Palmetto Health Baptist Easley

In an unprecedented fashion Palmetto Health Baptist Easley (PHBE) is Studer Group's first two-time winner of the coveted Fire Starter of the Month Award. Baptist Easley is a 109-bed general acute care facility located in the foothills of the Blue Ridge Mountains in the Upstate region of northwestern South Carolina. Founded in 1958, our community-based hospital is part of the state's largest integrated healthcare system - Palmetto Health.

In 1996, through the leadership of our COO and chief administrator, Roddey E. Gettys, III, we transitioned from a traditional healthcare organizational structure to self-directed management teams. With each team director forming a Leadership Team, we began measuring patient satisfaction through Press Ganey Associates, Inc. Within four years, we started holding employees accountable to six performance competencies: communication, customer service, teamwork, technical excellence, continuous learning and initiative/innovation/adaptability.

Consistent throughout our 49-year heritage has been our commitment to the residents of Pickens County to provide them the healing ministry of Jesus Christ with the trademarks of quality, Christian compassion and care.

To capture the spirit of this commitment, Baptist Easley launched a marketing campaign in 2002 featuring the motto - Care You Can Believe In. Reinforced by the six competencies, this slogan quickly burst through its advertising confines to become the standard for all 800 employees to live by. Utilizing an outside agency to conduct a communications audit including mystery shopping, we learned that although we had the vision for excellence, we still were lacking some of the basic skills needed to achieve it.

When several of the Leadership Team directors heard Quint Studer speak at a Press Ganey conference in Nov. 2002, a fire was ignited for Studer's methods, strategies, practical tips, the five pillars and the nine principles. With a mature management team infrastructure already in place, the climate was right to quickly execute the practical Studer prescriptives.

Our first Studer take-away was realizing that the six competencies had little meaning unless there were clearly defined standards of behavior to accompany them. In 2003, inspired by Studer, we added bullet points to each competency. For example, under communication, we established a standard phone greeting for all internal and external phone calls. And under customer service, we said that we would escort visitors to their destination as needed.

Over the next eight months, we provided intense training towards these standards to most of the 800 employees. Training classes and materials were customized to address each department's needs. Then we provided coaching-style training as a follow-up with an emphasis on creating and using the Key Words at Key Times. Reminder pocket cards of the key words were created for various departments to hardwire this process.

By Oct. 2003, we saw that the best way to optimize our success was to formalize our relationship with the Studer Group and to have access to the coaches and other resources. From that point, we have seen remarkable increases in our Press Ganey scores, but we continue to feel the challenge of how to "sustain these gains." Following are further details of our story:

Service Excellence Teams

Inpatient Team - We currently are celebrating being in the 99 percentile ranking for the last two reporting periods. We attribute this success to commitment by our employees to providing care with excellence and compassion. Hardwired initiatives have become the lifestyle of our employees. We continue to use the following hardwired processes:

• Discharge Phone Calls - An all-nurse staff (paid and volunteer) makes these calls within 72 hours of patients' release. This hardwired process allows us to solve problems over the phone, to collect data and to follow up immediately with identified needs.
• Patient Rounding - This hardwired process is primarily conducted daily by the charge nurses.
• Employee Forums - Held twice a year, this setting allows for dialog on what is working well, what are the obstacles, and what we can improve.
• Key Words at Key Times - These have been utilized in all areas. There continues to be ongoing training with new and current employees as to why they are important and how to use them.
• "Questions About My Care" brochure continues to be a tool for keeping patients better informed.
• Patient Communication Boards continue to be utilized in each room. These have greatly enhanced the communication process between staff, the patient and the patient’s family members/visitors.
• Birthplace Food Treats - We try to meet the needs of new moms through customized meal menus, pizza celebrations, snack baskets and gift bags. The Birthplace unit has been a major contributor to our ability to sustain the gain in our Press Ganey scores.
• Birthplace has added bedside lamps to their patient rooms at the suggestion of one our patients to make the room feel more comfortable.

Other initiatives that have been hardwired throughout the nursing units include:

• Managers conducting employee rounds.
• New recliners were purchased for all patient rooms to allow more comfortable seating/sleeping for family members who may be staying with patients. Congratulatory cards are sent to new moms and dads.
• Sympathy cards are sent to families upon the death of a patient during their hospital stay.
• Get well cards are placed at the bedside and signed by all caregivers and then mailed to the patient following discharge.
• Volunteer Services recognizes patients hospitalized during a birthday or anniversary.
• Birthplace materials have been translated into Spanish to further improve communication.
• Employees are given special rewards when recognized by patients and/or families as giving “very good” care.

Emergency Department – We continue to work to improve our patient satisfaction scores. We are pleased to have had scores greater than the 80 percentile ranking over the last two reporting periods.

