Blue Ridge HealthCare

  • Location: Morganton, NC
  • Award: Evidence-Based Leadership Healthcare Organization of the Month
  • Awarded: June 2005

Blue Ridge HealthCare: Making Strides on a Journey to Excellence

To gain an appreciation for the June Fire Starter’s progress on its Journey to Excellence, you have know the starting point.

Blue Ridge HealthCare (BRHC) was created in 1999 by the union of long-time competitors with conflicting cultures from historically rival communities in Morganton and Valdese, NC. Located in the foothills of the Blue Ridge Mountains, the new system consolidated two community hospitals and their affiliates into a single, non-profit system that also included two nursing home/short-term rehabilitation centers, a home health company, a freestanding wellness center and a continuing care retirement community, as well as several physician practices. The boards of the two hospitals had the courage and foresight to confirm the merger into perpetuity after a two-year opt-out provision expired in 2001.

At that point in the life of the new system, the cultural divide between employees based in Valdese and Morganton was as deep as the valleys criss crossing the surrounding foothills. Employee, physician and community buy-in to the idea of a unified healthcare system was at an unhealthy level. Today, BRHC has a success story in the making, verified by impressive gains and continued progress along many fronts.

Blue Ridge has set a priority on changing the way healthcare is delivered in the community. The Journey to Excellence is one of three key strategies driving the change.

First, a clinical strategy is creating Hallmark Services to attack the area’s major health problems: heart disease, cancer, women and children’s health, bone and joint disease and digestive disorders. The system is also recruiting physicians to support these service lines.

Second, a facilities strategy will be breathing life into the hospital campuses over the next three-to-five years. With construction commencing this year, the Campus Redevelopment plan will pump $100 million into the aging buildings with new facilities and technologies, primarily tied to the shift toward outpatient care. A separate plan is under development for Blue Ridge’s long term care affiliates.

Third, a cultural transformation strategy is aimed at building a new culture that unites nearly 2,000 former competitors into colleagues, under a single mission - "To Enhance Life by Excelling in Care" -- and with a common vision - "To Be the Best Community Healthcare System in America." To create the new culture, BRHC launched its Journey to Excellence in January 2003 in partnership with The Studer Group. Three goals framed the Journey to Excellence (JTE), namely, to make Blue Ridge HealthCare:

  • A great place for employees work
  • A great place for patients and residents to receive care
  • A great place for physicians to practice medicine.

During his launch speech before the system’s 120 managers, directors and senior leaders, BRHC President & CEO Kenneth Wood said, "If you believe this is a journey worth taking, then I challenge you to pack away old attitudes, rid yourself of perceived barriers to change, prepare to learn, prepare to lead and anticipate success."

Two-and-a-half years later, BRHC is, by all accounts, a vastly different organization. The Journey is producing results that are having a measurable, positive impact on:

  • Work force stability: Employee turnover in the hospitals has been cut from about 30% in 2002 to less than 15% in 2004. RN vacancy rates are less than 10%. The vacancy rate in long term care has been reduced from 56% system wide (including 110% at one facility in 2002) to about 14% in 2004, among the lowest in NC.
  • Employee Commitment: Overall employee commitment jumped from the 65th to 79th percentile between the first and second year of the Journey to Excellence.
  • Patient satisfaction: Supported by six JTE teams, managers and directors at BRHC have led staff to make significant strides toward the ultimate goal of reaching the 95th percentile on patient satisfaction. Overall consistency remains a major goal, although from 2002-2004, ED satisfaction climbed from the 28th percentile to 78th percentile; outpatient satisfaction rose from the 76th to the 91st; and inpatient satisfaction increased from the 7th to the 67th percentile. Satisfaction in long term care, home health, the retirement community and the wellness center is now consistently high, ranging between 95 and 100% in 2004.
  • Physician Buy-in: The system’s first Physician Cultural Survey in 2004 found overall buy-in at the 70th percentile. In 2005, it rose to the 74th percentile.
  • Public Image: The system’s first baseline community survey showed that more than 80% of respondents noticed an improvement in customer service at the hospitals since the Journey began and believed the new system is moving in the right direction.

While there are many successes, Wood constantly reinforces to everyone on the BRHC team that the Journey to Excellence is about "progress, not perfection."

"This is not a sprint. This is a marathon. It is about creating a way of life within our organization that calls us back to our roots in healthcare," he said.

