Care Assure’s Deb DeGarmo and patient Evelyn Brown
Fall _____ 2015
Advancing the care continuum Care Assure leverages HCA’s scale, IT investments and commitment to patient care See page 6
HCA-backed study reduces post-op infection rate Local, regional and national programs keep HCA eco-friendly London calling: meet HCA’s English hospitals Hope Fund turns 10
EXECUTIVE PERSPECTIVE Providing outstanding patient care is what we do every day at HCA – but some of our methods are more visible than others. In this issue of YOU magazine, we wanted to pull the curtain back on some of our behindthe-scenes initiatives. As an extension of our mission to care for and improve human life, one of our most important goals is to continually work to enhance our patients’ care and experience. Across HCA, our facilities have developed a wide variety of patient navigation strategies to help us achieve this goal. From Sarah Cannon’s nurse navigators who guide cancer patients through treatment, to our contact center staff who facilitate physician appointments with our patients after urgent care and emergency department discharges, to a variety of care coordination strategies across the company, assisting patients in their time of need is the focus. These and other strategies designed to help shepherd patients through the many touch points in healthcare are an important part of improving their overall experience. This issue’s cover story highlights one of these patient-centered navigation programs, called Care Assure. We have piloted Care Assure in the East Florida and West Florida divisions, are deploying it across other divisions and are excited about the results we have achieved. Thanks to major investments in IT and the hard work of our IT&S department to build a learning healthcare system, we are able to identify “red flags” when patients have certain tests done. Skilled nurse navigators then work to track and interpret these red flags, and use their findings to schedule doctor’s appointments or further testing for patients at risk. Like other navigation programs across HCA, Care Assure is a huge endeavor with many moving parts, all operating behind the scenes to improve our patients’ health and experience. We know it will save lives, and are eager for you to learn more about it on page 6. In addition to leading in our clinical initiatives like Care Assure, HCA is also a recognized national leader in research and development. On page 18, find out how our collaboration with the University of Iowa in the STOP-SSI study has led to procedures that greatly reduce infections in patients undergoing cardiac or jointreplacement surgery. Another advantage to HCA’s scale is our ability to make a meaningful difference when it comes to taking care of the environment. Read about a few of HCA’s comprehensive sustainability programs on page 14. And finally, have you ever wondered what HCA’s London hospitals are like? As the story beginning on page 16 explains, healthcare in the United Kingdom is very different than it is in the United States. But there are many similarities as well, and just like in the U.S., our British counterparts are focused on, and succeeding in, providing the best patient care possible. All our initiatives to improve the health of our patients and communities are enabled by you: our employees. Without your hard work and willingness to go the extra mile, our innovations and advances wouldn’t make that final leap from idea to implementation. Thank you for your tireless dedication to improving the care experience for our patients. Best regards,
A. Bruce Moore Jr. President, Service Line and Operations Integration 2
you season | 2015
Fall 2015 HCA Mission Statement Above all else, we are committed to the care and improvement of human life. In recognition of this commitment, we strive to deliver high-quality, cost-effective healthcare in the communities we serve.
HCA Values In pursuit of our mission, we believe the following value statements are essential and timeless. We recognize and affirm the unique and intrinsic worth of each individual. We treat all those we serve with compassion and kindness. We act with absolute honesty, integrity and fairness in the way we conduct our business and the way we live our lives. We trust our colleagues as valuable members of our healthcare team and pledge to treat one another with loyalty, respect and dignity. We foster a culture of inclusion and diversity across all areas of our company that embraces and enriches our workforce, physicians, patients, partners and communities.
HCA Chairman & CEO R. Milton Johnson Senior Vice President, Corporate Affairs Jana J. Davis Vice President, Communications Operations Jeff Prescott Director of Communications Thad Taylor Content Manager Carson Hanrath Send comments to YOU.Magazine@hcahealthcare.com
Designed and Published by Parthenon Publishing www.parthenonpub.com President Bobby Stark Chief Operating Officer Carlton Davis Managing Editor Joe Morris Creative Director Lauren Kessinger
INSIDE F E AT U R E S
4 Hope Fund turns 10 HCA’s employee-driven assistance funds marks a decade of help, hope and healing.
6 Better medicine Care Assure combines HCA’s strength and innovation to help patients even before they need it.
10 The world of HCA HCA’s size and scope make it a national leader in providing high-quality healthcare.
12 Bug busters STOP-SSI study lets HCA lead the way in reducing post-op infections for ortho, cardiac patients.
13 Calling the shots Flu season is here – have you had your vaccine yet? Learn about HCA’s annual program.
14 Going green for good Sustainability programs at the local, regional and national levels keep HCA eco-friendly.
16 London calling HCA’s hospitals in London provide outstanding care to Her Majesty’s subjects.
18 Safe and secure Are you an information-protection superhero? Here’s how to protect work and personal data.
19 Hiring help New websites and upgraded mobile capabilities have made HCA’s hiring process a lot easier.
Keep up with HCA online. Visit www.hcatodayblog.com and follow HCA on:
HCA’s CNO responds to ‘The View’ stethoscope comments and reaction The Miss America pageant is better known for swimsuits and sequins than scrubs and stethoscopes. That changed when Kelley Johnson, a nurse who competed as Miss Colorado, performed a monologue about her nursing career. She eventually took second runner-up in the competition. Afterward, The View host Joy Behar asked why Johnson had “a doctor’s stethoscope” on during her monologue. Nurses took to social media to bash Behar’s comments, and advertisers such as Johnson & Johnson exited the show. For her part, Johnson said during an Ellen appearance that she wanted to honor and recognize nurses, something HCA’s chief nursing officer Jane Englebright (who also is patient safety officer and senior vice president of the Clinical Services Group) wanted to do as well. She blogged about the role nurses play in healthcare (read her blog at http://bit.ly/NurseTalent), and the response was immediate and overwhelming. “We have 70,000 nurses providing quality care for our patients every day, so I thought I should write something about it,” she says. “People often think that nurses don’t do medical work, that they don’t use a stethoscope — that only doctors do.” In the end, Englebright says, the firestorm (and subsequent on-air apology) showed that a nurse’s job is often misunderstood. “Most of the people who commented on this at the national level just wanted to talk about what we do,” she says. “It’s inspiring and helpful to nurses in the hospital to see this conversation taking place, and so I hope it continues.”