• Implemented Pull to Full process which takes patients immediately to an available treatment room.
• Implemented Fast Track process where “minor” conditions are treated quickly in a separate area of the Emergency Department.
• Quick triage process.
• The Emergency Department physicians are conducting discharge callbacks.
• Televisions have been placed in all rooms.
• Communicating patient satisfaction scores to the staff and the practitioners on a weekly basis.
• Rewarding staff when they are recognized by patients/family members for doing a great job.

Outpatient Surgery - In Dec. 2002, we were in the 12th percentile, but as of April 2005 we had risen to the 98th percentile. Our scores have remained in the top 10% since 2005 and the top 2% since July 2006. This sustained improvement has resulted largely from enhancements in the following areas:

1. Facilities
   • Completed renovation of the Surgical Waiting Room, including a fish aquarium.
   • Added volunteers to the waiting room to help coordinate information and access between family members and medical staff.
   • Distribute complimentary refreshments twice a day.
   • Implemented a beeper system for waiting families.
   • Added an electronic tracking board in waiting areas
2. Care Delivery
   • Hardwired pre-op and discharge phone calls.
   • Trained employees and volunteers on how to use Key Words at Key Times (keep you informed, take very good care of you, privacy)
   • Educated medical staff at quarterly surgical department meetings with measurement factors that relate directly to physician care.
   • Send patients get-well cards signed by all who cared for them.

Outpatient Services - Having been in the 25th percentile in the first quarter of 2003, this sector has seen a consistent rise and has maintained scores in the 80th percentile and above. Hardwiring and improving scores consistently for 15 different modalities has been challenging. We attribute our success to these highlights:

We created a more customer friendly registration process by utilizing our very attractive atrium area to greet patients and begin the registration process. We also are using this area for additional waiting to ease congestion and overcrowding in key identified outpatient departments.

1. In response to concerns of patients getting lost in the corridors, we have improved signage and added special access telephone stations called “tree phones” utilizing our hospital logo, the stylized Palmetto tree. These phones give patients and visitors direct access to request escorts and/or directions.
2. In response to access for convenient and adequate parking, we have added “free” Valet parking.
3. The Outpatient Services Team has grown to include more point of service representatives who impact the overall patient experience.
4. These team members have improved their knowledge of the Press Ganey process by studying the reports and learning how to interpret the data.
5. Formal training around the Key Words at Key Times.

Employee Satisfaction (also serves as Reward and Recognition Team)

1. Hardwired thank-you notes. Directors are held accountable for writing four employee notes a month.
2. Hardwired 30-day check-in process in which managers meet with new employees after 30 days of hire to conduct a formal check-in.
3. Our chief administrator conducts the 90-day check-ins with new employees in lunch-type forums. These are hardwired and published for the calendar year. Questions asked include:
   • Based on your first 90 days, what do you consider to be my greatest priority as the administrator?
   • As a hospital, what are we doing well?
   • What would you recommend that we do differently?
   • Do you know what is expected of you?
   • What can we do to make employees feel welcome?
4. Our chief administrator also conducts monthly employee forums called the "3 I's" (Information, Inspiration, and Ideas). Each employee has at least one opportunity each year to participate in this lunch or breakfast forum. They are asked to share department success stories, department issues, concerns and/or barriers to providing exceptional customer service.
5. Created a Reward and Recognition Wall in a high-traffic employee and visitor corridor to recognize Employee of the Month and of the Year, Volunteer of the Month and of the Year, Golden Palmetto Attitude Award Winners, and the Medical Staff Leadership.
6. Motivational messages are found throughout the hospital. One example is mounted boldly at the main employee entrance that serves as a daily reminder that "Through these halls pass the dedicated and compassionate caregivers of Palmetto Health Baptist Easley."
7. Employee Loyalty (years of service) Recognition occurred during the May 2004 Hospital Week and was so successful that we have continued to use this as a recognition opportunity each year. Employees were also are recognized with gift bags including gift cards to various local stores and the gift shop. The dollar value of the Wal-Mart gift cards was linked to years of service (35 years = $35)
8. Keys to Care You Can Believe In is a new employee recognition tradition held each May during Hospital Week. During this time, the main corridor is set up with stations to represent the six competencies. At each station are key-shaped cards where employees are invited to recognize coworkers, managers, or directors for excellence in any of the six competency categories.
9. The Care You Can Believe In Campaign continually is reinforced through:
   • The eight-month training in 2003 of the defined standards of behavior connected to the six competencies was incorporated into the new employee orientation process. Keys to Care You Can Believe In Brochure - Using icons to symbolize each of the six competencies, we use this tool to integrate the standards of behavior throughout our communication-related activities.
   • Elevator Door Signage - Using a vinyl-wrapping technique, the six competencies with their icons has recently been replaced with the five new standards of behavior adopted by the entire Palmetto Health system to ensure they continue to be an integral part of the hospital's daily life.
   • Elevator Posters - To serve as a reminder to employees and as a promise to visitors, the standards of behavior are being highlighted one per month through this elevator poster campaign. Using four employee photos per poster, this is another way to recognize high performers.
   • Caught Giving Care You Can Believe In stickers and tokens - These tools were provided to high performers to "catch coworkers in the act" of following the standards of behavior. This program is being piloted with one department before going hospital wide, the action is written on the card associated with the appropriate competency. Then it is given to the coworker along with a sticker to wear. The card is redeemed in the cafeteria for a food item. Then the cards are returned to the department manager to collect the data and for additional employee recognition. Photos of the "caught" employees are also displayed on the communication board (6b).
10. In lieu of the annual performance review process, we asked all employees to sign an employee commitment form supporting the new standards of behavior. Using the Studer Group High - Medium - Low Performer Process, we had a 100 percent employee turnout. This number was confirmed through the accountability tools in place with the Leadership Team.

