For the past five years, Rochester General Health System (RGHS) has been on a journey to become the greater Rochester region's most respected and trusted healthcare provider of choice. And our RGHS team – nearly 10,000 enormously experienced physicians, care providers, support specialists and administrators – has made impressive strides, as we work to build excellence into everything we do. We are proud to accept the Healthcare Organization of the Month award for April 2012, in recognition of our achievements to date and our exciting potential for even greater success in the months and years to come.
About Rochester General Health System
For more than 160 years, Rochester General Health System (RGHS) has served the greater Rochester community and its surrounding neighbors in western and central New York. Today, we provide outstanding healthcare through eight affiliates that form One Great Health System:
Rochester General Hospital (RGH), the health system's flagship affiliate, a 528-bed tertiary care facility that treats more Monroe County patients than any other hospital.
Newark-Wayne Community Hospital, a 120-bed facility primarily serving the outlying counties of Wayne and Ontario.
Two long-term care facilities, Hill Haven and DeMay Living Center.
The Rochester General Medical Group, with more than 40 practices spread throughout our two-county primary service area.
A Behavioral Health Network that provides psychiatric care to adults and children.
Independent Living for Seniors, a program designed to enable the frail elderly to live in their own homes while being served by a network of supportive services.
An Ambulatory Division that provides a comprehensive network of efficient, superior-quality outpatient care facilities with wide community accessibility.
These facilities and divisions serve our growing community of patients through the passionate efforts of our dedicated team, and with the support of unique community partnerships and invaluable relationships with esteemed healthcare institutions across the country.
Although we do not seek out awards or recognition for the quality of our services, we celebrate the high standing of RGHS among our regional and national peers as ongoing validations of our efforts. In recent years, RGHS and/or its affiliates have earned a wide array of notable national rankings and recognitions, including:
Number 3 in New York State for Overall Hospital Care (CareChex – Delta Group, 2012)
Number 1 in New York State and number 3 nationally for Cardiac Care (CareChex – Delta Group 2012)
Recognized as a Top 100 Integrated Health Network (SDI Health, 2007-2012)
Nurse Magnet Re-Designation (American Nurses Credentialing Center, 2009)
Nationally recognized Hemophilia Center (National Hemophilia Foundation)
Recognized nine times as a Thomson Reuters National Top 100 Cardiac Hospital
Top Quality Rating – Cardiac Surgery Performance (Society of Thoracic Surgeons, 2010)
Exemplar Hospital for Infection Prevention (Institute for Healthcare Improvement, 2011)
Designated a Primary Stroke Center (The Joint Commission, since 2003; New York State Department of Health, since 2005)
Stroke Gold Plus Achievement Award / Target Stroke Honor Roll (American Heart Association and American Stroke Association, 2011)
Number 3 in New York State for Overall Surgical Care (CareChex – Delta Group 2012)
Recognized as a Top Performing Hospital (Premier Healthcare Alliance, 2011)
NOVA Award (American Hospital Association, 2011)
Top 125 Hospital (AARP, 2009)
NICHE Designated Hospital (Hartford Institute for Healthcare Improvement, 2005-2011)
Baby-Friendly Hospital (World Health Organization)
Excellence, Every Day
Over the years, and despite dramatic shifts in the medical landscape brought about by such factors as federal healthcare reform, the RGHS mission has remained constant: to improve the health of the people we serve by providing a comprehensive range of high-quality services that combine clinical excellence with patient-focused compassion, efficiency and convenience. All RGHS team members are united in their commitment to deliver compassionate care, positive clinical outcomes, and unparalleled customer service to every patient, at every encounter, every time.
At the same time, however, we recognized five years ago that RGHS – although respected and appreciated by patients and the community – needed to evolve from "good" to "great" in order to become the region's most trusted provider of choice. To facilitate a renewed focus on that commitment, we established a system-wide customer-service initiative in which every affiliate and department/unit leader met with team members throughout RGHS – individually and in groups – to seek out new ideas that would boost patient satisfaction. Before long, we began to implement dozens of new system-wide patient-focused initiatives; and soon, unsolicited compliments and feedback began pouring in from patients and their friends and loved ones – acknowledging the kindness, reinvigorated energy levels, and positive attitudes that were transforming their overall perceptions of our organization. Across our system, patient satisfaction figures showed dramatic – and sustained – improvements.
