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Temple University Hospital-Episcopal Campus

  • Location: Philadelphia, PA
  • Award: Evidence-Based Leadership Healthcare Organization of the Month
  • Awarded: May 2006

From its inception more than 154 years ago, Episcopal Hospital has had a proud heritage of service to indigent patients in the community. Reverend Alonzo Potter and a physician, Dr. Casper Morris founded the hospital to care for the needs of the underserved poor in the North Philadelphia community. The hospital has continuously focused on its mission to accommodate the needs of the surrounding community and the country. This includes caring for Union soldiers during the Civil War, setting up specialty wards during the polio epidemics of 1916, and sending clinicians to staff hospitals during World Wars 1 and 2.

In the year 1999, the hospital experienced its ultimate challenge in the changing health care marketplace. Population declines in North Philadelphia were severe, with more than an 18% loss of population over 15 years. This resulted in a 6.5% decline in hospital volume over a two-year period in the mid- 1990’s. Faced with a significant loss of its patient base, soaring health care costs and with government under funding for the services, the hospital confronted the stark possibility of closing. In order to survive, Episcopal was acquired by a larger health system, the Temple University Health System. Many of Episcopal’s staff, physicians and core programs including intensive care units, obstetrics, cardiology and orthopedics were transferred to and assimilated into other facilities within the health system.

With many of its services and staff redistributed, much of the hospital stood empty- the future of Episcopal Hospital remained in doubt. At the same time, another facility within the health system was struggling with similar operational and financial issues. It too was not able to compete in the very aggressive Philadelphia health care market and much of its medical surgical, intensive care and obstetrical care had been relocated to another facility, leaving it with only 60 psychiatric beds. At the same time the tertiary teaching hospital in the system, Temple University Hospital was struggling with issues related to lack of capacity and the need to expand. The Psychiatric Crisis Response Center, located within Temple University Hospital was the busiest psychiatric emergency service in the Philadelphia region and frequently had to restrict and divert services because it was over capacity in its limited space. While Temple University Hospital needed more medical and surgical beds to support a growing surgical program, a 21 bed psychiatric unit occupied premium space on the campus.

Major executive management changes within the Temple University Health System occurred in 2001. In developing the strategic plan for the future of the health system, the management elected to develop a restructuring plan whereby all the behavioral health components of the system would be relocated to one facility. Episcopal Hospital, with its proximity to Temple University Hospital, it’s central location in the heart of North Philadelphia, and its large unused units became the focus of the plan to revitalize the hospital and the community. Named the “North Philadelphia Revitalization Project,” the restructuring and renovations to Episcopal were designed to: re-establish the Hospital’s presence in the health care community, preserve old jobs, bring new jobs to the surrounding community, and provide the behavioral health programs with the ability to expand services. With community and local and state government support, in 2002 the plan resulted in comprehensive renovations to four units within the hospital and one floor of a medical office building. While expanding the behavioral health services, the hospital continued to provide an active emergency department, a small 15 bed medical unit, and radiology and laboratory services.

Some thought it sounded like a recipe for disaster. Take a behavioral health program from a large teaching hospital and combine it with a behavioral health program at a small, community hospital. Relocate both to a third facility that had once functioned as a full service hospital. Different cultures at all three places? Certainly! Morale issues? Definitely! Trepidation and uncertainty were of course widespread.

The new entity was renamed the Temple University Hospital- Episcopal Campus and opened as 114-bed behavioral health facility with a 15-bed medical unit, a full-service Emergency Department, a Crisis Response Center and a full array of ancillary services including Radiology and Laboratory. The challenge in this move wasn’t just logistical. Looking back, it was relatively easy to create beautifully renovated units, move patients and staff, and write new policies and procedures. Instead, the real challenge was to create a unified spirit among the staff from three different hospital cultures while providing excellent patient care, meeting aggressive performance improvement standards, and ensuring high patient satisfaction.

With no tool to measure our results at the time, we set out to develop our own metrics and goals and experienced favorable results. The downside was that our tool didn’t compare us with similar facilities nationally. In 2003, we signed up with Press Ganey Associates and anticipated what we thought would be wonderful first-quarter results. Imagine our disappointment when our overall score was 74.4, which put us in the 7th percentile. Not only were we crushed we also were embarrassed.

