St. Joseph Mercy Ann Arbor President on Top Outcomes Performance: 'It Starts With Culture'

Alonzo Lewis shares the strategies that have enabled St. Joseph Mercy Ann Arbor Hospital to be named the #1 Major Teaching Hospital in America, and how culture drives the hospital.

Each year, Fortune/IBM Watson Health names the 100 top hospitals in America based on studies of hospital outcomes performance data. Winners are put into the following groups: 15 Top Health Systems, 100 Top Hospitals, and 50 Top Cardiovascular Hospitals. Among the 100 Top Hospitals category is the 15 Top Major Teaching Hospitals.

St. Joseph Mercy Ann Arbor Hospital, a teaching hospital with 547 beds in Ann Arbor, Michigan, was named the #1 Major Teaching Hospital in America for 2020, making this the 11th year that the hospital has made the 100 Top List.

Alonzo Lewis, president and COO of St. Joseph Mercy Ann Arbor Hospital and president of St. Joseph Mercy Livingston Hospital recently spoke to HealthLeaders about this accomplishment, and how the workforce and patient culture plays a role in driving the hospital to greatness.

This transcript has been edited for clarity and brevity.

HealthLeaders: What strategies has Ann Arbor hospital taken to consistently make the Fortune/IBM Watson Health 100 Top Hospital List 11 times, and becoming the No. 1 major teaching hospital in America?

Alonzo Lewis: There is a pretty unique culture of high performance and excellence here in our health ministry. It's not so much a recipe; it's something that develops organically and gets maintained over time. You have to put the time and energy into tending, and caring, and feeding that culture in the right way. 

It starts with having a highly engaged medical staff. I've been in this field of healthcare administration for almost 30 years, and this is probably the most highly engaged medical staff that I've experienced in my career. We've got physicians and physician leaders incredibly active in our quality committee. We have physician representation and positional leadership on our stewardship council, where we review our budgets and our finances, and we make resource decisions there.

We have a more strategic capital advisory committee. We're intentional to ensure that that committee is co-chaired by an administrator and a physician leader. That co-chair process ensures that we have good physician leadership on the committee to make those robust capital decisions that need to be made on an annual basis. It's a very thoughtful process that goes into how we spend capital, and our physician leaders' fingerprints and input are all over those decisions.

We have a physician engagement committee that identifies younger physicians who have an interest in taking on physician leadership roles later in their career. It's a way to keep them connected and give them a meaningful agenda to work through, and work on, to support enhancement of our organization and culture over time.

It starts with culture. The engagement of our medical staff is second to none. We've got an incredibly talented and compassionate nursing and ethical staff across both of our inpatient and outpatient care settings. I'd be remiss if I didn't talk about the role that pharmacy plays and how highly skilled those professionals are that support how we administer care to our hospital, how we design protocols, how we put things in place to support highly reliable care.

I am hugely sensitive to the role that support services plays in achieving these tangible outcomes that drive these rankings across organizations, such as ours.

We've got a coach of experts from our senior leadership team, our management team, and our physicians, so we are routinely looking at our outcomes. We are routinely looking at our patient experience comments [and] at complaints that may come our way and identify where we might have a common theme.

HL: What strategies are in place at Ann Arbor and Livingston hospitals for patient experience, clinical outcomes, and operational efficiency?

Lewis: We've got our Trinity Health Leadership System, which is our way of branding visual management and the use of Lean principles to drive how we improve care processes and our core outcomes. If you walked into our boardroom, you'd actually see a visual representation of our balanced scorecard. You'd see some trending information around each of those indicators, and below that you'd see specific action plans that people and teams are accountable for coming together to work on.

Our leadership team digs deep into one of those at every meeting. We get up from our table, we go to the board, the accountable executive gives us the quick summary of that particular indicator, talks about the specific action plan, and we have meaningful dialogue around where that particular leader might need additional support to reverse the trend or to accelerate movement on the outcome.

That process creates shared accountability. It's not just our finance people focused on our supply costs per case-mix adjusted discharge; it's everybody around the table to have the ability to influence that particular indicator. And through that process, we create shared understanding of what we're working on. Then we can take that information and have those same deep-dive conversations as a department to support moving that metric.

We have patient advisory teams and committees where we hear routinely from the voice of our patients. We start every board meeting with having a patient come in, and we give them 10 minutes to share their experience how they encounter our health system, all the things that went well, and they share with us with brutal honesty around where we can improve.

Our board is made up of certain positions that are internal to our organization, and community members that are external, and we've got our leadership team there as well. So, you've got a multidisciplinary group hearing front and center.

We also take patient advisors and we put them on key projects. [Two to three years ago] we put $25 million into our Cancer Center. We had three oncology patient advisors on the steering committee that provided oversight for the design of that new campus. That was instrumental in terms of how we redesign care processes, and what additional amenities we put within that new Cancer Center. Having that voice of the customer there at the table enables us to improve and design and hear processes, and how we do the core work that meets the needs of patients.

The other thing I'll speak to is a collaborative practice team. We might have a collaborative practice team come together around improving our hospital-acquired infections. They may deep dive on a bloodline infection. We bring physicians, physician leaders, nurses, nursing leaders, environmental services workers, etc., [together]. They own a particular project or indicator and they're accountable or responsible for taking on the remedy, or to improve upon that particular metric. Those collaborative practices report out through our quality committee.

So those would be some of the strategies in which we organize teams of people and data to drive improvement of outcomes.

HL: What specific areas or issues are you wanting to improve for the Michigan communities?

Lewis: Every couple of years we do a community health needs assessment and it identifies what's happening in our community and where we might need to focus a lot of our effort.

This pandemic has illuminated the fact that we have a unique opportunity to be better connected. When you look at how the pandemic affected certain socioeconomic groups, certain ethnicities, etc., that illuminated a gap for us that I am intentional around closing.

I would also say that there are a number of community organizations doing great things across southeastern Michigan and across the ministry service area that we serve. The question then becomes, how connected is my leadership team to many of those community organizations? How do we open those two lines of communication to better collaborate? How do we share our leadership? How do we better find those areas of interest and alignment between me, the organization, and my leadership team? We can then have a greater collaborative effort for healthcare improvement, and also be better prepared to respond to a pandemic next time something like this happens.