Thursday, February 25, 2010

Patient Satisfaction on the Rise

All hospitals have their patient satisfaction results viewed on a publicly reported website. Our data from April 2008-May 2009 is posted below in the top graph. It shows our overall score of 69% for Likelihood to Recommend. As I have listed in other blog entries, you always want to shoot for "absolute satisfaction" (a goal of all Ascension Health ministries).

I also included our most recent Net Promoter Score results through HealthStream Research. This data is trended through February 3, 2010 and shows us moving in a favorable direction since April-June 2009 (the 4th Quarter of our Fiscal year). We have gone from 63.5% to 76.9% and have had a lot of focus around our coordination of care among the associates, physicians, volunteers and patients. Obviously, there are many factors which go into a patient experience. SJMC is part of Ascension Health, the largest non-profit health system in the nation. For the past three years, Ascension Health has looked to each hospital to ensure a Consistent, Exceptional Ascension Health Experience. While each hospital has plans around key patient satisfaction priorities, Ascension Health provides a newsletter with some best practices and success stories.

We are committed to ensuring you get updated and accurate information from us directly around any of our outcomes. Please feel free to contact me with additional information you would like me to post.

(click on images to enlarge)

Tuesday, February 23, 2010

Mayor's Prayer Breakfast

This morning I attended the 49th annual Mayor's Prayer Breakfast. This event is organized every year on or near George Washington's birthday by a committee of concerned individuals, in the name of 122 Mayors in the five-county Kansas City metropolitan area. It is supported entirely by voluntary contributions. Each year the theme of the event emphasizes ethics, morality and spirituality in business, labor, the professions and government.

The Breakfast Committee honored the 2010 Fund Recipient: the Child Protection Center (CPC). The CPC is the only nationally accredited children's advocacy center providing forensic interviews and evaluations to children who are alleged victims of sexual and physical abuse in Jackson and Cass counties in Missouri. The CPC serves approximately 700 children and their families each year.

Jane Chu provided the Breakfast presentation. Ms. Chu serves as the president and CEO for the Kauffman Center for the Performing Arts, located at 16th and Broadway in Kansas City, and scheduled to open in Fall 2011. Ms. Chu's presentation focused on leadership during ambiguous times, illustrated by the quote, "When you don't know where the path is, which direction should you go?" She shared the story of her mother Rosemary's journey from Communist China to the U.S. Her mother's story illustrated how important it is to have the courage to make changes and take chances when you are in your "uncomfort zone." What an inspiring story.

Congratulations to the CPC and thank you to Ms. Chu and all the Mayors.

Thursday, February 18, 2010

The Breakfast Club

Twenty-five years ago, The Breakfast Club was released in theaters. The tagline read, "They only met once, but it changed their lives forever."

Today, I held our first "Breakfast Club" meeting with approximately 20 employees and volunteers. We met from 7a-8:30 and it was really a very open and direct conversation. The feedback was great to hear and it gave us a chance to learn more about each other and our respective issues and concerns.

I will hold these Breakfast Club meetings at least every other month with a group of 15-20 so everyone has an opportunity to participate. The common themes and recommendations will be shared with our management team and each hospital department. It was very helpful to hear the exchange of ideas.

The discussion focused around 5 questions to get the dialogue started:

1. What would make St. Joseph Medical Center a better hospital?
2. What is the one thing you want to do but have not been able to do at the hospital?
3. What should we stop doing?
4. What do we do really well?
5. What are your other questions, concerns and suggestions?

Essentially some themes and recommendations from today's meeting included:

- People are seeing an increased workload per patient or situation, in part because of all the additional stress our communities are feeling in this economy. For example, our Public Safety Officer indicated that our incidence were up 20-30% over prior year though the census and volumes have not increased by that percentage.

- We need to become more comfortable reporting the "bad" things so we can work on ways to improve or change how we do things. I will share an A3 Board (see A3 reference below by Jamie Flinchbaugh, founder and partner of the Lean Learning Center in Novi, Michigan)

- I love this one...STOP sending out emails by individual departments to say they are closed on a holiday. Send one with all the departments closed. This will give people a chance to read the critical emails for better patient care. We are targeting Memorial Day as a time to own up to this improvement.

- Take an hour some day to "Walk in the Shoes" of another department. This will help us get to know each other better, improve patient placement and overall coordination of care.

- Review the amount of contract help and see if it would be better to hire people to fill these roles more effectively.

