How top hospitals achieved success
Engaged employees, happy patients, useful technology, and the right leadership philosophy are key to becoming a nationally recognized hospital, according to leaders at two Malcolm Baldrige National Quality Award–winning facilities.
Since 1999, the Baldrige award recipients have included healthcare organizations that have achieved excellence in performance. Only one or two healthcare organizations are honored each year.
San Diego–based Sharp Healthcare is a 2007 recipient of the award.
“It doesn’t mean we’ve arrived; it means, basically, that we’re making progress and we’re going in the right direction,” says Nancy Pratt, senior vice president of clinical effectiveness at Sharp. Pratt says the process of applying for the award has helped Sharp define and live up to its mission, vision, and values.
“We’ve used the Baldrige feedback over the last four years to help us fine-tune and adjust and focus our efforts,” says Pratt. With the help of the Lean-Six Sigma performance improvement program, Sharp streamlines protocols to improve cycle time for processes such as door-to-balloon time, or the time from when a patient arrives in the ED to when the patient has a balloon inflated in the coronary artery.
“For a lot of things in healthcare, time is an important variable,” says Pratt. “Cycle times are an important part of patient care, and we do a lot of work with Lean and Six Sigma to drive those.”
At Sharp, frontline staff members are expected to participate in identifying and solving issues. Simply asking staff members to comply with an existing protocol won’t work, Pratt says.
“It’s not about compliance,” says Pratt. “If it’s about compliance, you never get there. It’s about 14,000 people pulling in the same direction. That is a formidable force.We have people who like coming in to work and like what they do.”
So does North Mississippi Medical Center (NMMC) in Tupelo, a 2006 Baldrige award recipient. The largest rural medical center in the nation, with 650 beds in the main hospital, NMMC currently holds employee retention and satisfaction rates above 90%.
NMMC leaders have several philosophies about their employees, including the philosophy of servant leadership. Karen Koch, PharmD, MHA, research director at NMMC, says although the concept is not new, it is effective in developing a culture of engaged employees by creating an atmosphere in which leaders must embrace authority rather than power, listen to employees, meet employees’ needs, and hold themselves accountable.
Employees are also empowered to help change processes and protocols through several programs. They are asked for ideas on how to improve their department, and those whose ideas are used are rewarded and recognized.
Koch says an abundance of employee recognition helps keep staff members happy. Employees are also surveyed on a regular basis (informally about every quarter, with a more formal survey every two years) to assess any problems they might have.
NMMC employs a full-time career counselor in the HR department to help ensure that employees have chances to grow while at NMMC.
The center also allocates $1.4 million annually to help employees advance.
“We’ve offered [our employees] a lot of opportunities for advancement [and] a lot in tuition reimbursement. There are some flexible schedules, but the main thing is that we listen to their needs and wants, and if they’re legitimate needs, we meet those needs,” says Koch.
Sharp Healthcare’s patient satisfaction rates are consistently high, a fact Pratt attributes partly to hourly rounding.
“Hourly rounds work. When you’re out there asking the patients if they need anything instead of waiting for patients to ring on a call light, it’s a lot more effective at preventing mistakes,” says Pratt. “It’s also a lot more effective in making sure that we meet their needs when they’re in our hospital.”
Koch says NMMC uses tried-and-true practices to keep patient satisfaction rates high. It uses Press Ganey to survey patient satisfaction and ensures that physicians and nurses address the patient, introduce themselves, explain what is occurring, and give the estimated time of how long a treatment will take.
Protocol also ensures that patients are thanked for choosing NMMC.
“It sounds like an old-fashioned thing … but we implemented it and it was very successful in our emergency room,” says Koch. “It’s a basic courtesy but has done a lot to help improve patient satisfaction by always being polite and engaging with folks.”
The center also lets patients know that their comments about the service they are receiving can be addressed through the hospital’s care line, which provides a way for compliments or complaints to be processed and addressed. The system also helps to identify and quickly resolve common problems.
“We really try to take advantage of complaints,” says Koch. “We use them as an opportunity to improve.”
Koch says the early implementation of electronic medical records has helped NMMC develop strategies to improve.
“Physicians are scientists, and they are data-driven,” says Koch. “We are fortunate that we have electronic medical records and that they have been able to capture a lot of clinical data.”
The data is used to create physician profiles of performance. Physicians who do well in a certain area are asked to be physician champions. The champions are called upon to help improve a process and educate their peers on the subject. The champions serve as role models to physician peers and act as consultants to outcomes managers.
This way of engaging staff members in quality improvement has helped the center’s quality improvement efforts work. For example, NMMC reduced occurrences of deep vein thrombosis (DVT) after launching a program, led by a pharmacist and nurse who gathered data on the process and realized physicians needed to be more aggressive.
The team concluded that action, whether it was prescribing heparin (a blood thinner known to reduce the risk of DVT) or applying special stockings to reduce the risk of blood clots, needed to be taken immediately. The team suggested placing a standing order on an at-risk patient’s chart to prompt the physician to take action. The team collaborated with physicians to educate them on the topic and bring it to their attention.
Sharp and NMMC benefited from years of feedback from Baldrige examiners before winning the award, and Pratt and Koch agree that leadership must be educated and engaged in quality improvement to obtain national awards in organizational performance.
“The key element is that leadership has got to be engaged in the process,” says Koch. “A quality improvement department on its own cannot go after Baldrige. It’s so multifaceted.”