St. David's Georgetown raised the standard of care outside the four walls of its hospital.

When CEO Hugh Brown rounded on the orthopedic surgeon responsible for 35 percent of the hospital’s volumes to ask what he could do for his patients,
the surgeon responded definitively: Improve patients’ experiences at post-acute facilities.

At St. David’s Georgetown Hospital, a 111-bed
community hospital near Austin, Texas, patients are wowed by the organization’s commitment to excellence. After all, the hospital is part of St. David’s HealthCare, a 2014 winner of the prestigious
Malcolm Baldrige Award.

But at post-op visits, these same patients would express frustration with the post-acute care providers to whom they were referred for rehab. Delays in receiving pain management and physical therapy were among the leading concerns.


Since St. David’s Georgetown Hospital isn’t affiliated with any post-acute care (PAC) providers, the hospital’s contact with them had been mainly transactional, admitting patients who needed hospitalization, discharging patients who needed their services, and documenting readmission rates and transfers. But, with CMS incentivizing performance networks between acute and post-acute providers through its 2014 IMPACT Act, a more collaborative approach was due.

When Brown approached the executive directors of several PAC providers in the community, he was met with enthusiasm about collaborating. They were interested in growing volumes and reducing length-of-stay as they shifted to episodic reimbursement mandated by CMS. Earning back referrals from St. David’s would align with that plan.


“I explained that for our physicians to begin referring patients again, we’d need to address two issues: clinical quality and culture…and that it was in the best interest of the health of our community for us to work on these things together,” explains Brown. “It was straightforward for their clinical leaders to rework processes to ensure patients received pain medication promptly and physical therapy the day of arrival, as our surgeon required.”

“What was more challenging was addressing the cultural component to ensure our hip and knee replacement patients would enjoy the same commitment to ‘exceptional care to every patient, every day’ that we made at St. David’s. They didn’t have the resources that we did to access Studer Group coaching and evidence-based leadership tools.”

So Brown offered to coach the executive directors and nursing directors as a group during a series of executive leadership collaboration meetings he hosted at the hospital. He shared the “why” of establishing a mission-driven culture and introduced Studer Group’s healthcare flywheel®, as well as the AIDET® communication framework and leader rounding on employees.

Leaders learned how to collect actionable feedback using five evidence-based questions during rounds (rather than “howdy” rounds, as Brown calls them). Then he showed them how to use a stoplight report to track implementation of action items transparently. They also studied the principles of patient and employee engagement from Craig Deao’s book “The E-Factor: How Engaged Patients, Clinicians, Leaders, and Employees Will Transform Healthcare.”


Within a few days of beginning the coaching sessions, Brown heard from one of the executives who was excited about the staff’s reception of the new tools and the actionable feedback he was getting with evidence-based rounding. Physical therapists and charge nurses from the PAC providers are also now meeting with St. David’s service line leaders to share challenges in their operating environment and to brainstorm solutions (e.g., rounding on patients every two hours instead of hourly due to larger patient-to-nurse ratios).

Today, PAC facilities can confidently meet St. David’s Georgetown Hospital’s clinical expectations, so physicians are referring patients to them again. Patient experience is also improved, and the organizations are still working to hardwire excellence. The focus of coaching has shifted to accountability.

Over the next six months, St. David’s will begin tracking readmissions, infection rates and patient experiences based on surveys, as well as patient days for its post-surgery hip and knee replacement patients in skilled nursing facilities in order to meet targets established by each surgeon.

“Like most great sea changes in healthcare, this type of initiative needs to be executive-led,” advises Brown. “Reach out fairly and uniformly to all post-acute leaders with a message that what happens after discharge matters. Don’t your patients deserve to have the same great experience in every organization?”

  • Hugh Brown is CEO of St. David’s Georgetown Hospital in Georgetown, Texas.

    Hugh Brown, CEO, St. David’s Georgetown Hospital

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