IMPERATIVE: Patient Satisfaction
CASE STUDY: Meriter Hospital
MADISON, WISCONSIN Meriter Hospital is a 448-bed non-profit community hospital that provides comprehensive health services for residents of a seventeen county area in south-central Wisconsin. It is a major teaching affiliate of the University of Wisconsin and the fifth largest hospital in the state. As Madison’s Emergency Services market leader in a very competitive healthcare market, Meriter Hospital has always valued a high-functioning Emergency Services Department. Late in 2006, it became apparent to Meriter’s Administrative and Emergency Services leadership that a significant improvement initiative was overdue if Meriter wanted to retain its Emergency Services market leadership position and meet patient care expectations;
- Patient wait times and throughput times continued to climb above acceptable levels creating a risk of patients leaving without being seen and ambulance services diverting patients to other facilities.
- Patient satisfaction levels had fallen significantly below the 75th percentile using a national survey tool comparing Meriter to over 700 other hospitals nationally; Overall hospital inpatient activity continued to climb, making timely inpatient admissions from the ES very difficult.
- Employee satisfaction and morale were falling and turnover increasing as the stress of a busy ES and employee overtime took its toll.
- A key competitor, UW Hospitals and Clinics, the only Level 1 Trauma facility in the region, was planning the grand opening of their new state-of-the-art Emergency Services Department in June 2007.
Recognizing the need to enlist outside help to facilitate the kind of change necessary to address multiple operational and performance issues, Meriter’s leadership engaged Compirion Healthcare Solutions, a Milwaukee-based consulting firm. Compirion was chosen for their unique behavioral approach to process improvement and high performanceCompirion was chosen for their unique behavioral approach to process improvement and high performance. According to Vice President of Programs, Tim Sio, who championed the project, “Compirion was chosen for their unique behavioral approach to process improvement and high performance. Their approach was in line with leadership’s belief that to make long lasting change, you had to start with the behaviors of all of the team members involved in the care continuum and achieve alignment around purpose. We also agreed that this was a Meriter-driven project with Compirion playing an important and key support role. Meriter had to take ownership of the effort if we wanted long term and sustainable success.”
A multi-disciplinary team of Meriter management, staff, and physicians representing clinical and support departments across the hospital was convened to work on the project. With support from the Compirion consulting team, three key measures of success were identified for the effort;
- Sustain the Emergency Services market leadership position
- Improve patient satisfaction rankings to the Top 10 percentile
- Decrease patient throughput times to Top 10 percentile performance
In addition, Compirion assisted in the establishment of several key work teams and provided specific measurement tools and training for team members to immerse themselves in the Emergency Services Department processes. According to Sio, “Compirion trained the team members to do fundamental observational work of the key processes that made up the ES care continuum. The outcome of that work was enlightening for everyone involved.” The work team progress and key performance measures were summarized weekly, reviewed by the project steering committee and course corrections and resources allocated to the work teams as needed. This approach was crucial in sustaining the project momentum and team communication.
The Compirion consultants “lived” in the department. Making themselves available on all shifts, they took a very measured approach to reveal issues and observe hospital staff and their behaviorsThe Compirion consultants “lived” in the department. Making themselves available on all shifts, they took a very measured approach to reveal issues and observe hospital staff and their behaviors. According to Compirion project manager, Lisa Adams, “We tried to actively engage everyone on the staff and inject a positive approach. We coached the managers on how to coach peer interaction because sometimes people forget to be civil to each other -– especially when they are stressed. We made sure to incorporate the ideas of the staff members and soon we began to see a staff-driven change. Actually, they did the work!”
The work teams were set-up to address specific operational gaps; Patient Satisfaction Team, Registration/Triage Team, Throughput Team. One team in particular, the NOW (Staff) Team played a critical role in the improvement efforts. Chaired by charge nurse Mary Ryan, staffed with charge nurses, clinicians, support staff and physicians, and facilitated by Compirion, this team focused on real-time management. Their achievements included successful standardization and full implementation of over thirty emergent and urgent care protocols within six weeks; redesigned physician and nurse roles; the use of real-time acuity, rounding and service inspection tools; the creation and implementation of accurate pre-saturation and workload peak predictors used for staffing, coordination and teamwork among ED and all inpatient areas; a full assessment of workload by shift and position within ENA guidelines; and an effective system to adapt resources to need at key trigger points of the day. These changes were the main driver of several improvements in flow allowing the treatment of an increasing daily patient load, (from an average of 108 to 124 per day) in less time and with higher patient satisfaction scores. Most importantly, this completely eliminated diversion hours and improved the payer mix.
Sherry Casali, Emergency Services Department Director, lead the Registration/Triage Team. At both the front-end registration and back-end discharge processes, there were too many steps to go through before getting a patient into a bed or out the door. According to Casali, “The Meriter Team assisted by Compirion consultants redesigned the front-end flow by developing strategies for moving the critical patients out of the ES and into beds as inpatients. Registration was handled at the back end.” They also shortened the process by eliminating unnecessary steps and standardizing the triage, discharge and assessment processes.
Casali describes Compirion as “Very organized and methodical. They were working on-site alongside staff, listening and guiding people, which contributed a big part to the success. What they really created was an opportunity for a cultural change in the departmentWhat they really created was an opportunity for a cultural change in the department.”
After a little more than six months of the Compirion – Meriter engagement, patient satisfaction soared over 24% to a Top 10 percentile ranking, the market leadership position was sustained, employee turnover declined and billable volume was up by 9%. In December of 2007, the Meriter Emergency Services Department received recognition as a “Star Recipient” (a Meriter internal recognition program) for their dramatic improvement in Patient Satisfaction.
To insure lasting results and continued improvement, the Steering Committee continues to meet weekly. Patient throughput has improved significantly and will continue to get most of the team’s attention in early 2008. As part of their Sustainable Results Program, the Compirion team returns to the hospital twice during the year at no charge to check on the team’s progress and provide insight and feedback.
