CoxHealth Connection January/February 2017

VOLUME 13 ISSUE 1, JANUARY/FEBRUARY 2017

The nursing assistant training program is just one of the ways we’re training new health care professionals. We’ve committed to a variety of ways to guide professional growth and help caregivers build a career while providing the best care for our patients.

Inside Meet two graduates of the nursing assistant program at Cox Branson. Page 4 See how international nurses are helping us serve our patients. Page 5 Photo: Mike Wingo

Growing our own Professional development programs are helping us retain the best talent to care for our patients.

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ven as a child, Ashton Hamilton knew she wanted to care for others. She watched her mother provide daily care for her grandfather as his health declined. As soon as she was old enough, Ashton began helping her mom with the little extras of care, like making sure her grandfather had a small glass

of the chocolate milk he loved each morning.

By late 2015, she was starting Cash school at Missouri State University, working parttime in restaurants and thinking about how to begin her career.

One evening while perusing job

postings with her mom, she saw a listing for a unit assistant position at Cox South and she decided to apply. Her first assignment was in MICU and it was a perfect fit: “I knew right away I had a love for critical care.”

Now, her search for a parttime college job has become the foundation for a career. She

enrolled in the first nursing assistant training program in 2016 and she’s now working as a nursing assistant in MICU as she begins her nursing classes this summer.

She’s taken the first steps on a path that CoxHealth has worked to make clear and navigable for professionals who want to dediSee GROWTH, Page 6

Key to success: Your good Large projects and individual efforts are creating savings and helping us make the most of our resources.

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s the Working Smarter program enters its fourth year, projects are helping us find the best ways to control costs, grow revenue and improve efficiency.

From January-September of 2016, Working Smarter projects added up to $11.9 million in validated impact. Leaders like John Chastain, system director of budget management, say the program is currently working on a list of projects that can add up to more than $30 million.

But that doesn’t mean the work is done.

“It can appear that we have a long list of identified projects and people don’t need to submit ideas, but that’s rarely the case,” Chastain says.

Many projects have a months-long timeline, or they may involve contracts that only come up for renewal annually. “That’s why it’s important that people keep submitting ideas to fill that pipeline.

We count on projects like these to Chastain meet our budget goals and to help fund some of the other things we want to do.”

In addition to the projects at right, Chastain notes a few of the ways we’re producing savings: LED lighting: In the second year of switching to LED lights, we’ve converted the outdoor lighting at Cox North and work on some clinic properties has begun. In total, the change saves $256,000 annually.

Pharmacy changes: More than 30 initiatives, including switching to generic drugs and leveraging discounts through Mid-America Service Solutions (MSS), will save $688,000 in 2017.

Leasing at Cox North: Space in the Medical Tower at Cox North has been leased to tenants such as the City of Springfield and the Greene County Prosecutor’s office, a move that brings in about $260,000 per year.

Have an idea for an improvement? Share it by emailing working.smarter@coxhealth.com. A new innovation portal called Solutions Group will also be available soon on the revamped intranet.

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Pharmacy

changes

Joanna Snyder knows all too well how challenging it can be to manage the costs of pharmaceuticals.

Snyder recently took over the role of Pharmacy system business manager, after serving four years as a financial data analyst for the department.

The same drug costs that affect our household budgets also affect the Pharmacy on a systemwide level.

“It’s constantly changing and it Snyder all depends on the market,” Snyder says. Tracking those changes and finding opportunities is no small task. That’s why Snyder and the Pharmacy team took on a variety of Working Smarter projects.

One of the first major changes was bringing the process of compounding medication for IV usage back in-house. In the past, some of those processes had been

outsourced, but as drug prices rise, it became more cost effective to work with the components in-house.

One example: Anti-hypertensive drug nicardipine had been $70 per bag from an outside vendor. By purchasing the drug in a vial and preparing bags in-house, each bag can be made for less than $20. That change alone saves $100,000 annually.

Standardization has also been key to controlling costs. Omnicell cabinets now have a standardized drawer for their anesthesia workstations, preventing overstock and focusing on the most cost-effective products. The change saves $36,000 annually.

