VOLUME 15 ISSUE 1, JANUARY/FEBRUARY 2019
Flanked by renderings that show the vision of Cox Monett’s future, CoxHealth leaders announced the replacement hospital project at a news conference in December. The new hospital, slated to be complete in 2021, will replace the current Cox Monett facility, which originally opened in the 1950s. Photos: Mike Wingo
Rural health renaissance Cox Monett’s award-winning care and culture will soon have a custom-built facility to match.
R
Rural health care faces challenges, but there is one community that is defying the trends. In the spring of 2021, Monett will become home to a new 70,000-square-foot hospital, replacing the current Cox Monett facility. “The project is part of CoxHealth’s strategic efforts to ensure that populations in rural areas have access to the care they need,” Cox Monett President Darren Bass told attendees at a December news conference. “Rural health care is in a tough place. I don’t know that you will find a health system anywhere else in the
country that is investing like CoxHealth is investing.” The new facility will include an enhanced Emergency Department, multiple operating rooms and an attached 27,000-square-foot
clinic. The hospital will be located on the north side of U.S. 60, just east of Monett. The new hospital will continue to offer Cox Monett’s current services and leaders are analyzing opportunities for new or expanded services. Cox Monett is currently seeing growth in labor and delivery and outpatient services. “We are going to be doing a lot of the same things, but keeping more community members here in Monett with a higher level of service,” Bass says. See ‘CITY’S STRENGTH,’ Page 6
Service spotlight
Nurse Holli Harter takes the time to personalize the care she provides, and patients take notice. Check out her secrets to service success below.
Photo: Mike Wingo
Care is a two-way street
H
Holli Harter’s calming, positive energy is contagious. It’s not only evident in the smiling faces of her colleagues in the Post-Anesthesia Care Unit at Meyer Orthopedic and Rehabilitation Hospital, but also in the hearts of the patients she cares for and on the minds of each family in the waiting room. Recently, the RN was mentioned by name on three different patient discharge reports. One family noted a particularly delicate touch following a complicated surgery. “She went above and beyond to keep us informed and showed love to us,” the family wrote. “She even prayed with us. She took time to make sure he was comfortable. She called us later on to make sure that things were going better for him. You don’t find nurses like that every day.” For Harter, it is particularly sweet to hear the kind words of patients or their family. In her line of work, most people don’t remember her – and that’s a good thing. “When they come out of anesthesia they’re usually pretty disoriented,” she says. “We’re kind of like the ghosts of MORH. If everything goes according to plan, we’re just that blurry face you might remember fondly as you pass through PACU.” Harter is a patient advocate through and through. Her approach to care involves sitting down with her patients so they know the right questions to ask, but also the occasional silly dance. The 28-year CoxHealth employee shares some wisdom she’s collected at right.
2
Share your service story We want to know your top tips for improving the patient experience! Email us yours at CorporateCommunications@coxhealth.com. Hear your patient: “It’s not enough to only listen to your patient, you have to really hear them. What are they saying to you? Even the smallest bit of information can affect their care.” Be thoughtful: “Little things matter. I was on the PICC team for 10 years. Ask them which arm they prefer to have their PIV or line in. They know their bodies. Placement can affect how they eat, sleep and go to the bathroom. I want them to be comfortable.” Whatever it takes: “I treat every patient as if they are my family member. I try to make them as comfortable as possible. For example, playing their favorite Pandora music to relax them. I have even done the newfangled ‘floss’ dance to make them laugh. That helps get their endorphins flowing!” Do the homework: “Always read the history. Maybe they’re a veteran and
you need to be aware of PTSD and decrease environmental stimulation when they wake up. Maybe they’re a former or current opioid user and that knowledge gives you direction of how to help control their pain. You need to know starting them at the lowest pain level isn’t going to cut it.” Teamwork is everything: “We are like a pit crew, but instead of tire changes we do vital signs, pain medications and comforting warm blankets. My favorite quote about teamwork is, ‘It’s not the team with the best players that wins, it’s the players with the best team that wins!’” Remember the family: “My mom had breast cancer, I know how it feels to be on the other side. My job is mainly patient focused, but I try to update the family whenever I can. I understand not knowing what is happening with your loved one in surgery is a helpless feeling.”