Believing that our care was much better than our scores indicated, we became very proactive. Luckily our health system believed that external assistance was needed to educate staff in new ways to improve patient satisfaction. Studer Group was commissioned to provide formal classes and ongoing consultation to management and staff regarding the essential steps needed to improve patient and staff satisfaction. All senior managers attended a two-day Studer conference designed to jump start the service excellence program. The Health System purchased “Hard Wiring for Excellence,” by Quint Studer for every manager, and mandated that it’s principles be applied to all aspects of care throughout the facilities. Lauren Charles and Pat Treiber, consultants from the Studer Group, provided onsite education, guidance and role modeling to staff on a regular basis. Staff were enrolled in programs to highlight patient satisfaction and system wide Core Principles were developed to provide staff with direction, a sense of mission and purpose. Using the five pillars of People, Service, Quality, Finance and Growth, over the next two years the management staff of the Episcopal Campus customized and embraced the Studer Model. Our Executive Director, Kathleen Barron set the tone as she met with staff in employee forums, stating, “It is not enough to work hard, we must work together.” Employee Forums, Nurse Rounding, Leader Rounding, Discharge Call backs, Thank You notes, Ambassador Rounds, Focus Groups and Employee Satisfaction initiatives were implemented and have become a way of life at the Episcopal Campus.

We are hardwired to make a difference.

Today, the Episcopal Campus is a hub of clinical activity. The reconfiguration of services proved to be very successful. With an enthusiastic and committed workforce, management team and engaged physicians, we have achieved the following:

I. SERVICE

Over the past two years, we have watched with pride as our patient satisfaction scores have soared from an overall score in the 7th percentile in the 3rd quarter of 2003 to the 98th percentile in the 3rd quarter of 2006.In October 2005, Temple Episcopal received the Press Ganey Compass Award for excellence in patient satisfaction.

II. PEOPLE

Staff members are recognized on a regular basis for service excellence. Employee Recognition Programs including “the Best of Temple Episcopal Awards, were developed mimicking the Academy Awards.

Incentive programs were established to award staff with monetary compensation for ideas that saved the hospital or health system money. One employee saved the hospital thousands of dollars by identifying that certified mail instead of inter company mail was being utilized to send mail to health system affiliates.

In 2005 the Annual Employee Appeal in raised of the campus raised enough money for a new outdoor patient recreation area. In 2006 the Employed elected to raise money for new artwork for the patient areas and new furniture for the hospital main lobby.

Employee Turnover is reflective of overall employee satisfaction as well as the effectiveness of the organization’s hiring and retention practices. In each quarter of 2005, Episcopal’s Employee Turnover rate trended lower than our compare-group, VHA, which is comprised of 35 regional hospitals. This movement is indicative of the effectiveness of our current people strategies:In the last two Employee Opinion Surveys administered, 2004 and 2005, Episcopal scores exceeded the National Healthcare Norms in each of the eighteen (18) dimensions surveyed.

  1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr.
TUH-EC Turnover Rate 1.46% 1.45% 1.20% .82%
VHA East Coast Hospitals 2.70% 3.10% 3.20% 2.70%

III. QUALITY

The Hospital launched an initiative to reduce the use of seclusion and restraints- six staff members volunteered to become trainers. In one year 348 additional staff received training. The result was the elimination of the use of seclusion for two years and overall reduction in the frequency and length of time in restraints throughout the facility.

Other quality indicators include:

  • AMA rate of .26% 2005, .43% YTD 2006
  • Readmission rate, 2.5% 2005 2.17%, YTD 2006
  • The hospital successfully went through JCAHO, and State Regulatory Inspections
  • Two major new programs were initiated, smoking cessation, weight management
IV. FINANCIAL-OPERATING

Denial rate for third party payors is less than .05% for past 2 years The Crisis Response Center implemented a new 23-hour observation bed program where patients are treated in the CRC for up to 23 hours and then transferred to another level of care. There is a 90% diversion rate away from unnecessary inpatient hospitalization for substance abuse patients to more appropriate levels of care. This new product line generated revenues of $298,623 in FY 2005, and projected revenues of $410,000 for FY06.

Our use of agency personnel to staff vacancies has been reduced by $333,000, or 61% during the current fiscal year. Our use of overtime has been reduced by $267,000 or 22% during the same time period.

V. GROWTH

The average daily census in behavioral health increased from 106 in 2004, to 110 in FY 2005, to 113 in FY 2006.
Four new psychiatric beds were added to the bed complement in FY 2006
The Medical Surgical census rose from 8 to 10 in 2004, to 12 in 2005 and to 13 YTD in FY 2006.
Two additional Medical Surgical beds were added in FY2006 and an additional 4 are planned for FY 2007
CRC visits were 7528, in FY 2004, 8350, in FY 2005, and are on track for 9000 by the end of FY 2006, making the
service the busiest in Philadelphia and one of the busiest on the East Coast.

We are proud of our staff, their sense of purpose, mission and commitment to providing outstanding patient care.
We are pleased that our health system has been named one of the “Best Places to work in Pennsylvania” for two
years in a row.

We are hardwired for excellence!!

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