VOLUME 15 ISSUE 3, JUNE/JULY 2019
One goal: simplify access Teamwork, technology and a strong culture help us serve patients on their schedules.
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If you want to make rapid change, you have to identify your challenges and face them headon. That’s exactly what we did in 2018 when CoxHealth declared the single most important issue in ensuring our success: improving patient access. We are in a pivotal time of patient choice and the decisions patients make today will affect their health care – and our success – for generations. “Last year, we were at a point where two major contracts allowed our patients to choose their provider,” says Brock Shamel, administrative director, Regional Services. “It was imperative that we create loyalty. We knew if we gain loyalty now, we may have that for decades to come.” Loyalty is earned by giving patients what they want: Easy access to services and care. That singular focus has driven major change. We have added new approaches, enhanced our service culture and expanded our use of technology. Now, a year after the launch of our “Culture of Yes,” it is clear those efforts are paying off. Seventy-seven percent of CoxHealth’s primary care prac-
Over the last year, we have developed more ways than ever to say “yes, we can see you now” to our patients. From technology to new approaches, better access is ensuring CoxHealth’s success.
tices can see a new patient in less than a week; 60 percent offer same-day appointments. For specialty care, 60 percent of clinics can accommodate new patients in two weeks, up from 30 percent at Shamel this time last year. Improved access has created a 9.3 percent growth in primary care, compared with last year. We have also added more than 20,000 new ambulatory visits.
More importantly, access goes to the core of our mission: being there for our patients.
Keys to success
Getting more patients in our doors is no small feat. The access strategy had two key parts: First, we needed to make access seamless and customer-friendly. “Patients need to be able to drive their care on their terms – when they want it, how they want
it,” Shamel says. “The more we can do that, the more likely we are to be their first choice.” Secondly, we had to change ourselves. We have created success by shifting our culture toward one of saying, “Yes, we can see you,” and making structural changes to make that claim a reality. Last year, physicians and leaders looked closely at the access we offered. At the time, three- to six-month wait times See ‘ACCESS,’ Page 6
Savings
Service spotlight
Employee Health crunches the numbers and changes processes to create efficiency.
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In Same Day Surgery, hourly rounding and a strong AIDET script are keeping patients like Lee Wilder, seen here with nurse Becca Humphreys, informed before their procedures.
A one-minute strategy for better patient perceptions C
an a 60-second interaction make a difference in how patients perceive our service? Can regular rounding work wonders in a fast-paced unit? The teams in the Post-Anesthesia Care Unit and Same Day Surgery at Cox South say yes. Like all areas, PACU and Same Day Surgery were looking for the best way to improve patient satisfaction. They found an answer in working well across departments and committing to clear patient communication. When they studied patient complaints, a theme emerged: patients experienced delays and they didn’t feel informed. “One of the biggest issues is wait time,” says Weaver Nurse Manager Misty Weaver. “Waiting to have the surgery or waiting to see a doctor can be stressful, and it can harm patient perceptions.” Staff members work quickly and they were in the habit of preparing a patient and moving on to the next, often without regularly revisiting patients once they had been prepped. “We had to reset our minds to: ‘If that was us sitting in that room, we would want someone to tell us what is happening.’” To improve patient perceptions, the units turned to a familiar customer service favorite: hourly rounding. “The floors have done hourly rounding for years. It’s new to us because we didn’t see ourselves as having an issue with that,” 2
Share your service story We want to know your top tips for improving the patient experience! Email us yours at CorporateCommunications@coxhealth.com. Weaver says. “The more we dived into it, the more we saw that we didn’t always do a very good job keeping patients informed.” In the past, staff might prepare a patient for a procedure and then move on to the second and third patient. Now, if the first patient is still in the unit when staff are finished prepping the second patient, staff members will go back and check on them. “Staff know patients will be happier if we keep up with rounding and tell them what to expect,” Weaver says. “There won’t be as many questions or complaints if we are proactive. “We need to focus on the things we can control, and we can keep patients as informed as possible.” There are multiple departments involved in pre- and post-op care, so it takes a team effort to get everyone on the same page. The Unit-Based Council audited staff interactions with patients, examining what patients and families are told at each step of the process. They quickly saw ways to improve and standardize communication. Working together, the teams in PACU and SDS came up with See ‘PACU,’ Page 6
When people are hired at CoxHealth, one of the first questions they are asked is, “Would you roll up your sleeve?” CoxHealth vaccinates new employees against diseases like measles, mumps, rubella, chicken pox and more, which adds up to a significant investment in lab and vaccine charges. In the past, Employee Health would automatically draw three tubes of blood for six different labs on each employee, including rehired employees, to check immunity. Based on the results, employees would get the required immunizations. After CoxHealth added a strategic goal of “Working Smarter’ – finding new ways to save money or improve a process – Employee Health Manager Carol Grantham started asking a different question first, “Have you worked at CoxHealth before?” Presumably, rehired employees would have been vaccinated against many of the same diseases and may still have immunity. Grantham thought drawing three vials of blood and conducting the full lab work on rehired employees would be a waste of resources in terms of money for the lab charges and time for Employee Health, Laboratory and the new employee. “I got very excited because it drives me crazy when I see waste,” says Grantham.
