Colorado hospital rolls out the red carpet and gets results
By treating patients as guests and employees as partners, hospitals can create a culture of patient-centered care that resonates throughout the organization, says Becky Jessen, MEd, vice president of marketing at Community Hospital in Grand Junction, CO.
What won’t be successful, she cautions, is trying to cut and paste the idea onto your organization. "Unless you have that culture, have everybody on the same path, you don’t get anywhere," she explains. "Some people want a quick program or one little concept, but you can’t do it without starting at the beginning."
Extending that philosophy from "check-in" — it’s no longer called "admitting" — to the billing process resulted in Community Hospital being awarded a benchmark designation for patient satisfaction by the Colorado Health and Hospital Association in 1998, 1999, and 2001. The awards, which are based on a survey tool of the Picker Institute and cover eight western states, were not issued for 2000, Jessen explains.
The 78-bed hospital received the designation in all four categories — emergency department, inpatient, outpatient tests and treatment, and ambulatory surgery, she adds.
"We have seen the hospital continue to grow and do better and better in terms of satisfaction surveys," Jessen notes, "but it comes down to the fact that the folks that work here want to work here."
Although Community Hospital always had a customer-service focus, the culture of partnership was created three years ago when the current CEO came on board, she explains. "He has an incredible vision of where the hospital is going as far as improving the patients’ experience."
The discussion about the hospital philosophy and how employees treat patients and each other begins in the hiring process, Jessen says. "Our whole orientation program is called Partners,’ so [potential employees] understand at the beginning this is not like most hospitals. Most people find it refreshing."
In the initial interview, the job candidate is told that if he or she doesn’t feel comfortable with the partners/guest philosophy, it would be best not to pursue employment at Community Hospital, she adds. "If [the individual] is not willing to work on a team or put the customer first, we know it’s not a good match."
One of the things that promotes teamwork, Jessen notes, is that while many hospitals are very compartmentalized, her organization strongly supports what it calls "cross-education" to break down the barriers between departments. Not using the more common term "cross-training" is a very deliberate choice, she points out. "We consider training something you do to a seal or a dog."
Along the same line, the word "leader" is preferable to "manager" or "director," says Erica Eng, patient advocate and director of guest services. "You manage things, but you lead people," adds Eng, who was hired about a year ago to fill her newly created position.
"It’s so important to remember the power of language," Jessen says. "We always add partner’ to employee’ or volunteer.’" People coming in for treatment are "patient guests," she adds. At "check-in," guests are greeted in a "reception" — not "waiting" — area.
The idea behind these hotel-like terms, she explains, is to change the hospital-patient paradigm. "A patient is someone who’s awaiting medical treatment, someone who will be done unto,’ who will be at our mercy," she notes. "A guest is someone who is invited into a home or facility, and that’s how we want them to feel."
Community Hospital’s tag line, she points out, is: "Where you are your physician’s patient, but always our guest."
Continuing that theme, a freestanding surgery center that opened in 2001 has "no OR [operating room] suites," but rather "procedure areas," Jessen says. "We call first-stage recovery wake-up’ and second-stage recovery is sit-up.’"
Although the guests/partners philosophy started with the hospital’s CEO, once it caught on, other people began coming forward with suggestions, she adds. Like in a hotel, stands with little cards that say "cleaned by so-and-so" are placed in guest rooms, as are decorative cellophane bags containing lotion, soap, pen, and notepad, Jessen says. "That idea came from the environmental services department."
"Our CEO really wanted each of the departments to come up with its own service standards or expectations, how we as a group want to approach each of our guests so they feel comfortable and welcome," Eng notes. It is hospital policy, for example, that every guest will be seen within 10 minutes or someone will go back to the guest and explain why this has not happened.
Hospital meals are prepared on a "demand" basis, Eng adds. "Every guest is oriented by staff as to how to order their own food. They can order between 7 a.m. and 7 p.m., and the meals all are different — liquid, diabetic, or normal. The service standard is that your meal will be served, from order to table, in 30 minutes or less. It’s usually 10 minutes."
Environmental services staff, she says, knock on the patient’s room door, introduce themselves, and ask, Is it OK if I clean your room now?’"
"During the Partners orientation, we talk about the external and the internal customer, and there is a real emphasis on treating each other with kindness and respect," Eng adds. "With the employee partners feeling that they have input, that their ideas do matter and make a difference, they can’t help but turn around and treat guests with the same respect and caring."
The billing process — problematic at most hospitals — also was examined with the partners/guests initiative in mind, she notes. "It was brought to our attention how poorly that process was run. Our vision was to completely change it."