The ability of projects to dial in only what is needed also paid off for our flu vaccine. This year, Pharmacy did a Working Smarter process map of flu vaccine usage and, for the first time, we used the exact amount ordered. Usually, more than 1,000 doses are wasted. In addition to the increased efficiency, working with MSS has saved more than $70,000 on this year’s vaccine.

Change belongs to all of us

“

The idea of continuous improvement is the new CoxHealth way of doing our work.

”

While Working Smarter projects are crucial to our ongoing success, Clinical Services Vice President Amanda Hedgpeth says another effort is even more important – creating a culture of performance improvement in everything we do: “We want everyone to be in the mindset of – what didn’t go well yesterday? What process can I put in place to make it better?

The idea of continuous improvement is the new CoxHealth way of doing our work; it’s all about how we create value for our patients and show respect for our employees while making improvements.

Our biggest asset is our employees and that is especially true when we look at performance improvement because we rely on the people doing the work to be the ones to come up with the ideas on how we can improve.

So, if you are asked to be involved in a performance improvement project, please jump in full steam. We know everyone is busy and some might feel they don’t have time for another project, but the truth is, we can’t afford not to focus on the things that will make our work, and possibly our care, even better than it is today.”

Can you hear savings now?

We all know how quickly the costs can add up for our personal cell phones and those costs are increased by an order of magnitude when you consider the number of phones in use across CoxHealth.

In an effort to trim those costs, Brandi Wasson,

systems manager in Communications, began looking at the way we use our phones.

“Having (IT Administrative Director) Jack Cole, an expert at negotiating contracts, as a mentor has given me a passion for the idea that saving money should be in the front of my mind,” Wasson says.

She began by looking at our data usage, one of the largest costs in cellular service. In the past, service

stewardship By the numbers

A Working Smarter project has reduced the turnaround time on ambulance billing to a mere four days, down from more than 100 in some cases in the past.

Working Smarter projects continue across the system, adding up to major improvements. For the period of Jan.-Sept.

2016*: $11.9 million total validated impact $7.4 million revenue cycle impact $1.1 million labor impact (cost avoidance, reduced overtime, etc.) $3.3 million Non-labor impact (supplies, materials, cost of drugs, etc.) * Working Smarter switched to a fiscal year schedule in Sept. 2016.

Photo: Russ Weller

Improving EMS

billing

Sometimes it takes an inter-departmental team effort to track down the cause of a problem and find a solution.

That was the case about 18 months ago when the Performance Improvement team helped Pre-Hospital, Registration and Claims Processing work together for a Working Smarter project on ambulance billing.

The goal was simple: improve the turnaround time on bills for ambulance transport and ensure timely payment.

Before the project, the complexity of billing for ambulance service was causing delays in getting bills submitted.

Sometimes, it would take months to get bills out the door, resulting in denials and causing a backlog of work. The

was purchased as a pool of minutes, a relic of the days when we used Blackberry devices.

Wasson worked with a representative from AT&T to investigate the options. With a little negotiation, they identified a plan with unlimited minutes and a pool of data for the organization, saving about $49,860 per year.

The Communications team also audited

teams had seen an increase in volume and with incredibly busy workdays it was easy for the billing process to be pushed to the back-burner.

Teams from across the EMS and billing process came together to examine all the steps involved in getting an ambulance bill created and processed. Like many process improvement projects, it brought teams together to ask questions, challenge the status quo and get a better view into how their work affected others in the value stream.

The team broke the process down to three buckets: registration, review and charge. In each of those, they conducted “time studies,” looking at how each hour of work is spent and trying to find ways to streamline.

They quickly identified barriers, such as the “batching” of bills, in which staff members would wait until a few bills

phone usage, looking at unnecessary services and features that could be reduced, or billed back to users if they wanted to keep Wasson them on their devices. Those changes saved more than $1,200 per month.

Finally, the team looked at “zero usage

had built up before processing them, and parallel processes that could be consolidated. They immediately began working on balancing workloads and approaching the bills on a “first in, first out” basis.

“We worked together across the departments to find out what everybody needed most and deliver it,” says Shelly Hillhouse, performance improvement manager.

The ultimate goal was to reduce the turnaround time to four days. After nine months of work, they hit that goal, and they’ve maintained it for more than six months.

