United Hospital District (UHD) has a legacy of being recognized as being an organization completely dedicated to ensuring the patients of our area have the highest quality medical services right at home. UHD is an independent rural health system with a 25-bed critical access hospital, three clinics, home health, hospice, an inpatient adolescent chemical dependency treatment center and ambulance service.
UHD's path to extraordinary began in 1995 when the organization made the hard commitment to doing what was right versus what was easy and took control over our strategic direction by aligning with a new provider clinic in town who believed rural health care was much more than band aids and transfers. The legacy of this decision is that since that date, the strategic health care direction for the community has been cohesive and consistent with the Hospital and the community Providers advancing toward the same goals.
In 1999, after success with an integrated strategic direction between the Hospital and provider community was achieved, UHD's focus shifted to two imperatives; deliver the highest quality care in the country in an extraordinary way. To further these imperatives, UHD invested heavily in the quality process and hard wired into the culture of the organization the idea that if we cannot provide the highest quality of service to our patients we have the obligation to send them to where they can receive the highest quality care – what we now know as "connecting to purpose".
To "WOW" our customers when they access our services, UHD initiated building projects in 1999 and 2005 to transform the physical plant to a truly unique, modern, impressive location to provide care and services. Single patient rooms with hotel like design and amenities, with LEAN principals incorporated to eliminate needless interruptions to the care process laid the foundation. The only thing missing was the culture change.
In 2006, with the establishment of a partnership with the Studer Group, UHD moved from a "program of the month" philosophy to one that got serious about culture. And today, the culture is second to none.
Evidence of Culture Change:
PEOPLE PILLAR: UHD is the employer of choice in our market due to focusing on several key areas. First, we invested heavily through the Leadership Development Institute format in our leaders to ensure we had the very best leadership team in place for our employees. Skill in critical conversations, providing meaningful performance feedback, high-middle-low conversations, and employee development were taught. We then focused on employee related initiatives and developed employee standards of behavior, a formal employee attitude and improvement process, monthly CEO forums, rounding, thank-you notes, and a managing up process were all put in place. Finally, all of these were bound together with a very high degree of accountability through the leader evaluation manager system.
Because of the items listed above, turnover reduced from 20% in 2007 to 11% in 2009 and is at 6.6% YTD in 2010. Moreover, in 2007, total nursing turn-over was at 0% annually. This level of performance was unattainable in 2009 due to the retirement of two nurses with a combined 85 years of service with UHD. Provider vacancies were also filled with UHD successfully recruiting a general surgeon, an orthopedic surgeon, three family practice physicians, and an orthopedic mid level provider in 2007-2008. Employee satisfaction rates have increased over each of the last 3 employee perspective reports significantly as well. Finally, and most telling, 150 applications were received for the last open position at UHD – a registration position – yes; UHD has a 0% vacancy rate.
SERVICE PILLAR: Through integrating the Studer principles, such as key words, AIDET, service recovery, discharge phone calls, and nurse/nurse leader rounding, into the UHD culture, amazing results have been achieved. Patient satisfaction for inpatient and ED went from the 61 and 77 percentiles respectively in 2006 to the 97 and 95 percentiles respectively for 2010 year to date. Further, year-end patient satisfaction scores have ranked above the 90 percentile in the ED and the 95 percentile for inpatient each year since 2008.
QUALITY PILLAR: At UHD, quality is not a department; it is a way of life. Quality is core to UHD's being; it is an intrinsic business strategy. From the UHD governing board and medical staff to the most part time volunteer, the desire to offer the best, safest, highest quality product, no matter what, is ingrained.
"Zero" is the goal and it is achieved in many areas. Zero SSI's for the last 7 quarters. Zero readmissions within 30 days since 2009. Zero skin breakdown since 2009. Inpatient fall rate is 0.06 per 100 patient days over the last 2 years, and medication variances averages 0.09 per 1000 doses from 2005 to 2010.
FINANCIAL PILLAR: UHD's philosophy of providing the highest quality care with extremely high patient satisfaction has been the flywheel that drives the organization's financial performance. UHD has been listed several times on Modern Healthcare's 25 most profitable CAH list since 2005 and has been a LarsonAllen "Gold Standard" facility each year since 2006. Since 2006, net margins as high as 14.6%, 291 days of cash on hand, a 25 day reduction in days in accounts receivable, and a debt service coverage ration of 5.2 have allowed the organization to do is needed versus what could be afforded. In 2009 UHD started two projects with $19.5 M price tag. The first project which was completed in August becomes the nations' first LEED (or "green") inpatient adolescent chemical dependency treatment facility in the nation. The second project consolidates the organization and makes UHD a much more patient convenient organization. UHD equity accounts for 50% of the project.
GROWTH PILLAR: Because of a focus on quality and service, strengthened by virtually no turnover and employer of choice status, UHD has experienced significant growth. Clinic volumes increased 28.8% from 2008 to 2009 and that trend seems to be continuing through 2010 as well. This increase in utilization has grown net revenue by an average of 9% over the last 3 years as well.