The HCA Magazine for Those Making a Difference
is everyone’s job HCAHPS scores reflect patients’ interactions with each employee
See also: Employee rounding improves communication, pg. 14 | Training tomorrow’s doctors today, pg. 19
EXECUTIVE PERSPECTIVE Keeping score helps HCA find new and innovative ways to improve patient care When someone says they want to “know the score,” that usually means getting information about the situation at hand. That’s certainly true in healthcare, where HCAHPS scores tell a hospital what its patients think of the care they received. These results do everything from offering a look at how effectively we are providing care to setting reimbursement rates, so they are hugely important. That’s why HCA invests a great deal of time and resources into getting this information into the hands of clinicians and caretakers. Nobody knows your facility better than you do, and when you see areas of opportunity and improve them you create the best, most innovative solutions. That’s one reason why HCA will be focusing on the best ways to share information and best practices in order to progress in areas that might need some attention, and to continue to improve care and service that are already excellent. Our size and scope mean that we have thousands of talented people who can — and regularly do — provide us with great ideas on how to improve the patient experience. Now we are focusing on the best ways to harness that ingenuity, and share it across HCA. Have a great idea? Use the link on page 10 to share it with us online. As far as innovation at HCA goes, we have a lot more to talk about in this issue. Be sure to read about employee rounding on page 14. Rounding is a practice that encompasses everyone, and is designed to help us put our best foot forward by sharing information on what’s working, and what’s not, so we can improve. Rounding makes sure that every employee knows that he or she is heard, and that all suggestions, even the ones we can’t act on right away, have value. Also in this issue, learn on page 7 about how HealthTrust makes sure that all HCA hospitals and facilities have the best, most environmentally friendly cleaning supplies and other materials. HCA hospitals work with their communities in so many ways, and ensuring that we have a cleaner environment today and tomorrow is just one way that we can give back to the people who trust us with their healthcare. Speaking of giving back, it’s no secret that HCA employees are incredibly generous. Whether it’s helping a coworker in need, donating to the HCA Hope Fund so that all employees can access funds in an emergency, or traveling across the world to make life better for communities that have very little, our people show just how much they care, and how far they are willing to go, every day. Enjoy just a few of their stories on page 16. And where would we be without well-trained physicians? HCA is leading the way with its physician training program, which puts us at the forefront of educating the next generation. Read all about it on page 19. One common element in these stories, and those you read on our HCA Today blog and on Atlas, is the focus on achieving goals and providing the best patient experience possible. This dedication to excellence is what sets HCA apart, and it’s why we continue to introduce initiatives that will help us do our jobs better and more efficiently while also giving our patients those “wow” Mission Moments. Thank you for all that you do for HCA every day. Regards,
Spring 2016 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 Cover image and photos on pages 8-13 were taken at TriStar Centennial Medical Center.
Lyn Ketelsen Chief Patient Experience Officer 2 you season | 2015
INSIDE F E AT U R E S
4 Around HCA
Doctors saving lives on planes, HCA’s military recruiting receives honors, and more from around HCA’s hospitals and facilities.
7 Creating the right environment HealthTrust works to ensure that HCA hospitals have green-friendly cleaning and other supplies.
8 HCAHPS and you
Improving the patient experience is everyone’s job. Learn how hospitals are evaluated, and how everyone can make a difference.
9 Working together is key
Chairman and CEO Milton Johnson lays out his vision for providing outstanding patient care.
14 Employee rounding arrives
Program will improve employee communication, job satisfaction and overall patient care.
16 HCA gives back
From individual efforts to companywide programs like the Hope Fund, HCA employees are a generous and caring community.
19 Teachable moments
Physician training program allows HCA to take the lead in preparing the next generation of doctors.
HCA celebrates nursing contributions year-round When Nurses Week rolls around in early May, every HCA facility highlights the many contributions nurses make to outstanding patient care. That attention is well-deserved, but HCA nurses deserve kudos for all they do, every day of the year, for patients, families and their fellow medical professionals. As senior vice president and chief nurse executive Jane Englebright is fond of saying, there’s never been a better time to be an HCA nurse. There are more directions for a nursing career to take than ever before, from caring for a wide variety of patients on a Med-Surg unit to providing the specialized care required in the ICU. Many nurses are going back to the classroom, achieving certification as part of HCA’s ongoing Med-Surg Nursing Initiative, while others are moving into management positions that range from charge nurse all the way to CNO. To get a sense of how wide and varied the role of an HCA nurse is, watch “A Day in the Life of a Nurse,” a video that pays tribute to all that HCA nurses do. Please follow this link: http://bit.ly/HCANurse. Interested in knowing more about nursing opportunities at HCA, or know someone who might be a great addition to our team? For more information on nursing careers at HCA, please visit hcanursing.com.
