Saint Thomas Rutherford Hospital

In October 2012, Saint Thomas Rutherford Hospital (STRH) partnered with the Studer Group as a pivotal next step in establishing evidence based best practices as a premier healthcare facility. Our commitment to implementing Studer principles has proven successful in creating a culture where associates are happy to work and physicians enjoy practicing, and thus improving patient care and satisfaction.

To mark the beginning of our Studer journey, the name "A Time to Excel" was chosen to signify a new mindset for STRH. Unlike other program trials in the past, “A Time to Excel” efforts were purposed to build a true culture of accountability and performance excellence. Today, we can proudly say that "A Time to Excel" has truly become an integral part of our organizational culture, with an evidence-based leadership approach matched by excellent nurses, dedicated staff and first class physicians.

One of the first action steps was to define the desired culture. Several teams worked together on standards of behavior, associate engagement and physician engagement. Leadership made rounds to patients and associates in order to find out what was working well and to seek opportunities for improvement. Specific tactics also were given to leadership along with accountability markers for achieving the expected results. Senior leadership, directors and managers live the standards alongside associates ─ and 100% commitment is expected by all. As associates witnessed these standards in action, anyone wearing a STRH badge felt empowered to take part. Associates have learned to recognize what works well and how to "manage up" one another.

Another component of “A Time to Excel” was providing staff with the coaching and tools needed to provide excellent care. Heightened attention was given to the Emergency Department with various out-of-box tactics to improve throughput and patient satisfaction. Throughout the hospital, as tactics such as hourly rounding, AIDET (acknowledge, introduce, duration, explanation, thank you) communication, and white boards became part of everyday practice, associates realized they had more time to spend with patients and their families.

Elevating attitudes within our culture has yielded continual improvements in our pillars of accountability─People, Service, Quality and Safety and Finance─and as a result improvements in our Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys and financial stability.

People
Since the implementation of "A Time to Excel," we have noted an overall reduction in turnover, improved physician satisfaction and increased associate engagement.

In 2014, open forum attendance increased in the third quarter. On a survey of 104 physicians, we noted improvements across the board from 2013 to 2014.

• Nursing Morale improved by 18.9%
• Patient Admitting improved by 7.0%
• Nursing Care improved by 5.8%
• Pharmacy improved by 5.9%
• Timeliness of Ancillary Reports improved by 5.1%
• Laboratory improved by 10.5%
• Rehabilitation Services improved by 5.2%
• Patient Supplies improved by 12.7%
• Senior Leadership Responsiveness to Concerns improved by 9.6%
• Overall Organization Effort to Improve Patient Care improved by 5.8%

Service
Providing excellent care and services is at the heart of the "A Time to Excel" culture. By July 2013, improved inpatient patient experience was demonstrated by achieving our 75% goal for net loyalty score (NLS). Our score continues to trend with consistent improvements through 2015.

Many initiatives aided in improving our NLS; however, Emergency Department-specific engagement is particularly notable which resulted in a significant increase in volume. The ED retained a dedicated Studer Coach, who visited monthly to focus on the unique needs of emergency departments. Quick Look Nurse, Pull Till Full and Results Pending Holding are examples of tactics put into place. Extensive work was done on leader and charge nurse rounding, specifically focusing on patient needs. ED leadership and inpatient leadership formed process improvement teams to look at inpatient processes to help with ED throughput. Tactics developed include Throughput/Discharge Nurses, Top 5 Lab tests and decrease Lab TAT, Eves changed their shift change times to mimic patient flow.

Additional efforts we continue to use throughout departments include:

• Communication Boards. Templates for the white boards were installed in all medical/surgical, maternal child and critical care patient rooms. Policy was written to define the time and responsibility of updating the boards during each shift. They are monitored during nurse manager rounds and logged on manager rounding tool.
• Nurse Manager Rounding. Patient Care Services (PCS) implemented a formal plan outlining specifics for nurse manager rounding on patients on each floor. This data is logged, recorded and presented at PCS division meetings.
• Thank You Notes. Guest Relations. the Emergency Department and Medical Imaging adopted a program to write thank you notes to all discharged inpatients.
• Standards of Behavior called "Be Attitudes." The Standards Team developed a very detailed plan to concentrate on one “BeAttitude” each month to ensure the BeAttitudes were hardwired by leadership and staff.
• Patient Call Manager. Our discharge call program encompasses staff members throughout the house who make discharge phone calls to patients within 48 hours of discharge. This has been in invaluable too in collecting information to report to our directors for continued improvements.
• Associate Recognition Program. The associate recognition program includes on-the-spot recognition of associates, Associate of the Month and Associate of the Year selected among monthly recipients.

• In 2014, STRH's fourth quarter percentile ranking in patient surveys improved in all areas: Clean/quiet; doctor communication; responsiveness; pain management; communication; and discharge.

• "Left without being seen" fell from 3.9 FY 2012 to 1.3 FY 2014. From arrival to departure, the length of stay decreased from 361 minutes FY 2012 to 213 minutes FY 2014 for admitted patients and from 171 minutes FY 2012 to 144 minutes in FY 2014 for non-admitted patients.
• Decision to admit to head in bed decreased from 248 minutes FY 2012 to 73 minutes FY 2014.

Quality and Safety
The "Time to Excel" efforts also have proven to benefit the quality and safety of care provided to our patients. Results in this area include:

• Quick Look Nurse in ED Lobby decreased safety issues and helped recognize sick patients sooner.
• Catching incidents before they happen. "Near Miss" safety reporting doubled in FY 2013 to compared to FY 2012.
• Bronze award for organ donation from the TN Organ Donor Association
• Decentralized pharmacist (assigned to unit) now a best practice across Saint Thomas Health and Ascension Health.
• ED pharmacy technicians being added to care team so patients receive medications faster.
• Opened progressive care beds.
• 40% reduction in Hospital Acquired Conditions (HACs)
• Surgical services throughout improvements, including reduced time required for surgical scheduling; registration dropped to 12 minutes on average; and patient arrival to ready for procedure 96 minutes down from 185 minutes.
• Patient call manager allows us to additional safety concerns.

Finance
With Studer principals at our core, our ongoing efforts to reinforce “A Time to Excel” have been validated with significant increases in income from recurring operations. We are developing solid grounds from which patient, associate and physician satisfaction will continue to grow.

"Being recognized as Studer's March 2015 Health Care Organization of the Month is an honor earned by each and every associate who has embraced the 'A Time to Excel' culture," says Gordon B. Ferguson, STRH President & CEO. "We will continue working together, striving for greater excellence, but it is truly an honor to have this opportunity to recognize all that we've accomplished. Together, we continue in our journey in becoming the hospital of choice for our primary and secondary service areas."