Size Matters
How to Scale Results
It turns out that bigger is actually better, at least when it comes to scaling high performance in healthcare today. In fact, it’s the only way to efficiently reduce risk, step up technology investment, and consistently deliver quality clinical outcomes to patients. The intense pressure to reduce costs—and the resulting race to scalability—has led to a veritable frenzy of recent merger and acquisition (M&A) activity in every sector of the industry.
The secret ingredient for success? A culture of alignment, engagement, and transparency. Culture is so important that some organizations value it even more highly than the actual financial terms of the deal (see “On Choosing an Acquisition Partner,” page 7). In fact, back in 2014, Henry Ford and Beaumont Health systems did not move forward with their merger because, as the Beaumont CEO said at the time, “We are not aligned on how to achieve our vision for a model system.”
The truth is, when it comes to successful M&As, it’s no longer enough to be a holding company adding hospitals if you want to realize the benefits of scale quickly. To excel in today’s environment, you need a true operating system…one that quickly standardizes the use of tools, processes, and outcomes to bring the kind of consistency entity-wide that Centers for Medicare and Medicaid Services (CMS) describes as HCAHPS “Always” behaviors that earn optimal reimbursement. And to get there, you need objective performance that clearly defines success for all.
The Chassis for High Performance
What works best? Many health systems increasingly rely on Studer Group’s Evidence-Based LeadershipSM (EBL) execution framework to align new entities quickly, ensure accountability, and hardwire consistency. For example, in 2007, Community Health Systems (CHS), a fortune 500 company based in Franklin, TN, engaged Studer Group to help develop its Community Cares platform, based largely on EBL. When CHS doubled its size that same year by acquiring 55 hospitals from Triad, and then added 70 more through its 2014 acquisition of Health Management Associates, the organization didn’t have to worry about alignment and accountability. In fact, it gained new momentum in its quest towards high reliability.
“The hallmark of our success has been our ability to quickly replicate high performance across many facilities,” explains CHS’ Lynn Simon, MD, MBA, president, clinical services and chief quality officer. “As a result, we’ve achieved over 70 percent reduction in serious safety events in over 130 of our legacy hospitals (pre-HMA acquisition) over the last four years. It’s because of our Community Cares platform…how we communicate and align to our goals and expectations. I also credit an embedded culture of high accountability.”
Scale Training
How does such a large organization achieve these kinds of results more quickly than many small hospitals a fraction of this system’s size? By scaling standardized training quickly, for one thing. CHS uses Studer Group’s Leadership Development Institute model to roll out safety training concurrently to more than 10,000 leaders at 190 hospitals.
In November 2015, for example, leaders nationwide began their quarterly training by watching a simulcast recorded video that included an opening safety message from the organization’s chairman and CEO, Wayne Smith. It included a segment featuring the new Care Transitions composite on the HCAHPS survey for FY 2018 to prepare and align CHS’ affiliated hospitals to this domain. The video also gave Simon an opportunity to ensure that every leader in the organization understands—and can cascade the message—that there is a direct correlation between evidence-based behaviors like Hourly Rounding® and bedside shift report with better clinical outcomes.
Afterwards, local leaders gathered to complete specific exercises and post-work focused on their facility’s experience and goals. To keep safety top of mind, CHS begins every meeting (and every LDI) with a “safety moment” where a story about a good catch to avoid an error brings everyone back to purpose and worthwhile work.
Leaders actively work to capture and rapidly disseminate best practices too—like highlighting a recent experience at one hospital where diligent, routine equipment checks ensured a defibrillator was in good working order and saved a patient’s life—so everyone sees what right looks like. (It’s perhaps no surprise that CHS’ South Baldwin Regional Medical Center in Foley, AL was ranked number one in the country recently for “overall recommended care” by WhyNotTheBest.org and that 118 of CHS’ hospitals make The Joint Commission’s list of Top Performers on Key Quality Measures.)
Outperforming the Nation
“With top quartile HCAHPS performance, Baldrige Award recognition, and some of the highest star ratings across the nation, it’s clear that HCA’s American Group aspires to world-class patient experience,” points out Tammy Keeler, MPH, Studer Group’s vice president, partner development.
In fact, during CMS’ most recent HCAHPS reporting period, the 7 divisions (more than 80 hospitals) in HCA’s American Group outperformed the U.S. hospital national average for overall ranking (i.e., 9s and 10s).
David Huffstutler, president of the HCA Central and West Texas Division, attributes it to unwavering commitment to Studer Group’s Evidence-Based LeadershipSM over a decade. “It creates a structure, context, and model for us to train and educate with an evidentiary basis,” he says.
“We are also finding that organizations interested in aligning with HCA are considering our use of Evidence-Based LeadershipSM as an assessment tool,” he adds. “They understand that if these tools and processes are applied, they will demonstrate evidence of broad organizational performance in clinical quality and patient experience…what they’re looking for in a partner.”
It Works
The most important thing to know is that whether your organization owns six hospitals or 200 hospitals—whether it’s for-profit or not-for-profit— Studer Group’s Evidence-Based LeadershipSM execution framework provides a reliable infrastructure to deliver the benefits of scale quickly. And best of all, as Capella Healthcare CEO Mike Weichart notes, “If we want to get it right for patients, we have to get it right for employees and physicians. Studer Group’s Evidence-Based LeadershipSM tools can significantly help the organization deliver on that commitment.”
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