Community Commitment Powers Sarasota Memorial’s Achievements

Added on Feb 16, 2017

Community Commitment Powers Sarasota Memorial’s Achievements
By Diana Mahoney
Industry Edge February 2017

Sarasota Memorial Health Care System is bucking national and local trends thanks to its long history of patient-centered care, its appreciation for the value of an engaged workforce and its understanding of the central role that consumerism plays in health care transformation.

In July 2016, the publicly owned, not-for-profit safety net hospital for Sarasota County, Fla., achieved a coveted 5-star rating from the Centers for Medicare & Medicaid Services (CMS) in the agency’s first release of its Overall Hospital Quality and Safety ratings.

Well above the median 2.88-star rating achieved by safety net hospitals nationally, the 5-star rating earned the health system membership into a fairly exclusive club. Of the nearly 5,000 facilities eligible for rating, SMH was the only hospital in Florida, and one of only 111 nationwide, to receive the top score, and it is one of even fewer to have sustained its 5-star rating in the two reporting periods since the initial release.

Given its safety net status, this accomplishment is no small feat. As the only public hospital within its four-county market area, SMH serves nearly 90% of the Medicaid patients and 65% of the self-paying hospital patients in Sarasota County. It is also the only hospital in the county that provides obstetrics services, maternity care, newborn intensive care, inpatient pediatric care and inpatient psychiatric care. It operates a community clinic providing free specialty services for underserved residents. And in 2015, the system opened the first and only trauma program in the county. Together, these services are essential to the hospital’s ability to meet the diverse needs of the community it serves, and they are also major sources of the $80 million to $100 million in uncompensated care the system provides each year, according to Shawn Halls, manager of Consumer & Competitive Strategy for the 819-bed health system.

These considerations, together with reductions in disproportionate share payments under the Affordable Care Act and other federal policy changes that limit the use of supplemental payments, put safety net hospitals at a disadvantage. In fact, the findings of a 2012 study published in the Archives of Internal Medicine found that safety net hospitals, because of the resource strain associated with high levels of uncompensated care and the complex medical issues of the low-income patients they serve, perform more poorly than other hospitals on nearly every measure of patient experience, which in turn puts their Medicaid reimbursement at risk.

Yet a different picture emerges from SMH. In addition to the CMS rating, the health system has earned Magnet Nursing Services Recognition from the American Nurses Credentialing Center, received an “A” for patient safety by the Leapfrog Group and been designated as one of the great places to work in health care in Becker’s Hospital Review, among numerous other accolades.

“I can tell you without hesitation that this is because we have phenomenally good leadership and phenomenally good employees who really buy into the mission of our hospital,” according to Halls. “You can’t achieve the things that we do without that being true. The depth and breadth of the services we provide are unparalleled in the region, but that also means we are much bigger than any of the other hospitals in the area. In that way, we have to work much harder together to make sure every aspect of care—quality and experience—is addressed.”

The size of the hospital and its history in the community—SMH was founded as the first “modern hospital” in Sarasota County in 1925—also contribute to a deep sense of accountability among the staff, which further drives engagement in the mission.

“We are a huge hospital in a relatively small community, and we are one of the largest employers in the county, second only to the county itself. Most people know someone who works here, has worked here, wants to work here, has been treated here or has had babies here,” Halls said. “Our people have very deep connections to the hospital and to the community. That gives us an advantage, because we recognize that we are treating our friends and family or loved ones. It keeps us committed to our vision of being the best place to be a patient, the best place to work and the best place to practice medicine. That’s who we are as a brand.”

And while awards and recognition are nice validation, the most important validation comes from patients themselves, Halls said, noting that the organization has been using patient feedback to evaluate processes and drive improvement for nearly 20 years.

“When I started working here in July 1998, I came into the research department and realized something didn’t make sense,” Halls said. At the time, the hospital was using a very costly but not very useful survey tool, “so although we were seeing survey numbers that said we were scoring, for example, a 4.25 or 4.35 out of 5.0 for some measures, that wasn’t consistent with what we were seeing in practice, through interaction with patients,” he said. “That’s when we contracted with Press Ganey. We needed the comparative data to get real insight into our performance. It was the only way we were going to be able to get an honest assessment.”

The first report was an eye-opener, Halls said. “It showed that we were at the 15th percentile for patient experience, which pretty much jibed with what I was feeling, but it sounds much different than 4.3 out of 5, so a lot of people here didn’t believe the data. Then we got our second report. We were at the 17th percentile. That’s when people realized, OK, the data are real. And that’s when we started a massive improvement effort.”

At the time, the health system was only measuring inpatient, outpatient and emergency department patient experiences, “but we threw everything we had at it,” Halls said. “I was emailing our patient experience advisor every day. I went to regional conferences to get up to speed. This was well before HCAHPS was even an idea, but we just knew that delivering on a promise of patient experience was going to be a differentiator for our brand.”

In health care in particular, brand is everything, Halls said. “With the exception of maybe someone walking out of the hospital with a healthy baby—and even that’s not anxiety-free—you’ve got a reluctant consumer base. They are sick or something is wrong. It’s stressful and it’s something they may never have been through before. If word spreads that we are not delivering high-quality care or meeting patients’ needs, it doesn’t matter how nice our buildings are. People won’t come.”

