Room temperature: • All individual heating systems in each room were cleaned and upgraded. • Individual room thermostats were added with signage explaining how to adjust the temperature. • Individual fans were provided as requested. • Window darkening coating was placed on the interior of the windows. • The return (fresh) air flow was increased to the pediatric unit. In addition, the venti- lation unit was replaced. (10/03) Staff sensitivity to inconvenience and staff attitude toward visitors: • Families were provided 20 percent cafeteria discount cards. (9/01) • Parents choosing to stay with their child were given hygiene supplies. (9/00) • A VCR was placed in every child’s room with appropriate controls. (11/02) • “Please Do Not Disturb” signs were placed in the unit. (1/02) • All units had distributed welcome pamphlets (and signs were updated). (5/03) • Snack, soda, and juice vending machines were made available in an area conve- niently adjacent to the pediatric floor. The changes that were instituted were measured by the results of the Press Ganey Report results from July 1, 2003, to September 30, 2003 (see Exhibit 16.7). An increase in scores was shown in all five areas of the needs assessment. CASE #3: Point of Star—Cost and Quality Title: “Guidelines for the Use of Interventional Cardiology Medications in the Cardiac Catheterization Lab—A Multidisciplinary Approach” Project team leader: Howard C. Cook Utilizing the principles of value analysis and evidence-based medicine, a program was developed highlighting guidelines for the use of glycoprotein IIb/IIIa inhibitors (abciximab [ReoPro], eptifibatide [Integrilin]), and the direct thrombin inhibitor bivalirudin (Angiomax) in interventional cardiology procedures. The goal of this project was to assure optimum patient outcomes and maximum financial efficiency. It was recognized that abciximab was utilized in approximately 60 percent of all cases involving these agents. This agent was also the most expensive of the three agents usually employed. A thorough review of the medical literature was undertaken to see whether there were specific indications or patient types who benefited most form the use of abciximab. For all others, the preferred agent would be eptifibatide (or bivalirudin, if the clinical situation was appropriate). At the same time, a national survey of top cardiac hospitals (based on Solucient data) was conducted to see whether they had established criteria for the use of these products. Once all data were reviewed, a proposal was presented to the cardiology steering committee for approval. At that time, criteria were fine-tuned and the project was approved. Educational signage was displayed in all procedure rooms, indicating situations in which abciximab would be preferred and requesting the use of eptifibatide (or bivalirudin) in all other patients. Target drug usage data, as well as 380 BEST PRACTICES INLEADERSHIPDEVELOPMENT AND ORGANIZATIONCHANGE cart_14399_ch16.qxd 10/19/04 1:19 PM Page 380 concomitant interventional medications used, were documented to determine compliance to approved criteria. Physicians who consistently used abciximab outside of approved criteria were contacted and the program was reviewed. There was a consistent reduction in the number of cases that fell outside of established criteria as the program continued. Success of the project was measured by evaluating the cost per case of interventional procedures in which the target drugs were used. Since its beginning in April 2003, the estimated annual savings to the institution is in excess of $250,000. There have been no reports of adverse drug events as a result of the therapeutic preferences of this program to date. CASE #4: Point of Star—People Title: “Creating a Best Place to Work” Project team leader: Joe Pinto, director, service improvement St. Luke’s wished to be recognized nationally in clinical outcomes, cost-effective care, and patient satisfaction. To achieve this recognition, the director of service improvement looked to Press Ganey to provide a large medium in which St. Luke’s could compete against over 1,600 hospitals across the country. Using the Press Ganey survey as well as its research resources, St. Luke’s was able to identify the questions that were highly correlated with employee friendliness and courtesy. As part of the analysis, St. Luke’s examined the questions that were highly correlated with the likelihood of patients to recommend the hospital to others. Following the assessment, a plan was devised based on the principle that happy employees correlate to satisfied customers, which in turn leads to patients that will recommend St. Luke’s to other people. Following the research and assessment of the future goal, the first step in the implementation process began