Keep up with HCA online. Visit hcatodayblog.com and follow HCA on:
HCA 2016 | you spring 3
Traveling physicians provide on-plane emergency care Flying can be a hectic experience for anyone. Ratchet that up a bit for two Cartersville Medical Center physicians, whose fellow travelers recently became patients. Dr. Carlo Oller, the hospital’s emergency room medical director, treated an unresponsive woman while his flight was on the runway in January. And Dr. Ankit Patel, an interventional cardiologist with Harbin Clinic Cardiology, gave aid to a semiconscious woman on a flight from Chicago to Abu Dhabi in February. “We were about an hour and a half away from Abu Dhabi, and I noticed a flight attendant come by with an oxygen tank,” Dr. Patel told local media. “It turns out there was a woman on the flight three seats in front of me who was having chest pains. I went over to help and realized she was semiconscious, sweaty and clammy, and her pulse was weak. I immediately got her to try to chew up four baby aspirin. She was 43 years old and had a 16-month-old baby with her. I noticed that she had barely moved out of her seat during the flight, and it was a 14-hour flight. I was worried that she might have a blood clot, because she was recently pregnant and she hadn’t gotten up from her seat and walked around during the flight.” Dr. Patel asked if the plane could land earlier, and was told it could touch down Left to right: Dr. Carlo Oller, who treated a in Qatar. As it descended, the woman’s woman while his plane was on a runway, and condition improved, and EMS transported Dr. Ankit Patel, who provided care for a woman her to a local hospital. on a flight from Chicago to Abu Dhabi. “She was awake and alive,” Dr. Patel says. “It was very rewarding knowing that she was alive. I’ve never had this happen when I was flying before. It’s something I’m proud of. I’m proud to be a doctor and that I was able to help save someone’s life, especially because it was a mother with a young child.” Dr. Oller’s experience also involved giving emergency care to a fellow passenger. He came to the woman’s aid after a request for medical personnel was broadcast over the plane’s announcement system. “She was purple, cyanotic,” he says. “She was drooling and was unresponsive. I tried to open her eyes, call her attention, and she wasn’t responding. So I opened her airway to allow some air passage.” He then told the flight attendant that the plane, which was still on the runway, would need to return to the gate. In the meantime, he got an assist from another attendant and a former ICU nurse, all of whom worked together to keep the woman’s airway open, as well as administer a defibrillator and provide CPR. “At that point [when paramedics arrived] she seemed to be waking up,” Dr. Oller says. “She was definitely grimacing, kind of retracting and moving around. She actually had a heartbeat and a blood pressure and at that point they took over. I gave them a little report. They left with her, and I went back to the plane.” “This is exactly the kind of stuff I do every day at work, but to do it [in] a place where you don’t have your instruments, where you’re very limited in the resources and what you can do, you feel pretty hopeless,” he says. “When I grew up wanting to be an emergency doctor or during my residency, this was the kind of stuff you would dream of being able to do one day. It was pretty cool to have been there [on] that flight, given the emergency, being able to respond and ultimately the outcome. Five minutes later, if she had needed assistance while we were in the air, the outcome would have been different.” 4 you spring | 2016
Band Against Cancer concert series to benefit Sarah Cannon
As the CEO of HCA, Milton Johnson is used to speaking in front of many different types of audiences. A recent appearance at the Country Music Hall of Fame and Museum, however, took him a little bit outside his usual travels — all for a worthy cause. HCA is partnering with Big Machine Label Group and other country music heavy hitters to support “The Sarah Cannon Tour,” part of a broader initiative called “Band Against Cancer.” The tour, headlined by Martina McBride, will raise funds for several charitable support organizations to provide resources to people batting cancer. At the Hall of Fame kickoff earlier this year, Johnson spoke about losing his mother to cancer, and why this is such a personal issue for him. Beyond her performances, McBride also will be the face and voice of a national social media and digital initiative that will raise awareness around cancer treatment and research. Its initial focus will be on people facing blood cancer, an underserved patient population requiring convenient access to cutting-edge treatment options in their communities. By providing resources and education, the initiative hopes to help patients access potentially life-saving treatments including stem cell transplants and the latest targeted medicines. “We are honored to have Martina be the voice that helps launch a grassroots effort aimed at empowering communities to take immediate action against cancer,” says Dee Anna Smith, Sarah Cannon CEO. “The more communities that band together, the louder our voices will be in this fight.” The tour will wrap up in October, with a concert at the Grand Ole Opry in Nashville, Tenn. More information, including tour dates and how to get involved, can be found at bandagainstcancer.com.
HCA’s military-recruiting efforts honored by U.S. Chamber of Commerce HCA CEO Milton Johnson, left, and military recruiter Avery King
Veteran recruitment is a very successful way for HCA to find top talent for all its hospitals. Recently the company’s Military Veteran/Military Spouse Hiring Initiative was honored with the Lee Anderson Award, “Hiring Our Heroes,” by the U.S. Chamber of Commerce. HCA’s recruiting teams and hiring managers have grown the company’s military veteran and military spouse employees to more than 11,200 military veterans and 2,600 military spouses. In 2015, HCA hired more than 2,700 veterans, a 14 percent increase from 2014. These military veterans and spouses fill roles such as chief information officer, vice president, director, technical services manager, clinical manager and many others. HCA works to retain its military-veteran employees through both formal recognition and career advancement opportunities. The company provides tuition reimbursement to veterans and military spouses who wish to strengthen their career opportunities through higher education and certifications. HCA also assists medics in pursuing their registered nurse degree through the Medic2RN program, and supports programs that matter to its veteran employees, including Fisher House, the USO and Operation Stand Down.
