Stewart Memorial Community Hospital

  • Location: Lake City, IA
  • Award: Rural Healthcare Organization of the Month
  • Awarded: February 2012

2012 marks the 50th anniversary of Stewart Memorial Community Hospital's tradition of excellence with a personal touch. SMCH is a 25 bed Critical Access Hospital composed of not only our hospital facility, but five physician clinics and four retail pharmacies, all of which employs 287 people. Our non-profit organization provides 46,772 patient encounters annually, serving approximately 17 neighboring communities in rural northwest Iowa.

Four years ago, CEO Leah Marxen shared her vision of becoming the best rural hospital in the nation and set out to meet that challenge. The leadership team began this quest by providing opportunities to staff and so began the Stewart Journey to excellence, first focusing on providing great care to every patient every time.

Through this journey, we have been honored to be nominated for some very noteworthy awards and the Fire Starter award topped our list. We are very humbled to be chosen for such a prestigious honor from The Studer Group. We are sure you will find by our many accomplishments, this journey to excellence has brought and continues to bring us many opportunities to raise the bar of care and compassion in our community and surrounding areas.


Stewart Memorial Community Hospital strives to hire, promote, and retain excellence in the people who care for our patients. We've made huge strides to make this the best place to work, with our employee satisfaction ranking in the 95th percentile in the nation. We were named the Des Moines Register Top Places to Work in 2011, a prestigious award that was won stemming from a nomination submitted by an employee. There have been many strategies we have applied to make SMCH the best place to work. In our journey, we started aligning behaviors.

The Standards Committee worked hard on drafting our Standards of Behavior, which every employee is required to commit to and sign. A dress code was implemented with each department choosing their color, instilling more of a sense of pride. This has not only been a morale builder, but aids in identifying care providers for our patients and guests.

A merit based employee evaluation tool based on our Standards of Behavior, and tied directly to pillar goals, was implemented and welcomed by staff. Expectations of the communication process are clear, include employee rounding, 30-day and 90-day follow up, and Distinguished/Successful/Unsatisfactory (DSU, or High/Middle/Low) conversations are mandatory for department directors in managing their staff. Our zero-three year employee turnover rate has decreased by 4% to 7.76, saving thousands of dollars in employee orientation and hiring cost. The peer interview process helps us select high performing individuals to be a part of our team.

Stewart Memorial Community HospitalOur Vice President of Nursing and Ancillary Services was named to the Top 100 Nurses. Our CEO was chosen by the Studer Group to be a part of a CEO panel presentation to rural hospital leaders across the country.

Stewart Memorial Community HospitalOur Rewards and Recognition Committee was formed and introduced many avenues of rewarding employees. The Golden Pillar Award is awarded monthly to a department for an achievement with a measurable improvement. The winner displays a gold pillar in their department for the month, receives a framed certificate and a huge bowl of gold candies as a way of saying "Way to go!" Each month nominations from staff, patients and guests are reviewed and a Champion of Standards is named. This is someone who has displayed exemplary behavior and gone above and beyond their duty at work or in the community. This award is the highest honor an employee can receive, and comes with a certificate and gift card. These two awards are announced in the cafeteria, we are well pleased at the overwhelming number of staff who attend this brief presentation each month. A committee reviews the year's winners and a Champion of the Year is named at the annual Employee Awards Banquet.

The Service Hero Luncheon is held bi-monthly, which is a time for the Leadership Team to say thank-you to staff, physicians and volunteers who have been named specifically on patient surveys or nominated by a Department Director or Supervisor based on meeting pillar criteria. Other methods of recognition in place by the R&R Committee are naming the Provider of the Year, based on the measurement of their individual service scores to our patients; WOW cards that have a monetary value are given from any employee to another for any reason and are redeemable at our pharmacies, cafeteria or gift shoppe; and the Heart of Gold award goes to an employee that has done something significant for a co-worker and is passed every two weeks from an employee to another employee in a different department, who wears a special tag that attaches to their name badge.

Great strides were made in physician engagement when our CEO began rounding with each physician. Medical Staff meetings with a rigorous agenda and a specific educational topic or speaker to address the group are held each month. A physician scorecard was put in place. Physician satisfaction increased by 8% to 4.74 on a scale of 5. SMCH has successfully recruited 14 new providers in the past four years. Our orthopaedic surgeon claims she was sold on SMCH during recruitment efforts when she received a gift basket that included hand embroidered tea towels by one of our Auxiliary members, the personal touch.