by creating a customer service program. This program was mandated and was designed to illustrate the necessary steps to implement appropriate customer service behaviors and standards of performance. Key areas ranged from conflict resolution to service recovery and etiquette. The second step was creating the employee recognition and reward committee. This committee of staff members is charged with awarding the PCRAFT (pride, caring, respect, accountability, flexibility, teamwork) award to twelve hospital employees per year (see Exhibit 16.2). These employees are required to consistently exhibit the values of the organization, and documented examples have to be included in their respective nomination form. The third key step in the strategy process was the implementation of awards for departments’ patient satisfaction scores. The objective of the departmental quarterly recognition program was to reward and recognize employees, managers, and departments for outstanding achievement related to patient satisfaction. To achieve recognition, a department must receive one of the following: • Highest percentile ranking on the survey • Overall mean score that is highest above the hospital mean score • Highest percentile ranking consistently (three quarters or more) • Largest improvement in overall mean score ST. LUKE’S HOSPITAL AND HEALTH NETWORK 381 cart_14399_ch16.qxd 10/19/04 1:19 PM Page 381 Following a win of this award, the department managers receive up to $100 to be used on the department, accompanied by recognition from the COO and at monthly management meetings. The final component of the overall strategy focuses on individual achievement via the “High-5” recognition. A staff member who has his or her name appear in patient letters, Press Ganey comments, over the phone, in patient letters, or through Project Bravo recognitions—a St. Luke’s program that recognizes employees for positive customer service—more than five times receives a High-5 Award. The recognized employee receives a gift certificate to either a restaurant or other outside facility, a letter from the COO, a pin with the slogan “above and beyond,” and their name displayed on the Employee Wall of Fame. The results of this comprehensive strategy are based on Press Ganey scores and other major achievements. In 2003 marked achievements in Press Ganey scoring included the following: • The Environmental Services Department scored within the ninetieth percentile for four consecutive survey periods in the measure of room cleanliness and staff courtesy. • The nursing staff ranked above the eightieth percentile in nurses’ attitude. • Organizational achievements included a ranking over the eightieth percentile in overall cheerfulness, eighty-fourth percentile in staff sensitivity to the inconve- nience of being in a hospital setting, and eighty-third percentile in attitude toward visitors. Although the Press Ganey scores alone provided tangible proof of success, just as valuable was being named in the “Best Places to Work Foundation for Pennsylvania.” In the Top 100 Best Places, St. Luke’s ranked twenty-eighth in the large-size category (employee number greater than 250). The award is based on a written summary of practices, as well as an anonymous employee survey of randomly selected employees. The employee survey represents 75 percent of the total grade. LEADERSHIP COMMITTEE OUTCOMES As leadership forum programming continued to evolve, the steering committee established a linkage committee. The linkage committee membership was rep- resentative of the entities within the network. The primary goal of the linkage committee was to link education to changing behavior. To exercise this goal, accountability grids were created following each leadership forum. The accountability grids (Exhibit 16.8) contained expectations for senior and middle management leaders with defined timelines as appropriate. The expectations contained within each accountability grid related to the education provided at the leadership forum. Several works, born out of the leadership forum, have contributed sig- nificantly to the organization’s definition of leadership skills. One of these works is the leadership core competencies, which was the result of work 382 BEST PRACTICES INLEADERSHIPDEVELOPMENT AND ORGANIZATIONCHANGE cart_14399_ch16.qxd 10/19/04 1:19 PM Page 382 accomplishments by the entire leadership team. Seven key competencies were identified: • Motivator • Team builder • Goal orientation • Communicator • Commitment to service • Organized, prioritizing • Resourceful Each of these competencies has specific behavioral identifiers that further define each competency. The management performance evaluation was redesigned by an ad hoc group of managers who participated in the leadership forum. This group designed a new management evaluation tool that incorpo- rated the core leadership competencies (Exhibit 16.9). An additional work that originated out of the leadership steering committee was the development of a booklet on service excellence standards of perfor- mance. This booklet clearly defines, in a behavioral way, the standards set for “concierge service delivery” on the part of all members of the hospital team. All new employees are required to attend concierge training as part of the orienta- tion to the hospital. ENDNOTES 1. Collins, J. (2001). Good to great. New York: HarperCollins. 