CHRISTUS Health - Irving, TX
"Guaranteeing Service, Achieving Success"
CHRISTUS Health, a multi-state health care system with 22 acute care facilities measured by Press Ganey, began a Journey to Excellence in July 2000 with a goal of having each facility reach the 90th percentile by June 2006. While attainable, the goal seemed daunting given the scores achieved in the first quarter of measurement (July-September 2000). The overall system score reached the 40th percentile (82.3 mean score), with the facility scores ranging from the 4th to 97th percentile.
Implementing strategies and tactics to begin a culture change and focus on providing exemplary patient service with each and every encounter is a large task for one hospital, but attempting the same with twenty-three facilities and more than 26,000 employees is quite an ambitious goal. However, CHRISTUS leadership was committed to reaching the 97th percentile and began the implementation of a systematic approach for achieving results.
CHRISTUS leadership quickly realized the significant impact of patient satisfaction on the system’s overall financial performance and clinical quality delivered. As a result, patient satisfaction scores became an integral component of the CHRISTUS balanced scorecard. The scorecards are reviewed by the system and regional leadership teams and governing boards every quarter, with improvements included in the annual strategic plans.
Actionable Steps
Aligning incentives with goals for improvement was an important early step in the process. Specific patient satisfaction incentive goals were set for all leaders throughout the systems, thereby rewarding individuals for their commitment to overall system improvements and fostering an environment of sharing and teamwork.
The patient satisfaction goals contained three levels of achievement, with higher rewards for each level attained. The goals were based on expected levels of improvement over the previous year’s baseline score. The degree of improvement was calculated to get every region to the 90th percentile by June 2006, with equal increments of improvement expected each year. Employees in facilities that reached orexceeded quarterly and annual goals were awarded bonuses.
The leadership began by communicating regularly with patient satisfaction leaders at each facility and setting facility-specific goals. Despite some initial success, progress was inconsistent and the score returned to the 41st percentile by the end of the quarter ending March 2003. The system lacked the conviction and consistency necessary to achieve significant, sustainable changes that would create improved patient service system-wide.
To remedy this, the CHRISTUS Service Guarantee was implemented. While guaranteeing service seemed a bold step for a health care system, CHRISTUS leadership believed that it would offer a public commitment to the level of importance the system placed on creating the ideal patient experience. To facilitate the development of this program, an internal committee was formed to study the Priority Indexes from the Press Ganey report for each facility.
It quickly became clear that the key drivers of overall patient satisfaction centered around communication issues, courtesy, providing prompt care, and paying attention to the special needs of patients. By improving in these key areas, overall service would improve.
Immediately, internal communications began highlighting patient satisfaction scores, citing facility-specific information for comparison. Scores were widely promoted via the organization’s intranet, internal newsletters, communications to the board of directors, etc. A system-wide program was also launched to heighten attention and interest in the CHRISTUS Service Guarantee.
The program includes specific promises to patients, complaint tracking, and a means of rewarding patients for bringing concerns forward. The guarantee is based on three driving factors and priorities for improvements in patient satisfaction:
• Courteous, prompt, and compassionate care
• Concern for your special needs and privacy
• Open, honest communications about treatment
The program includes a process for tracking complaints and initiating rapid-cycle improvements, as well as more than 40 internal and external communication tools customized for each facility. These tools include newspaper/newsletter advertisements, billboards, posters for patient rooms and patient letters, behavior expectations, staff training, and daily computer “pop-up” messages to reinforce key service behaviors. In addition, an employee reward and recognition program was developed to build “Champion Teams” throughout the organization that focus on satisfaction.
“Must-Have” strategies were developed to enhance staff interactions with patients and their families:
• Scripts and key words for patient encounters
• Rounding programs
•Clear expectations and measures of accountability
• Processes for transferring best practices across facilities through individual meetings with facility satisfaction teams and monthly system-wide team sessions
Results
As a result of CHRISTUS Health’s efforts, system and facility scores have increased significantly. Within nine months, the system score reached the 52nd percentile, with five facilities scoring above the 75th percentile. A year later, in December 2004, the system reached the 67th percentile, with eight facilities at the 75th percentile or higher, and only one below the 40th percentile. It took CHRISTUS Health forty-two months to attain a mean score of 84, but only twelve more months to reach a mean score of 85.
The system has maintained a mean score above 85 from November 2004 though February 2005. In addition, CHRISTUS Health significantly improved its financial performance:
FY2002 FY2003 FY2004
NetIncome/(Loss)
Millions ($90.421) $20.002 $108.614
Operating Margin -0.9% 1.1% 1.4%