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St. Mary’s Medical Center

  • Location: Huntington, WV
  • Award: Evidence-Based Leadership Healthcare Organization of the Month
  • Awarded: May 2004

The Studer Group is pleased to honor St. Mary’s Medical Center as May 2004 Fire Starter of the Month. St. Mary’s view this designation as an acknowledgement of our determination to make a true cultural change in our organization.

While special thanks goes to Sr. Diane Bushee, S.A.C., St. Mary’s Vice President of Mission Integration, for her unwavering commitment to building service excellence at St. Mary’s, we dedicate this Fire Starter Award to each and every employee, physician and volunteer who has joined us on this journey. And, we dedicate it to the tremendous people of the Studer Group who have traveled side-by-side with us for the past three years.

How did this journey begin? In 1998, as St. Mary’s Medical Center continued a process of evaluating its transition into the new millennium, the following realities were identified. To remain competitive, St. Mary’s must:

  • Improve patient experience
  • Optimize patient, staff, and physician satisfaction
  • Improve clinical and financial outcomes
  • Decrease LOS and better prepare patients for discharge through enhanced management of patients in the system
  • Ensure appropriate utilization of resources at the appropriate level
  • Decrease cost per case.

A project, Patient Care 2000, was initiated in 1999 with a targeted completion date in 2000 to help us attain these goals. Five design teams were established to define the process by which we could realize our expectations.

It soon became apparent to these design teams that the one central step to improving the delivery of patient care was to improve patient, employee and physician satisfaction. A separate team was organized to study this issue and make a recommendation to Administration for a plan of action.

The committee recommended that St. Mary’s contact the Studer group after considering variousoptions.Administrationagreed and the St. Mary’s/Studer partnership was born in February 2001.

A Studer Group staff member did an internal assessment of SMMC. Through this assessment Studer evaluated how it could assist St. Mary’s to not only reach the next level of excellence, but to achieving its goal of improving patient, staff and physician satisfaction by becoming the provider and employer of choice in the our region.

When the internal assessment report was finalized, the following recommendations were made:

Culture

Findings: The internal assessment revealed that the mission and healing ministry of the Pallottine Missionary Sisters were pervasive throughout the organization and the values of compassion, hospitality, reverence, interdependence, and stewardship were visible and understood by all staff. However, more focus needed to be given to creating Standards of Behavior.

Recommendations: Employees needed to help define the Standards and the specifics of how they were to be lived out in the workplace. Managers had to be trained and held accountable for living our values and role-modeling behaviors, as well as holding staff accountable. These Standards were to be constantly communicated to ensure "top of the mind" awareness throughout the organization.

Actions: A Standard of Behavior booklet has been created with direct input from staff. All employees are required to sign a statement that they have received a copy of the Standards and that they will abide by them. These Standards of Behavior have been integrated into annual performance evaluations.

Service Excellence

Findings: A patient representative handled patient concerns and rounded on patients to inquire about service, but no formal service recovery program existed. St. Mary’s did not utilize scripting, some of its nurse managersdid notroundregularly on patients, and discharge phone calls were not being made.

Recommendations: To reach the highest levels of patient satisfaction the key tools of scripting, service recovery, manager rounding and standards of behavior needed to be implemented and anchored to optimize patient-staff interactions. Focus and attention needed to be provided via the service teams to foster service improvement at every opportunity and keep service excellence thriving.

Actions: A Service Recovery Team provides a mechanism for staff to address patient complaints immediately. Service Recovery Tool Boxes are available on patient care area to provide immediate acknowledgement that SMMC has failed to meet expectations. Scripting has been developed; both the nurse managers and senior administration engage in regular rounding. Discharge phone calls are utilized.

Leadership Development

Findings: St. Mary’s had a strong commitment to staff education and leadership development. However, some leaders needed the tools and skills necessary to live the SMMC values, change the culture, and get results in order to help the organization achieve and sustain excellence. Consistency, accountability (or ownership) and a renewed focus was necessary to create mature results-oriented leaders who were passionately connected to vision and purpose.