2. Loehr, J., & Schwartz, T. (2003). The power of full engagement. New York: Simon & Schuster. ST. LUKE’S HOSPITAL AND HEALTH NETWORK 383 cart_14399_ch16.qxd 10/19/04 1:19 PM Page 383 384 BEST PRACTICES INLEADERSHIPDEVELOPMENT AND ORGANIZATIONCHANGE Exhibit 16.1. Strategic Plan Goals and Objectives Mission Statement. The mission of St. Luke’s Hospital and Health Network is to provide compassionate, excellent quality and cost-effective health care to residents of the communities we serve regardless of their ability to pay. The entities constituting the St. Luke’s Hospital and Health Network will accomplish this mission by • Making the patient our highest priority • Promoting health and continuously improving care provided to heal the sick and injured • Coordinating and integrating services into a seamless system of care • Improving the level of customer service provided throughout the network • Ensuring all health care services are relevant to the needs of the community • Striving to maximize the satisfaction of our employees, patients, medical staff, and volunteers • Training allied health professionals, nursing and medical students, and residents in a variety of specialties and to attract them to practice within the network’s service area Vision Statement. The entities of St. Luke’s Hospital and Health Network will be nationally recognized for excellence in clinical outcomes, cost-effective care, and patient satisfaction. This vision will be achieved by • Continuously improving patient, employee, volunteer, and physician satisfaction • Benchmarking clinical outcomes and improving the processes that lead to optimal care • Managing the resources of the network to minimize costs • Partnering with physicians and other providers, recognizing our success is dependent on cooperation and common goals • Continuously updating our view of “reality” consistent with a rapid changein the environment, technology, and the practice of medicine cart_14399_ch16.qxd 10/19/04 1:19 PM Page 384 ST. LUKE’S HOSPITAL AND HEALTH NETWORK 385 Principles. The following principles will be the foundation of the goals, manage- ment, and future development of the network. • Each network entity has a responsibility to operate financially at break-even or better on a stand-alone basis over the long term. Our entities should focus on their core services and divest of nonprofitable services that are not essential to our mission. • Day-to-day management of operations must be performed locally. It should be based on a continuously simplified management structure that promotes effec- tiveness, efficiency, and accountability for its integrity. However, decentralized management still requires various degrees of network oversight to coordinate the allocation of resources and informed decision making. • The development of any network is an evolutionary process that depends on members’ sharing a sense of purpose, belonging, and a commitment to collec- tive success. There needs to be an ongoing commitment to integration, leading to a seamless system of care. • To establish and sustain the St. Luke’s “brand” of quality and customer service, it is necessary to establish network-wide standards that are measured against national benchmarks. However, each entity must decide how best to implement them in a cost-effective and responsible fashion. • Regular and effective communication is a prerequisite for integration, satisfaction, and ownership among the network’s stakeholders. • Employees are one of our most important assets. • Medical care should be delivered at the local level as a first choice and within the resources of the network whenever appropriate. • All persons included in the network are accountable to the community to adhere to the network’s mission and vision and ultimately to improve the health status of the community. Exhibit 16.1. (Continued) cart_14399_ch16.qxd 10/19/04 1:19 PM Page 385 386 BEST PRACTICES INLEADERSHIPDEVELOPMENT AND ORGANIZATIONCHANGE Exhibit 16.2. Management Philosophy, Vision for Patient Satisfaction, PCRAFT Core Values, Service Excellence Standards of Performance, and Performance Improvement Plan The management philosophy, vision for patient