Led by Senior Leadership and 17 teams involving about 150 employees, the organization has taken The Studer Group approach to developing and hardwiring excellence while putting its own BRHC "brand" on tactics that support the Nine Principles and the Must Haves. JTE even won a coveted Silver Tusk Award in 2004 in internal relations from the Carolinas Hospital Marketing & Public Relations Society, a group representing healthcare organizations in North and South Carolina.

Many milestones have been achieved along the journey since 2003.

  • Standards of behavior, developed by the Standards Team from interviews with 200 employees, have been adopted for all employees. In a signing ceremony before employees, senior leaders personally committed to lead by example. Job applicants must sign off on the standards before receiving an application. The BRHC Board of Directors has also adopted the standards. A monthly Standard of the Month quiz on the BRHC intranet, also hardwired into staff meeting agendas, helps keep standards top-of-mind.
  • Multiple tools have been developed by the Affirmation & Appreciation Team/Partnership Council for affirming individual commitment to practicing the standards and to delivering excellent care and superior service. In addition to handwritten thank you notes and WOW Cards (More than 9,000 have been presented), WOW Scratch Cards, and Value Meal Coupons are presented for on-the-spot recognition. The Merit of Excellence recognizes employees for extraordinary acts and includes recognition by the Board of Directors. Recognition is hardwired into performance appraisal and leader performance expectations.
  • The Affirmation & Appreciation Team/Partnership Council also plan special events to encourage teamwork and esprit de corps throughout the system. This year’s third annual SummerFest attracted more than 7,000 employees, physicians and their families to a full-fledged carnival at the county fairgrounds. Employee Service Award were part of the celebration. Parties with a Purpose celebrate special achievements, such a Valdese Hospital’s 2005 JCAHO accreditation with no RFIs.
  • The Measurement Team works with each affiliate not only to develop and report survey results (available on a JTE link on the company intranet), but also on diagnosing trouble spots revealed by them. The team also presents PACE Awards (Patients Acknowledging Customer Excellence) at the quarterly LDIs recognizing highest and most improved survey score. The system will receive six PRC Four- and Five-Star Awards this summer for 2004 survey results.
  • The Service Recovery Team has developed more than 40 toolkits accessible 24/7 across the system. A tracking program is being developed to mine service improvement opportunities at the unit level, based on the use of Service Recovery tools.
  • Working with Senior Leadership, the Accountability Team developed a groundbreaking performance appraisal system for employees and leaders. The system aligns line employee, manager, director and senior leader performance with BRHC’s Corporate Scorecard and Standards of Behavior. Importantly, it differentiates clearly "high and low performers," directly in response to employee sentiments expressed on the first and second annual cultural survey. An extensive catalog of educational offerings have been created to assist employees in addressing areas of clinical and non-clinical need identified through the appraisal process.
  • The four LDI teams have planned and carried out nine two-day Leadership Development Institutes, each with their own distinctive theme. Mandatory homework (linkage) assignments help ensure that leaders understand and apply lessons learned.
  • The Communications Team has produced a "Build A Communication Board" kit, covers JTE activities in the employee newsletter and organizes Blue Ridge Briefings around the system three times year. Led by the President & CEO, the Briefings are themed, includes prizes for attendees and include spot surveys to taken the temperature of the organization on an ongoing basis. Twelve one-hour sessions are conducted at all work sites in the system during each round. JTE team leaders routinely report their team activities through a "JTE Team Activities" report available system wide on the BRHC intranet under the JTE link on the home page.
  • Every member of the Physician Satisfaction Team is assigned as a personal liaison to a group of physicians. The team’s activities complement a Physician Liaison Program where Senior Leaders are required to maintain contact with their own group of physicians, a requirement hardwired into their performance appraisal via the Corporate Scorecard. The team routinely helps identify and communicate physician requests for news and replacement equipment for follow-up by Senior Leaders. It also plans Doctors Day activities on both hospital campuses every year that have received regional awards for special events.
  • Two Resident Satisfaction Teams have implemented a bevy of activities contributing to satisfaction ratings at 95% for above in the retirement community and in the two long term care facilities, from addressing "quick wins" to themed birthday parties and an "End-of-Life" Tribute program to celebrate the life of residents who pass away.

Outside the JTE teams, an ever-expanding inventory of creative activities, benefits and incentives is helping propel BRHC on its journey to becoming a great place to work, including an innovative Journal Club. Led by senior leaders and selected directors, Journal Clubs are groups of managers and directors who meet to read, study and discuss best selling books in healthcare and business. Unlike most "reading circles," lessons learned from the books are formally incorporated into everything from performance appraisal to leadership development at BRHC.

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