Grandview Hospital Wins Award for Improved Patient Satisfaction
DAYTON, OHIO...Grandview Medical Center, Dayton, Ohio and their consulting firm, Compirion Healthcare Solutions received the Kettering Medical Center award of excellence for “Improvement in Emergency Services.” Grandview is a member of the Kettering Medical Center Network, a faith-based Adventist Network in Allopathic and Osteopathic traditions. Grandview ED and Compirion received the award for achieving improvement in four key areas: overall patient satisfaction ranking - into the top 20th percentile, patient likely to recommend ranking - up 15%, total LOS – down 25%, and billable volume - up 10%. The improvements were accomplished within six months.
During the first quarter of 2006, before the improvement, patient satisfaction ranking in the emergency department at Grandview Medical Center had fallen into the Press Ganey 8th percentile. Reimbursements were being challenged from Anthem Blue Shield and Medicare causing losses in revenue. By end of third quarter, the situation showed no significant improvement and flu season was approaching. Complicating matters, the ED was about to loose a key physician to frustration. The new hospital director felt the hospital didn’t have its processes in place and recognized the need to rebuild the department from the ground up refocusing on the patient.
Hospital administration set project objectives with specific measurable goals that would result in better outcomes for the patient. Goals included achieving core measures performance in the top 10th percentile; reducing turnaround time to less than three hours; reducing patient-to-physician time to within 30 minutes; and increasing Press Ganey patient satisfaction rankings to the top 25th percentile. A financial goal was also set – to grow $8,000 per week in new revenue, net expenses. Hitting all targets within six months was the final challenge.
To facilitate the change, Grandview’s administration enlisted the help of Compirion Healthcare Solutions, a Milwaukee-based consulting firm. According to Brenda Kuhn, Chief Nursing Officer, Vice President for Patient Care, and Executive Sponsor, “Compirion was chosen for their unique behavioral approach, management philosophy and their willingness to put their entire fee on the line by providing a money-back guaranteeCompirion was chosen for their unique behavioral approach, management philosophy and their willingness to put their entire fee on the line by providing a money-back guarantee. Compirion sent a team of two to work with the hospital ED staff. The Compirion team had a non-cookie-cutter, behavior-focused approach that was different. They embedded themselves in the ED environment and observed. They defined those changes that would have the greatest impact and built teams from the ED staff to carry them out. Every member of the department was actively engaged in the improvement process. A weekly dashboard was created to measure results.”
The Compirion team redesigned workflow throughout the department and made it patient-focused and patient-friendly. They developed and implemented a patient satisfaction program and revamped the Charge Nurse system, changing the way work was assigned to improve patient flow. The development of the Charge Nurse role was a pivotal point in the project. It was soon realized how integral a part it played not only in bridging the communication gap between the ED and AOC, but as an important part of the bigger picture of patient throughput and flow within the ED, the hospital, the community and neighboring hospitals.
According to Vicki McElfresh, Charge Nurse, ED Grandview, “The ‘Wow’ moment was the shift in viewpoint of the staff and physicians. They stopped seeing the Charge Nurse as someone they could complain to who took care of problems. Instead, they saw a person who knew the big picture, developed plans and understood how to prevent problems. With tools, role modeling and coaching, the Charge Nurse suddenly took on a new leadership role. Barriers were broken down as they began to think outside the proverbial box. This new proactive approach allowed the Charge Nurses to be true leaders, internal role models and to hold staff accountable to a standard of care for the patient. Soon the rest of the staff started to emulate the Charge Nurses in taking responsibility!” Dr. Charles McIntosh, ED Medical Director commented, “We saw a cultural change in the ED. As the staff and physicians began understanding the importance of change process, they became more involved in the department. The changes the team developed made our work easier and the result was better patient careThe changes the team developed made our work easier and the result was better patient care.
Having the Emergency Department physicians involved with the change gave them a better understanding of throughput process. Eliminating old habits resulted in better flow of patients (door to physician) and meeting quality standards.”
At the front end, a squad communication and management program was put in place. Specific goals for treating pneumonia and cardio cases were set by the Grandview team. These included performing blood cultures before antibiotic and administering antibiotic within four hours for patients with community acquired pneumonia. For cardio patients, goals included EKG upon arrival and door to balloon time in 90 minutes or less. Other improvements included developing a stroke program, bedside registration and improved patient tracking. Finally, the Compirion team designed a system to assess saturation level in order to determine when to divert.
In order to reach the financial goal, the team implemented several key initiatives. The first was development of a system of expectations and accountabilities. Next was improvement in the quality of documentation by implementing new charge forms. They determined a “top twelve list” of ways to maximize revenue and insisted they be printed on all documentation. To measure and ensure compliance, they developed and implemented a charge/ documentation audit tool. To improve reimbursements, they worked with Anthem Blue Shield, and Medicare to help define goals.
By week four, total LOS time was down 24%. At the project start date, Press Ganey results were in the 16th percentile. By month four, Press Ganey results were in the 78th percentile and climbing.
At the end of the project, total LOS had dropped from 4.03 hours to 2.9 hours. Press Ganey rankings were in the 100th percentile. Billable visit volume increased by seven patients per day for a growth of more than 10%. Number of patients likely to recommend the Grandview ED were up 15%.
“I really enjoyed working with them,” said Kuhn. “Their clinical lead was exceptional as was their data person. Compirion was quick to respond to issues that came up before they became problems.” According to Kuhn, They promised they would help us hit the target in six months and they didwhat impressed her most with the Compirion team was “They promised they would help us hit the target in six months and they did. Their unique behaviorally focused methodology changed the culture in the Emergency Department. The physician we almost lost says he now looks forward to coming to work every day.”
The steering committee continues to meet weekly to go over the data report card. As part of a Sustainable Results Program, the Compirion team returns twice during the year to review and make any adjustments.
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