The road ahead in 2019
Creating an outstanding patient experience is key as we close in on earning Magnet status.
A
fter more than five years of concentrated effort, the finish line for achieving Magnet status is now in sight. “It’s really exciting to be at this point, after so much effort,” says Karen Kramer, vice president and system chief nursing officer. Magnet designation is the most prestigious distinction hospitals can earn for nursing excellence and high-quality patient care. The Magnet pursuit is an investment in doing what is best for patients while providing an excellent work environment. Ultimately, Magnet status helps hospitals attract the best nurses. The designation is awarded by the American Nurses’ Credentialing Center after hospitals have met strict criteria that indicate performance excellence. Only about 8 percent of U.S. hospitals achieve the distinction. Kramer says we are already performing at a Magnet level in many areas. In the Kramer final stretch, we must continue our clinical excellence and keep improving our service. “Our centralized focus needs to be on the patient experience,” Kramer says. “Look at where your unit is on patient experience and work on how can you improve. That’s how we can all come together.” CoxHealth recently brought in a consultant to assist with the final stretch of the Magnet
-
Visualizing strategy: The icons representing our four key strategies recently got a new look, courtesy of CoxHealth’s Marketing artists. You’ll be seeing the icons in future intranet and Connection reports on projects driven by the strategies.
Where do we focus in a changing environment? As 2019 gets underway, we sat down with David Taylor, corporate vice president, for a look ahead at the key strategies guiding CoxHealth. “For 2019, it is really about building on the plan we developed in 2018,” Taylor says. That plan focuses on four strategic priorities: Unify /standardize – Creating one patient experience (one chart, one bill). Population Health – Coordinating care and reducing per-capita cost. Academic Medicine – Growing talent with medical school and educational partnerships. Regionalize / Access – Growing our regional footprint and making it easy for patients to get the care they need. We’ve made a lot of progress and this year will see further development of key initiatives, including: • Continued growth of telemedicine. • Expansion of urgent cares, like the new facility opened last fall in Lebanon. • Pediatric subspecialty services, such as the addition of pediatric gastroenterology, pediatric endocrinology and pediatric neurology. • Implementing campus and ambulatory master plans. journey. Lori Carson has helped more than 50 hospitals achieve Magnet status, and in December she visited Cox South to hold sessions with nursing leaders. Carson was impressed with how
The ambulatory plan includes the development of Super Clinics in and around the Springfield metro area as well as Branson. These facilities will be designed to accommodate 15 or more providers, plus other ancillary services. • Expansion of specialty pharmacy services to help patients with the ongoing Taylor management of complex medications used to treat rare or chronic health conditions. CoxHealth is putting significant resources into planning, which will allow us to prioritize the most essential projects. Right now, that includes opportunities in home care service integration, with Oxford and Home Parenteral Services now organized under Debbie Cain, vice president of Home Care Services. At the same time, Taylor says business realities mean we have to be nimble and ready to adapt. “Sometimes the market changes faster than our plan and you have to adjust. We have a planned approach, but it is hard to predict even three years into the future. Things change so quickly, there’s no such thing as a long-term plan any more.”
well we are doing with staff engagement and participation in quality improvement. Over two days, leaders examined each of the more than 70 standards that must be met.
Our explanation of how we’re meeting those standards will form the basis of our magnet application. Magnet applications are typically hundreds of pages See ‘MAGNET,’ Page 7 3
Mastering the art of viole As tense encounters with patients and families keep rising, caregivers are perfecting their de-escalation skills.
H
Health care is an intense environment. Patients are having rough days. Families are stressed. The conditions are right for tensions to boil over, and if they do, caregivers can be caught in the middle. When it comes to workplace safety, the best way to handle a potentially violent situation is to prevent it altogether. That’s why nurses and patient care staff are focusing on de-escalation as an essential skill. The numbers illustrate the need: In 2018, Public Safety officers in Springfield assisted with potentially violent situations more than 2,600 times. For staff in the Emergency Departments, Psychiatric Services, 700 East at Cox South and other areas, de-escalation has long been a critical skill. Fortunately, with practice, it’s a skill anyone can develop.