Sarah Cannon Research Institute featured at world conference The International Association for the Study of Lung Cancer (IASLC) selected Sarah Cannon Research Institute investigators to present in 11 oral presentations, seven posters, an education session and a symposium at the recent 16th World Conference on Lung Cancer (WCLC) in Denver. The WCLC is the world’s largest meeting for lung-cancer experts to review research data. Sarah Cannon researchers highlighted studies on immunotherapies and molecular targeted agents for lung cancer. “Lung cancer takes more lives than any other type of cancer every year,” says Dr. Howard A. Burris III, chief medical officer and executive director of Sarah Cannon’s Drug Development Program. “With the emergence of immunotherapies as well as targeted therapies tailored to genetic mutations, we are observing a promising shift in how we can more effectively treat this disease. Our participation in the WCLC annual meeting demonstrates Sarah Cannon’s leadership in investigating novel agents designed to improve outcomes for patients.” To see more, visit http://sarahcannon.com/campaigns/world-lung. 2015 | you fall 3
ville were flooded with inquiries from hospitals and other facilities nationwide. Because of Hurricane Charley just a few weeks earlier, the leadership team’s inboxes were already overflowing with emails from HCA employees nationwide who wanted to help. There was no official mechanism for employees to donate, and so that convergence of need and willingness to help would soon give birth to the HCA Hope Fund.
“HCA has always taken care of its own, something our employees really take to heart.” —Jack Bovender
Weathering the storms Born during Hurricane Katrina’s aftermath, the HCA Hope Fund continues to serve A decade after Hurricane Katrina devastated New Orleans, survivors and those who assisted them are sharing stories of strength and resilience. For many in HCA’s senior leadership, the days and weeks following the disaster showed just how strong the bond is between all HCA employees as thousands reached out to help their evacuated and often homeless counterparts. For Jack Bovender, former chairman and CEO of HCA, Katrina and its aftermath are a “defining moment” for HCA, when the company did anything and everything it had to do in order to get patients and staff out of harm’s way and to safety. Whatever was needed, whatever it took, he says, it was done. “I was so proud of what we did, and how we came together to make a difference in that horrible situation,” Bovender says. “Everything HCA did after Katrina showed who we were, and what we were. The Hope Fund was the crown on top of that defining moment. And now it’s there for a lot of people if there’s an earthquake, tornado or hurricane. And it’s also there for the one person who has a life-changing event and needs some help. That really shows the kind of company that HCA is.” Within hours of Katrina’s landfall, conversations began that would lead to the Hope Fund’s creation. On the ground, Mel Lagarde, then 4 you fall | 2015
president of the Delta division and now president of the MidAmerica division, had remained at Tulane Medical Center in order to help the physicians and staff there deal with an influx of patients from other hospitals in the area, as well as others who had been rendered homeless by the storm. He was in constant communication with Bovender, as well as Sam Hazen, then president of HCA’s Western Group and now president of operations, and former chairman Richard Bracken, who then was president and chief operating officer of HCA. At the same time, the corporate offices in Nash-
As the Hope Fund was being formed, HCA swung into action in many other ways in the hours, days and weeks following Katrina. From evacuating patients and employees from Tulane Medical Center, the nearby Charity Hospital and other nonHCA facilities, to providing food, water and medical supplies, HCA devoted resources and compassion to the disaster area. The newly created Hope Fund received its tax-exempt number within two weeks of filing with the federal government, and it quickly joined the relief efforts. “HCA as a company has always taken care of its employees, and the employees have always rallied around each other,” says Joanne Pulles, president of the HCA Hope Fund. “While it was best known in the early years for large-scale disaster assistance, it is now recognized for providing personalized help and support in a variety of crisis situations facing our employees and their families. If someone has a home fire, for example, or a major illness, the Hope Fund steps in and offer support. Someone at Charleston’s Trident Medical Center can donate a small amount every pay period, and that helps someone working at Good Samaritan Hospital in San Jose. People want to help, and the Hope Fund enables them to do so every day.”
HCA, The Hope Fund and Hurricane Katrina In the days following Hurricane Katrina, former HCA chairman and CEO Jack Bovender sent out daily emails to the entire company. In addition to keeping everyone updated on rescue and repair efforts, he also highlighted the work of the new Hope Fund: • More than $1.5 million was granted to 768 employees to meet immediate living expense needs • St. David’s Foundation partner in Austin and the Methodist Foundation in San Antonio each contributed $250,000 (in addition to HCA’s own $4 million contribution) • $344,000 was contributed from HCA employees
Almetra Finley, PBX Operator Sunrise Hospital and Medical Center, Las Vegas Major surgery dealt Almetra Finley some adversity last year, but as she worked to get back on her feet physically and financially, she received another blow. “My 31-year-old daughter was diagnosed with a complex, inoperable brain tumor,” says Finley, who is a PBX operator at Sunrise Hospital and Medical Center in Las Vegas. “This required me to make several trips back and forth to UCLA Medical Center so I could be at her bedside.” The plan of care included multiple, daily radiation treatments, as well as arranging for follow-up care, because the aggressive medical approach meant the loss of sight in one eye, as well as some other ongoing physical aftereffects. “Last year was a trying time for my family,” Finley says. “We got through my surgery, and her treatments, and have just been taking it one day at a time. But it all took a toll, and I really faced some financial hardships.” She was aware of the Hope Fund, as it had been discussed during her new employee orientation, and she was contributing via payroll deduction, but didn’t think about utilizing the fund until a supervisor reminded her of the possible assistance. The Hope Fund came through, and the assistance was everything she had hoped for and more. “My resources were exhausted, and housing costs in Los Angeles are ridiculously high,” she says. “I truly did not know how I would manage it, and with the Hope Fund’s help everything worked out really well. I am truly grateful for the assistance, and really can’t thank the Hope Fund’s donors enough.” HCA is a remarkable place to work for many reasons, she adds, and the Hope Fund is just icing on the cake. “Had I been with another company, I have no idea if I would have been able to get this kind of assistance,” she says.