- Review our own department's inventory to look for waste. Utilize a central area to share supplies when appropriate (e.g., paperclips, pumps, etc). Steve F. in Purchasing sent out a note a few weeks back asking people to let him know what overstocked items we had so we could share across departments.


- Communicate why changes are made and the expected benefits for the organization.

- Communicate issues to specific people rather than as a "global problem." Those doing what they need to do should not have to get the same message as those not following our protocols.

- Enforce our existing policy rather than create a new one just because people do not follow the current policy.

- Stop saying someone is too busy to help. We are here to support one another so make sure to speak up if you need help.

- Share key data about the hospital and department so everyone can provide support on achieving the overall goals of the organization.

- Our volunteers are great. SJMC is a very friendly place. There is a lot of cooperation among units.

This breakfast was just one more thing which makes it so enjoyable for me to serve the employees, volunteers and physicians at and Carondelet Health.

Please let me know if you have similar get togethers in your organizations and the benefits realized.

A3 Reports:
A3 Reports are simply a waste free way for report writing and communication. But the basic building blocks of the A3 report provide a nice little template for good thinking. Here are frequent failure modes in using A3s:

The Problem Statement. There are few things both more fundamental and more frequently fouled than the problem statement. How you structure the problem statement determines your focus. Make sure your problem statement is actually about the current observable condition, not about a perceived solution, cause, or what you want.

The Current Reality. This is not a sit-down exercise; it is an activity. Go observe. See what is actually happening. You want the as-is, not the supposed-to-be or the my-belief-is version of reality.

The Target Condition. This is not the result you would achieve; this is how you will change the work in order to get the result. We don't just want to uncover solutions to problems, we want to design the work to create a new and better reality. Bad systems beat good people, and our job is to change the system.

Work in Pencil. Two things happen when we work in pencil. First, we are much more likely to draw pictures than on a computer. When we draw a picture, we are more likely to capture the system view, not just the results view. Second, we should be willing to backtrack as we learn. At least half of problem statements should change based on what you learn going through the exploration.

Don't grab A3s as the next lean tool. If you do that, you will have the same result as any time you grab a tool. Use it to help you understand and change the thinking of the organization. A3 does not change the thinking, but it makes the thinking that we hold visible. And you cannot change what you cannot see.

Tuesday, February 16, 2010

Employee Recognition - Modeling the Mission

We had a great turn out today for our employee luncheon honoring employees for their respective years of service. This is a tradition we brought back last year with celebrations every other month. It gives us a chance to share stories with each other and really reflects how much our associates model our mission.

Two employees were celebrating 30 years. Sally W. and Elizabeth 'Betty' Adamson (she said I could list her name and post her ID badge). Check out her original ID badge below - it included date of birth and social security number (blocked out). Clearly this is prior to additional regulations around privacy. We celebrated 370 years of service today - a luncheon record. Congratulations to those honored today.

Anyone else have their original badge from over 30 years ago?

Monday, February 15, 2010

Deadly Hospital Infections

I read an article entitled “Deadly infections: Hospitals can lower the risk, but many fail to act” in the March 2010 issue of Consumer Reports. St. Joseph Medical Center as part of Carondelet Health in Kansas City has implemented the following recommendations from leading authorities in infection prevention to prevent hospital-acquired conditions.

Carondelet Health has a comprehensive infection control program, with dedicated nurses to support efforts to monitor and prevent infections.

Our program incorporates evidence-based practices from leading authorities in infection prevention including the Centers for Disease Control and Prevention (CDC) and the Association for Professionals in Infection Control and Epidemiology (APIC). In addition, we comply with regulations from government agencies such as the state and local health departments, the Occupational Safety and Health Administration (OSHA) and the Centers for Medicare and Medicaid Services (CMS), as well as accrediting bodies such as the Joint Commission.

We have implemented all of the essential elements of an infection prevention and control program to prevent healthcare-associated infections, including central-line bloodstream infections, including:

-Proper hand hygiene (washing hands before and after patient care) is essential for our staff as well as patients and visitors.

-Use of appropriate barrier precautions, such as gloves, gowns, masks, caps, etc., by healthcare workers and visitors.

-Separation of patients with serious infections from other patients to prevent the transmission of infection.

-Environmental cleaning and decontamination of equipment, especially items that are frequently touched or are close to patients, such as bedrails and bedside equipment.

-Monitoring the cleaning, disinfection and sterilization of instruments and equipment used for patient care.