gs are all around, if you look
Photos: Randy Berger
Grantham and her team implemented a new process. Now, if the employee is a rehire, staff draws only one vial of blood for a titer test to check their immunity against a range of diseases. That one change saves CoxHealth between $16,000 and $20,000 every year. “Everyone on the team is proud of that one,” says Grantham about the project. Grantham “They really enjoy when we find the money. I always like to play with spreadsheets and show the savings because if you can see it, then it’s real money.” Finding savings – big and small – in our daily work is what the Working Smarter initiative is all about. The more we save, the more money is available for wage adjustments, new equipment and other investments in us and the organization. With a Working
This summer, the Working Smarter team is focusing on reducing waste. Managers are asked to connect with their teams to identify three ways you could reduce waste in your area. Try to identify potential savings in money, time or other resources. Employees can also email their managers with their ideas. Check Connect Daily and the intranet for the official idea submission form. We look forward to hearing your ideas and celebrating our success of working smarter together! Smarter challenge now through August, CoxHealth is hoping to expand on earlier successes and engage more people like Carol to make working smarter a key part of our culture. Grantham easily embraced the Working Smarter initiative because
she is wired to save money. She was raised on a farm and was aware from an early age of the importance of careful money management. “I try to operate my area just like I do at home,” says Grantham. “If I want something at home and it doesn’t make sense, I don’t get it. Or if it makes more sense to invest a little more money to save money down the road – then I will do that.” One key money-saving behavior Grantham uses is taking the broad view when it comes to a process change or a new project. Grantham encourages others to think the process through to discover what other department might be affected or might have the same need. For example, savings from the new-hire immunization project helped the department invest in PortaCount machines for a new method of TB mask fitting.
Employee Health’s Carol Grantham finds ways to reduce waste and save money throughout her department. Recent examples include the launch of PortaCount respirator fit testers (left), which allow Employee Health to handle all TB mask fitting. In the past, fittings were done unit-byunit, which tied up staff time and ran the risk of inconsistent fittings. The new process will save about $16,000 annually in labor. Employee Health also modified their process for new hires. Instead of automatically drawing three tubes of blood for immunity testing, they now ask questions first. If a staffer is a rehire, they may already have necessary immunizations. That lets Employee Health draw and process a single tube, saving lab time and cost.
“This summer we will begin using the gold standard of TB mask fitting,” says Grantham. “It took several years of working through it and it was a big investment. But I was able to put down on paper how much money we will save by using this machine versus having nurses on the floor taking time out of their day, which affects patient care.” Moving mask fitting from the nursing units to Employee Health is expected to save CoxHealth $16,000 in labor charges, even with hiring two part-time employees in Employee Health to do the mask fittings, and up to $186,214 in savings when you factor in the enhanced OSHA compliance that the new process brings. “I feel like we all have an obligation, if we want to continue to have this job 20 years from now, we need to be making good decisions now,” says Grantham. 3
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We are constantly doing things to better the community. This is a great time to improve our health care.
Historic step for M
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Mackenzie Lay
Labor and Delivery For Labor and Delivery nurse Mackenzie Lay, providing care at Cox Monett means taking care of her community. Her family goes back four generations in Monett and she knows what a new hospital will mean for her hometown. “I’ve lived in Monett all my life and I want to take care of people in the community I grew up in,” she says. “I have always been passionate about helping people -- being there for them in good and bad times. It’s a way to give back.” Monett is evolving and there is a spirit of community pride that Lay sees reflected in area parks, neighborhoods and businesses. “We’re constantly doing things to better the community, and this is a great time to improve our health care,” she says. While she and her colleagues love the family feel and teamwork at Cox Monett, they know their practice will be even better in a new facility. Lay points out that the current Labor and Delivery unit was originally designed as nuns’ quarters. Bathrooms are small and the rooms can be cramped. That’s all about to change. Building a hospital from scratch offers a chance to get everything right – from more space to improved workflows. Right now, nurses and staff are assisting in the design of the new unit – listing their “must-haves” and weighing in on the position of beds and infant warmers. “It’s great that nurses will have a say,” Lay says. “The new hospital will give us the opportunity to not worry about structure and workflow and focus on our patients.” Ultimately, that continued patient focus will mean more residents of Monett will take advantage of care close to home. “Everyone is looking forward to the new hospital; we’re ready for it to be done,” Lay says. “This project will draw more people in. It’s an exciting new environment and more people will want to come to Monett to have their babies.” 4
As ground is broken on the new hospital, Monett’s team looks to the future and celebrates a new national recognition.
