From the June 2022 issue of HealthCare Business News magazine
By Michael A. Janis
Our mission at all 15 hospitals in Hospital Sisters Health System (HSHS) is “to reveal and embody Christ’s healing love for all people through our high-quality Franciscan healthcare ministry”.
As a faith-based healthcare institution we knew that we would need to focus on strategies that would carry forward the vision that our founding Hospital Sisters had 149 years ago when they traveled from Germany to provide quality, compassionate care in the U.S.
At HSHS St. Anthony’s Memorial Hospital, the cultural framework for carrying out our mission happened when we established our “I Promise” service philosophy. “I Promise” encompasses a standard of behavioral expectation and colleague commitment to embody our Core Values of Respect, Care, Competence and Joy with patients, providers, visiting families and each other.
At the genesis of “I Promise”, all colleagues (full-time, part-time, and PRN) met with our CEO to discuss “I Promise”, answer questions and affirm their commitment to behavioral expectations. Any new colleagues also meet with the CEO, CMO or CNO as the final interview prior to employment to discuss the “I Promise”, to ensure that the colleague is a good fit for the organization and the organization is a great fit for the colleague.
All colleagues attend a welcome event which helps further connect the meaning and tremendous importance of “I Promise”, as well as share the fruits that have come from our commitment to high behavioral expectations. Each colleague receives an “I Promise” service moments guide that provides further detail on behavioral situations and what it means to embody our Core Values through “I Promise”. After 90 days of employment, each colleague has a follow-up meeting with their administrative director and signs their “I Promise” commitment card.
Standardized approach to complex problem-solving
Our organization chose to work with the IMEC Recognition Program (formerly known as ILPex – Illinois Performance Excellence), a performance improvement organization, to help validate hardwired internal processes as well as identify opportunities for improvement. Our documented outcomes from our process improvements have earned our hospital numerous awards, including two bronze and one silver award from IMEC, which leverages the vigorous Baldrige Framework for Performance Excellence to guide Illinois organizations to higher levels of performance.
One of the major steps in the standardization process included adopting the SBAR (situation, background, assessment, recommendation) structure and pairing this with the Plan, Do, Check, Act cycle (PDCA). Every department selects at least one project that they are working on tied to performance improvement. Examples of past projects include medication reconciliation, blood culture contamination, operating room case start times, and cleanliness of the work environment. While the projects are quite diverse, the systematic approach to problem-solving is consistent and provides a level playing field for true results.
Standardization creates focused attention on objectives and efforts so that everyone is driving toward the same desired outcomes. Additionally, having common tools and terminology increases understanding and engagement among all staff. Our front-line colleagues can better understand our objectives and their roles in our journey of continuous process improvement.
Identifying priorities and areas of focus
Selecting the appropriate project amongst many departmental challenges can be difficult. My recommendation is to align your decisions with your strategic plan. The four “pillars” in our strategic plan are Human Potential, Physician Alignment, Site of Care Transformation and Unified Organization. When our leaders propose difficult problems that need solving, we weigh them against these pillars. If a problem does not align with a pillar, we determine it does not warrant our focused attention and resources at this time.
The next step is to understand the significance and reality of the problem. We review external benchmarking resources for performance as they are available, like Press Ganey. We also elicit external feedback from patients’ family and community members who serve on a committee created for this purpose. This external feedback really enhances our ability to see where we are as an organization and helps uncover our blind spots.
Other factors considered in this assessment phase are the initiative’s strategic fit, time to completion, ease of completion, return on investment, and resources required to accomplish it. In some cases, we agree that the process needs improvement, but we won’t pursue it if we don’t have the right people, resources and bandwidth in place to be successful. We also might conclude that the results of an initiative will have minimal savings for the hospital or for patients, and thus is not worth the effort required. These discussions are part of our weekly “Innovation Tuesday” leadership team meetings.
Achieving and maintaining high quality
While our leadership team meets once a week, problems and opportunities to solve them arise every day. To address this at St. Anthony’s, representatives from nearly every area of the hospital gather for safety huddles four times a day, every day to problem-solve the day’s current and potential problems. This includes radiology, nursing, lab, wound care, materials, maintenance, environmental services, health information and others. Within 15 minutes, we cover relevant issues in all departments in our 133-bed hospital. Each huddle follows a structured process to discuss:
• Celebrations from the previous day
• Great Catch or Lesson Learned
• Compliance Issues
• Staffing Levels and Help Needed
• Physician Focus
• Hot Topics and Key Takeaways for those not in attendance
Within these huddles, we are solving problems in real time for that day. For example, we learned that areas that had lower volume were sending people home when other departments could use help. This realization allowed us to shift those colleagues to help another department needing extra hands. This was extremely valuable during the pandemic when incident command was established, peak surge occurred and resources were sparse.
Another incident where shifting colleagues helped was when we had many orthopedic surgical cases scheduled one day. During huddle, we learned that our materials department was shorthanded due to illnesses. We shifted other people to materials to restock shelves with orthopedic implants and supplies so that surgery had the tools to stay on schedule. We might shift available nurses to radiology on days they report a high number of outpatient cases to help them manage post-procedure care. As I have cross-trained in phlebotomy, I’ve drawn blood in the patient care units to help our nursing staff when they were short-handed.
I realize that the idea of having four daily safety huddles sounds time-consuming, and initially at St. Anthony’s, several people expressed concerns that huddles would be a waste of time. But repeatedly, we have seen the value of these meetings throughout the day. Besides addressing potential issues immediately, the huddles help keep the focus and momentum on our larger process improvements. This helps avoid the No. 1 reason that many initiatives fail: lack of communication. Information that is discussed in the huddles is available to all colleagues through an online platform that they can access to see topics discussed. We’ve also gotten very efficient in our huddles to not waste precious time.
Key takeaways for achieving process improvements
First, your focus should always start with the mission and vision of the organization. Second, it is critical to have a standardized structure and process to solve complex problems. Finally, it must be adopted throughout the organization. Therefore, getting active support from leadership at the onset is essential. As with most big change initiatives, leadership buy-in and backing are essential.
I urge leaders and adopting organizations to be flexible. As you can imagine, selecting our methodology and then incorporating it into our daily workflow took considerable time and adaptability. Be prepared to be nimble in this process and understand that it will evolve over time.
Complex problem-solving and continuous process improvement have become an integral part of our daily operations at HSHS St. Anthony’s Memorial Hospital, and we continue to evolve for our patients, family members, visitors, colleagues and providers.
About the author: Michael A. Janis, MBA, RT(R)(CT)(N)CNMT, is executive director of Outpatient and Ancillary Services and served as interim president and CEO at HSHS St. Anthony’s Memorial Hospital in Effingham, Illinois. Mr. Janis delivered a presentation on this topic at AHRA 2021.