HL20: David Fox—Improving Care Through Accountability

This level of accountability launched the hospital in the right direction because for the first time all the members of management knew very clearly what the organization's goals are and what their contribution to the goals are, Fox explains. The goals were weighted to demonstrate priority, he says.

For example, if 20% of the organization's goal was on patient satisfaction— 5% for inpatient, 5% for the ED, 5% for ambulatory, and 5% for outpatient—and a nurse manager for one of the nursing inpatient units didn't have very good patient satisfaction rates, Good Samaritan would establish a weight for inpatient satisfaction of 25% on that unit.

It would score patient satisfaction on a five-point scale with anything over three being pretty good and four being really outstanding. "Everybody knows all the time how we are doing on achieving goals and that allows all of us to know, all year long, where we are doing well and where we are falling short."

Building loyalty

Historically, Good Samaritan hired for skill and prayed for cultural fit. It decided to not only change the focus by screening for skill and hiring for cultural fit, but also include lower-level staff in the hiring decision. Good Samaritan adopted a peer-interviewing system. If the manager determines a candidate could be a good hire, they send the candidate to the unit for shift-based peer interviews.

"We've trained about 450 of our best associates on how to do behavior-based interviewing," says Fox, explaining that two to three staff members will interview the person and give feedback to the manager. "If they say to the manager 'This person is not a good fit for our nursing unit,' then most of the time the nursing manager is obliged to accept their opinion and keep looking," he says.