at the fiscal impact. If we meet patients’ needs and we do what we need to do clinically, there will be some fiscal benefit. All of it comes together very nicely."
The golden rules’
While many process improvement initiatives were implemented, one of the most significant, says Ross, was an employee hospitality initiative that was codified into a set of "golden rules." "We have expanded them recently into a set of performance standards," she says. "Employees sign a pledge that they will commit to living by them."
"This is required as a condition of employment," adds Tucker. "Those who don’t sign are probably not going to be scheduled for work." (See "The golden rules’ of hospitality," in this issue.)
The process that led to the development of these standards began with patient responses indicating that Memorial’s staff were not being very courteous or friendly, Ross says. "This can be turned around by something as simple as seeing someone in the hallway who looks lost, and approaching them and asking if you can help, or saying Hello’ when you pass someone in the hall," he notes.
Campagna says a recent experience showed him how deeply engrained these rules have become in the collective employee psyche.
An attitude of service
"I was on my way out into the parking garage last night and saw a guy who looked lost," he recalls. "As I was asking if I could help, I saw another employee who said, Tony, I see you’re going home; I’ll help him.’ That kind of thing happens all the time here," he adds.
The entire process emphasizes rewards as opposed to punitive action, says Ross. "At the director level, we send the vice presidents names of people on a weekly basis who need to be thanked. If a patient sends a positive comment, we send the staffer a gold certificate signed by Steve, which is put on display in a public place in the patient care area."
Numbers up everywhere
The initiatives at Memorial have raised rankings across the board. "Our outpatient satisfaction team has helped us move up from the 25th percentile to the 90th," Campagna says. "Employees came up with suggestions to improve the process, such as escorting patients to testing areas; a greeter who enters patients’ names into a computer and goes out to find them and bring them into a cubicle for more privacy; a free valet program, because parking had become an issue. Volume scheduling is also up 25%."
"We’re absolutely convinced that attention to those issues has rewarded us with more patients," Tucker explains. "Last year, when we went to the board, we asked them to allow our target to be lower for profitability and to invest more money in service excellence initiatives because we honestly felt it would drive more business — and that has been the case. The population in our area is declining and aging, but we are garnering significantly more market share."
Need more information?
For more information, contact:
• Steven E. Tucker, President; Suzanne D. Ross, MSN, Director of Performance Improvement Resources; Anthony J. Campagna, Director of Laboratory and Patient Registry, Memorial Medical Center, 1086 Franklin St., Johnstown, PA 15905-4398. Telephone: (814) 534-9000. Internet: www.conemaugh.org.
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