“This really brought things under control and we check each week to make sure there’s not a backlog,” says Amanda Hedgpeth, vice president of Clinical Services, who sponsored the project. “The project has helped the teams work together to focus on solutions.”

devices” – phones that were no longer in use, or that had belonged to employees who left and Communications hadn’t been notified.

In the fall of 2016, that amounted to 100 devices. Those devices are now suspended and will be terminated soon, saving $50 a month for each device.

The next phase? Many units have

charge nurse phones, or physician on-call phones that never leave the hospital. What if we could move those to wi-fi-only and save the $47 each month in cellular fees?

“The potential for that is huge with hundreds of phones,” says John Chastain. “If we moved just 150 phones, that would save nearly $84,000 per year.”

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A new path, passion in healt Nursing assistant training offers an entry point for those changing careers or just starting out.

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Gabby Gomez Sosa and Kellie Sturgis were going to love working in health care – they just didn’t know it yet.

Kellie was a grocery store manager in Branson. Gabby was a former high school Spanish teacher and head coach of a women’s field hockey team. Both women were searching for something that would take their lives in a new direction.

“I was just kind of finding myself, asking, ‘OK what do I want to do now and where do I want to go from here?’” says Gabby.

Neither woman had ever worked in health care, but something piqued their interest when they heard about the training program available at CoxHealth that would end with them becoming nursing assistants at Cox Medical Center Branson.

“I went to a job fair and that’s how I met Debra,” says Gabby.

“They had information about this program and immediately I just knew, this was it.”

Debra Novinger, the Cox Branson nursing assistant program educator, says Gabby and Kellie’s stories are typical of those who have entered the program since it began in June of 2016 – people are able to get a fresh start with not only a new job, but an entirely new path and passion for their lives.

“I watch the students come to life, their eyes just open after they get the knowledge. It’s like the whole world opens up for them,” says Debra. “A lot of them say,

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“

There are so many people who would make a wonderful nurse assistant, but think they don’t have an avenue to gain the education. We are right here; it is not too late.

”

— Debra Novinger, educator, Cox Branson nursing assistant program

‘I’ve always wanted to be a nurse but time got away from me; life happened.’ There are so many people out there who are good hearted, want to help others, would make a wonderful nurse assistant and even have dreams of Sturgis being a nurse; but think they don’t have the time or funding, or an avenue to gain the education. That’s entirely wrong.

We are right here; it is not too late.”

The nursing assistant training program models the stateapproved program and includes 104 hours of clinical experience and 88 hours of classroom instruction. The program is in-depth, covering medical terminology, human anatomy and physiology plus hands-on experience, giving participants a firm foundation on the essentials of patient care.

Debra says nursing assistants work in several different areas of the hospital so our culture of

excellence and approach to care can be reinforced during training, and to allow the students time to find out which areas they are most interested in. At the end of their training, the nursing assistants interview with hiring managers to determine the best fit.

“It’s exciting. I’m definitely ready and definitely feel prepared,” Gabby said on her last day of training.

“At the beginning it could be very overwhelming. I’ve never Sosa been in health care.

But now it’s completely different and I look back and say, ‘Wow, I’ve learned so much with the girls and we’re prepared and ready to get to work.’”

Kellie graduated from the program in October 2016 and is working as a nursing assistant for the Progressive Care Unit at Cox

th care Participants in the nursing assistant training program at Cox Branson are hired as employees and are paid for the six weeks of education. The training includes simulation exercises, such as this one in the Pediatrics Unit, with interactive mannequins and one-on-one coaching from instructors. The program offers trainees a fresh start and a clear path to a career in health care.

Photos: Randy Berger

Branson. She loves her work and is thankful for the opportunity to help others.

“You see patients who are here for three weeks at a time and you see them recover, do a complete 180, and it’s amazing and emotional and you want to make them be better,” says Kellie.

Within her first year, Kellie can pursue state certification as a nursing assistant. Nursing assistants can also become preceptors and help train new students.

“Nursing assistants are a critical part of the care team. They are the front line and they will spend more time with any given patient in the hospital than any other professional,” says Debra.

“This program is giving people a chance to make a difference in other people’s lives when they don’t think they would ever have a chance.”

Nurses from around the world are now making CoxHealth home through partnerships with our international nursing programs. Nurses like Mosope Adeyeye, Amina Suleiman and Vivelyn Padilla say working in the United States is a dream come true and the hospitality at CoxHealth has made the Ozarks feel like home.