Jennifer Schade, Medical Office Specialist Northern Utah Cardiovascular When Joshua Schade took a job closer to home in 2014, it was good news to wife Jennifer and their five sons. He would be on the road less, and even though the freight he was hauling was dangerous, he wasn’t too worried. “He hauled sulphuric acid, which is pretty nasty stuff, but he wore full protective gear when he had to unload it using a pressurized hose,” says Jennifer Schade, a medical office specialist at Northern Utah Cardiovascular, part of HCA’s Physician Services Group. “But there was an explosion, and the acid melted right through the clothing. He was covered head to toe.” Joshua suffered third-degree burns over 70 percent of his body, and spent six weeks in a coma. He has undergone 14 surgeries to date, including skin grafts and other procedures to re-cover his body literally inch by inch. “The process is really long, because he would do well with physical therapy in between the surgeries, and then another operation would slow him down again,” Schade says. “The doctors are thinking that soon he can go to rehab, so that he can
continue to re-learn how to walk, and feed himself. He has to really start over with everything. It’s been a long road, but he’s a fighter.” The Schades had just built a new home in August 2014, and so they had little savings to fall back on when Joshua’s accident happened. Jennifer was able to take time off through the Family Medical Leave Act, but the bills quickly began to pile up. She wasn’t familiar with the Hope Fund, but when she heard about it she was eager to learn more. “With neither of us working, what money we had set aside went really fast,” she says. “I spoke with someone in our office who told me about the Hope Fund. I was still in shock, because it was soon after the accident and I didn’t know if he was going to live or die, and I was trying to keep things together for our five boys.” Jennifer’s call to the Hope Fund made a world of difference. “When I saw that deposit, I just broke down,” Schade says. “Right before his accident, Joshua had been saying that we needed to get our savings built back up. Without this help, we would have lost our house. Things are still scary, but I’ve been able to focus on caring for my boys and my husband. The Hope Fund has been an absolute blessing to our family.” 2015 | you fall 5
OUR CARE Care Assure creates a partnership between HCAâ€™s healthcare providers and the patients who rely on them.
6 you fall | 2015
Better medicine Care Assure leverages HCA’s scale, IT investments and commitment to patient care to improve patient outcomes For Evelyn Brown, November 13, 2014 was one for the books. It began with her feeling a little off, progressed to an unexpected hospitalization and, soon after, she found a new friend. “I was a few days away from having heart surgery, because I was dealing with atrial fibrillation and couldn’t take blood thinners,” Brown recalls. “I was due at the doctor’s office for advance blood work. By the time I got there I really felt bad, and it was just getting worse. They sent me straight to Orange Park [Medical Center], where it turned out that my potassium was so low that I could have died.” Although in and out of consciousness for the next few days as her potassium levels improved and her heart procedures were performed, one person she remembers throughout is Deb DeGarmo. “She was there the minute I was, and we talked about a few things while I was coming in and out,” Brown says. “And she’s been with me through rehab and everything else since. She’s a godsend.”
New role, new challenges DeGarmo, a former hospital director of cardiac services, is now the Orange Park Medical Center nurse navigator for Care Assure, an innovative clinical navigation program developed by HCA to ensure better communication, better care and better outcomes, by educating and helping navigate patients after hospitalization. By acting as the bridge between patient, doctor and hospital, Care Assure’s nurse navigators are able to make sure that patients understand their often-complex care pathway, schedule and attend important follow-up appointments, get and take their medications appropriately and otherwise secure the vital services they need. Patient feedback and experience with Care Assure, which launched at JFK Medical Center in Atlantis, Fla., in 2012, has been highly favorable and the program is now making its way across HCA. It also gets high marks from physicians for helping them treat patients more efficiently, especially those who often need their care most, while
“Care Assure focuses on improving clinical navigation, which can lead to better outcomes and reduction of waste. The program helps prevent patients from falling through the cracks in healthcare and instead facilitates navigation, even when patients have complicated clinical care plans.” — Dr. Steven Manoukian
providing better care coordination throughout the process. “It’s an extension of their care,” DeGarmo says. “Many people are confused once they go home. They get a lot of paperwork and
Care Assure’s 5 step approach to improving care Big data + clinical navigation = better outcomes
Care Assure identifies high-risk patients that meet evidence-based clinical criteria.
Nurse navigators collaborate with medical teams.
Patient care coordinators schedule and confirm follow-up appointments.
Care Assure teams track appointment status and provide patient coaching to improve attendance.
Nurse navigators follow up with patients to close the loop on the episode of care.
2015 | you fall 7
Care Assure benefits patients and providers Patients
Ensures patients receive care they need following inpatient admission and leads to: • Reduced missed appointments • Increased evidence-based care • Additional quality-adjusted life years
Improves the efficiency of medical practice: • Physicians see more of the patients they ask to follow up • Physicians see patients with clinically proven disease and/or risk
Improves quality of care and patient satisfaction by: • Extending the continuum of care beyond the hospital • Increasing hospitals’ coordinated care • May reduce readmission costs
instructions as they are preparing to leave the hospital, and it’s an anxious time for them. What we’re doing with Care Assure is making certain that the transition of care goes much more smoothly, so they actually receive the care that is prescribed. “While answering questions and concerns, I was able to ease Evelyn’s anxiety about her planned care. I also explained that as the Care Assure nurse navigator, I would be contacting her upon discharge to ensure follow-up. We connected numerous times both before and after surgery, including at rehab and several months later when she was back home, truly building a long-term relationship.”
to Care Assure’s success in the long term. “Given the often high-risk and time-sensitive nature of their conditions, coupled with complex case pathways, the program’s focus now is on cardiovascular patients. The impact of coordination is measured through clinical and operational metrics and necessary adjustments are made to further improve patient experience and outcomes,” says Dr. Steven Manoukian, vice president, cardiovascular service line, for HCA’s Operations and Service Lines Group and another of the program’s leaders. “Improving healthcare value is an important goal, which means improved clinical outcomes, potentially at lower healthcare cost, in part due to more efficient processes,” Dr. Manoukian says. “Care Assure focuses on improving clinical navigation, which can lead to better outcomes and reduction of waste. The program helps prevent patients from falling through the cracks in healthcare and instead facilitates navigation, even when patients have complicated clinical care plans.”