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When Cox Monett’s new hospital opens in 2021, it will be a new, world-class home for the award-winning care our teams provide. You don’t have to take our word for it, though. For the second consecutive year, Cox Monett has been named as one of the nation’s top 150 Best Places to Work in Healthcare by Modern Healthcare. The recognition program honors workplaces throughout the health care industry that empower employees to provide patients and customers with the best possible care, products and services. Cox Monett is the only critical access hospital in Missouri selected for this award, and one of only two hospitals in Missouri to be named to this prestigious list. The award is the latest in great news from Monett. On May 1, CoxHealth and community leaders made Monett history by breaking ground on the new Cox Monett Hospital. The $42 million facility, which is set to take around two years to complete, replaces the current hospital that was built in 1953. The project reaffirms CoxHealth’s commitment to providing health care in rural areas. The new hospital is the culmination of years of planning and it has sparked tremendous enthusiasm among staff and the community. With the ground freshly broken, we spoke with a few Monett employees about what it means to be a part of this pivotal time in Cox Monett history.
Monett
Judy Flehmer
Keyla Martinez 200 Med-Surg
Crowds braved the threat of rain on May 1 for the formal groundbreaking of Cox Monett’s new hospital. The facility, which will be located just east of Monett on U.S. 60, is expected to open in spring 2021. Photos: Steve Snyder
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I would never have Cox Monett Operating Room thought I could work To say Judy Flehmer has deep Cox Monett ties would be through this time. an understatement. This is history for this Flehmer was born at St. community. Vincent’s, the hospital that would become Cox Monett. Four of her siblings and her mother have all worked at Cox Monett. When she was 16 years old, she started working as a nurses’ aide in Med-Surg. One of her friends had a driver’s license and she would pick up Judy and a few other teens who carpooled to the hospital. They worked Friday evenings and a 6:30 a.m.Flehmer says she’s excited about how a new hospital will 3:30 p.m. shift on Saturdays. transform care in Monett. “I made lots of beds and cleaned bedpans and thermome“This will be state-of-the-art technology for our families and ters – we washed everything back then,” she says with a laugh. for generations to come,” she says. “The location is exciting, She developed a love of caring for patients and she began where patients can look out the window and see trees and the a nursing career. She worked as a nurse at Cox Monett, then sky. They can look out and see God’s nature. Nature heals.” took time to raise a family before she returned to the hospital Flehmer says she tries to live by CoxHealth’s vision of 20 years ago. being the best for those who need us. She’s proud to see a new Even then, in 1999, there was talk of a new hospital. When hospital bring that vision to life for everyone to see. the project was announced last December, Flehmer was ecstatic. “I would have never thought I could work through this “We’ve talked about it for so many years. I thought I time,” she says. “This is history for this community and the would never see it before I retire,” she says. “Now I know I can surrounding area. Not many people can say they worked at St. hold on for a few more years and see it happen!” Vincent’s, Cox Monett and the new hospital. It’s an honor.”
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Getting a new hospital will be like opening a Christmas present!.
Keyla Martinez first set foot in Cox Monett as a high school student in the health occupations class at the Scott Regional Technology Center. “When I came here, I was a baby,” she says, laughing. “I came in and job shadowed on Med-Surg. That’s when I realized I really like this.” She knew she wanted to work in health care, and she saw a chance to build a career. Martinez is working on the unit as a nurse assistant and she is set to graduate from nursing school in December. With the new Cox Monett hospital in the near future, she hopes to grow her career alongside Cox Monett’s growth. “I like the environment here. Everyone is so friendly. You know everyone. It’s almost like a family here,” she says. “It’s a friendly hospital. I’ve never seen anyone frown. The teamwork here stands out – if you need help, there is someone right away who will stand up and help you,” she says. “We’re all friends and we get along really well.” Martinez says she is excited about caring for patients in a new hospital, where Monett’s award-winning services can be delivered in a space that reflects the team’s excellence. “It will benefit us to have the new technology and the new building. It’s a big step up in care for Monett and the surrounding towns. A new hospital will bring more advanced care here and open us to bigger things in the future.” She says she’s grateful she got the chance to start her career in the original Cox Monett and she will get to see her career transition alongside the hospital. “I’ll be graduating soon and then hopefully be an RN in the new hospital. Getting the new hospital will be like opening a Christmas present! It’s super exciting.”