Sisters separated as children reunite more than 40 years later at HCA hospital
Decades after being separated in their native Korea, sisters Holly O’Brien and Meagan Hughes wound up working on the same floor at Doctors Hospital of Sarasota.
By the time she was five years old, Poknam Shin had lost her mother and father, seen her younger half-sister, Eun-Sook, taken away by a stepmother, run away from authorities and been placed in an orphanage in her native Pusan, South Korea. At age 9 she was adopted by an American couple from Alexandria, Va., who renamed the woman now known as Holly Hoyle O’Brien. Her new family was large and loving, but she never forgot her younger sister. Efforts to find her through orphanage records failed, but O’Brien, now 46, says she never gave up. Meanwhile Eun-Sook Shin, now Meagan Hughes, had also spent time in an orphanage, and then was adopted by a family in Kingston, N.Y. The family relocated south, and she eventually wound up working as a physical therapy assistant in Venice, Fla. She, along with a friend, both wanted to continue their healthcare careers at Doctors Hospital of Sarasota. Around the same time period, O’Brien moved to Sarasota in 2005 and began working at Doctors Hospital on the fourth floor Med-Surg unit.
Coincidences already abound, and there are even more. Julie Bennett, clinical nurse manager for the Med-Surg unit, kept being told about someone named Meagan that she should interview. They met, Hughes was hired and went to work on the fourth floor. The two sisters worked the same shift, and hit it off right away. Over conversations, the stories began to line up: Korea, missing family, orphanages, American adoptions. Finally, O’Brien ordered DNA test kits. The tests showed the familial link,
and the sisters have since been strengthening their bond. “We see people’s lives change on a dime up here,” Bennett said in an interview with local media. “Every day, we see some of the most emotionally charged stories. But typically it’s with patients, not personnel.” O’Brien, who does not have children but now has two nieces, could only say that “I have this very strong belief that God must be... Like, whatever I’ve done, I must’ve done something good in my life.” 2016 | you spring 5
From the HCA Today Blog: Small patient has big impact on emergency room staff As a registered nurse and the emergency room director for Rapides Regional Medical Center, Shawn Moreau has experienced her fair share of nearcatastrophes. Even so, a day last December stands out. “A 9-month-old was rushed to our ER with a life-threatening Shawn Moreau condition,” she recalls. “What I witnessed next was a mother’s love, a medical staff’s skill and a ‘Christmas miracle.’” As she tells the story: “It was the usual, busy day in the ER. I was rounding with patients and staff when an announcement was made that a critical patient was en route and would arrive in five minutes. During that time, we learned a little boy was choking and the grandparents and mother were rushing the baby to our hospital. With few words, and concerned, but steady faces, my team readied the room with the necessary equipment. We then stood at the ambulance bay… every second mattered. The sound of screeching tires approached and one of our nurses rushed to grab the baby. He was breathing, but barely. I gave the family my assurances the best team was working on the baby and would do everything to save him. Back in the emergency room, our ER physician worked diligently to retrieve the object from the baby’s airway. It soon became clear that surgery — a last resort — was necessary. I ran to the operating room to meet a surgeon and prep them on the case. That’s when I saw our chief of surgery and explained he was needed in the emergency room right away. He ran back with me, no questions asked, even though he is a cardiovascular surgeon and so does not see a lot of children or issues like this. We knew he could do it. Then the unexpected happened. With the team in place and inches away from operating, our ER doc tried once more to clear the baby’s airway. This time he was successful. The baby gasped for air and cried. There was not a dry eye in the room.” Find this story, along with many other articles about happenings at HCA facilities, at hcatodayblog.com. 6 you spring | 2016
Recruiting team pitches in to help coworker travel cross-country to reach injured son When Lavonda McGlory – an associate recruiter for HCA’s Continental Division – traveled to Denver last December, it began as just a regular business trip. Within an hour of her landing, everything changed. “I got a call that my son had been in an accident, and had been taken to the hospital,” McGlory says. “I called my manager there in Denver and told her I needed to get home; I was hysterical, and she came to the hotel room and sat with me for hours. After she got me calm and to sleep, she worked on getting my flight changed to the next morning.” McGlory’s 22-year-old son, DeMarcus Mayes, had suffered severe injuries after being stuck by a motorist as he skateboarded with friends. Her family had rushed to the hospital to sit and wait for news, and members of HCA’s recruiting team in Nashville took turns sitting with the family, getting them food and setting up hotel rooms. They even found time to establish a GoFundMe campaign to help pay for expenses related to McGlory’s travel and other needs, says Deborah Casaubon, vice president of talent acquisition. Unfortunately, a snowstorm grounded McGlory’s flight out, and she spent the better part of the next two days waiting at the airport while the Denver recruiting team worked the phones, trying to find a way out. Finally, she caught a flight to Chicago, and made her way to Nashville from there. Sadly, her son died a few days later. McGlory says he had said in the past he wanted to be an organ donor, so after he was declared brain dead she honored his wishes. She reached out to her HCA colleagues to let them know in case they had anyone on the transplant list, and one of his kidneys did go to an employee’s family member. “Other people received his heart, lungs, pancreas and other kidney, so he saved a lot of lives,” McGlory says. “The HCA Hope Fund also came to our aid, and provided some assistance that helped with funeral expenses. I can’t say enough about how wonderful everyone at HCA, in Nashville and in Denver, was to me and my family the whole time.”