service lines may be added in the future. “Care Assure is an excellent example of clinical innovation, in that we are always enhancing what it can do,” Dr. Manoukian says. “By leveraging the latest clinical guidelines, we regularly revise the Care Assure program to include new disease processes, treatments and/or patient populations who might benefit. We are currently exploring additional cardiovascular conditions such as heart failure, due to the high risk of short- and long-term adverse outcomes and readmission.” Care Assure also helps patients who may be at risk for cardiovascular disease later in life. “There are certain criteria that help identify these patients with risk factors for cardiac issues who would benefit from Care Assure,” DeGarmo says. “For instance, if they have cardiovascular risk factors and do not have a primary care physician, that’s a concern right there. Also if they are diabetic and more than 50 years old or a smoker, a Care Assure navigator will be notified. I see some of them before they are discharged, and others I get in touch with just after they’ve left the hospital. We talk about their diagnosis, clarify questions regarding medications, schedule all necessary follow-up appointments and anything they want to know more about, really.” The next step, she continues, “is to help ensure they attend their appointments and if they don’t, I reach back out to determine what obstacles they encountered and provide necessary resources to help overcome them.
Old idea, new concept Post-discharge follow-up isn’t a new part of healthcare, but building an entire program to identify and then help specific groups of patients as they navigate the system is a more unique and robust approach, says Chuck Hall, president of HCA’s National Group and one of Care Assure’s founders. “This idea goes back many years,” Hall says. “Through a lot of conversations with experts in this space, we realized that the best way to continue care coordination for a particular population when they leave the hospital is to establish our own system and processes, and use certain clinical information that we have readily available through the electronic medical record and other information systems, to provide better care.” Indeed, HCA’s ability to leverage its data collection and analytics tools are a key 8 you fall | 2015
Identify, interact and facilitate Care Assure uses a data approach to identify individuals who may need care coordination. The program also employs widely accepted evidence-based guidelines to develop individualized care plans in conjunction with the patient’s healthcare provider(s), which often includes important follow-up after discharge. At present, Care Assure is primarily being used for cardiac patients, although other
If they are supposed to have home healthcare and that hasn’t happened, I will call and see what’s going on. There are a lot of intersections where something can get turned the wrong way, so I work to correct that.”
a follow-up appointment for the potential heart issue. That’s when Care Assure identifies the patient based on the abnormal echocardiogram and swings into action. “When a Care Assure navigator identifies a patient at high risk for future complications based on their condition, and they reach out to the patient, they increase the likelihood that patients are navigated to the evidencebased care they need and that’s a huge win,” she says. “Care Assure does more than ensure follow-up, it is potentially saving lives.”
“Care Assure focuses on patients who have high-risk conditions, works with their providers to schedule the care they need and facilitates navigation through that process.”
— Lindsay Stergar Ensuring patient follow-up and care coordination There are some basic numbers that help illustrate the need for Care Assure. Approximately 80 percent of patients do not understand their discharge instructions. Only 40 percent of patients follow up with their specialist or primary care physician, despite the majority being instructed to do so. “There are a multitude of reasons why patients may leave the hospital, but don’t follow up and instead just disappear,” says Lindsay Stergar, HCA’s operational leader of Care Assure and AVP of the cardiovascular service line. “Care Assure focuses on patients who have high-risk conditions, works with their providers to schedule the care they need and facilitates navigation through that process. In addition, the team educates patients and provides additional resources needed to help overcome challenges with the continuation of care. Lastly, as patients live longer, they are often less capable of understanding and complying with increasingly complex care pathways.” “The Care Assure process increases the likelihood that a patient receives their physician-ordered care and is not lost to the healthcare system,” Stergar adds. For example, a patient might be admitted to the hospital for shortness of breath due to lung disease. While there, he or she undergoes an echocardiogram, revealing a cardiac abnormality which requires follow-up. On discharge, since the patient feels fine, they may never make nor attend
Service Lines Group. “We use data to reach patients who might need crucial care, but may be unsure how to obtain it or unable to navigate the healthcare pathway. Healthcare is complicated. Patients aren’t unwilling to seek care; they often just don’t know where to start. Care Assure gives them someone to talk to, and helps them move to the next stage of getting diagnosis and follow-up care. Since HCA is in the business of helping people get better, Care Assure fits right in with our mission statement.”
Resuming a regular life For Evelyn Brown, that also meant help with some issues around her rehab stay, continued input on medications and much more. “When I had a problem, Debbie made a call and got it fixed,” she says. “I got home, rested up for about three months and went back to work. I teach an art class once a week. It’s a Japanese form of advanced embroidery with silk thread, called bunka shishu, and we compete internationally. I was told I’d eventually feel like a new human, and I do.” The best part, she says, wasn’t just having someone help with medical issues, but just having someone show concern. “Debbie is very diplomatic,” Brown says. “She would ask about pills and medicines, but never made me feel like a child. She made me feel like part of the team. She’s just so kind, and when you’re ill, kindness means everything.”
“Care Assure is a way for HCA to be truly proactive and get patients the care they need. We use data to reach patients who might need crucial care, but may be unsure how to obtain it or unable to navigate the healthcare pathway.”
—Bruce Moore “It’s a great feeling to see so many lives being affected,” Hall adds. “We measure the number of years the quality of life will be improved and/or extended by the early identification and treatment of diseases, and when I see those quality-adjusted life year (QALY) numbers go up for a patient because of early intervention, it’s very satisfying. HCA has the resources to take this very good idea that’s been developed and deploy it across the entire enterprise, so it will help hundreds of thousands of people. That’s hugely rewarding.” “Care Assure is a way for HCA to be truly proactive and get patients the care they need,” adds Bruce Moore, president of HCA’s Operations and
“The best way to continue care coordination for a particular population when they leave the hospital is to establish our own system and processes, and use certain clinical information that we have readily available through the electronic medical record and other information systems, to provide better care.” —Chuck Hall 2015 | you fall 9
The world of HCA 168 hospitals and 113 surgery centers located in 20 states and The United Kingdom.
10 you fall | 2015
225,000 total employees 79,000
Patient care support
Environ/food service/ plant operations
Employed physicians and medical practitioners
*Employee information is from September 2015. Unless otherwise noted, other information is for fiscal year 2014. . The term “HCA” refers to HCA holdings, Inc. and its affiliates, unless stated or indicated by context. The term “facilities” refers to entities owned or operated by subsidiaries or affiliates of HCA Holdings, Inc.