Recommendations: It was recommended that St. Mary’s establish a Leadership Development Institute with quarterly training sessions for as many key leaders as possible. The Institute’s purpose would be to develop mature leaders who support specific goals and specific results.Actions: Quarterly, off-site leadership development training sessions were implemented in fall 2001. These two day sessions focus on addressing issues, fostering communication and skill building forourmanagementstaffAccountability

Findings: The internal assessment revealed that while some managers stressed the need for greater accountability for specific results, there was also a perception that with this increased accountability there would be a loss of the family culture at St. Mary’s. Peer interviewing was not being done at St. Mary’s.

Recommendations: St. Mary’s had to hardwire accountability into leadership via 90-day action plans, leader report cards, and results-based leader evaluations. Having management focused on connecting-the-dots at every opportunity would allow staff to see the value of their efforts as worthwhile and making a difference. Peer interviewing was important to help give staff some ownership in the hiring process.

Actions: 90 day action plans, leader report cards and accountability for results have been hardwired into the performance expectations of SMMC managers. Peer interviewing has been adopted by several managers.

Communication

Findings: Communication was identified through interviews and survey documentation to be a significant issue at St. Mary’s. Open communication was important to staff and managers.

Recommendations: Communication boards, CEO forums for employees, "managing up" techniques, employee surveys and encouraging feedback were all recommended for implementation to help connect staff to goals and vision, and to foster relationships. Leaders’ ability to communicate with staff had to be developed and made a major job expectation.

Actions: House-wide communication boards, quarterly CEO forums, "managing up" techniques, bi-annual employee surveys and the encouragement of employee feedback through suggestion boxes and an employee suggestion committee have all been adopted.The employee newsletter, Vital Signs, formally published monthly isnowpublishedbi-weekly.

Reward and Recognition

Findings: St. Mary’s had implemented recognition programs for employees who demonstrated exceptional service and care to patients, families, fellow co-workers, and the community. However, employees asked for more "informal" recognition of staff.

Recommendations: St. Mary’s needed leaders to provide immediate informal recognition of employees and hold leaders accountable for frequently recognizing staff. Effective recognition should be immediate and specific (for example when nurse managers are rounding and hear positive comments from patients). To encourage the managers to become more aware of positive employee behaviors they were asked to send "Thank You" notes to employees for going the extra mile.

Actions: Scripting for informal recognition was developed. A rewards and recognition team was established to celebrate wins and connect actions with successes. Reward and Recognition tool boxes provide managers with fun ways to acknowledge staff. Banners were created to hang in units with monthly 99 percentile patient satisfaction.

Conclusion

Obviously, it is impossible to cover all the findings, recommendations and actions that have occurred over the past three years. It is possible to demonstrate the results of our organizational and cultural change.

St. Mary’s changed patient satisfaction survey companies from Gallup to Press Ganey in June-August, 2002. Results of the first Press Ganey patient satisfaction survey were eye-opening:

Inpatient - 55th percentile
Outpatient - 64th percentile
Ambulatory - 47th percentile
ER - 7th percentile

If we needed proof that SMMC had some work to do, we had just received the necessary jolt.

By May 2003 the scores showed some progress:

Inpatient - 54th Percentile
Outpatient - 70thpercentile
Ambulatory- 73rdpercentile
ER - 14th percentile

Perhaps all this effort is paying off.

As of 2/29/04 Qtr the scores are:

Inpatient - 82nd percentile
Outpatient - 65th percentile
Ambulatory - 59th percentile
ER - 69th percentile

Have we made significant improvement in some areas? Absolutely. In 2003, SMMC was one of only seven companies in the nation to be named as a Top 100 Employer for Working Mothers by Working Mother Magazine and as an AARP Top Employer for Workers Over 50. In fall 2003 the results of a Tri-State survey conducted by the National Research Corporation showed that respondents viewed SMMC as having the Best Image and Reputation, the Best Physicians, the Best Nurses, the Most Personalized Care, and the Best Accommodations and Amenities.

Do we continue to have challenges in others? Absolutely. Are we deterred? Absolutely not.

No one ever said that there was a shot or a couple of pills we could take to fix what was ailing service excellence at St. Mary’s Medical Center. We knew from the beginning that hard work and some difficulty lay ahead.

But at least the hard work and difficulty are shared by staff and managers alike. No longer is service excellence seen as "your" problem. It is acknowledged as "our" problem and seeking the solutions are required together.

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