-Proper disinfection of the patient’s skin prior to medical and surgical procedures

-Sharing information with patients and families so they understand the importance of infection prevention practices in all healthcare settings and at home.

Please to do not hesitate to contact us with any additional questions or concerns.

Cake Anyone?

The staff on 4 East received this cake over the weekend for Valentine's Day from an appreciative family. These are the type of gestures which give me great pride of the care we provide each and every day.

I saw some King Cakes around the hospital today. Send me any photos of King Cakes around your organization. Enjoy the remainder of Fat Tuesday and happy Mardi Gras.

Friday, February 12, 2010

Public Safety Officers

Last week, I had a chance to have lunch with our Security team who are now officially our (drumroll please)...Public Safety Officers.

We changed the name to reflect the additional scope of services these proud associates provide - safety, security and emergency preparedness for our hospitals.

The team is seen below with Larry R., Regional VP, of Facilities Management, Mike K., Regional Director and Sr. Gabe, CSJ, Spiritual Care.

Our team has, would you believe this, over 250 years of experience in healthcare and almost 400 years in overall serurity/protective force work.

There is such a sense of pride, empowerment and humilty with this team. We are truly a safer place because of them.

Thursday, February 11, 2010

I'm Listening - Did You Say Something?

As someone originally from the east coast, my family was never short on words. We all understood the "Art of Talking." When one of my siblings went off to college, I think my parents were shocked to find how much I actually talked! Well, not literally, but clearly I was allocated a larger voice with fewer people in the house.

Being a strong listener is something I have always strived for through my career and it was something which was identified as an improvement opportunity for our leadership tam through our recent Associate Engagement surveys. To add to it, many of us have cell phones which provide constant entertainment, news, assistance in our daily lives, calendars, social networking, etc. which bring us closer to larger groups of people or people not in the area. On the flip side, it puts distance between us and the person(s) right in front of us.

With all the challenges hospitals and healthcare organizations face every day, it is no easy task advancing an organization. Without a doubt, it truly takes a village to manage a hospital...and better listening.

I read an interesting article and pulled some key excerpts below:

Learning The Art Of Listening
Steven Berglas, Ph.D., 07.09.09

You're tuning out and you don't even know it. Slow down and open your ears.

Seasoned management consultant Harry Levinson wrote a book called Ready, Fire, Aim: Avoiding Management By Impulse. Its core message: Only after considering a series of options--and not just the ones apparent in the heat of the moment--can you hope to make consistently decent decisions. In short, it's about the importance of listening.

The fact is, getting people to listen--really listen--is hard. And given how busy entrepreneurs are, it's easy to see why they most of all might fall prey to "selective" listening. Unexpected thoughts or approaches vying for purchase in an already crowded cranium can come off like a bunch of hot air. Result: Entrepreneurs flicker in and out of conversations, often missing the good stuff.

St. Joseph Medical Center and our sister hospital St. Mary's Medical Center were really struggling with their recruitment efforts. Out managers and staff were all very frustrated with the Carondelet Recruitment Center (CRC), our recruitment team and the executive team for allowing these struggles to continue. We listened to our managers and changes were made. I'm happy to say our most recent Recruitment Scorecard reflected improvement in Manager Satisfaction, retention rate, overall time to fill and RN time to fill. It was a true collaborative effort with our CRC, managers, executive team and candidates. We listened to each other and results were delivered:

- Our manager satisfaction rate is 97% over a target of 80%. It has improved from 47% in March 2007.

- Our 90-day retention rate is 93.5%, an increase over a baseline of 70% in 2007 and an already ambitious target of 90%.

- Our overall time to fill and RN time to fill are around 50% faster than the goal of 54 and 66 days, respectively. On average, we are filling our open positions in less than 30 days.

Active listening certainly does make an organization stronger. I look forward to hearing from you.

Wednesday, February 10, 2010

Going Undercover

Larry O'Donnell, President & COO of Houston-based Waste Management.
Source: Dan Littlejohn: CBS

Well, the new show Undercover Boss on CBS just started after the Superbowl starring the President & COO of Waste Management. On Monday, I was walking through the different units and at least five people asked me if I had plans to go "undercover." Interestingly enough, I have done this at St. Joseph Medical Center (SJMC) and most of my previous employers. Since word gets around quickly, it has to be done early into the job or in areas where people do not know you. I tend to get around on a lot of shifts, days and departments so I am familiar with the majority of our team even if I have not met everyone.