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PACU From Page 2
a simple, 60-second script. The script guides staff through the AIDET (acknowledge, introduce, duration, explanation and thank you) process and it ensures every patient hears a consistent message. Here are a few keys to their script: Introduce yourself – Staffers can be busy, but it is vital to make a successful first connection with patients. “When we bring patients back, someone needs to get in there as soon as possible to give the AIDET speech,” Weaver says. “Patients who don’t know our procedures or who are nervous need that first touch.” Watch your references to time – Nurses and nursing assistants would casually say, “I’ll be back in a minute.” Patients can interpret that differently and it can lead to dissatisfaction. It’s safer to put the focus on hourly rounds and then follow through. Be transparent – Teams set expectations with patients and families by working proactively to keep them informed. Staff now speak in terms of number of cases (which we can control), not in terms of minutes or hours (which can change). They may tell a patient something like: “You are the doctor’s third case. The first case is complete and the second is ready. You will be informed hourly about progress.” Weaver says standardizing rounding and the AIDET script has worked wonders – and it’s something any unit can do. The key is involving staff in creating the perfect process. “Everyone needs to audit what they actually say in their interactions with patients. Have a colleague observe you and give notes,” Weaver says. Once you know what is being said, talk as a group about what you should say. What do your patients most need to know? When you know that answer, develop a script that covers that information in 60 seconds. “People are busy and you don’t want AIDET to just be more work,” Weaver says. “You need to involve the people who do this every day in figuring out what needs to be said. Then, they will get the most out of what they’re doing in each patient interaction, and patients will notice.” 6
Access key: Make life easier for patients From Page 1
were not uncommon. They examined how those wait times affected our service and, ultimately, our finances. “The fiscal picture made it clear: If we don’t correct this, we may not be sustainable in the long term,” Shamel says. CoxHealth and Cox Medical Group built a strategic plan designed to modernize CoxHealth’s practice and give patients more options. The plan’s changes started by giving patients centralized access points. A few examples: 269-INFO: The most obvious centralization can be seen in the expansion of 269-INFO. The info line has long been a touch point for new patients, but leaders were determined to get the most out of the service. When the access campaign began, a patient calling the info line could see one of 16 providers scheduling through the service. Now, the info line can connect patients with more than 140 providers. Orthopedics: Orthopedics had been identified as a pain point for access. Leaders and physicians partnered to create an orthopedic walk-in clinic. Primary care physicians are the primary referrers to the clinic, which now sees more than 30 patients per day. 24/7 urgent care: Expanding the Turner Center Urgent Care to 24 hours gives patients a walk-in option, other than an ED, overnight. Currently, the urgent care sees nearly 40 patients each night. In addition to creating centralized access points, we also expanded our use of technology to create a seamless experience for patients. Virtual Visits: Our virtual visits service, which connects patients with a provider via phone or computer, is on pace to break 5,000 visits this year. Promotions like SPF30, a $30 visit through the end of July, give patients a chance to try our services. Save My Spot: The Save My Spot feature on CoxHealth.com has kept more patients out of the waiting room. With the service, patients can book a time with their phone, arrive and walk right in. “It has been a great satisfier and it has helped with our recommendation scores online,” says
Simplified access and great service are key as patients have more choice. In 2018, we launched the Culture of Yes campaign, which included an emphasis on service (in Connection, above) and expanded access points. In a year-over-year comparison, 269-INFO scheduling jumped dramatically, as seen in the gray (‘18) and yellow (‘19) bars in the graph (above, right). Online scheduling and virtual visits also rose, with nearly 5,000 visits expected this year.
Jann Holland, vice president of Marketing. Online scheduling: In June, we kicked off a new Cerner app for scheduling new patients. Now, the app offers any new patient the ability to schedule an appointment with a provider online.
Patients want fewer steps
So after a year of major change, how do we maintain our momentum around access? Shamel says CoxHealth’s strategy going forward is built around one thing: simplicity for our patients. Anything that can reduce the number of steps between a patient’s initial request and their first point of access is on the table. For example, Cox Medical Group is working with consultants to simplify phone access into the system. If they see a patient process that requires five or six calls, they are working to reduce those to one or two.