Photo: Mike Wingo

Nurses are right at home here at CoxHealth Our growth to meet our patients’ needs has always meant devel- patient she had cared for. They were so excited to see her they invited oping our own workforce and attracting the best talent, but in 2016 Vivelyn to their family’s New Year’s dinner. those efforts moved to another level as CoxHealth implemented its “I never thought they would remember me,” she says. “They are first international nursing program. So far, 92 highly skilled nurses with so nice! I was so glad I was able to experience American hospitality.” backgrounds abroad have accepted job offers, and the first nurses in Cash says our partners in the international nursing program have the program began arriving last fall. recognized CoxHealth as having a best prac“People have been so welcoming and tice in the integration of nurses, both into the By the numbers excited to have them as part of the team,” health care system and into the community.

So far, 92 international nurses have says Kim Cash, administrative director of In addition to the new nurses who accepted positions. Of those nurses: nursing, noting that the average internahave come to the U.S. through the program, tional nurse brings 8-9 years of experience.

Nursing leaders also found ways to advance 76 have their BSN “Everyone likes to have someone who is the careers of other current CoxHealth 12 have their MSN excited to be here and care for our patients.” employees who had immigrated to the U.S. 4 have an ADN with a desire to For nurses like Vivelyn Padilla and “We already had people working here complete their BSN Mosope Adeyeye, the warm welcome and who had been nurses in other countries,” support goes a long way toward making the Cash says. She and her team began identiAs of mid-January, seven international Ozarks feel like home, even when their famifying colleagues with a nursing background to nurses have gone through the lies are thousands of miles away. see if they would be interested in transferring onboarding process. The nurses are “It’s been so nice, everyone is approachtheir experience to nursing in the U.S. Nursing now seeing patients in units including able, and it’s easy to walk up to anyone, your leaders helped the employees get their Med 100 at Cox Branson, Jared managers or directors, and ask questions,” credentials reviewed and they implemented Neuroscience and the second, third, Mosope says. She came to the U.S. from a 16-week course at Cox College to get them fifth and ninth floors at Cox South.

Nigeria six years ago to study nursing and she ready for board examinations. “It can be decided to stay – taking jobs in Texas before complicated and expensive to go through the coming to Cox Branson, where she works nights on the Med 100 unit. process. They just needed the tools and resources.”

“So far it has been good, better than I expected,” she says. “The Cash says the investment pays off in outstanding care and in the experience has been great and everyone made it easy for me.” difference CoxHealth is able to make in our colleagues’ lives.

On 900 East at Cox South, nurse Vivelyn Padilla says she’s “It’s like a dream for them. They came to the U.S. and it’s a enjoying the environment, where she’s been caring for patients complex process to get licensed here,” she says. “We’re investing since September. She says she’s been impressed not only with her in our own and growing our own. We’re offering an opportunity to colleagues, but with the warm welcome she has received from patients. achieve a dream with our support.”

“The patients are so good and so nice, they’re glad I’ve come Vivelyn says that’s definitely been the case for her. here to take good care of them,” she says.

“I am so blessed to work here,” she says. “I achieved one of my She was at church in December when she ran into the family of a dreams and it’s an answered prayer for me and my family.”

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Growth

From Page 1

“

It’s been nice to have the ladder and see how you can progress and continually learn more and more.

cate themselves to patient care.

It’s part of a strategy to “grow our own” – bringing the right people into the organization and then helping them progress in their careers. It’s an approach — Ashton Hamilton, that is a win-win for everyone nursing assistant, MICU – employees who are growing professionally are more satisfied, and patients benefit from the ever-increasing skills of those who make CoxHealth a long-term home.

In nursing at CoxHealth, several programs are supporting professional growth: from nursing assistant training for newcomers to the field, to the STAR clinical ladder and RN-BSN programs for nurses. In big and small ways, the programs are building a future for our community and our patients by attracting, retaining and developing the best talent.

“We’ve always had a natural progression of taking people in and helping them grow,” says tunities if I want to take them.”

