Many of these hospitals faced obvious problems. Some were drowning in red ink, some had lousy employee satisfaction, some were losing patients to other hospitals, and some were dealing with all of the above. Other hospitals faced less pronounced challenges. How do you maintain quality and employee and patient satisfaction while relocating to a new facility? How do you improve documentation systems and improve employee satisfaction? While the starting points for these hospitals varied, the end goal was the same: How could they transform themselves from being just a good hospital into a truly exceptional healthcare facility?
For many of these facilities, getting staff members and trustees engaged in the improvement effort was the first obstacle to overcome. Some employees may already believe their organization is great--even if there is no measurable data to support that claim--and the notion that their hospital doesn't already provide the best care may be news to many community hospital trustees. Senior leaders need to eradicate the mindset of, "We don't have a problem with that." From what I have heard, the best way to do this is through open communication, transparency, and measuring data. How do you know what needs fixing if you don't track and measure staff engagement and quality?
Hospitals need to engage every employee from the chief executive officer down to housekeeping staff, says Steven J. Simonin, CEO of Wright Medical Center, which won the HealthLeaders Top Leadership Teams award for the small hospital category in 2007. "It is all about accountability, communication, and dealing with your low performers," he says.
Other hospitals must overcome the thinking that their facility is handicapped by limited staff, money, or volume, and therefore can't achieve greatness. When it comes to quality, for example, many small facilities lack the IT to adequately measure and report their quality. Most don't have a dedicated quality department either, so the responsibility often falls to nurses and physicians, further removing them from direct patient care. Limited volumes and smaller sample sizes mean statistical reliability can come into question. But experts agree that having a different set of quality metrics is not the answer. Small hospitals need to be held to the same standards as larger facilities. They may even have some advantages over larger systems; their small size often enables them to implement changes quickly that can improve quality, experts say.
I spoke with Mike Youso, president of Fairview Northland Medical Center, after his 40-staffed-bed hospital won the Premier Award for Quality in heart failure and acute myocardial infarction in 2007 for the second year running. His advice for small community hospitals? Set the expectation and have no exceptions. "We had to finally decide that we were going to stop moaning about the criteria and just get it done."