“HCA’s size and scale enables us to invest in the people, processes and technology to fulfill our unwavering commitment to the care and improvement of human life.” —Milton Johnson, CEO
Approximately 5 percent of all U.S. hospital services happen at an HCA facility, including:
· 20.6 million
· 7.5 million
emergency room visits
Ranked 79th in the Fortune 100
115 hospitals are on The Joint Commission’s list of top 1,099 performers on Key Quality Measures.
Eight hospitals named to Thomson Reuters Top 100 hospital list
HCA named one of “World’s Most Ethical Companies” for the fifth year in a row
$2.2 billion in capital spending in 2014 to expand or bring new services to the communities served.
$2.5 billion in uncompensated care cost, estimated for 2014. 2015 | you fall 11
“We are very efficient and respected, and our partners know they will obtain meaningful data and support from us. These collaborations are great ... for the patients who entrust us with their care.” —Dr. Edward Septimus
Because of its number of hospitals, HCA is a sought-after partner for clinical research that leads to more effective patient care.
Study aims to stop SSIs Groundbreaking research in HCA facilities leads to reduced post-op infections
out by academic institutions, government agencies and private entities as a collaborative partner. “We are very efficient and respected, and our partners know they will obtain meaningful data and support from us,” Dr. Septimus says. “And these collaborations are great not just for HCA, but the patients who entrust us with their care. Because many of our hospitals are medium-sized, community-based facilities, our results are generalizable to most hospitals in the United States. They are very proud that they get to take part in creating better ways to take care of patients, and, more importantly, the patients benefit since we will implement these new care regimens in all of our facilities.”
In facility terms, more is better A recent collaboration between HCA and the University of Iowa has led to better, safer care for patients – and done so in record time. The Study To Optimally Prevent Surgical Site Infections in select cardiac and orthopedic procedures, or STOP-SSI, was conducted in 20 HCA hospitals. It focused on individuals who were undergoing cardiac or joint-replacement procedures, and put into place a series of advanced procedures designed to reduce the opportunity for infection to take root in their surgical sites, says Edward Septimus, MD, medical director of infection prevention and epidemiology with HCA’s Clinical Services Group. “We were looking at joint replacement and openheart surgeries, because if someone is colonized with Staph aureus (MSSA or MRSA), then their chances of having a post-operative infection is significantly higher than someone who is not colonized with these organisms,” Dr. Septimus says. “What we wanted to do was find a way to lower that risk, and we were able to do so.” The most common and effective way to get rid of the staph bacteria on the skin and nose before surgery is to put a specific ointment, Mupirocin, into a patient’s nose. That’s followed by an antiseptic bath in a chlorhexidine (CHG) solution for optimum effect. The study, which was completed 12 you fall | 2015
by researchers at HCA and University of Iowa, with funding from the U.S. Agency for Healthcare Research and Quality and in collaboration with the research arm of The Joint Commission, set out to establish protocols for the duration and frequency of these pre-op measures. “If someone tested positive for either MSSA or MRSA by nasal swab before surgery, then we began a five-day decolonization regimen,” Dr. Septimus explains. “And if a patient wasn’t colonized with MSSA or MRSA, they still received a bath the night before and the morning of their surgery, as a preventive measure.”
Major outcomes in record time Because of its size, HCA is able to bring a lot — in this case, 20 facilities — to the table. That meant that the study could be done in a much shorter timeframe than is usually possible. It also meant that significant data was collected, and outcomes reported, quickly. “We were able to show that these efforts reduced complex, deep infections by 42 percent,” Dr. Septimus says. “And we were able to do this in 20 hospitals, over a year and a half, because we had access to more than 40,000 surgical procedures.” HCA has a long and successful track record for these types of major studies, and is routinely sought
“As a learning healthcare organization, we can bring to the table the ability to conduct these studies at lightning speed in terms of the amount of data, patient volumes and statistical significance produced as outcomes,” adds Julia Moody, director, infection prevention. “We are able to provide central coordination from our corporate headquarters, and from there, reach out to all the hospitals by way of webinars, coaching calls, tool kits and lots of other communication. We also can create compliance-checking tools and other rapid adoption assessment tools so that we can make sure all the staff involved know what’s going on. The big winners are the patients with infections avoided based on the care delivered by the healthcare teams.” Now the new procedures will be rolled out to all HCA hospitals offering these types of surgeries, adds Jason Hickok, AVP, research and academic affairs, infection prevention and lab. “As was proven with our ‘Reduce MRSA’ study, leadership participation at the local level is key, because leaders become highly engaged with relationship-building with staff and surgeons and provide the support needed for high protocol compliance,” Hickok says. “Now our goal is to get the protocol training completed enterprise-wide, so that we can hard-wire these infection-prevention practices throughout HCA.”
Calling the shots The flu vaccine reduces: • flu-related PICU admissions by 74%
HCA’s flu-vaccine program keeps employees and patients healthy
Each Year: • 5-20% of U.S. residents get the flu
• flu-related adult hospitalizations by 71%
• 200,000 people are hospitalized for flu-related complications
• flu-related hospitalizations of people aged 50+ by 77%
• 3,000-49,000 people die from the flu
Employees can even come in for vaccinations on their days off.
Seasonal influenza is dangerous for everyone. HCA sees thousands of patients every year who have been hit with the flu, and it can be fatal for children, the elderly and those with weakened immune systems. It’s also highly contagious, and so it can easily spread to anyone who comes in contact with the person who’s ill. Because the flu is so dangerous, HCA provides free flu shots to all employees. And it’s also why HCA requires all employees who interact with patients in any way to have a flu shot, or to wear a mask in any area where they might encounter a patient. Because the flu virus can live on surfaces for hours, employees choosing not to vac-
cinate must wear a mask during their entire shift. This requirement will run from Nov. 1, 2015 to March 31, 2016. Whether or not an employee chooses to receive the flu vaccine during this period, he or she must register that choice by Oct. 31, 2015 at hcaflutrack.com. If any employee has questions about the flu vaccine policy and its requirements, they can speak to a supervisor, or email firstname.lastname@example.org. The flu can be devastating to HCA’s patients. Thanks to all employees for working to not only keep HCA hospitals in compliance with regulatory standards, but also for keeping patients and their families safe.