Lavonda McGlory’s son DeMarcus died tragically in an auto accident when she was halfway across the country, and her HCA family didn’t rest until she was home.
Creating the right environment HCA ensures safe and environmentally sound facilities with help from HealthTrust HCA strives to choose the best products for the environment – all with the goal of providing excellent patient care. Being a part of HealthTrust allows us to do just that. HealthTrust, a group purchasing organization (GPO), offers solutions for total cost management across hospitals and affiliated healthcare facilities. As a founder and current member of HealthTrust, HCA is part of an organized process of identifying and selecting contracts with suppliers for clinically recommended products and services that can improve patient and employee safety as well as promote waste management and lower operating costs. “Clinical quality is always the first priority,” says Faye Porter, director of sustainability and education for HealthTrust. “HealthTrust also takes into consideration sustainability attributes, which will vary by product. These may include packaging, transportation and end of life/disposal considerations — things that are important not only for patients but also for physicians, clinicians and everyone working in a facility.” HealthTrust assists facilities with environmental choices by ensuring the availability of devices that can be used more than once after going through a special process known as reprocessing.
These could include items such as blood pressure cuffs and pulse oximeter probes, as well as diagnostic catheters and multiple devices used in the operating room. All reprocessed items are FDA-approved, which means that they meet the same standards as other equipment. Facilities collect and send for reprocessing some of the medical devices they have used, which reduces waste and lowers costs for hospitals.
Sustainability planning promotes healthy environments HCA has an active Sustainability Steering Committee headed by Alan Yuspeh, senior vice president and chief ethics and compliance officer. The Steering Committee’s Environmentally Preferable Purchasing Task Force, chaired by Missy Eslinger, assistant vice president of value analysis, explores purchasing items that are beneficial to sustainability and the environment. HCA facilities always consider the impact on the indoor environment before introducing a new product or process into the facility. In addition, HCA facilities are virtually mercury-free.
“HealthTrust offers environmentally safe chemicals on contract, and HCA’s available portfolio includes green-certified chemicals,” Eslinger says. “In making these choices, our facilities are supporting and championing sustainability in the facility and their local communities,” she adds. HCA serves on HealthTrust’s Environmental Sustainability Network (ESN), which works at a national level with industry leaders and educates vendors about expectations related to environmental choices. “HealthTrust is helping make opportunities for sustainable choices transparent,” says Anna Ward, HCA’s sustainability manager, who along with Eslinger serves on the ESN. “Each and every one of us has a critical role in affecting the patient experience and demonstrating to our patients that we care about his or her welfare,” Yuspeh adds. “We continue to work with our GPO to implement solutions that consider a healthy environment for our facilities, patients, employees and communities.”