Communication Team

1. Developed a newsletter around the five pillars.
   • The dual purpose is to inform employees and serve as a reward and recognition tool, such as recognizing new employees and volunteers.
   • The newsletter template also ties in with the ongoing Care You Can Believe In marketing campaign.
   • Employee numbers are buried within the text and results in gift certificates when found. This has provided an extra fun factor to reading the newsletter.
   • The newsletter is available both via e-mail and printed copy.
2. Installed employee communication boards in five locations throughout the hospital:
   • Each column follows the five pillars with specific information assigned to each pillar. For example, photos of new employees and volunteers with a brief introduction are always placed under "People."
   • Arrangements were made with HR to save the ID Badge photo to be used for this purpose. This hardwired process has accelerated the availability of new employee and volunteer photos for display.
   • A variety of templates were designed as tools for the display layout. The background color changes each month to help signal that a new board is up.
   • The communication team sponsored a half-day off-site retreat to educate over 60 employees on how to provide an informative communication board. The employees present were selected by their directors to lead communication teams in their respective departments. Each department throughout Baptist Easley now has its own department specific communication board using the five pillar approach.
   • The hospital COO, chairperson of the Communication Team, along with a select member from the communication team tour the hospital on a quarterly basis and award prizes to departments whose communication boards meet the criteria established by the team.
   • The Communication Team from Easley also has assisted our Corporate Communication Team in developing strategies for the boards now being installed at Palmetto Health Baptist and Palmetto Health Richland in Columbia.
   • A communication board has been installed in the physicians’ lounge. This board also is set up using the five pillars and provides information to all physicians including free CME opportunities.
   • Communication boards have been installed in the lobbies of all Baptist Easley employed physician practices. These boards serve as a great way to communicate with patients using the five pillar approach.

Physician Satisfaction - This team was formed in Jan. 2004 and meets on a monthly basis. After developing an internal physician measurement tool during 2004, we elected to engage an external survey organization to assist us in measuring our physician satisfaction as compared to other hospitals across the U.S. In 2006, we partnered with Press Ganey to conduct the Physician Satisfaction Survey as they were already established partners with the employee and patient satisfaction survey process. Listed below are a few of the initiatives we have taken to improve Physician Satisfaction:

• Conducted Physician Satisfaction Survey in June 2006 and received a rating which placed us in the 92% in overall satisfaction as compared to the all hospital database.
• In conjunction with our Press Ganey consultant, we communicated the results of the survey during August and September to the following: Medical Executive Committee, Executive Leadership Team and Physician Satisfaction Team.
• Utilized the results of the survey to train 100 leaders at our quarterly institute in September 2006. We developed action plans to improve Physician Satisfaction to include:
  • Created thank-you notes for physicians
  • Conducted Physician Practice Appreciation Day for physician staff (annually)
  • Scheduled visits to physician practices to meet with physicians and staff regarding hospital services and opportunities to enhance our service
  • Updated the physicians lounge
  • Conducted at least two reward and recognition physician events per year
  • Held physician forums to identify physician issues and/or requests, to enhance the practice of medicine at Baptist Easley.
  • Leaders now include Physician Satisfaction as part of their annual performance plan.

Leadership Development Team

The Leadership Development Team was formed in 2003 with one-day institutes held monthly. Since that time, we continue to conduct quarterly two-day institutes focused on the five pillars. We also doubled the number of participants by including managers and supervisors in addition to directors.

Leadership Accountability Team

Directors, managers and supervisors now utilize the LEM per our partnership with the Studer Group which includes:

• Annual goals which are cascaded down from the overall hospital goals.
• Monthly score cards
• 90-day action plans