Christus Health, Irving, TXHospital Systems/Large Hospitals (500 or More Beds)A CULTURE OF EXCELLENCE
When the Sisters of Charity of the Incarnate Word healthcare systems in Houston and San Antonio merged to form Irving, TX-based Christus Health in 1999, the new leadership team faced a host of challenges. The system was plagued by financial losses, discouraging results in clinical quality measures, and low satisfaction rates among its patients and employees. The system’s new president and chief executive officer, Thomas C. Royer, MD, knew he had to introduce a program that would result in each of Christus’ hospitals showing marked improvements—not only in their daily operations, but also in patient and employee satisfaction.
One of the leadership team’s first moves was to craft a strategy for improving four key areas: clinical quality, service quality, financial stability and community value. Deemed the “Journey to Excellence,” the initiative set out to reach incremental, measurable goals of improvement in each of the four areas. “Excellence is not a luxury; it’s a necessity. The four components of the Journey to Excellence program were clear to us. We have to offer the right product to the right person. We have to deliver that product in an exemplary way. We have to offer affordable care but also create a revenue stream by offering the lowest cost, highest quality healthcare. And finally, we have to bring value to our community,” says Royer.
Completing the 60-month plan to achieve excellence, defined by Christus’ leadership team as being in the 90th percentile in service and clinical quality, has not been without its stumbling blocks, however. Realizing their improvement action plans were either not being fully implemented or were not being “hard-wired” into each of the system’s regional operations, the senior leadership team had to create a culture in which all employees are held accountable.
“In order to maximize brain power and people power, we started teaching and embracing what I call ‘professional backtalking.’ We want our team members to push back and tell us honestly and openly what’s working and what could work better so we as a team can come to a consensus about what needs to be done to improve,” Royer says, adding that he’s been able to create an environment in which employees at every level feel comfortable “talking back” by having senior leaders in place who are confident in their leadership abilities and are willing to listen to and act on constructive criticism.
Since the Journey to Excellence initiative was put in place in 1999, the system has seen marked improvement in all four areas of focus. In fact, net operating income at the system—which at the formation of Christus Health was negative $146.1 million—has increased to $107 million. After having seen such success with the first round of their Journey to Excellence program, the team decided to implement a second phase. “We expect to be at 90th percentile for all four goals by 2009. If we’ve already reached that goal, we expect to show that we’ve been able to sustain it. We will make sure we sustain those goals and have them hardwired into our system to create more of a culture of excellence.” —Kathryn Mackenzie
Cabell Huntington Hospital, Huntington, WVCommunity and Mid-Size Hospitals (100-499 Beds)AN INSIDE-OUT REMODEL
In 2004, the senior management team at Cabell Huntington (WV) Hospital decided it was time for some major upgrades at the 268-staffed-bed teaching facility. Some areas of the physical plant had not been significantly updated since the 1950s, and the hospital’s culture was also in need of repair after suffering a contract-related work stoppage.
So senior leaders at CHH made it their primary business focus to rebuild their hospital—inside and out. To do so, the team decided everyone in the organization had to be involved.
“Healthcare is not an individual sport; it’s a team sport,” says Brent A. Marsteller, president and chief executive officer at CHH. “We’ve all got to be working with the same colored jerseys on, working for the same goal. Teamwork was critical to accomplishing our goals.”
From the beginning of the construction process, staff members were encouraged to share ideas that would be incorporated into the design. By guiding construction, staff could help ensure that CHH provided the best service for patients, Marsteller says. “They made the decisions on how to build these facilities; their input drove us to these decisions,” Marsteller said. “You have to have a team approach—I can’t tell you how to improve processes in X-rays or labs, but I guarantee you the people in there do.”
Seeing that their opinions mattered helped employees take ownership of the hospital, allowing senior management to overcome any resistance to change and establish a sense of trust among staff. The management team began meeting regularly with physician leaders, managers and other employees to develop strategic and operational goals.
