Magruder Hospital and Clinics is a not-for-profit, critical access hospital located along the shores of Lake Erie in Port Clinton, Ohio. The hospital opened its doors in August 1940 as the first and only hospital in the county. Today, the hospital includes inpatient and outpatient facilities and physician offices with a staff of 390 team members including 27 Active Medical Staff physicians and nearly 100 Courtesy Staff.
In August 2007, after examining approaches toward service excellence, senior leaders launched the foundations of Evidence-Based LeadershipSM recently learned at the Studer Group conference, Taking You and Your Organization to the Next Level. Two key foundations are leadership development and leader evaluation. Becoming a Rural Partner helped us assemble material for a two-day leadership development institute in less than three weeks. The entire leadership team was introduced to the concepts from the Healthcare Flywheel®: purpose and worthwhile work at the hub, passion, pillars, and principles. The organization committed to excellence and our flywheel was set in motion.
This motion is visible throughout Magruder Hospital as our staff renders care to patients; it is discussed at every board meeting, medical staff meeting, and hospital staff meeting. We are professionals focused on and working toward making Magruder a better place to receive care, practice medicine and employees to work. We started measuring the right things and we tracked a steady increase in the metrics we use to measure our progress based on our five pillars: People, Service, Quality, Finance and Growth.
In our People pillar, our commitment to excellence led us to start with an employee-developed “Standards of Performance.” Rolled out in late 2007, these standards are now the code of behaviors every employee working at Magruder has agreed to display. People pillar tools such as employee forums, rounding, thank you notes and peer interviewing led to significant positive cultural change. Employee satisfaction scores began to improve: overall score improved 9 percentile points after one year. Our most significant increase was in the area of teamwork, moving from the 16th percentile in 2006 to the 81st percentile in 2008. We also received five “Best in Class” ratings in the following areas: Overall job satisfaction, Benefits satisfaction, Productivity/ efficiency, Strategy/mission, and Job stress. Through the first eight months of 2009, we have maintained a turnover rate under 8%, compared to 18% in 2007.
Within our Service pillar, we have experienced some exciting increases within our patient satisfaction scores. Prior to 2007, our scores for inpatient and emergency room care were averaging in the 60th percentile ranking. In fact, we did not know what to do with the scores. At the time, it was felt it was a nursing responsibility. Today, we know better. With the introduction of pillars and hospital-wide ownership of patient satisfaction, everyone has a role. AIDETSM, post-discharge phone calls, and hourly patient rounding were implemented. Our 2008 inpatient scores began climbing and reached the 98th percentile. In early 2009, our Emergency Department reached the 96th percentile for patient satisfaction for the first time. In 2008, we began measuring outpatient perception of care. The results from these outpatient satisfaction surveys are also strong, consistently rating at the mid-80th percentile. The positive comments and compliments received from our patients underscore the positive changes made to our culture. Compliments and thank you letters indicate the positive and lasting impressions on our patients.
Metrics in our Quality pillar have demonstrated continual improvement. We utilize an internal Quality Index comprised of ten items, including both clinical and non-clinical areas. One metric in our index is “slips and falls.” Magruder experienced a 50% reduction in falls from the prior year by implementing a new “Falls Prevention Program.” We attribute this success in part to hourly rounding, coupled with new patient beds that warn the staff when a patient may be in danger of falling. We also use the standard CMS index or bundle to measure progress. Two items in this index where we celebrated progress are the pneumonia and the heart failure indices. The composite score for CMS pneumonia measures set improved from 61% in 2007 to 91% in 2009 and the heart failure CMS measure set improved from 66% to 98 % in 2009.
We believe improving performance in the three mentioned pillars, People, Service, and Quality has positively impacted our Finance and Growth Pillars. Although ending 2008 with a slight operating loss, our 2009 year to date results show an operating margin of 4%. The cultural change has taken root in the non-clinical areas with improvements we attribute to better teamwork among leaders and employees. Non-clinical metrics are demonstrating the same positive direction. Recently, a major metropolitan hospital came to visit our housekeeping department to determine how we scored so high in patient perception of cleanliness. One contributor to success is our housekeepers’ use of AIDETSM right alongside our clinical staff.
We are thankful while on our journey of excellence we have great advice from Studer Group coach, Lauren Charles, RN and the examples and lessons from Fire Starter organizations previously honored. We are humbled by receipt of this award. Whether we are at the bedside or in a support role to a caregiver, it is an honor and privilege to be able to come to work and know that we make a difference in the lives of others.