269-INFO: a one-stop access point
The future of access: online scheduling soars 150+ providers available for online scheduling
Later this summer, CoxHealth is set to go live with Kyruus, an enhanced physician directory that will power the Find a Physician section of CoxHealth.com. Patients needing a primary care physician can search the directory and see primary care providers sorted by first availability. The directory will also let patients search for providers
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It’s getting back to why we’re here. We have to create access, we need to be here when patients need us. Brock Shamel
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administrative director, Regional Services
and specify any number of preferences, such as gender, location and insurance options. “It has a lot of self-serve capabilities that allow patients to direct their care,” Shamel says. CoxHealth is also rolling out a patient reminder app, which launches as a pilot this summer. The app will allow clinics to send appointment reminders to patients via phone or text – complete with the location of the appointment and a number to call if there are
questions or a change needs to be made. In addition to technology, clinics are also revamping their workflows to allow for more access. In primary care clinics, leaders are looking at ways to add walk-in options, both for established patients and for new patients. “We are shaping our primary care clinics to offer same-day access and build a true medical home model,” Shamel says. Clinics are working to streamline daily life for staff and providers as well. That means improvements to the electronic medical record, and helping clinics take a team approach to handling their patients. “We want patients to see the clinic team as their provider,” Shamel says. “A group-based approach will enhance our ability to always care for our patients’ needs.” Shamel says the effort around access has led to improvements throughout our clinics, as teams take ownership of the “culture of yes.” “I couldn’t be more proud of the teams that made this happen,” Shamel says. “It’s getting back to why we’re here. We have to create access, we need to be here when patients need us.”
Making an impression with access messages Yes, CoxHealth can see you now – and it is Marketing VP Jann Holland’s business to make sure the whole community knows it. She and the Marketing team started by focusing on employees of local businesses whose health plans were switching to open access. “When providers change, their messaging is: ‘you can keep your doctor,’” Holland says. “But we wanted people to know, you can now choose us!” Billboards around the area offered “Yes, we can see you now” messages targeted to people covered by Aetna, Anthem and United Healthcare. Meanwhile, Holland’s team created customized digital ads that were served to 126 key employers that had moved to open access plans. The ads used an approach known as geofencing, which creates a digital “fence” around key businesses. When someone is using a smartphone app Holland with ads inside that fence, they would be served a digital ad reminding them that they can seek care at CoxHealth. Clicking on the ad takes users to dedicated pages on CoxHealth.com that explain why CoxHealth is a great choice for care. That campaign earned two million impressions in two months. CoxHealth.com saw more than 400 unique visitors from employer groups in the first month. In December, CoxHealth drove messages about the Flu20 promotion and virtual visits. “We drove more than one million impressions per month, with good engagement,” Holland says. “And our virtual visits performed strongly in that timeframe.” In addition to targeted digital advertising, we also focused on paid search campaigns and targeted, paid social ads on Facebook. “We wanted to be in the social space because we know people are exchanging information on their health choices and experiences on Facebook,” Holland says. Those digital approaches were part of an integrated awareness campaign that also included: • Press releases on virtual visits, Flu20, SPF30, 24/7 urgent care and other services • Outdoor billboards near key employers • General awareness advertising featuring Save My Spot, 24/7 urgent care and “Yes, We Can See You Now” messages. • Print awareness advertisements in publications like the Springfield Business Journal and 417 Magazine. Between November 2018 and February 2019, the combined integrated campaign generated more than 8.5 million impressions. 7
3850 S. National Ave. Springfield, MO 65807
Forbes ranks CoxHealth a ‘best employer’ Forbes has recognized CoxHealth as one of America’s Best Employers in 2019. The first-ever ranking by Forbes of the top employers by state has CoxHealth as No. 18 in Missouri out of all industry types, the No. 3 health system in Missouri out of 156 hospitals in the state, and the No. 1 best health care employer in southwest Missouri. Forbes recognized 2,500 U.S. companies with 500 or more employees on the ‘best employer in America’ list that is based on results of an independent survey of more than 80,000 employees across the nation.
Magic Word
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,
department and phone number. The 58th correct answer will win. Clue 1: An area of land for growing crops or raising animals. Clue 2: To subcontract, as in: “We had to _______ out some of the work.”
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: Kaitlyn McConnell
Steve Snyder Yvette Williams
June / July 2019
Living our vision with improved access
Our patients want care on their terms. We are making that a reality with focused efforts around access and service. Page 1
Quest for savings
If there is a queen of Working Smarter, it might be Employee Health’s Carol Grantham. Check out the savings she has found. Page 2
Making it simple
Looking ahead in Monett
With ground broken on the new hospital, we talked with staffers about what it means to be at Cox Monett during this pivotal time. Page 4