Kim Cash, administrative director of nursing. “It’s Cash says the nursing assistant training program always nice to see nurses who have grown with us.” is a great entry point for community members who The ladder for professional growth begins want to get a start in health care. The program even before high school is complete, with offers several weeks of paid education that can programs like Medical Explorers and GOCAPS make participants eligible to apply for nursing bringing students into our facilities to get a first assistant positions. For CoxHealth employees who look at work in health care. aren’t in clinical roles but who would like to be, a Cash says plenty of colleagues get their start certified nursing assistant sponsorship program just like Ashton did, working as unit assistants. is available through Recruitment and Retention.

“Those jobs are a nice foot in the door,” Cash Once you’ve begun, the sky is the limit for those says of the flexible, part-time positions. “They wanting to pursue further education. offer experience partnering with a nursing assis“With programs like these, you gain clinical tant and a nurse and they allow unit assistants to experience that will benefit your practice,” Cash see a variety of areas.” says. “You get to know the leaders and the culture For college students, positions as a patient and know that you are a good fit for CoxHealth, safety assistant are another popular entry point whether you choose nursing, radiology, medical – allowing for a full- or part-time schedule and school, or whatever your path may be.” regular hours.

For Ashton, the path is clear: she wants to Ashton knew as soon as she settled into her pursue nursing, focusing on critical care, med-surg unit assistant job that she wanted to stay in health or emergency medicine. care. Before long, Cash and System Director of “It’s been nice to have the ladder and see how Nursing Education Gina Ellerbee approached you can progress and continually learn more and her to be one of the first candidates for the new more,” she says. “You have to have passion for it nursing assistant training program.

– if you don’t have passion for the job, you won’t “I adore Gina and Kim,” Ashton says. “They succeed. People here look for that passion and want what’s best for employees and it’s great that drive and they compliment you on that and knowing that they’re keeping an eye out for me encourage you. I feel so grateful and so blessed to and showing me that there are different oppor- be in an organization that does that.”

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Caring Meet our latest Daisy honorees, recognized for outstanding patient care: Debra Lay, Radiology Care Unit, Cox South Debra was recognized for the extra care she provided to a patient who suffers from severe claustrophobia. The patient was scheduled for an MRI and because of a traumatic experience in her past, she requested anesthesia for the procedure. After talking with the patient, who had traveled from an outlying area for her test, Debra began making calls to find an anesthesiologist.

Blake Isenmann, Cox Monett Engineering From the nomination: “Blake was attending new employee orientation at Cox South. In Monett, we had a string of EKG failures, leaving only one working machine. We needed a backup and the cardiac department at Cox South notified us that we could borrow one from them.

Blake was Isenmann contacted and asked if he would pick up the EKG machine and bring it back to Monett.

Granted, Blake was in new employee orientation, it was his first day of employment and he did not know where departments were located at Cox South. Blake found his way around, picked up the EKG machine, and made it back to Monett with the lifesaving equipment.”

beyond medicine “Due to her extraordinary concern for me, Debra found a physician who could help me later that day,” the patient wrote. “Never can I remember having such a totally involved nurse who took a challenging situation and skillfully demonstrated all the attributes of a nurse who is deserving of the Daisy Award.”

Edwin Espinoza, Critical Care, Cox Branson Edwin received two nominations from the families of patients he cared for in the Critical Care Unit. Both noted the extra consideration he offered to their family members.

Monett honorees Sheila Carver, Respiratory Care Heidi Clark, ER Debbie Creed, APC

Lay

Espinoza

Choate

Edwin helped an out-of-state family get back to their hotel after an emergency brought them to the CCU and he provided compassionate care for patients and their families.

“Edwin was one of the nicest people we met while my husband was there,” one family

Gayle Mattingly, Cox Monett Rehab and Sports Medicine Mary George, Radiology Lisa Wolf, Surgery

Dr. Tommy Trent, ER Amanda Harbaugh, Cox Monett Rehab and Sports Medicine

member wrote. “He always had a smile on his face and he always asked if we wanted or needed anything. I spent the night and he came into my husband’s room quite often to make sure he wasn’t in pain and to see if he needed anything. You need more like him.”