“In making these choices, our facilities are supporting and championing sustainability in the facility and their local communities.” — Missy Eslinger 2016 | you spring 7
All employees, from every department, can play a role in improving the patient experience at every HCA facility. 8 you spring | 2016
HCAHPS: What’s it mean to you? Satisfaction scores show the way to improving the patient experience Every day throughout HCA facilities, conversations about improving patient satisfaction are happening. But what does that mean? What needs improving? And how is success measured and shared? The main way patient satisfaction is measured is through a survey some patients receive after they go home. It’s called the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS. The questions cover many aspects of the patient’s stay, from how well pain was managed to whether or not he or she was treated with courtesy and respect. Every aspect of a hospital stay is assessed, so it’s not just about how doctors and nurses interacted with a patient. Every contact matters. “It’s important for everyone to understand how the survey touches many aspects of a patient’s stay,” explains Lyn Ketelsen, HCA’s chief patient experience officer. “Often people believe that it’s just clinical staff who are being evaluated, or that it’s just one area, such as Med-Surg, that’s reviewed by patients in the survey. That’s not true — it’s the entire experience that person has while they are in an HCA hospital.” It’s important to remember, she adds, that “patients tend to see all staff as caregivers, from doctors, nurses and lab techs to environmental services and dietary staff. That’s why everyone who comes into contact with patients, be it admissions staff or post-discharge billing personnel, must realize that they are being evaluated as part of a team — and focus on providing outstanding service.” HCAHPS is a critical driver of HCA’s operations — and every employee has a role to play in helping hospitals get the highest scores possible. But how to start? To fully understand how HCAHPS works, and how
Working together, HCA can achieve new heights in patient care and satisfaction By Milton Johnson, Chairman & CEO At HCA, quality patient care and improving the patient experience is at the core of everything we do. Because of our size, scope and expertise, we are uniquely positioned to lead the healthcare community in this regard, and we are doing just that. Even so, there is always room for improvement. We owe it to our patients and their families to provide an exemplary experience in every care setting. And, as I’ve visited caregivers across our organization, I’ve seen firsthand that there is a very deep desire to give our patients the best possible care we can and with the best possible personal experience. That is why I’ve set an ambitious patient experience goal for HCA: By the end of 2018, every one of our facilities will be represented in the top 25 percent of HCAHPS scores in the country. Many of our hospitals are already there, and chief patient experience officer Lyn Ketelsen and her team have begun grouping facilities with similar needs and knowledge together to share advice and expertise that will help the rest achieve this goal. The key to success is making sure that we all are focused on creating a supportive, responsive and high-quality atmosphere for our patients and their families. To succeed, we all have to dedicate ourselves to achieving this goal. When a patient and his or her family consider a hospital stay, they think of the person who provided that “wow” moment. Often, that person is a doctor or nurse. But it also could be: • the friendly intake professional who answered questions about confusing insurance information • the dietary worker who brought in a satisfying meal every evening • the environmental services tech who made the patient’s room sparkle and did so with a smile • the pharmacist who came by as the patient was leaving just to make sure all medication
instructions made sense • the discharge coordinator who called a couple days later to make sure follow-up doctor
appointments were all set I see the dedication and focus of these and many other staff members when I visit our hospitals,
urgent care clinics and surgery centers. I talk to patients, and they tell me about the quality of care they are receiving. We know our patient experience goal can be achieved. We’re not reinventing the wheel here; we’re working to make the excellent care we provide even better. One of the hallmarks of HCA is our shared desire to excel at what we do. We set goals, and we execute them better than anyone. So, we’ll keep doing what we do so well, each and every day. And along the way, we’ll share advice and learn from one another, so we can continue to improve the input we’re getting from our patients, and to make sure that tomorrow’s care is even better than today’s. We have the shared desire to achieve a common goal: industry-best patient experiences, and the patient-satisfaction scores that showcase our care. Now we will set about leveraging the experience and knowledge of the thousands of talented people who work in our facilities every day. I look forward to watching our innovation and initiatives unfold in the coming months. I have every confidence the goal I have set out will be met and that together we will set a standard of excellence of which we can all be proud. 2016 | you spring 9
“We want to be efficient so the patient can be on their way, but to make sure they never feel like they are just a number.” — George Puente, Imaging Manager
9 Factors of Engagement The right attitude and behavior go a long way toward improving the patient experience, and that translates into higher HCAHPS scores. Here are nine rules of engagement that help make that happen: 1. Active listening: Pay attention to the patient, repeating statements back if necessary 2. Non-multitasking: Focus on the patient interaction 3. Eye contact: Look at the patient 4. Tone of voice: Use a kind and calm tone 5. Appropriate speech speed: Don’t talk too fast, especially if you’re providing lots of information 6. Appropriate use of touch: A gentle arm or shoulder touch can help communications 7. Appropriate use of humor/emotion: A little humor can help a situation, but only if the mood is right 8. Physical positioning (sitting, kneeling, etc.): Sit or kneel at the bedside, in the torso region, so the patient can see you easily 9. Energy mirrors the patient’s needs: Gauge the patient’s mood (energetic, frightened) and interact appropriately (being more cheerful, or more calm)
Quick question: Is there something you’ve done that improved a patient’s experience? Please tell us at bit.ly/YOUSurvey so we can learn from your success! 10 you spring | 2016
its results affect every HCA employee, it’s smart to start off with the survey itself.
Understanding how HCAHPS works So how did HCAHPS come to be, and why is it the chosen benchmark for healthcare services? In part, Ketelsen explains, because there was a national need for continuity. “HCAHPS is the first nationally leveraged patient satisfaction survey in the country,” Ketelsen says. “Prior to it, various vendors used their own propriety surveys. That limited the ability to benchmark consistently across all hospitals. The Centers for Medicare and Medicaid Services wanted to provide an opportunity for patients and families to select their healthcare providers using a common set of information, and so HCAHPS was created.” As to how the survey responses are measured, there is a formula that takes many things into account, Ketelsen says. “The majority of questions are evaluated by patients using a scale of: always, usually, sometimes and never, and the result is calculated based on the percent of patients who responded ‘always,’” she says. “This is known as the top box score. The overall rating, however, is rated on a numeric
Want to see all the questions? The full HCAHPS survey can be found at http://bit.ly/HCAHPSQuestions.