The No. 1 goal was to establish a strong service culture. Senior management decided the best way to achieve this was implementing a balanced scorecard to track key hospital metrics. A cross-functional team that includes representatives from throughout the hospital steers the maintenance and use of the scorecard.
“We think that’s important so that everyone in the organization knows what our vision is and how we are doing against that vision,” Marsteller says.
Using the team approach through all levels of the organization, CHH achieved financial profitability and secured donations from local philanthropists for the construction project. The “new” Cabell Huntington Hospital is opening in November and will feature a new emergency room, new critical-care areas, a new labor and delivery unit and upgrades to most patient rooms.
The focus on adapting the hospitalwide culture to make it the region’s best place to work, practice medicine and receive care has paid off, as well. The CHH emergency department, for example, received the national “Award for Excellence” from the Gallup organization in 2005. Also, a 2007 survey of admitting physicians placed the hospital in the 96th percentile nationwide for “how well the hospital’s leadership fosters an atmosphere of trust.”
Despite the success, CHH will not rest on its laurels, Marsteller insists and will continue to adapt its culture to make it the best possible facility for patients and staff. “You never stand still in this business. When you do, you sink.” —Ben Cole
Wright Medical Center, Clarion, IASmall Hospitals (Less Than 100 Beds)RENEWED MISSION
Wright Medical Center’s financial picture started to stabilize with its conversion to critical-access status roughly six years ago. The same could not be said, however, for the hospital’s work environment and senior leadership. “We were very reactive and putting out a lot of fires. It wasn’t a real pleasant place to work,” says Chief Executive Officer Steven J. Simonin.
At that time, the Clarion, IA-based hospital’s patient satisfaction ranked around the 50th percentile in the nation. The organization had high employee turnover, and its growth rate was about 3 percent. So in 2001, the senior leadership team embarked on a mission to transform the hospital into the best place for patients to receive care, employees to work and physicians to practice. The goal: to become the area’s best primary healthcare provider by 2006.
First on the agenda was looking at healthcare from a new perspective. In rural areas, providers have a mission to take care of their community, Simonin says. “We talked from a leadership standpoint that it is not about financials; financials will happen if we provide the best service and quality.”
Rather than spending 60 percent of their time focusing on the hospital’s finances, senior leaders worked with The Studer Group and identified five areas central to the hospital’s new perspective—service, quality, people, growth and financials—and now devote an equal amount of time to each. The hospital’s leadership also realized success depended on every employee. “We felt we needed to put a strong accountability factor in,” says Simonin. “We’re talking from the frontline housekeeper all the way to the CEO.”
To align the staff around the same goals, each of the five pillar committees includes representatives from every hospital department and is headed up by a member of the senior leadership team. The agendas are driven by the employees with the senior leaders guiding the process, Simonin explains. Each employee is expected to submit a “bright idea,” which can be anything to improve service or quality or growth or finances. These ideas are tied to employee evaluations, as well. Rather than give employees the same standard pay raise each year regardless of their performance, the 25-staffed-bed hospital ties annual raises directly to employee evaluations, which are based on standards of behavior, departmental results, personal objective results and facility results. “When our housekeeper is concerned about accounts receivable, it’s because one-fourth of his evaluation is based upon hospital goals, and AR is part of that,” says Simonin.
Wright Medical’s renewed focus earned it the Press Ganey Summit Award in 2006 for the highest inpatient satisfaction for the past three years running (99 percent). It also ranked in the top 2 percent nationwide for employee satisfaction, and its operating margin increased from approximately 0.5 percent in 2000 to 5.5 percent in 2007. Wright Medical now has its sights set on the Malcolm Baldrige National Quality Award.
Simonin’s advice: “It is all about accountability, communication and dealing with your low performers. The other thing is, don’t be afraid. There are a lot of risk-averse leaders out there. Typically in the rural areas, we defer to bigger hospitals to set our direction, and that is unfortunate because we have a lot of unique opportunities that don’t arise in the bigger towns.” —Carrie Vaughan