Elisabeth Choate, Critical Care, Cox Branson Three patient families nominated Elisabeth for the care she provided. They noted above-and-beyond efforts, such as printing out pictures of scenery for an elderly patient and

Springfield honorees Rhonda Bradam, Acute Care Therapy Dr. José Dominguez, Cox Medical Group

Janice Glenn and Valerie Wilkinson, Pre-Hospital Services Janice and Valerie responded to a house fire in October. All family members were out of the residence and were safe, but the family had several special needs children who were very upset. The children responded especially well to Valerie, who was able to calm and comfort them. Janice and Valerie made a series of phone calls and were able to get shoes, jackets and other necessities for the children, who were without their belongings after the fire.

A fellow paramedic wrote: “They were able to establish their own little mini-Red Cross and get things started for these special people faster than I ever would have thought possible.”

Alicia Stogsdill and Ashley Scott, Cox North Emergency Department; John Sheldon, Case Management This trio was recognized for the outstanding compassion they showed to an elderly patient who experienced a psychological episode while visiting friends in southwest Missouri. The elderly man was brought to the Cox North ED for a psychological evaluation after an incident at the Springfield-Branson National Airport, where he was attempting to board a flight home. He had become confused

Stogsdill

Scott

Sheldon

about the date – his flight wasn’t scheduled to leave for another five days. After discharge from the ED, his elderly friends were unable to pick him up and he had nowhere to go.

Staff made him comfortable for the night and took it upon themselves to call the airline and get his flight changed to the next day. They

then got him a room at the Cox Hotel, as well as cab vouchers for transportation. John Sheldon checked on the patient at the hotel and met the cab driver the morning of the patient’s flight to make sure he got to the airport.

“Ashley Scott and Alicia Stogsdill treated this patient with kindness and respect and were able to help him out when no one else would,” the nomination read. “Our staff went way above and beyond in providing an amazing service to this elderly gentleman and they make me proud to have them as part of our Cox North team.”

taking extra time to explain the care being delivered.

A few of the nomination comments: “Elisabeth has just been the best nurse and the greatest lady,” one family member wrote. “She was so nice to me and she told us what was going on so that we understood.

She acted like we were family. We just love her!”

A patient’s wife wrote: “Elisabeth is the kindest nurse we’ve ever had, she exceeds the everyday responsibilities. Without her I don’t think my husband would be here now.”

Sherry Jones, Acute Care Therapy Michelle Maxwell, Acute Care Therapy Carol Myers, Care Management Kami Oster, Cox Medical Group

Emily Lorenz, Cox Monett Volunteer Services From the nomination: “A hospital employee had a baby born with Down syndrome. Soon after, the mom requested to visit with volunteer Emily Lorenz. The Labor and Delivery nurse asked Emily if she would be interested in talking to the family and she was happy to do so.

Lorenz During the stay, Emily visited with the family several more times to reassure them that everything was going to be OK. Emily even brought a different shirt with her to the hospital and changed into it when she was visiting the family, then she changed back into her volunteer uniform.

Emily was very proud to tell her hospital family that there was a baby born ‘just like me.’”

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3850 S. National Ave. Springfield, MO 65807

‘I Will’ messages reinforce our values Have you seen new “I will” messages posted in our hospital facilities? They’re going up in high visibility locations at North, South, MORH, Cox Medical Center Branson and Cox Monett Hospital. The displays show faces of CoxHealth colleagues, along with the core values and commitments we live out daily. It’s another way of affirming what patients and visitors can expect from CoxHealth -- compassion, integrity, respect and safe care from people who listen.

Magic Word

Find the magic word and you could win your choice of a shirt or coffee mug from 1906, The Employee Store. We’ll give you a couple of clues and after you guess the word, find it in Connection.

Call 269-4154 and leave a message with the

magic word and the page on which it can be found. Include your name, department and phone number. The 52nd correct answer will win.

Clue 1: Nothing, nada.

Clue 2: “A ________ sum game.”

Connection is a monthly publication for the employees of CoxHealth 3801 S. National Ave. Springfield, MO 65807

Email us any time at CorporateCommunications@coxhealth.com Editor: Randy Berger 269-3171

Contributors: Yvette Williams Kaitlyn McConnell

Russ Weller Mike Wingo

Meeting patient needs by ‘growing our own’

January/February 2017

Meet the latest Daisy and Partners honorees from Branson, Monett and Springfield.

Pages 6- 7

See how we’re helping health care professionals build their careers. Page 1

From EMS billing to Pharmacy improvements, see how Working Smarter projects are helping us invest in our future. Page 2