satisfaction, and PCRAFT core values are, as follows: Management Philosophy for St. Luke’s Hospital Introduction • We believe that quality patient care will best be provided in an environment supported by a positive management philosophy. Objectives • To demonstrate by behavior and attitude that employees, physicians, and volunteers are St. Luke’s most valuable resource • To create a positive work environment through timely and effective communi- cation and involvement of employees, physicians, and volunteers Management Principles 1. Promote open, timely, and effective communication throughout the organization 2. Promote an environment that recognizes individual differences and encourages individuals to treat one another with respect and dignity 3. Foster an environment in which creativity and professional and personal growth are encouraged 4. Encourage decision making at the department level 5. Create clear goals, performance expectations, standards of accountability, and provide timely feedback to the people with whom we work; each employee is expected to • Cultivate a caring atmosphere in our hospital • Place the needs of the patients first • Interact positively with physicians, visitors, fellow employees and volunteers • Solve problems • Follow through on commitments • Continually improve hospital systems, emphasizing quality • Be fair and consistent in all dealings • Conduct all business dealings in an ethical manner • Be fiscally responsible cart_14399_ch16.qxd 10/19/04 1:19 PM Page 386 ST. LUKE’S HOSPITAL AND HEALTH NETWORK 387 • Treat everyone as responsible adults • Recognize there are consequences for all behaviors, both positive and negative 6. Provide a safe working environment 7. Provide a compensation and benefit program that enables St. Luke’s to recruit, develop, and retain qualified, loyal, and experienced employees Vision for Patient Satisfaction • St. Luke’s Hospital and Health Network wants to set the industry standard for achieving and sustaining the highest level of patient satisfaction for our patients and their family members in every encounter. Core Values • At St. Luke’s Hospital and Health Network, our people are the source of our strength; their commitment and involvement determine our future success. To achieve our vision, we are guided by our values. Great focus is placed on our values. The mnemonic PCRAFT was developed to help staff remember and more readily “live” the values. St. Luke’s Values are as follows: Pride—We take pride in our accomplishments and our organization. Caring—We show consideration for others and their feelings. We treat others, as we want to be treated. Respect—We recognize the value, diversity, and importance of each other, those we serve, and the organization. Accountability—We are responsible to make decisions and solve problems in a timely and effective manner. Flexibility—We adapt to the changing needs and expectations of those we serve. Teamwork—We work together to improve quality. Exhibit 16.2. (Continued) cart_14399_ch16.qxd 10/19/04 1:19 PM Page 387 388 BEST PRACTICES INLEADERSHIPDEVELOPMENT AND ORGANIZATIONCHANGE The mission, vision, goals, and member roles for the leadership steering committee include Mission • To fully develop the excellence within each leader Vision • To become the best leaders in health care . . . to be teachable again and always Goals • Educate to change behavior • Move from managers to leaders • Harness the creative energy of our network and focus it in the same direction • Create a service, action-oriented culture based on consistency, relationships, and accountability • Build trust • Reduce rework, redundancy, and duplication • Set up a built-to-last culture • Establish a focus on Five Points of the Star—service, people, quality, growth and cost—enabling us to align and connect back to our mission, vision, values, and goals Member Roles • In order to organize the work of the committee, ad hoc groups were established and still exist to support the different actions needed to ensure success of our endeavors; these Ad Hoc groups include Curriculum, content Communication Ambience, atmosphere Logistics Linkage Evaluation, measurement Exhibit 16.3. Leadership Steering Committee Mission, Vision, Goals, and Member Roles cart_14399_ch16.qxd 10/19/04 1:19 PM Page 388 ST. LUKE’S HOSPITAL AND HEALTH NETWORK 389 SERVICE COST PEOPLE GROWTHQUALITY Exhibit 16.4. The Five Points of the Star Model cart_14399_ch16.qxd 10/19/04 1:19 PM Page 389 . of interventional procedures in which the target drugs were used. Since its beginning in April 2003, the estimated annual savings to the institution is in. 388 BEST PRACTICES IN LEADERSHIP DEVELOPMENT AND ORGANIZATION CHANGE The mission, vision, goals, and member roles for the leadership steering committee include