HL20: David Fox—Improving Care Through Accountability

In addition, the organization established 27 standards of behavior that the staff must adhere to. A group of employees and managers created these standards that are representative of being a high performing and compassionate organization. "We said to the whole organization that we are going to live these behaviors and anyone—myself included—who doesn't live these behaviors will be asked to remediate," Fox says.

The results have been outstanding. Not only has Good Samaritan achieved higher physician, patient, and employee satisfaction rates, which are all in the 90th percentile, but it has improved clinical quality as well. For example, in 2004 Good Samaritan's outpatient satisfaction score was in the seventh percentile, Fox says. "No change happens without leadership saying we can do better, so we said outpatient satisfaction is going to be important."

Then Good Samaritan improved the technology around scheduling and registration, brought in new management where necessary to achieve higher results, adopted best practices for customer relations, and posted patient satisfaction results publically—weekly to the hospital staff and monthly on public boards in every department. By July 2006, outpatient satisfaction was in 99th percentile.

"We focused on culture, created standards of behavior, decided to hire people who are a cultural fit, and hold ourselves accountable to how we behave," Fox says. "As a result of these fundamental management moves, we really dramatically improved our performance over a short period of two to three years."