Once goals and the strategy to meet those goals were in place, communication was a key factor in being successful in attaining them. All meetings became more effective by aligning agendas with our pillar goals. Organization communication boards were developed and stationed in several key locations throughout the facility, as well as in each department, for transparency of our goals and results. The CEO began distributing the Weekly Update by email to all Department Directors and Board of Directors. Following Leadership Team meetings every Monday morning, brief intense Department Director "huddles" are held to share celebrations, information and address any tough questions. Within 24 hours of the huddle, the Department Directors are responsible to communicate that information to their staff. Huddle minutes are emailed out to all Directors and Board members immediately following the meeting. Our OB department publishes the Stall Street Journal to communicate important information, which is posted in our restroom stalls.


In Patient SatisfactionWith our commitment to provide excellent care to every patient every time, we have made great strides to improve patient satisfaction in the past three years. Having satisfied repeat customers is the key to our success. Using Studer principles and Must Haves we have moved the inpatient satisfaction scores from the 68th percentile to the 89th percentile and emergency room satisfaction from the 17th percentile to the 88th percentile.

It is not an unusual occurrence to see our team go above and beyond for our patients, ranging from a nurse bringing special order donuts in for a patient's family after she finished her shift, to arranging for a horse to be brought to our front door for a dying hospice patient to say good-bye. Another way we provide exemplary service is through our room service option provided by our Dietary department. This has received top scores from our patients. Giving compassionate care for our patients is the reason we come to work every day.

Discharge phone calls, pre-visit phone calls, hourly rounding, nurse leader rounding, bedside shift reporting, using white boards as one communication tool in patient rooms, offering Medical Home service in two of our clinics, offering a Coumadin clinic in one of our clinics, and having a Spanish interpreter have all contributed to the improvement of our patients' perception of care as reported on the Press Ganey category "likelihood to recommend our hospital" which increased 19% to the 88th percentile.

Although committed to give each patient the best experience, sometimes unavoidable delays occur. Recovery Tool Kits were introduced last year. Every department in the organization is equipped with a kit containing items to convey our sincere apology for an extended wait time, miscommunication with a patient or family member, to show them we care.


In our quality journey, we focus on saving lives. We measure our patients' perception of their quality using HCAHPS and CMS indicators. We feel this is a team effort, from care given by our paramedics out in the field to the extra touches given from our Housekeeping staff focusing on pain, and everything in between.

In the CMS indicators of CHF, PN and MI-1's, we are 100% compliant with all criteria. One of our new initiatives that proved successful was the Cardiac Alert protocol. This alert assembles all necessary staff quickly and allows the results to be in the hands of the physician within three minutes of the patient arriving in our ER.

Stewart Memorial's HCAHPS scores reflect the satisfaction of our patients' perception of their care. Patients who gave SMCH a rating of 9 or 10 ranks in the 95th percentile in HCAHPS. We know that providing quality patient care involves everyone. We feel the key component of our patients' perception of their quality of care is the team focus on developing tactics to make improvements on specific issues identified by the patient and extending them hospital-wide.

SMCH teams have implemented ways to keep the atmosphere in our patient areas quiet by using Spectra link phones rather than pagers, shutting doors near the ice machine to decrease noise, posting quiet signs, using a stop light to measure noise level and quiet reminders as computer screen savers. Our housekeepers, focusing on atmosphere, give out business cards to our patients or family members, our cleanliness measures have remained consistently high in the 93rd percentile.

SMCH is working on all eight composites of HCAHPS, most recently focusing on pain management. All departments, direct care and support staff are asking the patient about their pain level and intervene by doing what they can or involving the nurse for pain medication. Management of pain is eased with rice bags or offering other distractions. Our Pain Committee has taught staff through skits that PRN does not mean when requested, but rather as needed, based on professional decision. Other areas we're targeting are falls and reduction of medication errors.

Lab turnaround time for chemo patients has decreased to less than 30 minutes. Efforts of a combined committee proved successful to move this from 50-75 minutes average to 20-40 minutes. Improvement in ER flow has been dramatically influenced by nurses and paramedics drawing labs prior to starting the IV for our ER patients.

Our Ambulance department transfers have increased 30%, as well as experienced a decrease in transport time and referring transfers to other agencies. Two cardiac saves were made by paramedics who recognized a STEMI and took quick and decisive action to get these patients to the appropriate facility to provide the needed level of care.

Because of the efforts of all teams, inpatient satisfaction scores have increased by 21% to the 89th percentile, and overall patient ratings from a 9 to a 10 have increased to the 95th percentile in the top box score.

