Clark Memorial Hospital (CMH) is a 241- bed, non-profit acute care community hospital. CMH delivers a wide array of inpatient and outpatient services to patients of all ages. The hospital provides comprehensive inpatient programs in general surgery, urology, orthopedics, general and pulmonary medicine and obstetrics. CMH also delivers a broad range of diagnostic and outpatient services, with advanced programs in oncology, cardiology, ambulatory surgery, behavioral health, women's services and emergency medicine. CMH's health care market is extremely competitive with two Indiana hospitals and five large Louisville hospitals (including two major systems) within 15 miles of the main campus.
In 2001, Clark Memorial Hospital committed to create a superior work environment that would promote patient service excellence and drive sustainable financial results. Implementing Studer Group® Nine Principles®, the hospital began its journey of excellence. Embracing the hospital's mission to provide superior health services to the people and communities it serves, the leadership challenged themselves to undergo a culture change and to benchmark world-class organizations.
Led by Martin Padgett, President and CEO, and a four-person senior team, CMH built upon the foundation it had established over the previous years and looked to further advance its strategic objectives (People, Service, Quality, Finance, Growth, and Community). It became rigorous in tightly aligning the organization with measurable outcomes and holding each leader and each department to a balanced scorecard.
Clark Memorial Hospital continues to be dedicated to achieving clinical, service and operational excellence as it pursues its vision to be the best community health care provider in the United States. By holding to a world-class standard, CMH has greatly impacted patients' health, team members' work environment and physicians' practices. Recent survey results indicate CMH holds some of the highest scores for patient, team member, and HCAHPS satisfaction in the region.
The plan for achieving objectives follows the strategic plan and is categorized on Six Pillars of Success.
People: Team member turnover has been reduced primarily through a cultural change. Cultural changes included better peer interaction hardwired with thank you notes, leader rounding – which includes the senior leadership team – on all shifts, and several reward and recognition tools. In addition Human Resources conducted training sessions for peer interviewing to ensure cultural fit with new hires. Each new team member is given the Standards of Performance created by a Standards Team, and education on those standards is continual.
Historically, CMH measured team member (TM) satisfaction and engagement internally. This enabled tracking and trending of results, but it could not be benchmarked. Knowing the importance of team member satisfaction to organizational success, CMH decided to engage The Jackson Group in 2005 for nationally percentile-ranked results. The first survey in early 2006 showed TM satisfaction at the 62nd percentile while the second survey in December 2006 showed the TM satisfaction has increased to the 82nd percentile.
Feedback reports are distributed to all leaders. Low-scoring departments were asked to provide 90-day action plans for improvement and process improvement teams were developed as needed.
Service: Department specific patient satisfaction scores are provided in addition to overall scores to instill accountability for patient care. Tools again were provided and hardwired, such as hourly patient rounding, AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank) and key words. The top-scoring departments share their benchmark ideas for the organization, while the lowest-scoring departments provide 90-day action plans for improvement. Top-scoring departments are also presented with High Five awards that can be displayed while the department remains in the top five. Numerous reward and recognition celebrations are held. The hospital will mark patient satisfaction scores in the 93rd percentile for the first quarter 2008 with a celebration 10 cent lunch. These results indicated 75% of all departments scoring 85% or above in patient satisfaction.
Quality: All leaders were trained on process improvement tools to facilitate changes in their departments. For cross-functional processes, improvement teams were developed, including:
Bed utilization team – decrease patient discharges – The bed utilization team was integral in improving the growth of the hospital by increasing throughput of patients and reducing patient days. This improved patients' satisfaction with the discharge process. These best practices and results were presented at a national conference in 2008.
Core Measure teams for Cardiac, Pneumonia and SCIP – improve quality outcomes
Rounding team – improve overall patient care and team member satisfaction
Measurement team – measure improvements
Patient Safety team – rounding with board member to address issues of safety and quality
Workforce Management Team to help manage accountability with productivity and staffing
The latest monthly core measure results (February 2008) are the best since results have been publicly reported. Acute myocardial infarction is at the 95th percentile, pneumonia care is at the 82nd percentile, congestive heart failure is at the 82nd percentile and surgical care improvement project is at the 81st percentile.
HCAHPS results in April 08 showed CMH, in comparison to its local market, ranking the highest in 9 of the 10 questions and ranking 3rd on the remaining question. In the two main questions of the survey, providing the percent of patients who gave their hospital a rating of "9" or "10" on a 10-point scale and the percent of patients who reported "Yes" they would definitely recommend the hospital, CMH ranked higher than any hospital in its service area. In summary, CMH ranked at the 84th percentile nationally on the overall ranking of a 9 or 10.
Finance: Budget accountability reports were developed and implemented to curb expenses per patient registration. The reports monitor differences between actual and budgeted expenses. Departments with variances greater than 2% must provide an explanation within 30 days. In addition, finance began sending communications with daily patient statistics by department, so each team understood their impact. A major improvement initiative that improved the financial pillar was the renegotiation of payor contracts by our finance department and such initiatives as up front collections.
Growth: Clark Memorial has experienced strong growth the past five years and is the market leader among the hospitals in our primary market, holding 50 percent of inpatient market share in Clark County. In January 2008, a Wound Care Center was opened with a multi-disciplinary team of health care providers. Also, in the first quarter of 2008, CMH opened a new primary care office in the nearby community of Henryville, Indiana. In addition to the Henryville office, Clark Memorial Hospital has 3 primary care offices located throughout the county and staffed by employed physicians. There are a total of eight employed physicians currently; however, this strategic effort is growing steadily. Urgent care and diagnostic imaging services were expanded in 2006 through the completion of a new facility in Sellersburg, Indiana, located 7 miles from the main campus. The hospital also has invested in imaging technology, including digital mammography, 64 slice CT scan technology and advanced MRI and ultrasound.
Community: Outcome models were developed to measure the success of community health initiatives. In addition, benchmarks were developed with other community hospitals to evaluate the effectiveness of our programs. One of the most successful community events is the Men's Health Fair. Held in the spring of each year, this event is well attended by the community and provides health screenings, literature and free seminars.
The ultimate measures of success are the achievement of strategic objectives and the improvement in the health of the people we serve. CMH has received state and national recognition for its organizational excellence and service. It proudly boasts of its recognition as one of the Top 10 Places to Work in Indiana, the One Southern Indiana Economic Impact Award and the Taste of Jeffersonville (restaurant competition won by the Food and Nutrition Services team). Clark Memorial Hospital was also named an award finalist for the 2007 BKD Indiana Excellence Awards, 2003 Overall BKD Quality Improvement Award and 2003 BKD Gold Award in the health care category. The following year CMH received the BKD Bronze Award in the healthcare category. As a first-time applicant of the prestigious Baldrige National Quality Award CMH achieved a score in Band 3, with only 31 percent of healthcare applicants scoring higher. CMH is proud to be named two time recipient of the Studer Group Fire Starter award.