Next, we followed up that broad customer service program with an even more ambitious Strategic Plan that addressed specific tactical areas, and that has provided us with a roadmap for success over the past several years. Our work in the following strategic areas is ongoing, and showing great signs of success:
Deliver Great Care and Value – Clinical Quality, Patient Safety, Exceptional Service and Convenient Access – Through the Work of Our People
With a renewed commitment to creating a culture of patient safety, we aimed at not just the reduction, but the elimination of all factors that might contribute to patient harm. Thanks to such initiatives as our system-wide hand hygiene program, flu vaccination campaigns, more aggressive infection prevention techniques, and the founding of an internal Institute for Patient Safety and Clinical Excellence, we have seen significant, sustained reductions in serious hospital-acquired infections. Specific 2011 achievements include the virtual elimination of central line-related bloodstream infections in our ICUs; zero incidents of infection associated with total hip replacements; a 50 percent decline in dialysis bloodstream infections; a 10 percent reduction in hospital-acquired MRSA at our Newark-Wayne hospital; and a 30 percent reduction in C. difficile infections at our Hill Haven senior-care facility.
These achievements, along with an array of team member-initiated patient safety improvements led by a new Comprehensive Unit-based Safety Program, earned RGHS recognition in 2011 from the U.S. Department of Health and Human Services as a National Leader in Infection Prevention. Most importantly, the Mortality Index at Rochester General Hospital dropped from .89 to .75 – significantly below expected mortality rates.
Impressive indicators of our successful efforts to improve care and clinical quality can now be found throughout our system. Our dialysis center scored a perfect 30 out of 30 score in the inaugural End-Stage Renal Disease Quality Incentive Program, created by the Centers for Medicare and Medicaid Services to gauge the performance of dialysis centers nationwide. Our Bariatric Surgery and Breast Center programs both earned Center of Excellence status in 2011 – prestigious national designations that recognize the excellence of our teams, and that enable care to be provided to a wider array of patients, regardless of insurance.
And with rising quality has come rising demand and incremental growth. RGH's Bariatric Surgery, Breast Center, Urology and Vascular service lines all increased share in 2011. Robotic surgery continued to grow, as well: in 2011, we performed more than 1,000 robotic surgical cases for the first time in a single year; and we anticipate our 5,000th overall robotic surgery case will occur in mid-2012.
Clinically Integrate Eight Affiliates and 1,200 Physicians into One Great Health System; and Develop Strategic Affiliation / Partnership Models in Secondary Service Areas
In 2011 we furthered our clinical integration progress with the newly coordinated hospitalist program, linking care efforts between Rochester General Hospital and Newark-Wayne Community Hospital. Our hospitalist program is now the largest in this region, with internal medicine specialists now managing more than 80 percent of all our inpatient cases. Eliminating "care silos" in favor of a more integrated system of care has reduced Length of Stay, lowered costs, and improved quality of care. Clinical services including medicine, surgery, emergency medicine, OB/GYN and pathology have also been integrated, with the chiefs of each service overseeing care and clinical functions at both of our hospitals.
These integration efforts were supported in 2011 by remote TeleHealth technology. Daily TeleICU rounds have been established between centralized Rochester General and outlying Newark-Wayne, setting the stage for future TeleHealth initiatives as we expand our formal partnership with other smaller, regional hospitals as part of our Secondary Service Area (SSA) expansion strategy. As those smaller stand-alone hospitals seek to collaborate with a nationally recognized tertiary-care facility such as RGH and prepare for the anticipated requirements of the Patient Protection and Affordable Care Act, we are evaluating these new partnerships and exploring ways to enhance existing relationships.
Invest in Programs, Technology, Innovative Community Outreach, and the Redesign of Clinical Processes to Better Serve Our Community and Prepare for Payment Reform
2011 saw unprecedented levels of strategic investment at RGHS, led by our new electronic medical record (EMR) system, Care Connect – at $65 million, the largest single investment in RGHS history. Our first "go live" phase of Care Connect in key areas began in November, and within the next two years Care Connect will be fully operational across our system, as well as in many of our community physician practices. Adoption of this cutting-edge technology supports our work in improving quality, clinical integration and patient safety, while further positioning RGHS to succeed in an environment of evolving quality-driven payment reform—which increasingly links reimbursement to quality and safety.
Another recent key infrastructure investment was the acquisition of a new ambulatory surgery center, the immediate success of which prompted us to accelerate our plans to form our eighth affiliate – the RGHS Ambulatory Services Division – earlier in 2012. This new affiliate represents another major step toward embracing a post-reform future in which the levels of care provided are more closely tailored to each patient's specific needs, with high-quality ambulatory procedures providing a cost-effective and patient-focused alternative to the former model of primarily inpatient-focused care. More recent and ongoing investments include a new emergency department and endoscopy suite for our Newark-Wayne hospital; the renovation of our Hill Haven senior-care facility, representing the growing de-emphasis of traditional nursing homes in favor of offsite managed senior care; and the opening of an administrative campus, which allows many of our administrative teams to operate from a centralized location.