HCA requires all employees who interact with patients in any way to have a flu shot, or to wear a mask in any area where they might encounter a patient. Those include: • patient rooms • procedure rooms • waiting rooms • hallways • any other common areas 2015 | you fall 13
Going green for good HCA’s environmental policies produce efficiency and savings
Environmental sustainability is an everyday focus at HCA. It’s always a great time to talk about recycling, renewable energy and other eco-friendly policies, and HCA is able to lead many of those conversations thanks to its longtime commitment to providing outstanding healthcare in the most sustainable fashion. “We actively pursue sustainability and cost savings in many operational areas, from new construction meeting environmental goals, to purchasing and recycling programs,” says Anna Ward, HCA’s sustainability manager. “We also focus on specific technologies, such as LED lighting and real-time energy metering. Our Sustainability Steering Committee develops strategies and, in partnership with our facilities, advances environmentally sound choices across our company. HCA’s sustainability program is supported by our strong leadership, facility and individual involvement.”
Between 2012 and 2014 HCA facilities recycled • 119 million pounds of cardboard, paper, aluminum and wood waste • 58,977 pounds of rechargeable batteries • 229 million pounds of construction debris, an amount similar to more than 64,000 mid-size cars • And diverted 3.1 million pounds of waste from landfills by reprocessing single-use devices 14 you fall | 2015
HCA’s CEO Milton Johnson says, “We have made great strides in implementing a sustainability program. Continued success depends on the support of everyone at our hospitals and other facilities.”
Committees with multiple goals To keep the sustainable practices momentum going, HCA has an active Sustainability Steering Committee headed by Alan Yuspeh, senior vice president and chief ethics and compliance officer. The steering committee, which was created in 2009, releases an annual HCA Sustainability Plan, and has four task forces: Construction and Major Renovation Energy and Water Environmentally Preferable Purchasing Waste Stream The Sustainability Steering Committee and the task forces collaborate with individuals from corporate, divisions and facilities. Every hospital has a sustainability coordinator who’s responsible for taking the annual plan and getting its components put into place on-site, as well as reporting back on problems or innovations that are found along the way. One area where HCA really shines is in new construction. Where practical, new hospitals, outpatient centers and other facilities are built to the U.S. Green Building Council’s Leadership in Energy & Environmental Design (LEED) certifications, which is the standard to strive toward for green building. To date, HCA-spearheaded projects that have achieved or are in line for LEED certification include: • Corporate data center in Nashville • • Medical Center Alliance in Dallas
• The Reston Hospital Center Medical Office Building in Reston, Va. • Nashville’s Lentz Public Health Center (constructed by HCA) • Pearland Hospital in Houston • Nashville Capital View, now under construction (future home of Sarah Cannon Research Institute and Parallon) • New hospitals in Texas and Florida “There’s a lot in place already, and we are approaching every renovation and new build with the goal of being as environmentally sustainable as practical,” says Greg Stein, vice president, design and construction and chair of HCA’s Construction and Major Renovation Task Force. Another way HCA is improving efficiency is through its Energy Service Center. The center monitors each hospital’s utility usage and spending, and works to make changes wherever possible to improve efficiency and lower costs. In some facilities energy usage can be monitored in real time, so the savings are immediate.
Where water-saving measures have been implemented, over 3,300 gallons of water is saved a year in each patient room. “The success of any energy effort relies on building maintenance, facility managers, the Energy Service Center staff, energy conservation engineers and capital investment working together in our journey to deliver high performance buildings that use less energy,” explains Brian Weldy, vice president of FacilitiGroup Infrastructure Solutions and chair of HCA’s Energy and Water Task Force. HCA facilities can purchase environmentally friendly items. One example is a program to purchase and use FDA-approved reprocessed singleuse devices. Options are also in place for purchase of reusable rather than disposable items. “As contracts are renewed, we seek to ensure that greener alternatives are available,” explains Missy Eslinger, director, supply expense management, HCA corporate supply chain and chair of HCA’s Environmentally Preferable Purchasing Task Force.
Many types of waste disposal are regulated by the U.S. Environmental Protection Agency, yet that includes less than five percent of pharmaceutical waste generated at HCA facilities. HCA’s proactive pharmaceutical waste program reduces the drugs going into the water supply by at least 90 percent.
By moving to LED lighting in certain areas, last year HCA reduced energy similar to the amount of electricity that would be consumed by watching television for about a decade.
HCA uses environmentally sound methods to dispose of waste such as hazardous, infectious and pharmaceutical wastes. The sustainability plan does not stop there. HCA is a founding sponsor of the Greening the OR initiative, which seeks to decrease waste from operating rooms. Programs also exist for recycling and reprocessing medical equipment. In addition, all facilities have significantly reduced mercury-containing devices. “We work with our facilities, analyze data and constantly assess where our waste is going, to look for environmental and cost improvements. We set goals, perform waste audits and seek sustainable solutions,” says Ward, who is also chair of HCA’s Waste Stream Task Force.
The Pearland Hospital in Houston was constructed to meet rigorous environmental standards.
Alaska Regional Hospital has won honors for its multiple sustainability projects.
Facilities have green partnerships All HCA facilities are members of Practice Greenhealth (PGH), a nonprofit organization working with the healthcare industry to provide environmental solutions and best practices. Each HCA facility has the opportunity to apply for PGH Environmental Excellence Awards. In 2015, these hospitals received a Partner Recognition or Partner for Change award for efforts with multiple sustainability projects including waste reduction and conservation: • Centerpoint Medical Center, Independence, Mo. • Parkland Medical Center, Derry, N.H. • Overland Park Regional Medical Center, Overland Park, Kan. • Lee’s Summit Medical Center, Lee’s Summit, Mo. • Specialty Hospital, Jacksonville, Fla. • Alaska Regional Hospital, Anchorage, Alaska
Overland Park Regional Medical Center also has received awards for its waste reduction and conservation programs.