Nurses Raymond Thurman and Stephanie O’Halloran say a successful de-escalation requires taking the time to listen to patients and empathize with their concerns.
Listening is key
Jody Shaw, a nurse on 700 East, says de-escalation starts with one simple step: listening. Shaw is one of the nurses who serve on CoxHealth’s staff assist team, responding to help staff diffuse situations. Frequently, Shaw by the time a staff assist is called, a patient or family member is frustrated and feeling like their concerns aren’t being heard. “Most of the time, they need someone to listen to them and answer their questions,” Shaw says. “About 75 percent of the time, just listening works to de-escalate a patient.”
Get the right people
One of the main de-escalation advantages of the staff assist is that it introduces new people. That step alone can diffuse tensions. On 700 East, nurse Jamie Dudley says staff frequently work with patients who have 4
De-escalation 101: When tensions rise, try this Work to understand the situation: Know the patient’s history. Talk to the primary nurse and find out what led to the need for de-escalation. Try to go into a situation knowing the patient’s case and what the underlying issues may be. Plan for backup: Have a game plan with other staff and
Public Safety if needed. Use the buddy system: Two people in the room at a time is good. More than two can increase anxiety and escalate things. Listen and empathize: Explain who you are and that you are there to help them. Ask the patient what is going on and let them talk.
dementia. In those cases, a staff member with a face or a voice that reminds a patient of someone from their past can be enough to trigger a negative response. “Just switching out the staff members who are talking to patients can make a big difference,” she says. “And there are times when calling a family member can help, too.”
Many times, a new staff member listening to a patient’s concerns can de-escalate a situation. Call for a staff assist: Any time de-escalation tactics aren’t working, staff can call their campus emergency number for a staff assist. Staffers in Monett and Barton County may contact Security.
Any time staff members at Cox South are in a situation in which a patient is agitated and de-escalation tactics aren’t working, staff can call 333 and ask for a staff assist. Nurse Stephanie O’Halloran says there is a lot of adrenaline involved when a staff assist is called. “You never know what you are walking
ence prevention Something as simple as a food request can spiral into a high-tension situation. In those cases, caregivers have to pick their battles and know where they can compromise. Shaw notes that she recently worked with a patient who wanted coffee at 3 a.m. She got him decaf and sat with him for a bit, listening to his concerns. “Everyone is human and wants to be treated with respect,” she says.
“
You have to be confident and make patients feel comfortable. Talking with them earns their respect.
”
“Just take five minutes and take them for a walk. Talk to them,” O’Halloran says. “Talking with them earns their respect. When you talk and listen, they can trust you and they can start to give a bit as well.”
Focus on common goals Photo illustration: Mike Wingo
into: It could be a confused older person, an irrational patient or a family situation,” she says. “Sometimes, a new person to hear the patient’s story helps.” For a successful de-escalation, engaging patients with two staff members at a time is ideal. Adding more staff in the room can increase tensions. “You have to be confident Dudley and make patients feel comfortable,” O’Halloran says.
Be flexible, be respectful
When patients are in a heightened emotional state, it is key for caregivers to offer suggestions, not commands. “Nurses like to be in control. We have lives in our hands and we take that seriously. But we have to think about how we can bargain to make this work,” O’Halloran says.
A successful de-escalation also requires that staffers examine their own goals in the encounter. “Ultimately, staff safety, patient safety and patient advocacy are your goals,” says Raymond Thurman, a nurse in the Emergency Department. When a patient is on the edge of being violent, it can be difficult to remember that you are on the same team. Thurman says it has been all too common in the past for caregivers to try to establish authority, rather than to listen and collaborate. The authority approach can make things worse. “You don’t want a struggle that ends with a winner and a loser,” Thurman says. “Because you won’t always be the winner.” Thurman says CoxHealth’s approach to safely handling agitated patients has improved steadily in his time with CoxHealth. “If you want to use anything clinical you learned as a nurse, you have to be able to de-escalate a patient first,” he says. “I love seeing de-escalation as a priority. It’s not just patient safety or staff safety. It’s one unified goal, and it makes empathy a priority.”