Among the process-driven innovations that have shown outstanding results and future potential is a patient-centered care model in our RGH emergency department that dramatically decreased door-to-provider times from more than 90 minutes in 2009 to consistently around 30 minutes today. LWOT percentages dropped from 4.86% to 1.45% in that same time, while patient length-of-stay periods dropped by 15% for treat-and-release patients and by 11% for admitted patients. And these accomplishments occurred during a time of continued total volume growth – our RGH emergency department saw a record number of patients in 2011.
Build and Retain a World-Class Medical and Dental Staff
We recognized some time ago that in order to have One Great Health System, you need to start with one great team. With that in mind, RGHS has developed targeted initiatives to both attract and retain top Medical and Dental Staff members who not only demonstrate superior clinical skills, but also embrace our values and commitment to deliver compassionate, service-driven care. We recruited 53 new physicians to our system in 2011, representing a net growth of 20 physicians, and hired or promoted several new physician leaders to help support the fulfillment of our long-term goals.
Because strong physician relationships pay dividends in every aspect of our operations, RGHS has long enjoyed a longstanding partnership with the Greater Rochester Independent Practice Association (GRIPA), to maintain coordination of care even among physicians in private practice. Through our partnerships with GRIPA and our physicians, our system has launched a bold initiative with Blue Cross Excellus to negotiate an innovative payment system which links reimbursement to performance – a move strongly aligned with the new value-based purchasing directions established by the Patient Protection and Affordable Care Act. When completed, our negotiations in this effort should result in very competitive RGHS inpatient and outpatient rates, and a quality-based pay-for-performance system that incentivizes community-based PCPs toward accepted national quality measures.
We have also made a significant commitment to cultivate the growth and development of our existing team members, specifically in the areas of leadership development, patient safety, and EMR awareness and proficiency.
Fund Our Exciting Future
In 2011, RGHS generated an operating margin of 2.8%, with 71.1 days cash on hand. This financial stability reflects sound planning coupled with the discipline to manage resources with absolute strategic discretion – especially important, given the anticipated realignment of inpatient/outpatient volumes that are expected to continue as we move closer to the full implementation of federal healthcare reform.
Tell Our Story: "RGHS is the Region's High Quality / Low Cost Provider"
By sharing our successes directly with our community of consumers and referring physicians, we ensure greater standards of health and wellness for our entire region, while supporting the achievement of our ambitious growth goals. We initiated plans in 2011 to take the lead in striking up a new conversation about healthcare in a post-reform environment, beginning with the formation of a Community Affairs Committee, which will help build and strengthen relationships with community leaders and health-related organizations. Also, a comprehensive Strategic Marketing Plan developed in 2011 yielded new and distinctive positioning: that Rochester General Health System is pioneering the new era of patient care, delivering clinical excellence in a patient-focused culture. That message is being promoted through additional programs designed to reach physicians, team members, employers, payers and consumers.
Together, these initiatives combine to form a consistent image of RGHS as One Great Health System, made up of trusted and highly skilled providers, which understands and meets the healthcare needs of our diverse community.
Progress in Achieving Our Vision
The work of our team members, physicians and volunteers over the past several years has produced dramatic results. 2011 was the best and most successful year yet for Rochester General Health System – in the midst of transformative changes and increased demands placed on our team members, we continued to grow and excel in all areas, including:
Despite the flat population growth of our geographic area, inpatient demand increased by 11 percent at Rochester General Hospital and by 8 percent at Newark-Wayne Community Hospital.
The RGH emergency department has clearly become the preferred ED in the region, as we saw more than 113,000 ED cases in the 2011 calendar year – up from 88,000 just a few years ago. That figure is higher than any other ED in our service area, and indeed makes RGH one of the busiest EDs in the entire state of New York.
Five years ago RGHS was the fifth largest employer in the Rochester area; today we are the number-three employer, with more than 1,000 positions added in the past several years.
Our HCAHPS results continued to improve in 2011, as we led the region and the state in almost every category. Patients give us high marks in areas including Communication with Doctors and Nurses, Pain Management, and Responsiveness of Staff. These scores offer some of the best insights available about how positively our work is received by patients. This sustained HCAHPS excellence was recognized at the national 2011 What's Right in Healthcare conference.
This remarkable progress in our journey – as a recognized clinical leader, a sought-after partner by other area hospitals, and in our emergence as our community's healthcare provider of choice – offers strong validation that we continue to be headed in the right direction to achieve our patient-centered goals, with continued diligence and a system-wide shared commitment to Excellence, Every Day.