What do Spiderman and Batman have to do with patient care? In Hershey Pennsylvania, they play an important role.
Window washers at Penn State Hershey Children’s Hospital were tired of scaring kids when they washed the windows. They asked the hospital if they could dress up like superheroes to make their job more fun and less startling for the kids. The result? Plenty of viral images and good will, but even more important, a message: Everyone at Penn State Hershey is part of the care team.
This was the topic of a workshop at the Health Forum and American Hospital Association Leadership Summit titled, “ Reducing Cost and Improving Patient Satisfaction through Collaborative Care: Developing and Measuring Team-Based Care for Surgical Patients.”
Linda Duncan, administrator in the Center for Enterprise Innovation at Penn State Hershey Medical Center (PSHMC) says the hospital was feeling good back in 2012. It had an increased market share and a strong bottom line but new changes in health care prompted hospital leaders to research the future strength of the organization. What they learned surprised them. “The hospital had high costs compared to competitors and did not show high quality scores,” said Duncan.
Furthermore, other strong hospital groups were posing a threat as they consolidated hospitals in that market. PSHMC leaders determined they needed to develop a plan to grow and increase value for patients. They knew this wasn’t just a job for leadership, but for everyone. They determined their most important task would be to break down silos, get rid of programs and policies that weren’t working and transform staff to work in teams.
The hospital used lean management principles to study their workflow and set about building a new system that emphasized quality, patient safety and value, with the patient in the center of it all.
Through this analysis, the group learned a few things that didn’t necessarily surprise them. Their hospital followed a very strict hierarchical model, with the physician at the top and other providers like nurses at the bottom. “Relationships trumped individual skills,” says Peter Dillon, M.D., chair of the Department of Surgery at PSHMC. Dillon and his colleagues knew this had to stop and they determined there was no better place to explore new care models than in the acute patient care arena. “It’s a complex system with a diverse group of workers with widely varying backgrounds,” says Dillon.
Soon, care teams were asked to find ways to break down barriers and share goals, needs and ideas, and practice mutual respect for each other, regardless of title.
How did they do it? First off, they identified their main communication weaknesses. Surgical teams filled out surveys that revealed most team members performed poorly when it came to coordination. But there were bright spots: Care coordinators, PA’s and nurse practitioners were doing a great job of working collaboratively and communicating well.
By learning from these groups, expanded teams implemented a variety of strategies that included team meetings in which everyone had a voice and communication tools that encouraged collaboration.
The groups also emphasized agility, knowing that as new information is uncovered, teams would need to react quickly. They also emphasized decision-making based on information from many different perspectives, rather than just leadership.
The result? Twelve months later there was a 9% reduction in readmissions, a 22% increase in HCAPHS overall satisfaction scores, and a 10% decrease in direct costs per discharge.
Hospital representatives say lean methodology helped them get where they were going, but people were at the center of this change. “You can use lean management tools but they are only as good as your teams’ ability to work together,” says Jan Phillips, director of surgical emergency nursing and care coordination at PSHMC.
PSHMC leaders say they are far from perfect and their work is a journey in progress, but it’s helped transform their processes in a way that improves value, quality and outcomes. They say it all seems obvious now, but sometimes the obvious isn’t always apparent. “Sometimes we expect things and we assume others know it, but they don’t,” says Phillips.