A No Excuses Culture Delivers High Reliability

How a Michigan Rehab Hospital Hardwired a Culture of ‘Always’

At Mary Free Bed, the nation's fifth-largest independent rehabilitation hospital, a commitment to patient experience is deeply embedded into the culture of the organization. And it shows. Over the last three years, inpatient engagement has remained steady at the 99th percentile. In 2016, hospital-acquired infections for catheter-associated UTIs were zero.

The Secrets to Success

"It's due to high engagement and a no-excuses culture," explains Mary Free Bed's CNO Ingrid Cheslek, RN. "There is tremendous potential for safety issues in our patient population. Newly diagnosed brain and spinal cord injuries make patients fearful, so our ability to connect with each patient impacts their ability to fully participate in their therapy, sleep well in their new setting, and be discharged to home, which is always our goal."

Cheslek notes that while Mary Free Bed, which recently marked its 125th anniversary, is a compassionate organization, accountability is primary. "We do an immediate and nonpunitive root cause analysis with the care team on any patient safety issue or outcome that's less than optimal," she says. "We use Studer Group's Evidence-Based LeadershipSM framework to hardwire a culture of 'Always'."

Cheslek also credits success to:

Removing barriers.

When nurse leaders said they didn't have time to round on patients to validate care, Cheslek ensured there were no mandatory meetings scheduled before the daily 11:30 a.m. safety huddle so they could make rounding a priority.

Engaged physicians.

Because physician leaders also serve as program directors (e.g., spinal cord injury, stroke, brain injury), they take active ownership of their teams. The program directors review quality metrics and patient engagement outcomes at all program meetings.

Leadership development.

Mary Free Bed facilitates four annual Leadership Development Institutes that focus on skill-building for critical leadership tools, such as how to run a meeting, setting expectations for execution and results, and how to council performance positively.

Transparency with data.

Outcome data is reported through the organization's Leader Evaluation Manager® so everyone can view each other's performance on goals...everything from quality metrics to financial targets and service expectations. The data is shared at monthly manager meetings, in finance meetings, on public communication boards, and at board meetings.

Empowering staff.

"We use peer interviewing to ensure we hire staff engaged in the mission and then round on them consistently to ensure front-line staff feel empowered to make decisions themselves," Cheslek notes. "They shouldn't have to request permission from a manager to meet the needs of our patients."

Celebrating purpose, worthwhile work and making a difference.

Every month, staff members share their "wow" moments about Mary Free Bed at a celebration for those with work anniversaries. "The stories are incredible," Cheslek adds. "One patient's mother shared that her in-ground pool was a constant reminder of the horrible day when her son nearly drowned. Some staff made phone calls to an excavator who could fill the space with dirt. The mother plans to make a garden where the pool was located."

It's no surprise that employee engagement at the hospital has increased dramatically. In one year, overall employee engagement has gone from the 56th percentile to the 93rd percentile. "It's a credit to our leadership team," Cheslek says. "They demonstrate great ownership and engagement with our teams every day."

  • Ingrid Cheslek

    Ingrid Cheslek, RN, BSN, MPA, NEA-BC

    Chief Clinical Operations Officer/CNO, Mary Free Bed

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