The patient experience data quickly became foundational to all decisions and actions across the organization. “We initially elected to receive quarterly electronic reports, and then we switched to monthly reports, which helped us be more responsive and agile,” Halls said. Over the course of four years, the health system’s inpatient experience scores skyrocketed from the 15th percentile to the 93rd percentile, outpatient experience scores increased from the 29th to the 80th percentile and ED experience scores jumped from the 41st to the 89th percentile.

Fast-forward to today, and the health system measures the patient experience across every service line. Managers run their own reports via the online portal as frequently as they want or need to keep their finger on the pulse of their teams’ performance, and the value of the data is universally recognized by providers, managers, administrators and executives, said Halls. “People are not always happy about the results, but the quality of the data has never been a question. The credibility of the data is central to everything we’ve built in patient experience and on the brand equity fronts,” he said.

As all health care organizations are well aware, success in the patient experience realm requires not only meeting high-performance goals, but also sustaining the improvements. In the years since the launch of its all-out patient experience focus, SMH has consistently achieved and maintained high levels of performance across patient experience measures.

Maintaining high performance requires constantly renewing the commitment to the patient experience improvement journey. “Patient experience ebbs and flows, and people come and go, so you sometimes need to provide reminders of why the survey data are valid, why it matters and how we do things,” Halls said. “At times—say, when we’ve had a new CEO or a new COO—we’ve had patient experience advisors and others come and meet with the C-suite to explain the data, how it works and why it’s valid. Presentations like that are invaluable for ensuring alignment and support.”

Every level of the SMH organization is involved in the patient experience journey. “We have an unbelievable leadership team, starting with our nine-member, unpaid board of directors, who are in it all the way,” Halls said. “They look at patient experience on a monthly basis, presented by our CEO, David Verinder. They want us to be delivering on the promise we’ve made to the community, so patient experience performance carries a lot of weight.”

The board’s commitment to the patient experience is evidenced by its commitment to large-scale infrastructure investments to better meet patients’ needs. One example was the board’s support for a $250 million, nine-story patient tower to enhance efficiency in patient care and greatly improve the experience for patients and their families. In addition to substantially increasing the number of private patient rooms—from 20% to 80%—the new tower was designed to improve navigation of the facility for patients, visitors and staff, Halls said. The nursing units were designed with an eye toward inter-unit interaction, and the upper floors were linked with those of previously disconnected, existing towers. A new main entry and a new orienting courtyard supported patient and visitor wayfinding, which, because of the hospital’s size, had previously been a source of confusion and unnecessary stress for patients.

Additional investments have included expanding community access to care through the development of a freestanding emergency room and health care center, new urgent care centers, a new pediatrics unit to replace an outdated unit, the trauma program, a rehabilitation pavilion and plans for an internal medicine residency program designed to address local physician shortages.

While patients are at the center of the SMH mission, employees and direct care staff are its foundation. “We learned pretty quickly that we can have all the plans in the world, but unless we’re measuring how our employees are feeling and perceiving their work environment, it won’t do much good,” Halls said. The hospital regularly measures employee and physician experience and engagement, and has focused HR efforts on creating a sense of pride and ownership among employees and staff to create lasting cultural change.

With all of the infrastructure changes in recent years together with an “incredible amount” of volume growth—“We’ve added 1,000 new employees and nearly half of those are nurses,” Halls said—it can be easy to lose sight of the fact that not everyone might fully grasp the mission of the hospital. “This is where employee engagement really matters,” Halls said. “Everyone needs to know why we do what we do, but also how their role connects them to the larger mission of the hospital. So, over the past few months, we have been aggressively working to make sure we are connecting back to the ‘why.’”

The key to building an engaged, high-performing, patient-centered culture “is more than just demanding they do better. It requires making sure people are feeling supported and have the material and equipment they need to do their jobs. And that has to start from the top down,” Halls said.

Meeting Patients Where They Are

To meet the diverse needs of its safety net population, the SMH leadership team pays close attention to consumer behavior and responds in meaningful ways. In 2011, the system opened HealthSquare in a local shopping center to provide the community’s many mall-walkers free screenings and health risk assessments, help them find a physician and make an appointment, teach them ways to manage and prevent chronic disease, and provide them with information about medical services available in the community. “We saw an opportunity to meet patients where they were most comfortable, and it became an incredibly valuable community resource,” Halls said, noting that the latest iteration of HealthSquare will be in a medically underserved region of the community “to make sure people who need the information and educational services the most have access to them.”

The health system’s social media presence has also grown in recent years. “We want to be where people are comfortable. We are on Facebook, YouTube, Instagram and Twitter. If people are in that space and that’s where they are comfortable talking to us, we want to be there,” Halls said. “It’s a way to humanize this big white building and put a face to it, to make it feel a bit smaller.”

And while they have not yet adopted online reporting of performance data, “it is very much on our radar,” Halls said. “It’s something people are looking for. It can be a differentiator, especially because of the integrity of the data, to be able to say, ‘Here are our data—good, bad or otherwise. Here’s how we are meeting your needs.’ With the credibility of our patient experience data, you can’t buy that kind of publicity.”

This eye toward consumerism, along with the commitment to fully patient-centered care, is good business practice, but it’s also a good-neighbor practice, Halls said. “We don’t ever want to lose sight of what it feels like to be on the other side of the 750,000 patient interactions that we have every year, so we do everything we can to ensure that level of empathy.”