A sustainable future “HCA has played a leadership role in environmental practices among healthcare companies,” Yuspeh says. “Our steering committee has representation from across the HCA enterprise, and we work with sustainability concepts and innovations that are appropriate for our operations.” Yuspeh adds that HCA will continue to assess projects and opportunities with an eye toward implementing new cost-effective environmentally friendly opportunities where appropriate. “We are motivated by seeking to do the right thing for our patients, employees and communities.” 2015 | you fall 15
London calling HCA’s healthcare network in the United Kingdom provides quality care and cutting-edge research London Bridge Hospital
The Lister-Ardmore Hospital
“We have hospitals in the United Kingdom?”
That’s the response of many HCA employees when they’re told about their counterparts across the Atlantic. They’re even more surprised when they find that the British hospitals, clinics and research facilities are well-known centers of cutting-edge care, and also play a role partnering with England’s National Health Service (NHS). “Several hospitals were bought by HCA in the 1990s, and then everything consolidated into what is now the International Division in 2000,” says Rebecca Pullen, corporate affairs director. “There are six main hospital facilities, and then additional primary-care facilities, laboratory facilities and a number of partnerships with leading NHS facilities. We also have some outpatient diagnostic centers and a branch of the Sarah Cannon Research Institute.” Healthcare in the UK is significantly different than in the United States. In England, the NHS was established in 1948 and provides care for every citizen, covering everything from primary care physician visits to prescriptions, emergency care and surgeries. Specialist services, consultations and other care also fall under its umbrella. “It’s all free when you access it – there’s no charge for anything from primary care, to dentistry, to prescriptions – A patient room at The and it’s any kind of healthcare Lister-Ardmore Hospital you could possibly want,” 16 you fall | 2015
Pullen says. “But the downside is that often you have to wait for access, which can in some cases be a long time.”
A role for private insurance and facilities When the NHS came about, many people thought private insurance and care might wither away. Instead, in part because of the waits that sometimes occur around popular procedures and also because of the benefits of private care such as seeing a particular physician at a time convenient to the patient, they have continued to operate alongside — and often in tandem with — the NHS. That’s where HCA comes in. “People have always been willing to pay for access to a particular doctor they wanted to see at a time that works for them, or have services more quickly,” Pullen says. “As the NHS matured and the pressures on it became greater, the waiting list got longer. HCA saw an opportunity to deliver world class care to the 10 to 12 percent of the population that has private medical insurance or are willing to make out-of-pocket payments. Before HCA came to the UK, you couldn’t really access complex care in the private sector.” When HCA entered the UK market, primarily in and around London and Manchester, it invested in complex care such as cancer treatment, neurosurgery and cardiac care. Those service lines were fairly limited in the private sector at the time, and many patients and physicians immediately sought HCA out. “Ninety percent of our doctors work in the
NHS, mostly in the big teaching hospitals of London and Manchester, but also do private sector work,” Pullen explains. “In fact, we have the privilege of working with some of the UK’s most pre-eminent doctors. Many of them will spend a half day a week, for example, in private practice, and so they work with our facilities then.” Another difference from the United States is that the private sector in the UK doesn’t deliver emergency care, so HCA in the UK doesn’t have any ERs. Patients who have additional private insurance or are willing to pay out-of-pocket make their way to HCA hospitals and facilities when they see their regular physician. Because of the limited number of people with supplemental coverage, HCA’s facilities in England only have about 150 beds on average. And while they do not provide emergency care at all, leaving that to the NHS hospitals, they set themselves apart in other areas. “We’re the only hospital group in the United Kingdom with intensive care in all our hospitals,“ Pullen says. “And then we are the only private facilities providing very complex care such as liver transplants. We also are very advanced in the more complex cardiac care and cancer services as well.”
Reception at Wellington Hospital
Just like in the United States, superheroes are a big hit in HCA’s London pediatric wards.
Physical therapy is a core component of HCA’s London operations.
Partnering with the NHS HCA has been able to connect with the NHS and academic institutions through its research facilities and Sarah Cannon expertise to share information, and also to provide some services to the national organization. “We run a number of private-patient units in partnership with the NHS,” Pullen explains. “Some NHS hospitals have private-care areas. We deliver the care, and then a share of the revenue received by us is returned to them and invested in the overall system. We also invest in cuttingedge equipment with the NHS. In fact, on a number of occasions, HCA has been the first to introduce innovative new technologies and processes to the UK.” For example, HCA works with University College Hospital in London to operate its private bone marrow transplant service. “We provide in-demand services, and some very complex care, at all our facilities,” Pullen says. “The treatment we offer attracts patients from all over the world. About one in five of our patients travels from overseas to the UK to access the care we deliver. HCA has really made its mark in the UK and beyond.”
Queen Elizabeth II meets with Mike Neeb, president and CEO of HCA’s International Division.
2015 | you fall 17
Safe and secure New training provides tips around protecting sensitive information Ever wanted to rock a superhero cape at work? Okay, maybe it won’t go that far, but a new training from HCA’s Information Protection department wants to show you how you can be a hero every day when it comes to protecting our patient, physician and employee information. The training, “Information Protection: Your Identity Depends on It,” launched in October on HealthStream. It’s designed to provide tips and tricks to help everyone keep sensitive data safe and secure, in your home life and at work. “Protecting our sensitive information is a big deal for our company,” Paul Connelly, vice president of information protection says. “Two-thirds of people surveyed wouldn’t go back to a hospital or provider who lost their data. With this training, we want to show employees that it’s up to them to wield their information protection warrior badge every day.” The training was created around a superhero theme, so in addition to being short (it’s just 20 minutes), it’s also pretty fun (if you don’t mind some bad puns). “What we wanted to do was create something that not only provided the ‘must-do’ procedures around workplace information, but also would share some good tips on how to protect personal information,” Connelly says. “Whether they’re shopping online or paying at the gas station, we want to empower employees with the knowledge of how to protect their identity at all times.” Much of the training relates back to the Code of Conduct training, like HIPAA requirements around patient information. “This is real-world, applicable training,” Connelly says. “What would you do if you saw someone without a badge walking through the halls of your hospital? Do you lock your workstation every time you stand up? It’s the little things that can make a positive impact.” In addition to touching on safety and computer tips, social media guidelines and email, etiquette around information sharing is covered as well. “We know our employees are dedicated to the care and improvement of human life, and we want them to understand that mission includes protecting their private information,” Connelly adds. “Whether you’re handling patient face sheets or downloading reports, ask yourself, ‘how will I protect this information?’ That question can make all the difference.” Visit the Atlas Connect Information Protection site for more details on “Information Protection: Your Identity Depends on It.” 18 you fall | 2015
“This is real-world, applicable training. It’s the little things that can make a positive impact. ” — Paul Connelly
Finding jobs at HCA just got easier Our redesigned website, CareersAtHCA.com, helps the best candidates land jobs at HCA
In today’s marketplace, having a career site that’s easy to find and easy to use can make all the difference in attracting and hiring great talent. With the launch of the new CareersAtHCA.com website, the best and the brightest candidates now have easier access to all the tools necessary to find a place in the HCA family. The redesigned website is now optimized for smartphone and tablet use and is focused on providing a clean user experience. “In the past, we’ve had several different sites that pointed people in different directions,” says Michelle Vidal, national director, talent acquisition operations. “Now all job seekers can come to one place. Jobs are easy to search by skill-set and location and high priority positions are featured prominently throughout our content.”