Keeping you safe at work
Our approach: new RL, staff assist, training and more Keeping staff members safe is a top priority for CoxHealth and in 2019 we are expanding our resources to do just that. The efforts begin with a new event/concern reporting system (RL) process that offers a straightforward, streamlined form for reporting workplace violence incidents. The new RL is the first of its kind and it represents a major commitment to preventing workplace violence. The new process will allow CoxHealth to track incidents, so we can better see trends and focus on prevention. The online form, found on CoxHealth’s intranet, walks users through definitions of abuse and violence, with space to explain how an incident occurred and who the perpetrator is. The new RL is only part of what we are doing in 2019. Other keys to our approach include: Staff assist – If a situation is getting tense, any staff member in Springfield or Branson can call their emergency number and request a staff assist. Staffers in Monett and Barton County may contact Security. The staff assist team that responds to the page includes nurses who are specially trained in de-escalation. New protocols for dementia and delirium patients – Teams are working to develop new recommendations on de-escalation tactics as well as medication and behavioral protocols to reduce outbursts that can lead to violence. Training for staff – The Center for Professional Development is offering de-escalation classes, which are mandatory for Psychiatric Units, Emergency Departments and the 7th floor at Cox South. The training is encouraged for anyone who may deal with an upset or agitated individual. 2019 will also include Mental Health First Aid training – designed to help staff members recognize warning signs before a situation escalates. Critical Incident Stress Management Team – CoxHealth’s CISM team, an interdisciplinary team that includes Pastoral Care and Case Management staff members, provides one-on-one follow up with staff members affected by workplace violence. Employee Assistance Program (EAP) – The free program, which began in 2018, offers phone consultations with professional counselors in the wake of a workplace violence incident. 5
A banner now sits in the field where construction on the Cox Monett replacement hospital is set to begin this spring. The new facility will be located on the north side of U.S. 60, just east of Monett. The completed project, seen in a rendering from December’s news conference, will feature 70,000 square feet of hospital space and a 27,000-square-foot clinic.
City’s strength drives growth New Cox Monett by the numbers Total size: 70,000 square feet of hospital space, along with a 27,000-square-foot clinic Patient capacity: 18 Medical-Surgical beds and 7 Labor and Delivery beds Total projected cost: $42 million CoxHealth investment: $35 million Community fundraising estimate: $5-7 million Crews are expected to begin moving dirt on the project in early March. The hospital will be built using a “design-build” approach, which allows initial construction to begin while the designs are still being finalized. That approach allows for an accelerated timeline, with an opening for the new hospital projected for spring or summer 2021. 6
From Page 1
At a time when rural health care is struggling and other small hospitals are being forced to close, it is the unique strength of the Monett community that makes the expansion possible. “I continue to be surprised and impressed with the quality of amenities we have in a town of 9,000 people,” says Jack Prim, board chairman of Monett-based Jack Henry & Associates. “We have a hospital that has received national recognitions for quality of care and leadership, all at a time when hospitals in rural areas are closing at a rapid rate. This is an opportunity to improve and expand health care in southwest Missouri.” Bass says the city’s progressive leadership group has made Monett a bright spot of rural growth. He points out that Monett’s City Council is constantly working to make the city better for new businesses to come to the area and for current industries to expand. “It’s the vision of our community leaders
that makes the difference,” he says. “Monett is growing. Businesses are coming in, families are coming in. Without growth, we wouldn’t be talking about this project.” Alongside the community strength, Cox Monett itself has had an outstanding run of excellence. In 2018 alone: • The hospital earned the Center for Medicare and Medicaid Services’ prestigious five-star rating for patient experience. • Cox Monett’s Auxiliary was named Auxiliary of the Year. • Darren Bass received the Missouri Hospital Association’s Visionary Leadership Award. • The hospital was ranked 39th in the nation on Modern Healthcare’s “Best Places to Work in Healthcare” list. Now, a new facility will become a physical space that reflects and supports the level of care Cox Monett is known for. Bass says he
Magnet From Page 3
“
Health care is pivotal, crucial and life-saving. This positions us to care for our community for years to come. Darren Bass
”
president, Cox Monett
“
The project is a tribute to the strength of this community. A hospital can’t survive without its community – we make each other stronger. Steve Edwards
”
CoxHealth president and CEO
and the Cox Monett team are excited about shedding the stigma of an “old” facility. “Everyone talks about the people here and our culture – we’re taking all of that with us into a highly efficient, safe environment,” he says. As Cox Monett’s services have grown, the hospital presented logistical challenges. For example, the current layout means new moms are wheeled through public areas following a C-section. When helicopters arrive, cars must be moved in the parking lot so they can land.
