The University of Kansas Health System’s Transformation Journey Spans Decades

Added on May 23, 2019

The University of Kansas Health System's Transformation Journey Spans Decades
By Andrea Fitzgerald

At the University of Kansas Health System, remarkable gains in patient experience performance and organizational culture over a 20-year period demonstrate that sustained improvement is a marathon, not a sprint. Since embarking on its transformation journey in 1998, the academic health system has raised its patient experience ranking from the 10th to the 90th percentile, reduced turnover by 60%, significantly decreased its risk-adjusted mortality rate, and more than doubled its market share in Kansas City.

This magnitude of integrated improvement reflects the robust efforts of the health system’s leadership to create a change-ready culture by translating its “formula for success”—delivering world-class patient outcomes and experiences through a committed and engaged workforce—into action.

Taking a patient-centered approach to performance improvement is what led to the rebirth of the organization, which had been at risk of closing in 1998, according to Chief Culture Officer Terry Rusconi. After nearly a century of university governance and state ownership, the organization, known as the University of Kansas Hospital (KU) at the time, had become so capital-starved and operationally deficient that it was projected to lose $20 million annually by 2000. To stay afloat and compete in Kansas City’s growing health care market, KU became an independent hospital authority.

Breaking away from the state and the academic enterprise, Kansas University Medical Center, was just the start, however. Once the hospital was on its own, leadership faced the daunting challenge of transforming its organizational culture.

“Under state control, staff and leaders had been doing the best they could with what they had, but it was a lethargic culture,” said Rusconi, who at the time was director of organizational development. “People had been frozen into thinking they couldn’t drive change.” 

Knowing that they needed to engage staff in change efforts in order for them to succeed, KU leadership made improving the patient experience their first objective. “Many organizations would focus on stemming the financial hemorrhage, but our executive team said, ‘We’re in the patient care business, so we need to lead with patients. That’s the reason our staff got into health care in the first place, and that’s what will inspire them,’” Rusconi said during a presentation at the 2019 CHRO Press Ganey Executive Summit in Washington, D.C.

Recognizing that improvements in quality and patient experience would drive sustainable growth and financial performance, Rusconi and other leaders set out to build a patient-centered culture founded on the principles of teamwork, accountability, and innovation.
Aligning the Workforce to the Vision

According to Rusconi, the first priority was to align leadership around the organization’s vision and then enable them to consistently and transparently communicate the vision to the entire organization.

“Every leader was expected to be a strong communicator and effective change manager capable of moving from silo to system,” he said. To help them fulfill those roles, KU facilitated strong two-way communication by providing leaders with the necessary information to cascade to their teams as well as empowering them to gather feedback from those team members.

To this end, performance data on patient experience, quality, people, growth, and sustainability (known internally as the “five star metrics”) were shared at biweekly leadership meetings to ensure transparency across vertical operations and ongoing alignment with organizational objectives.

KU also implemented leader rounding on days, nights, and weekends to drive alignment across all levels of the workforce. When rounding, leaders were able to reinforce the organization’s vision and values while addressing any questions from staff and asking about challenges and successes they’d had. “We wanted to assure staff that their voice was important and that there was a safety net beneath them as they transitioned from the old, dysfunctional system to the new culture,” Rusconi said.

Empowering Leaders to Drive Change

Building these safety nets required organizational leadership to both listen to staff and respond to their feedback. In order to demonstrate their commitment to meeting the needs of the workforce, leaders set up a “solutions line,” staffed 24-7 for six months at the beginning of the organization’s journey, for employees to call if they needed assistance in delivering patient-centered care. “Even if the request was as simple as needing linens for a patient’s room after their first call to housekeeping went unanswered, we wanted the workforce to know that we were listening and supporting them so that they didn’t revert back to previous broken systems or processes,” Rusconi said.

In this same vein of communication and support, President and CEO Bob Page, who was the vice president of performance improvement at the time, partnered with CNO Tammy Peterman to meet with nurse managers of units that were falling short of their patient experience goals. The purpose of these meetings was not punitive, Rusconi stressed. They were meant to set these managers up for success by first determining what they needed to work on—“maybe they needed coaching around sharing data with their team or celebrating moments of service excellence,” he noted—and then extending development opportunities, such as rounding with high-performing peers to observe how they engage their teams and create a caring work environment.

To formalize more opportunities for multidisciplinary collaboration, the organization also created partnerships among physician leaders, nurse managers, pharmacy directors, and other individuals to drive improvements in at least one metric. “Before becoming a public authority, we had many quality improvement teams that had been functioning for years and were still in the theory stage. After 1998, we reconstituted that work around making sure staff could brainstorm ideas in a collaborative manner and operationalize them on their units or departments,” Rusconi said.

Each of these strategies was vital for creating a sense of teamwork that cut across vertical silos and management layers, according to Rusconi. “Every member of the workforce is expected to live the culture, which hinges on the belief that we are all here for one reason—to care for patients,” he said.

Sustaining a Patient-Centered Culture

To continue building a high-performing workforce committed to delivering quality care and outstanding service, KU revamped its hiring processes in 2014, incorporating team and behavior-based interviews and a talent assessment into the application process.

According to Rusconi, each approach helps illustrate why candidates want to work at the organization and how they’d fit into the culture. “This ensures that we’re hiring not only the best and the brightest individuals, but those who can support our culture and continue making great strides in patient-centered care,” he said.

Over a 20-year period, KU has made substantial progress toward its goal of leading the nation in caring and healing by driving meaningful improvements across the continuum. Specifically, from FY1998 to FY2018, the health system has logged the following achievements.

  • Its patient experience ranking rose from the 10th to the 90th percentile.

  • Overall turnover decreased by 60% (which is 25% below the national average). 

  • Nursing turnover fell to less than 9% (which is nearly 50% below the national average). 

  • The risk-adjusted mortality rate dropped from 1.14 to 0.663.

  • Its market share across six counties in Kansas and Missouri rose from 4.6% to 12.7%. 

  • Total patient discharges increased by 271%, rising from 16,021 to 59,429 per year. 

The magnitude of KU’s integrated improvement demonstrates the powerful impact of culture on organizational performance, according to Rusconi. “If you nurture a patient-centered culture, then you can plant initiatives and change efforts will grow,” he said. “Without culture, the initiatives will die on the vine.”

As it grows its presence outside the Kansas City area, the health system is turning a greater focus on efficiency and cost-effectiveness to keep up with health care reform and other disruptions in the industry. “We aim to advance our commitment to the safest, most patient-centered care now and into the future,” Rusconi concluded.