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Satisfied employees called key to succes
Managing by fact, not by anecdotes, is key to success in today’s health care environment, says Edsel Cotter, CHAM, vice president of general services for Grant/Riverside Methodist Hospitals in Columbus, OH. Put another way, Cotter says, "In God we trust. All others bring data."
With that in mind, his organization developed a model called "fact-based management," which applies this philosophy to leadership, work force, process management, patient/family-focused care, and measurement.
The results of this management model are tied to the organization’s quality, service, financial status, and quality of work life, which in turn are recorded on a "score card" that is distributed throughout the hospital. (See related story, p. 94.)
Communicate the big picture
Leadership in fact-based management has to do with understanding and communicating the big picture, Cotter says. That means focusing on solid information rather than anecdotes — "not putting out fires, but looking at data," he adds.
In Grant Medical Center’s emergency department (ED), for example, employees were complaining about workload, high patient volume, and lack of coordination, and they were blaming various people or departments.
Drawing on fact-based management, the hospital put together a multidisciplinary team to study the situation, Cotter notes. "[The team] started tracking when a lab test was ordered, and when the results came back, how long before a patient was taken up for an MRI and when the patient came back, when a bed was requested and how long before a patient was told he or she could leave the ED for a bed.
"That information was brought forth to the executive staff, who were told, Here’s the root cause, here are the facts about what’s causing it, and here are the actions we need to take,’" he says.
The human resources aspect of fact-based management focuses on "creating, improving, and promoting systems, programs, and processes which enable us, the system, to be viewed as the employer of choice," Cotter says. "We want to create an environment of well-trained people who like to work here."
Most employees today don’t consider their jobs to be the most important aspect of their lives, which makes "quality of work life" a crucial element of the management equation, he points out. "Work is part of making life outside of work possible and pleasant."
That’s why variable staffing — "having the right number of people at the right time in the right place" — falls under this piece of the management model, Cotter says. The hospital also has a program for selecting and tracking employees and matching them to a job for which they’re more suited. "Sometimes people just need change."
It’s also his organization’s practice to empower employees "to do the job, to take risks, to do what satisfies the customer" without waiting for the boss to give the word, he adds.
"We view our work as a set of processes that are critical to our customers," he says. "We align our core processes, care of the patient, with operational patient care processes." That involves everything from the care administered by the nursing staff to the processes involved in getting food to the patient.
Under fact-based management, there is an owner of each process, he says. "The process owner is the person downstairs who gets the order request for a medical item needed on the patient care floor and sees that the item gets to that particular nursing unit.
"[He or she] makes sure that the process works from the time the item is ordered until it gets upstairs, as opposed to handing off [the responsibility] to a lot of different people. That person has to know what it took from start to finish to fill that order."
Under the patient/family-focused care part of fact-based management, the hospital looks at its internal and external customers, who ultimately define and determine the success of the continuous improvement processes, he explains. "This allows us to deal with the requirements of customers and provide a framework for anticipating their needs and meeting those needs."
For example, when satisfaction surveys indicated that patient food was not up to par — that hot items weren’t hot and cold items weren’t cold — the hospital looked at the problem through process improvement, Cotter says. "Plates were not staying warm in their covers, and we determined that we needed to replace the warmers. The complaints dropped off."
The hospital’s physicians, in their satisfaction surveys, said they wanted different items on patient charts. "We had a team look at the items that the physicians said would help them," he says. "The result was that we made some changes, including establishing critical pathways, which is something third-party payers also requested."
Measuring the processes to check for improvement is another important part of the model, he points out. In one instance concerning the patient transportation department, the ancillary clinical departments were complaining that patients were not arriving on time for tests. At the same time, patients who had finished the procedures were having to wait too long for return transportation.
Rather than listening to anecdotal information, the hospital installed a computerized measurement system in the transport department, he notes. "When nursing calls down, it’s logged in, and the request goes to the first available person. We’ve gained all kinds of efficiencies and can transport more people on time."
Grant Medical Center began fact-based management in March 1999, he says, which meant "changing the whole cultural game. Before, when somebody said to us, How do you manage?’ everybody had a different answer. Now we have the same focus."