Are you ready to say “always?” If you or a family member has been recently hospitalized, think about the experience and then answer these questions from the HCAHPS survey. The options are: never, sometimes, usually and always. • During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it? • During this hospital stay, how often did the hospital staff do everything they could to help you with your pain? • Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?
“I advocate for patients who cannot speak for themselves. We must bring heart and passion to those who are completely dependent upon us.”
Did you choose “always” in every case?
scale of 1-10 with the top box being the percent of patients who rated us 9 or 10.”
The high barrier of “always” One struggle with improving HCAHPS scores is the presence of “always” as an option for many questions. Very few people will check “always” on a survey, preferring a lower score, even if they were perfectly satisfied with their experience, Ketelsen says. “If you think about any activity it is very hard to commit to doing something 100 percent of the time and yet when it comes to patient care, that is what our patients and their families would expect,” she ex-
— Jyothi Challa, Assistant CNO
plains. “It’s a very high bar. Prior surveys were based on feelings, and would have the top rating be ‘very good,’ or ‘excellent.’ When the HCAHPS survey was created that changed to more of a frequency evaluation — and to do something 100 percent of the time is really hard.”
Making consistency an improvement goal One opportunity to raise the number of “always” responses for every HCA facility has come in the area of continued success. When an HCAHPS score indicates a problem to be solved, much attention is paid to making that happen. But for continued
success, the issue can’t just be identified and fixed. It must stay fixed. “We have to make sure things stay corrected, and that’s the hardest part of being a fast-paced culture and organization,” Ketelsen says. “We do so much so quickly, because we are taking care of people who in some cases are badly hurt, or very sick. But we have to remember that this is a marathon, not a sprint. We are very good at sprinting toward a goal or objective, then moving on to the next thing. Improving the patient experience is a marathon, and we have to think in terms of sustainability and consistency. It’s about what we’re doing over the long term, as well as what 2016 | you spring 11
Key terms in the patient satisfaction conversation HCAHPS: The Hospital Consumer Assessment of Healthcare Providers and Systems survey began to be used in 2006 for the voluntary collection of hospital data. Public reporting began in 2008 on the CMS hospital comparison website, hospitalcompare.hhs.gov. Top quartile: HCAHPS ranks participating facilities in four groups. The top 25 percent are considered the top quartile. HCA also ranks its hospitals this way, both in terms of overall HCAHPS scores, as well as for various survey questions and sets of questions. Always: The HCAHPS survey asks respondents to answer many questions with “never, sometimes, usually or always.” If the answer is not “always,” there is no credit given — not even partial credit. For example, if 75 percent of survey respondents said their nurses always communicated well, the hospital would receive a score of 75 for that question.
we’re doing in the short term to achieve a particular goal.” As examples, she highlights initiatives like nurse leader rounding, where nursing leaders visit with patients and their families to see how their care experience is playing out, along with employee rounding (see page 14), a way to ensure constant feedback between employees and supervisors. There’s also the communication fundamentals which allow for more successful communication between staff and patients, and between staff members as well. “These are methods we are deploying now, and there are several other strate12 you spring | 2016
“We get to know our patients, so we can become a goal-setting team with them.” — Erfan Izadi, Physical Therapist
In addition to hospitals, the HCAHPS survey soon will cover emergency departments as a standalone entity, health plans, outpatient and ambulatory centers, and clinician and group settings. gies that will provide whole new opportunities to improve our performance levels,” Ketelsen says. “And we know that the same action plan isn’t going to work for every hospital, and that’s why we are creating cohorts that help every organiza-
tion improve, no matter where they are in the HCAHPS journey.”