“
This is an opportunity to improve and expand health care in southwest Missouri. Jack Prim
”
Jack Henry & Associates; Cox Monett board member
“The new hospital will get rid of all the barriers we stumble over,” Bass says. He says an already award-winning team is eager to take their work to the next level. “We have been talking about the need for this for 15 years. It has always been something that was years away. Now, it’s within two years,” Bass says. “When we unveiled this to employees, people were leaning forward in their seats. When you walk around and talk with our staff, everyone is beaming.”
long and may take 1.5 years to complete. Here are the next steps: 1. Continue what we are doing on quality measures. 2. Expand peer-to-peer evaluations and add peer-to-peer evaluations for leaders. 3. Conduct a comprehensive educational assessment. 4. Standardize unit-based councils to drive improvements. Kramer shared details on the upcoming changes in 2019: Peer-to-peer evaluations: These evaluations are a Magnet requirement. There is plenty of evidence that peer-topeer feedback guides professional development and creates stronger nursing teams. The evaluations will focus on communication within the team, professionalism and creating a culture of accountability. Educational assessment: Nursing leaders are identifying educational gaps – any training staff members need, including training specific to particular areas. In the past, surveys have identified needs such as advanced de-escalation training, which CoxHealth now has in place. Unit-based councils: Unit-based councils are key since Magnet surveyors want to know improvement efforts are reaching staff at all levels. When surveyors talk to staff, they want to know: Are we all aware of clinical results and performance? Can everyone talk about how we are improving? Kramer says the councils are key as individual units work on quality efforts. On the eighth floor at Jared Neuroscience Center, for example, the unit-based council identified their fall rate as an area for improvement. They worked together on solutions, put new measures in place and tracked their results. “To get to the next level, we need units to look at what they are doing and what they need to do. We have learned so much through our Partnership Council and shared governance. When clinical staff have a strong voice in the organization, that’s powerful.” 7
#CoxHealthCommunity 3850 S. National Ave. Springfield, MO 65807
‘Blessing Boxes’ give back in Hollister, Monett Cox Branson is sponsoring the Lakes Area Leadership Academy’s “Blessing Box” project. The box, located near the Yacht Club in Hollister, will stay stocked with food, hygiene products and other items like gloves and blankets. Meanwhile, at Cox Monett, employees launched a Blessing Box in early 2018. The Monett box is located at Cox Rehab and Sports Medicine at 700 E. Cleveland Ave.
Magic Word
department and phone number. The 73rd correct answer will win.
Find the magic word and you could win your choice of a shirt or coffee mug from 1906, The Employee Store. Call 269-4154 and leave a message with the magic word and the page on which it can be found. Include your name,
Clue 1: Understanding another person’s thoughts and emotions. Clue 2: If you “walk a mile in someone else’s shoes,” you will express this.
Connection is a regular 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: Brandei Clifton Emily Letterman
Mike Wingo
January / February 2019
Keeping you safe at work
Meet the de-escalators
‘Everyone is beaming’
We are focusing on your safety by expanding workplace violence prevention efforts. Inside, four colleagues share their expertise on de-escalation and preventing violence. Pages 4-5
Investing in our
region’s health
Staff at Cox Monett are thrilled as CoxHealth announces plans to build a replacement hospital . Page 1