Emergency Room Satisfaction Patients who gave a rating of 9 or 10


Surgical ProceduresIn a period where some Iowa hospitals have seen slow growth or declines in patient volumes, we contribute our 17% surgical growth and 26% outpatient services growth to an addition of 14 new providers in our system. Since 2008, we have recruited four family practice/OB physicians, one family practice/Internal Medicine physician, two Nurse Practitioners, one Physician Assistant, three orthopaedic surgeons and three general surgeons. We have expanded our service area by acquiring a fifth clinic and partnering with specialty physicians to offer new services in our community. New service lines include 24/7 orthopaedic coverage, plastic surgery, stress testing, Coumadin clinic, expanded OB services, pain management procedures and state of the art laparoscopic surgeries.

SMCH continues to work diligently to build a world class surgery center and orthopaedic center of excellence. In 2011, by partnering with the reputable Des Moines Orthopaedic Surgery, we were able to complete our first total joint replacement. Dr. Hieb, one of the three highly skilled orthopaedic surgeons practicing at the hospital, expanded her services to include several new spinal and arthroscopic procedures. Stewart Memorial's state of the art surgery center has also grown to house Western Iowa Surgery, the premier surgical group in west central Iowa. This group, along with several other specialty surgeons, has brought to SMCH a 17% growth in surgical cases.

SMCH attributes its 26% growth in outpatient units of service to additional radiology services including new digital mammography, a CT scanner; expanded lab services to provide convenient services to patients; and 13% growth in ER visits.

ER Visits up 13%25 in 2011Perhaps SMCH's most striking accomplishment comes with the bragging rights of having the state's largest Auxiliary. One of the members also has served on the state Auxiliary board and held the position of state Auxiliary president. To date, the Auxiliary has contributed $712,751 to the hospital for equipment and supplies directly related to patient care.

Our well cared for facility is 50 years old with several outstanding updates and remodels, including a very attractive and comfortable OB suite and a $4 million renovation to build our state-of-the-art Surgery Center.


SMCH provides an economic impact on our area of $36,660,458 annually. We are a vital business in our community and the largest employer in the county. Our system is made up of a hospital, five physician clinics and four retail pharmacies.

SMCH has invested over 3/4 million dollars in our future with our IT infrastructure and systems to allow us to implement electronic health records, including digital mammography, PAC's, and electronic health record system for our clinics. The organization has recently met all regulations for Meaningful Use. This accomplishment resulted in a $704,000 incentive payment from Medicare and Medicaid. SMCH focused on its revenue cycle by reducing A/R by over $1 million. SMCH ended fiscal year 2011 with a small profit.

One key investment the hospital has made is to grow our Department Leaders through continuing education in our Leadership Development Institutes. Educational topics include how to effectively use our evaluation tool, root cause analysis, just culture, bomb threats, generational differences, accident investigation and safety issues. Through direct communication with our employees we gain better understanding of their educational needs to invest in them in this journey.

Leadership, by harvesting information through department rounding, encourages all staff to take advantage of educational opportunities and has sent 100% of Directors, in addition to a number of staff members, board members and physicians to Studer's Taking You and Your Organization to the Next Level, as well as a number of staff to What's Right in Healthcare?


Because of our dedicated staff, an empowered large volunteer base and the support of surrounding communities, SMCH has experienced gratifying relationships with programs such as prenatal classes, big brother/big sister, occupational health programs, the delivery of over 10,000 meals-on-wheels each year, educational "Lunch Connections", Caring Hands Closet, and a host of other charitable community activities of which our employees happily participate with gifts from their own pockets. We were named top corporate donor for the American Cancer Society for our employees' contributions for the Relay for Life, and we were recognized by the ALS Society for our fundraising efforts for this worthy cause in memory of our late physician, Dr. Paul Knouf.

When our community is in need, Stewart Memorial is the place where our people turn. When our area endured the devastation of an ice storm in 2010, our staff and facility were quickly prepared to house 60 people who were without any source of electricity, food or any means of proper care over a four day period. Cots were set up in our conference center, our dietary department provided ample meals including milk and cookies at bedtime, and served over 150 meals per day to our guests. Our maintenance department picked up and returned shut-ins who had no transportation available to the shelter, as well as maintaining our generators 24/7. This is just one more way we show our care and compassion to the people we serve and beyond.

The SMCH team is honored to be selected as a Studer Healthcare Organization of the Month. Every member of our team – from those who provide direct patient care to those who support care givers – plays a vital role in helping the organization deliver on its journey to excellence and helping the organization provide the community, patients, physicians and fellow employees with the best experience. We look forward to the challenges ahead to continuously improve and raise the bar for our patients and ourselves.

Stewart Memorial Community Hospital

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