uniqueness, information, culture and offerings. Our goal is to have every division site integrated into the new careers site over the next year. The first, HealthOneJobs.com, which represents the Continental division, has undergone the rebranding,” says Vidal.
Mobile access, social media key elements
When the project began, the goal was to look at the sites not just from HCA’s perspective as the job provider, but to figure out what searchers want in a career site — and then deliver. “In addition to the redesign of our main careers site and division sections, we are also ramping up our social media and paid search strategies,” adds Katherine Wright, digital marketing project manager. “That, along with being able to access job listings and applicaIT&S plays huge role tion pages from mobile devices, has created a much more wellIn addition to a new look and feel, the site has been enhanced rounded experience. We think all these elements, working together, with new sections and features. Much of that has been made poswill drive more qualified traffic through our applicant process, and sible by HCA’s IT&S department, which was heavily involved in all give us a larger pool of talented candidates.” aspects of the redesign. “It’s a far cry from what was in place just a few months ago,” “We wanted to leverage the expertise of our internal teams and notes Vidal. form a strong partnership,” says Deborah Casaubon, vice presi“Technically you could apply from your phone, but the process dent, talent acquisition. “They not only have the talent, they also was difficult and time-consuming, resulting in significant dropunderstand what HCA is and does. They helped us off,” she says. “Now you can do everything from a create an entirely new and better candidate experimobile device — from searching and applying for How to find us ence. The collaboration has been wonderful.” a position, to finding our job advertisements on Know a great candidate? “We’ve pulled it all together, because we want an Google and social media. More than 35 percent of Have them connect with excellent candidate experience,” Casaubon adds. our traffic comes from mobile and tablet users, so HCA’s recruitment team “This makes it easier for our applicants to engage we’re pleased to offer this expanded capability.” through social media: with us and understand who we are and the breadth “Now someone can see something that interests CareersAtHCA.com of the opportunities across HCA.” them on our LinkedIn page, click on it and aplinkedin.com/company/hca “Next up will be the development of divisionply from their phone,” adds Casaubon. “We really facebook.com/careersathca level career pages which will be integrated with weren’t mobile before, and career sites were scattwitter.com/careersathca our enterprise-wide site. This will provide us the tered all over. Now it’s in one place, and that’s a opportunity to showcase each division’s huge win for us.” 2015 | you fall 19
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THE HCA WAY
One surgery, two lives HCA specialty medical teams in San Antonio save mother and unborn child in rare procedure eventually include more than 75 people, began to organize around Ramos’ care as she slipped into a coma. She remained stable for 72 hours, during which time a donor was found, and then a simultaneous C-section birth and liver transplant procedure took place in Methodist Hospital’s hybrid OR.
Race against the clock
Frances Ramos and Max are happy and healthy thanks to a massive team effort by HCA care providers.
As a healthy young woman, Frances Ramos didn’t expect any complications during her pregnancy – at least, no major ones. She received appropriate prenatal care in her hometown of Harlingen, Texas, 250 miles south of San Antonio. Suddenly, at 26 weeks into her pregnancy, her liver began to fail and she was quickly transported to Methodist Healthcare in San Antonio, where she would receive maternity care, neonatal care and a liver transplant. By the time the young woman arrived at Methodist Hospital, she was in total liver failure and in need of an immediate transplant so she and her unborn baby could live. “This was a rare event for us,” explains Preston Foster, MD, FACS, surgical director of the liver disease and transplant program at the Texas Transplant Institute at Methodist Transplant and Specialty Hospital. Methodist Specialty and Transplant Hospital is a campus of Methodist Hospital. Dr. Foster, along with a team at Methodist Hospital that would
Despite the enormous odds, both mother and son made it through the surgery. Dr. Foster says he’d never seen anything like it in his 30 years of performing liver transplants. “There are about eight cases in the history of the world that were published,” he says. “It’s a one-in-a-million kind of thing with a premature infant.” After Ramos arrived in San Antonio, the medical team added her to the United Network for Organ Sharing (UNOS) waiting list at the highest status, giving her access to organs from Texas and Oklahoma. Her medical team began to coordinate a joint operation between the three Methodist hospitals. The team included members from the liver transplant, critical care, neonatal intensive care, labor and delivery, and surgery departments. When the donor organ was found, Ramos was moved into a hybrid surgery suite at Methodist Hospital. Lamar Albritton, MD, OB/GYN physician, delivered her son by caesarean section while the liver was en route. Max Joseph Ramos weighed only one pound, 13.5 ounces, and was immediately moved to Methodist Children’s Hospital’s neonatal ICU. Next, Dr. Foster and the transplant team removed Ramos’ liver and implanted the donor organ. The entire process took eight hours, and Ramos awoke without any complications. Fourteen days later she went home. Baby Max stayed in the NICU for two and a half months. In July, the two of them came back for a six-month anniversary celebration and reunion with their caregivers. The event was even more poignant when Ramos told everyone that she had signed up to be an organ donor long before she knew she would wind up needing a transplant, so now she is encouraging everyone she knows to be donors as well. She also can’t say enough about the Methodist Healthcare teams. “I’m beyond blessed,” Ramos says. “Who could have known this would happen? Six months ago nothing was looking good for me. They were thinking I wasn’t going to make it. But because of Methodist Healthcare’s teamwork and collaboration, both me and my baby are healthy and here today.”