David Fox, CEO of Good Samaritan Hospital in Downers Grove, Ill., believes transparency is critical to improving the performance of any hospital. At Good Samaritan, both overall organizational and individual manager goals are shared throughout the organization, and each manager's performance against those goals is then shared across the organization on a monthly basis.
"It's important for hospital leaders to be very open with what they're trying to accomplish, and transparent goals are part of that openness," says Mr. Fox. "If people don't know what goals they are working towards, how can they align their behavior and actions to achieve that vision?"
Objective, measurable, cascading goals
The first step to achieving transparency is setting and holding people accountable for organizational goals that are objective and measurable, says Mr. Fox. Aiming to be the "best hospital in the area" is certainly a goal, but it is not objective or specific enough to align behaviors. Instead, hospitals should select crucial areas within which to set goals and measure performance. Good Samaritan focuses on six key outcome areas: health outcomes, employee engagement, patient satisfaction, physician satisfaction, growth and "funding our future," which includes operating margin, expense management and fundraising goals.
The hospital's leadership begins the goal-setting process by determining the goals that will guide the organization within each area, and then these goals are cascaded down into narrower goals for directors and managers. By the end of the goal-setting process, each individual manager will have 8-10 objective, measurable goals, such as achieving a patient satisfaction rating of a certain percentile, says Mr. Fox.
The goals are then weighted by relative importance, and individual and organization performance against each goal is tracked monthly. Each manager's performance is published on the management's Intranet site, and Mr. Fox publishes what he calls his "report card" every month to the entire management team, physician leadership and the board of directors, he says.
Performance improvement
The biggest benefit to publishing these reports on a monthly basis is that every manager is able to immediately assess and manage areas for improvement. If performance was assessed only once per year, areas targeted for improvement could be overlooked for many months. Publishing the scorecards also allows managers of departments that many not be hitting certain goals to identify managers who excel in that area and contact them for information on best practices and other advice, says Mr. Fox.
For example, in its most recent physician satisfaction survey, the hospital scored in the 97th percentile nationally, according to HealthStream. However, leaders identified two areas the hospital could improve upon: ease of scheduling inpatient surgery and ease of scheduling and performing outpatient surgery. In response to these scores, the surgical departments are currently examining ways to improve upon both inpatient and outpatient surgical scheduling and recently implemented block scheduling for 60 percent of its cases. The hospital is also recruiting an additional anesthesiologist to expand the hospital's OR capacity.
Consumer interest in transparency
The hospital evaluated sharing its performance on clinical outcomes with its community on the hospital's Web site, but surprisingly found community members were, for the most part, uninterested in accessing the data. This lack of interest was an important lesson for the hospital as it works to improve its transparency with its community — a move that is expected to become more and more popular within the industry as consumer consciousness regarding healthcare decisions is likely to grow.
"A key learning for us was that, as we begin to be more transparent with patient, we will have to really work hard to boil down the information in a way that it can be easily understood by our customers," says Mr. Fox.
Outcomes
Transparency has apparently paid off for Good Samaritan — the hospital met or exceeded its goals in most of its key outcome areas for 2009. Employee engagement scores reached the 98th percentile, according to Morehead Associates, tying for the best results in the hospital's history. Physician satisfaction reached 97 percent. In core clinical measures, the hospital scored at or about the 90th percentile for all four of the following benchmark areas: acute myocardial infarction, congestive heart failure, pneumonia and surgical care infection prevention. None of these accomplishments would have been possible without aligned goals and transparent performance evaluation, says Mr. Fox.
Mr. Fox has served as CEO of Advocate Good Samaritan since 2003. He earned a graduate degree from the University of Chicago in healthcare management and previously served as president of Central DuPage Hospital in Winfield, Ill.