What HCAHPS means to HCA Providing the best experience and safe, quality care to all patients is the core goal of every HCA facility and employee. As you might imagine, HCAHPS scores provide a solid roadmap in terms of what’s working well, and what areas need improvement. There also are some serious financial considerations. The information patients provide affects many different parts of hospital operation, from measuring the quality of care to raising or reducing Medicare reimburse-
“You have to bring enthusiasm, telling the patient that you want to see them clean that plate! Let them know that someone cares.” — Shameka Manuel, Food Service Pro Tech III
HCAHPS adjusts for different situations Not every patient at a facility will be eligible to receive an HCAHPS survey. For example, psychiatric patients are not contacted. And within the HCAHPS scoring process, other factors are taken into consideration. For example, patients who are admitted through an emergency room visit tend to report lower satisfaction than those who have a scheduled hospital visit, so that’s taken into account. And maternity patients often score very highly because of the happy nature of their stay, so their scores are factored slightly differently as well. The goal is to provide as accurate a look at the entire facility as possible, and so there is some weighting in the final percentages. The results are made public, and affect everything from how a facility is viewed in the community to levels of reimbursement for treating Medicare and Medicaid patients. ment rates. (Every year, The Centers for Medicare and Medicaid Services withhold two percent of payments to hospitals; those who score above the national aver-
age on HCAHPS receive that money back, while those who score below do not get the funds returned.) The good news is, excellent patient
care and going the extra mile translate into higher patient scores, as well as higher reimbursements. That’s why every employee, at every HCA facility, matters when it comes to looking at current HCAHPS successes and challenges, and then mapping out strategies for improvement. All across HCA, plans to improve and enhance the patient experience are being developed and put into place. At the same time, patients are being discharged every day. What does that mean for employees as they approach their job? “Be exceptional at the job tasks and competencies that you know are important in your role,” Ketelsen says. “Be keenly aware of who your ‘customers’ are, and be willing to listen to their needs and then address those needs. And be open to looking for opportunities for that one little thing that just might ‘wow’ somebody. The patients really do remember those things, and it shows up in the surveys.” 2016 | you spring 13
Quality conversations Employee rounding improves communication, job satisfaction and patient care HCA’s annual employee engagement survey collects insights from employees about how they are feeling on a variety of issues. One area in particular the survey helps to measure is whether employees believe that their suggestions are being heard and acted upon. Because this input is so important, HCA is continually striving to implement improvements in the line of communication between employees and their supervisors. The latest example is a new employee rounding framework that will be deployed across the company in the coming months. “In the same way nurse leader rounding provides a listening post for nurse leaders to hear directly from patients and 14 you spring | 2016
their families what issues are important to them, employee rounding provides the same listening post between employees and their manager,” explains Lyn Ketelsen, chief patient experience officer. “What it boils down to is that we are creating the opportunity for people to have a one-on-one conversation with their department head or director. It’s an evidence-based best practice that really engages employees, and has been shown to improve satisfaction and employee retention.” “A lot of times people can become frustrated when they see an issue that gets in the way of providing great patient care or service, and so this will help make sure they have a regular avenue to voice those
concerns or ideas and a framework to know when the leader has addressed them.”
Enhancing personal connections Employee rounding works so well in part because it provides an opportunity for leaders and employees to step outside their roles and strengthen their relationships with each other. Rather than focus on an employee’s performance, he or she will be asked if they have the basic tools, equipment and information necessary to do their job, as well as what processes or systems might not be working as efficiently as they should and are in need of attention. “They’ll also be asked who’s doing a good job, so that good works and good deeds can
be called out and recognized,” Ketelsen says. “So in addition to identifying issues and taking corrective action, employee rounding also works for team building and support.”
In-person aspect is key “It’s a great way to stimulate dialogue with employees, because they feel like they are being communicated with, and that their leaders are working on solutions to issues they have,” adds Sylvia Young, president of HCA’s Continental Division. Young visits hospitals monthly or quarterly depending on location, and says one of the “joys of my job” is connecting with employees and patients in this manner. “I am headed out to four hospitals this week,” she says. “Last time I was on nursing units, and this time I’ll be in the outpatient testing and surgery areas. I meet with employees and ask them what’s going well, which starts the conversation in a positive way, and then I ask them to take me to see a couple of patients. I always sit down with those people, rather than stand, because I don’t want them to think I’m in a hurry. And I do the same thing with the patient: ask them what is going well, and then turn the conversation to areas where they think we could improve.”
Frequent touchpoints In general, most employees will take part in a rounding session once per month. Some may occur more frequently, some less so, depending on the size of the department. After
the session, the leader creates a “stoplight” report. The stoplight phrase refers to green, where the manager has a resolution in place; yellow, to show some action has been taken; and red areas, where a suggestion can’t be acted upon. “That kind of feedback is going to keep our employees well informed about everything that’s going on around them,” Ketelsen
says. “People are willing to give suggestions in a survey, or in a performance review. But that’s just once a year. This creates a much more effective way to engage people more frequently, and to put positive changes into place much more quickly.” The regular contact also will mean more in-depth conversations, notes Young. “In the past, we’ve been guilty of ‘driveby’ rounding, where it’s just been too fast to be effective,” she says. “It can’t be just ‘How are you?’ Now leaders will sit down and have a meaningful conversation with the people delivering incredible service and compassionate care to our patients.” In the annual employee engagement survey, HCA employees usually say that they would like more interaction with their managers, as well as overall hospital management. Rounding programs do that and more, say both Ketelsen and Young, who have seen the benefits firsthand. “When there is a regular avenue for feedback, the employee feels much more a part of the decision-making process,” Ketelsen says. “But what’s more, he or she can point out problems in their early stages, so that corrective action can be taken right away. Everyone wins, from staff to patients, thanks to better communication.”
