Northwest Community Healthcare sought and embraced a culture change.
Approximately two and a half years ago, the Arlington Heights, Ill.-based hospital decided to center its focus on patient experience and patient satisfaction as a vehicle for that change.
"It was our belief that everybody is focused on the patient, so if we can come up with something that is going to differentiate the patient experience, everybody would buy into the fact that significant cultural change is needed," said Stephen Scogna, CEO of NCH, in a focus group hosted by Care Logistics at the Becker's Hospital Review 6th Annual Meeting in Chicago.
Mr. Scogna spoke with Karl Straub, president of Care Logistics, about how to ignite culture change, and decided to center the strategy around Care Logistics' process related to patient throughput.
NCH presented its cultural change and patient experience initiative as the Aim for Excellence, a care coordination model focused on improving patient satisfaction. Through this initiative, NCH implemented Care Logistics' Hospital Operating System care coordination platform. This logistical control system for care enabled the hospital to more efficiently orchestrate the care of patients from admission through discharge.
"We wanted to differentiate ourselves," Mr. Scogna said. "We believe this process — in terms of the patient experience, in terms of logistics and really making sure the patient is at the right setting at the right time — was absolutely critical for us."
In addition to a process transformation, Aim for Excellence also initiated an organizational transformation for employees. Part of NCH's new care coordination model included the establishment of the Hub, a physical control center located right outside a patient care area where clinical care coordinators and case managers are based. Michael Hartke, executive vice president and COO of NCH, likened the Hub to an air traffic control system, where individuals receive data and use it to direct movement.
Additionally, a clinical care coordinator is also located at each unit, enabling a true hub-and-spoke model of care. Kimberly Nagy, RN, CNO and executive vice president of patient care services at NCH, said since the hospital has implemented its Aim for Excellence program, it has not gone on diversion one time.
"Everyone has the spokes," Ms. Nagy said of traditional care coordination models. "[We are] bringing the spokes to the hub to allow it to flow and work."
This new model required a change in historic hospital roles. While NCH expanded roles like the care coordinators, the hospital at the same time eliminated the charge nurse role, a change that wasn't easy for all employees accept. Ms. Nagy said it can be challenging to uproot and modify work process routines that employees have been accustomed to for the entirety of their careers.
To address this, NCH utilized its patient care leadership council to help disseminate information to front-line staff to engage them in initiatives that may drastically change the organization. This included less visible or underrepresented departments such as transportation.
"Those areas that are incredibly important to what we do everyday, they now were at the table saying, 'How can we better support what you do?'" Ms. Nagy said. "The organization realized that if they felt they owned it, it made sense to them, from a physician perspective, clinical perspective and support staff perspective."
Mr. Scogna said another obstacle to implementing the new care processes was the top-down way in which leaders approached the new model. Executive leaders presented the model they planned to deploy to staff. "As we started to implement that model, we began to realize there was more that we could learn from the employees in terms of the implementation of that model and the willingness to tweak that model," Mr. Scogna said. "These folks have wonderful ideas, and we need[ed] to step back and look at [them]."
Mr. Scogna added that leadership alignment was another key element to a successful implementation. Such an initiative requires a proper balance between having the right leaders and giving employees autonomy and resources to carry out the mission.
"At the leadership level, we said, 'This is how we're going to do our business,' but at the same point in time we had to give [front-line workers] the tools," Mr. Scogna said. Those tools included people who understood how to follow the new process and leaders to help guide the hospital through the changes.
Though NCH faced some obstacles and challenges in their Care Logistics implementation and subsequent culture change, the hospital had a very successful rollout of the initiative on an accelerated schedule.
The changes, both patient-facing and organization-facing, are apparent. In addition to reaching no diversion status, Ms. Nagy said NCH also has significantly improved a handful of other metrics, including the percentage of patients who leave the hospital without being seen in the ED. The national average is approximately 2 percent of the hospital's patient population. When NCH embarked on its Aim for Excellence program, its rate was 1.18 percent. Now, Ms. Nagy said the hospital is at 0.48 percent.
The patient-facing outcomes of Aim for Excellence are apparent. But Mr. Hartke said the initiative has also been successful in initiating the culture change that really sparked this transformation.
"It's given us an opportunity to centralize some functionality and help people understand, from a multitude of processes, what patients go through," Mr. Hartke said. "It gives them an opportunity to visualize that and then be accountable as well."
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