The hospital developed a statement that is visually attractive and easy to read, Jessen says. "The bottom line is very much like you would get from a credit-card company. (To see a copy of the bill, click here.) We have actually received notes saying, Thank you for a statement that’s easy to read and attractive. I didn’t like how much I owed, but at least I could figure it out.’"
To ensure that patients are fully informed about the clinical aspects of their stay, she notes, the hospital has two full-time patient educators — one for inpatients and another for outpatients. In advance of a scheduled procedure, outpatients meet with the educator and fill out a "health record book," Jessen explains. After the procedure, the educator calls the patient to address any remaining questions or concerns, she says.
Health record books are placed in the rooms of all inpatients who are educated throughout their stay, adds Eng. The three-ring binder contains preprinted information about the person’s condition, as well as pages to be filled in with patient history and current health information, she says. "There is also a page on [the patient’s] medications, and before they leave, we supply any lab or test results."
In addition, Eng says, the binder may include specific educational material the person’s physician has ordered.
The patient educator comes to the room to go through the different pieces of information with the patient, she adds, including pain management, how to contact a patient representative, and advance directives. "[Admissions staff] did the advance directives at first, but we found that was not efficient. People aren’t really listening at that point."
Every nurse at Community Hospital is trained to be a patient educator, to provide backup for the full-time staff, Eng notes. "With a hospital our size, we had to make sure the nurses on the weekend had the same skill set as the 8 to 5 staff." The nurses have enjoyed adding that kind of patient contact to their jobs, she says, knowing that "it is sanctioned by the organization for them to come in and have more time with the guests."
The patient educators sometimes are referred to as "physician translators," Jessen points out, "because they will go back into the room later to help unravel what the physician has said. We think that’s a critical role."
She emphasizes the importance of looking not just at other hospitals, but at the customer service industry when seeking ideas for improvement. "Ask yourself, How can that be translated to the patient experience?’"
In the end, Jessen stresses, the success of Community Hospital’s customer-service effort comes back to a way of thinking that is fostered from the top down. "It’s driven by our board of trustees, which is very engaged in where we’re going with this. One of [the board’s] strategic initiatives has to do with continuous quality improvement in guest services standards. If you don’t have that vision from the top, it’s very hard to support and keep it going. One department might be very excited, but if it falls down at any point, you won’t be successful."
"We understand that clinical outcomes are critical," Jessen adds, "but we also think there is another piece — that the mind and emotions play such a role in recovery. We’ve chosen to key in on that."
[Editor’s note: Becky Jessen can be reached at (970) 256-6205 or bjessen@gjhosp.org. Erica Eng can be reached at (970) 256-6291.]
Audio conference clarifies final EMTALA regulations
The final version of the recently proposed changes to the Emergency Treatment and Labor Act (EMTALA) is expected to become effective on Oct. 1. Issues in the final regulations could include changes to physician on-call requirements, "comes to the emergency department" definitions, later-developed emergencies, nonhospital entities, and prior authorization. With all the confusion surrounding the proposals during the past year, make sure you know what it takes to comply with the final regulations.
To keep you on track, American Health Consultants offers the EMTALA: Complying with the Final Regulations audio conference, scheduled for Tuesday, Nov. 12, 2002, from 2:30 to 3:30 p.m. Eastern time. The conference will be presented by Charlotte S. Yeh, MD, FACEP, and Nancy J. Brent, RN, MS, JD. Yeh is medical director for Medicare policy at National Heritage Insurance Co., Hingham, MA. Brent is a Chicago-based attorney, with extensive experience as a speaker on EMTALA and related health care issues. In June of this year, both speakers presented EMTALA Update 2002, one of AHC’s most successful audio conferences.
Each participant can earn FREE CE or CME for one low facility fee. Invite as many participants as you wish to listen to the audio conference for $299, and each participant will have the opportunity to earn 1 nursing contact hour or 1 AMA Category 1 CME credit. The conference package also includes, handouts, additional reading, a 48-hour replay of the live conference, and a CD recording of the program.
For more information or to register, call American Health Consultants’ customer service department at (800) 688-2421 or (404) 262-5476, or e-mail customerservice@ahcpub.com. When ordering, please reference effort code: 63221.
Bioterrorism prep checklist from AHRQ
Hospitals can download a survey on the web site of the Agency for Healthcare Research and Quality (AHRQ) that can be used as a checklist for assessing their capacity to handle potential victims of bioterrorist attacks or for evaluating emergency plans.
The site, which can be found at www.ahrq.gov, gives users access to the 42 questions in AHRQ’s Bioterrorism Emergency Planning and Preparedness Questionnaire for Healthcare Facilities. It covers such subjects as procedures to permit rapid recognition of credentialed staff from other facilities, on-call nursing policies, and designated areas of emergency overflow for patients.