Ownership in the Age of Transparency

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Ownership in the Age of Transparency

• Sandy Rush, BSN, MA, FACHE
• Director of Service Excellence
• Catholic Healthcare West

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Session Objectives

• Provide an overview of one systems journey to
  improved the patient experience
• Describe the differences in why some hospitals
  improved more than others
• Describe levels of accountability and the
  leaders role in accountability

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CHW Key StatisticsHospitals Medical Centers
41 Acute Care Beds 8,539 Skilled Nursing Beds
982 8th Largest not-for-profit system in
nation Largest hospital provider in
California Full-time Equivalent Employees
42,845 Physicians 9,688 General Acute Patient
Care Days FY07 1.7 million Community Benefits
and Care of the Poor FY2007 922 million
Mercy Medical Center Mt. Shasta
St. Elizabeth Hospital, Redding
Mercy Redding
St. Marys Reno
Sierra Nevada
Woodland Healthcare
Mercy Folsom
Mercy San Juan, Mercy General, Methodist Hospital
Mark Twain
St. Josephs Stockton
St. Marys Medical CenterSt. Francis Memorial
HospitalSequoia Hospital
Oak Valley Hospital
Mercy Medical Center Merced
Dominican Santa Cruz
St. Rose Dominican San Martin St. Rose
Dominican Rose De Lima St. Rose Dominican
Siena
Bakersfield MemorialMercy Hospital
BakersfieldMercy Southwest
French HospitalArroyo Grande HospitalMarian
Medical Center
St. Johns Pleasant Valley
St. Johns Oxnard
San Gabriel Valley Medical Center
Northridge Hospital
Community Hospital of San Bernardino
Glendale Memorial
St. Bernardine Medical Center
California Hospital St. Marys Long Beach
St. Josephs Phoenix Mercy GilbertChandler
Regional
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CHWs Mission - Promote the healing ministry of
Jesus

• Delivering compassionate, high-quality,
  affordable health care
• Serving advocating for the poor and
  disenfranchised
• Partnering with the community to improve the
  quality of life

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FY 05 Challenge with Patient Satisfaction

• Lack of focus
• 13th percentile
• 2 year goal to move to 80th percentile
• First year little movement

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Nursing Care Bundle
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Accountability
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So How Do We Make It Happen?
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We Educate
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We Post Policies
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We Expect Magic
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Surprise
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3 Es for Excellence

• Educate
• Expectations
• Execute

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Educate

• Educate
• Test for competencies
• Show results
• Keep it centered on patient care
• Explain the plan, and invite staff to come along
• Make it clear that if they dont there is no
  place for them

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Expectations

• Time frame
• Allow a grace period
• Be clear when the firm accountability starts
• Identify how staff will be held accountable and
  what tools will be used.
• Establish consequences (both for the staff and
  for the patient) for both compliance and
  non-compliance

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Execute

• Essential
• High performers are counting on it
• Middle performers are watching for it
• Low performers are counting on the fact that
  youll loose focus
• No surprises

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Its All About Leadership - Who is Your Staff
Following?
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As a Leader, What is Your Commitment?
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Start with yourself

• Be present
• Learn the skill
• Prove you are doing it
• Intense candor to the discussion

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Start with yourself

• Shadow the staff all shifts
• Demonstrate your own commitment
• Test staffs knowledge and awareness
• Be willing to tweak the process, but do not
  abandon the process.

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Obtaining Feedback

• Direct Staff Observation
• Patient Interview
• Quizzing Staff

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Measure and Communicate the results

• Measure both Quantitatively ( How many / How
  often) and Qualitatively ( How well / what
  results)
• Link rewards to performance so everyone knows who
  to go to for role modeling.
• Dont hesitate to show individual results when
  ever possible and share broadly

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Accountability

• Consequences. No consequence- no accountability.
• If you permit it,
• you promote it

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What It Took to Prevail

• Unwavering focus on the objective
• No excuses
• Dogged determination
• The unwavering resolve that comes with knowing
  your objective is RIGHT

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The Diamond Difference

• Consistent, thorough education
• Clear expectations
• Consistent leader rounding auditing
• Controlled customization
• Continued vigilance
• C Suite Focus

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Excellence Requires Consistency
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Wisdom of the Ages

• Excellence is what we repeatedly do
• Excellence, then, is not an act, but a habit.
  
  Aristotle

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Getting Results - The Nurse Leader

• Model the behaviors
• Hold people accountable
• Observe Staff Recognize/Coach/Counsel
• Round on patients
• Celebrate successes
• Manage up staff doing a good job
• Share results

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• In a hospital life and death are on the edge of
  happening every day and pain is ever present.
• In your hospital how many people will die today
  and how many will be born?
• Today is the last day on earth for some of your
  patients, and they are spending that last day
  with you.
• And today is the first day on earth for some
  people, and they are spending that day with you
  as well.

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What could be more sacred than to be with people
on their first day of life, or their last day on
earth?   What could be more meaningful than to
be present with them when they may be in their
greatest pain or highest joy? Taken from
Radical Loving Care