Monroe County Hospital

  • Location: Albia, IA
  • Award: Evidence-Based Leadership Healthcare Organization of the Month
  • Awarded: October 2007

"In early times, there was always someone charged with keeping the fire going. If they were successful, people lived. If they failed, people died."

There are two places you can light fires; inside your organization and outside your organization. The October, 2007 Fire Starter of the Month, Monroe County Hospital, does both.

Monroe County Hospital is a very special place today. It's a place where people drive past other hospitals to work; the hospital that had 290 applications for 9 open positions last year and has a waiting list for jobs. Walk through the halls and you see employees high fiving one another and giving out wooden nickels in support of the behavioral standards. Departmental silos have been torn down, and employees genuinely like each other. Visitors can feel the difference when they enter. Patients get very good care. And physicians enjoy practicing medicine. A fire burns inside MCH called The MCH Difference.

It wasn't always like that. In 2001, one out of every four employees quit MCH. Patient satisfaction was in the 29th percentile. Quality was poor. And the hospital had lost a third of its cash reserves.

So what happened to turn it around? Certainly it was the engagement of the Studer Group and the implementation of the Nine Principles. But more than that, it was an absolute commitment to our people. It's following the Good to Great mantra of putting the right people in the right seats on your bus. According to CEO, Greg Paris, "It's believing in your people; believing that they will do the right thing because you've hire good people, and understanding that that will result in better service, patient outcomes and financial results. We've identified five key steps in the development of an Employer of Choice culture:"

  • It's setting a vision and identifying values and behavioral standards to take you from today to that vision. At MCH, attitude and fun are two key values. You control your own attitude and you know it's ok to have fun at work.
  • It's building relationships through rounding and thank you notes to the home. And it's getting to know your people on a personal level, supporting them during tough times, and helping them learn and grow. The MCH Difference is sending birthday cards to employees and their children with $2 bills and handwritten notes in them. It's MCH-U, an in-house college with classes taught by employees. And it's fun activities, hardwired into the day.
  • It's hardwiring accountability through public report cards in every department, evaluations tied to measurable goals, and deselecting people who choose behaviors that are inconsistent with your values.
  • It's hiring right – employees selecting the people they work with and orientation that talks about culture before anything else. It's a culture so strong that a 3-11 Ward Clerk can tell the CEO he can't hire an Assistant Administrator candidate because they aren't a good fit.
  • And it's celebrating all the time, including on Celebration Day – a day each month dedicated to identifying and embracing all that goes right at MCH.

Monroe County Hospital is only the second hospital to be recognized as a Fire Starter Hospital on two separate occasions (the first in November, 2005). With 25 beds and a $12 million budget, it is also the smallest hospital ever to win the award. The results show what's special about this critical access hospital located in southern Iowa.





Employee Turnover




Employee Satisfaction




Inpatient Satisfaction




ER Satisfaction




OP Satisfaction




Infection Rate




Work Comp Premiums




Cash Increase (Decrease)




Total Margin




But the fire created at Monroe County Hospital burns in other facilities, too. Over the past two years, more than 70 hospitals have called, e-mailed or visited Albia to learn from The MCH Difference. Hospital leaders have presented in more than 30 locations, including Phoenix, Atlanta, Orlando, and Chicago. And it does so without charging anyone. "One of the things I remember Quint saying early on," said Paris, "is that our charge is to improve healthcare, and that isn't limited to our own institutions. If my child gets injured in the town down the road, I want them to get very good care at that hospital. When I think about how our employees have impacted thousands of employees and patients across the country, it makes me very proud."

That's The MCH Difference.

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