Monroe County Hospital

  • Location: Albia, IA
  • Award: Evidence-Based Leadership Healthcare Organization of the Month
  • Awarded: November 2005

“We want to be different!” The Management Team at Monroe County Hospital in Albia,Iowa first uttered that phrase in 2000 at a strategic planning retreat. The hospital’s employee satisfaction was in the 48th percentile and turnover was 26%, patient satisfaction was in the 43rd percentile, and cash in the bank had dropped by 35%. “We want to be different” meant “we don’t want to be average anymore.”

The MCH Difference was born out of that 2000 management retreat. The dream was a different place to work – one where employees loved their jobs and acted like owners. And patient care would be different – patients would become advocates, raving about their care. The path was to implement the Studer philosophy in order to become an organization with a culture of service and teamwork.

Let’s fast forward to October, 2005. Employee satisfaction had risen to the 98th percentile and turnover was less than 9%. Patient satisfaction in the ER, Inpatient, and Outpatient areas were 98th, 95th, and 91st percentile respectively. Medication errors were reduced by 60% and there were zero nosocomial infections for the previous year. Cash in the bank had doubled. Different had taken on a brand new meaning. And at the Rural Partnership Institute in Minneapolis, Monroe County Hospital became only the second rural hospital, and the smallest hospital ever, to be awarded the Studer Group’s Fire Starter Award.

How does a 25 bed hospital in the poorest section of Iowa have the resources to transform a culture? Where does change come from? And how does the fire stay litthroughout the organization? The answer is quite simple – the difference is their people. MCH Management and the Board of Trustees subscribe to the theory that you mustgettheright people on the bus and move the wrong people off. They believe in setting expectations, holding people accountable, and celebrating the wins. The organization believes that if you have engaged employees, the patients will get great care. Quality, safety, and finances will take care of themselves.

To the Studer Group’s six must haves, a team of Fire Starters developed 29 behavioral standards and a service recovery program that would become benchmarked by dozens of hospitals across the country. Every employee in the organization pledged to follow the standards, which include things such as greeting everyone in the hallway, walking customers to their destination, and asking every customer what else the can do for them. The service recovery program gives ownership of every service issue to the employee who discovers it. And if the employee feels that quality care or service was not delivered, they have a menu of remedies at their disposal to make it right, including writing off up to $1500 in charges – no questions asked.

At every quarterly LDI, another must have was introduced and implemented. An internal college, MCH University, was created to train employees on the standards, service recovery, and key words. Thank you notes to the home became dinner time conversation. The fire was lit.

As the quality measures began to show improvement, employees connected the dots between their behavior and patient care. They recognized that they were making a difference to someone every single day. And the momentum never stopped.

Monroe County Hospital continues to do things differently. There are TVs in the ER exam rooms; surgery and hospice families receive pagers so they canfeel free to move around the facility; and ER charts each have a 20 minute timer on them, reminding anyone in the vicinity to check on and update a patient. Celebrationsareregularoccurrences with games, free food, and laughter always on the menu. And the staff and management genuinely care for each other. High fives in the hallway are the norm.

Recognizing that relationships are the foundation to implementing change, MCH continues to focus on this area. Birthday cards from the CEO are sent to each employee, along with a $2 bill (because $2 bills, like engaged employees are a unique and special find). Employee’s children also receive a birthday card, with a note from the CEO thanking them for sharing their special Mom or Dad. Rounding and sharing wins also helps build those relationships.

If relationships effect change, accountability sustains it. Leader and employee evaluations focus on measurable results related to the Hospital’s pillar goals. And they measure employee performance in the three areas it takes to be a high performer – job skills, behavior, and being a good teammate. Report cards hang outside every department, detailing the department’s quality results. Public bulletin boards share all quality information, everything from financials to medication errors. Service pledges, carrying the CEO’s home phone number are hung throughout the organization.

According to the Gallup employee satisfaction survey, 92% of MCH employees are engaged. That means they have a common direction – a vision of best patient satisfaction in the nation. It means they enjoy coming to work everyday – where fun is embraced as a value that can reduce the stress in health care. And it means employees care about the people they work with, because they know they can count on each other. It’s not numbers, scores, or awards that matter – it’s worthwhile work, greatpurpose, and making a difference every day. That’s The MCH Difference!

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