I would like to share some of my experiences going undercover at SJMC and prior employers:

- Housekeeping /Environmental Services (EVS)
- Barista in our coffee shop
- Omelet maker

In EVS, I had a whole unit of staff ignore me for a couple of hours. Not even a greeting came my way when I said hello first. It was not until I changed back into my suit when people quickly looked up and realized I was the one cleaning their patient rooms.

At the coffee shop many people were extremely friendly though appeared to be in a rush - very typical of coffee drinkers.

As an omelet maker, it was a mixed crowd. I had my badge flipped backwards for awhile and found myself in a similar situation as I did when in EVS. After flipping my badge around to show my title, I noticed people changed their approach.

Overall, most people were cordial but not as engaging as I would want to see as an employee. There has certainly been an opportunity across all my employers where all employees could be more engaging and supportive of one another.

In prior organizations, I started monthly breakfast meetings which allowed an opportunity for employees to understand the direction for the organization and share their thoughts on ways we could make the hospital a better place for patients, physicians and each other. It also allowed people the opportunity to meet and "break bread" with other departments which fostered collaboration across the hospital. We are starting similar breakfasts next week at St. Joseph Medical Center.

And yes, I am open to going undercover in your area...let me know if you have an interest.

Friday, February 5, 2010


The other day, I discussed with my team the importance of managing our financial performance. I suggested that everyone look at their budgets and then manage their expenses as if they only had 90% of that amount to spend. This philosophy could pertain to quality issues, staffing, supplies or volume.

The same method can apply in our personal lives. If you have a budget to spend $1,000 on your credit card, focus on ways to manage to $900. Two outcomes may occur: you will be relieved you planned ahead when the bill turns out to be $1,000 or you will have an extra 100 bucks. Both outcomes are positive.

Sure, you may not know when or what will happen but if you really look at your day, your business, your personal life, there are trends you can follow. Basically, the point is having the discipline to keep 10% in reserves for the time it is critical. Cynde, our Chief Nursing Officer, took my discussion to heart and left me a small gift:

As you can see, the good folks who make Lifesavers plan ahead for all contingencies: there is actually an extra 10% sealed in reserve.

Wednesday, February 3, 2010

Respect My Time - Get me out of this hospital


Can you imagine going to Chipotle and having a dining experience for almost 2 hours? For that matter, would you expect to leave a 5-star restaurant within 30 minutes? Every time I visit a restaurant, their focus seems to be on valuing my time and demonstrating value for the food, service and overall experience. By the way, it drives hospital people crazy to compare a hospital experience with a restaurant experience. Interestingly enough though, consumers do look at the experiences in the same way in that they expect us to value their time and demonstrate value for the care (instead of food - though we do happen to serve great food at St. Joseph Medical Center), services and overall experience.

For the past year and a half, SJMC has truly excelled around our Emergency Department diversion (not closing the ED to ambulances) which was a daily practice of the hospital prior to that timeframe. I know that I have bragged about this in prior blog entries. We typically average less than 5 hours with a majority of months at zero. Unfortunately, we saw a spike in January with almost 30 hours of diversion (the majority of this in the first half of the month). This not only hurts our efforts to serve our community, it also increases the length of stay for our patients and reduces our hospital and Emergency Department census.

Note: The Institute for Healthcare Improvement (IHI) indicates that Hospital flow can be measured at several levels, and each level provides a portion of the total measurement picture (see:

Patient and Community
Hospital Throughput
Hospital Activity
Hospital Performance

Fortunately, our nursing leaders took matters into their own hands and changed our Bed Meeting from mid-day to 9:00 a.m. and 3 p.m. A Bed Meeting helps focus on getting our patients most effectively through their hospital stay with a focus on their safety and respect for their time (not many patients want to stay longer in a hospital unless is critical to their health). I am pleased to see that our ED diversions have dropped back down over the past couple of weeks. We will continue to watch the success of the enhanced Bed Meeting and I expect we will see the following improvements with respect to patients' care and time:

- Reduced length of stay for patients who are appropriate for discharge;
- An increase in the the percentage of patients discharged by 11:00 a.m. and
- Reduced length of stay in the Emergency Department (allowing us to get those needing admission to the inpatient floors in a more timely manner and those ready for discharge to go home in a more timely manner).

I would like to thank our nursing leadership team for taking charge of this issue. While it is painful in many ways to change a system that has been in place for many years, it is very rewarding to see that this change leads to better outcomes and experience for those we serve.

I look forward to hearing from you.