“People are willing to give suggestions in a survey, or in a performance review. But that’s just once a year. This creates a much more effective way to engage people more frequently, and to put positive changes into place much more quickly.” —Lyn Ketelsen, HCA Chief Patient Experience Officer 2016 | you spring 15
HCA gives back HCA finds ways to give back to the community it serves — and beyond PROVIDING OUTSTANDING PATIENT CARE is what drives every HCA professional – and often, that care doesn’t stop at the hospital doors. From fundraisers to professional partnerships, HCA facilities are heavily engaged in the health and well-being of the communities they serve. What’s more, HCA as a company often engages with largescale national, even international, efforts to provide emergency
relief and more following disasters. And then there’s the HCA Hope Fund, which is funded by HCA employees to support their coworkers in need. Whether it’s the 5K fun run for a local charity, helping fellow employees who have encountered unforeseen expenses or donating to relief efforts for people halfway around the world, HCA demonstrates every day that its giving culture has no limits.
Methodist Healthcare local outreach efforts showcase HCA’s community involvement In San Antonio, a longtime and successful HCA and Methodist Healthcare partnership pays rich dividends for the community. The San Antonio division encompasses nine Methodist facilities, which are owned in equal parts by HCA and Methodist Healthcare Ministries. This means that the hospitals operate in the same manner as every other healthcare facility within HCA, but that they also undertake some nonprofit functions as well. “The IRS requires that we submit a community health assessment, and then a health-improvement plan based on that assessment,” says Carole Harris, community relations specialist. “For us to do that work, we need a lot of input. We’re a member of the Behr County Health Collaborative, which is made up of hospitals and other health-related organizations in San Antonio. We work with them to come up with five priorities, and then base our community outreach on those five priorities as a part of a three-year plan.” This allows all HCA/Methodist hospitals to engage with the community in many different ways, and to have a stronger outreach than they might have without the assessment and partnerships. “We as a healthcare system are doing these assessments every four years, and they really help us button down strategies and goals for the hospitals,” says Palmira Arellano, vice president of marketing and public relations. “We are involved with health literacy, youth mental health and many other programs thanks to working with the city, county, school districts and other partners. This lets us create a very comprehensive, strategic attach on the gaps in healthcare in our community, and tackle them together.” In addition, the hospitals have a strong internal giving component. Methodist Gives is an annual drive to raise money for the HCA Hope Fund and other charities, and also donate to specific community endeavors. “You hear ‘population health’ a lot as buzzwords today, but we have been involved in activities around that thinking long before it was on a lot of people’s radar,” Harris says. “Methodist Healthcare is very engaged in supporting both the community it serves, as well as the employees who provide that care.” 16 you spring | 2016
HCA chief operating officer Sam Hazen, left, and CEO Milton Johnson, right, present TSU officials with a donation to provide health science scholarships.
HCA’s corporate gifts provide assistance at home and abroad Leadership at every level within HCA strongly believes in providing support to worthy organizations within the community. At the local level, that can be by participation in health fairs, 5K runs for specific charities and much more. At the corporate offices, senior leadership has embraced the company’s giving philosophy as well, making sure that HCA is there when tomorrow’s healthcare leaders are being trained, or when people halfway around the world need medical care. Nepal earthquake relief HCA donated $1 million to support three international disaster-relief organizations following the Nepal earthquake. Doctors Without Borders and MedShare International each received $250,000, while HCA provided $500,000 in matching funds to donations made by HCA employees and vendors to the American Red Cross and its relief efforts in Nepal. “As a healthcare provider with approximately 225,000 employees who treat millions of patients
every year, our people have dedicated their professional lives to caring for others, and we have a long history of supporting humanitarian efforts,” says Milton Johnson, chairman and CEO. HCA and The HCA Foundation have given almost $95 million to various charities since 2010. Areas and issues affected include the Ebola outbreak in West Africa, Typhoon Haiyan in the Philippines, the Haiti earthquake, the Indonesian tsunami and Hurricane Katrina.
HCA employees work with children in their communities, as well in other countries, such as Haiti, where they provide medical and humanitarian aid..
TSU scholarship donation A recent example of the company’s contribution to our communities is a donation of $1 million, to be given over four years, to Tennessee State University’s scholarship programs for students in health science disciplines through the university’s College of Health Sciences. The donation is part of HCA’s annual Caring for the Community campaign, and will help ensure that there is a steady pipeline of qualified healthcare providers now and in the future. The campaign has four key pillars — learn, serve, give and lead — and has engaged 64 percent of HCA employees as volunteers with various organizations and causes, and 66 percent of HCA employees in giving. “HCA is woven into the fabric of communities,” Johnson says. “We are in the relationship business with our patients, physicians, vendors, each other and in our communities. We are proud to support our neighbor, TSU, and we have many graduates who have done an outstanding job for us.” “Tennessee State University thanks HCA for their support and for consistently recognizing the talented young people we produce by investing in them,” says Glenda Glover, the university’s president. “This is not the first time HCA has backed TSU, and we appreciate yet another generous donation that will provide us the opportunity to recruit, graduate and prepare students for employment as top-notch healthcare professionals who deliver quality services across the country.”
Clinical mission trip connects employee’s skills with people in need Many HCA caregivers donate their time and expertise to outreach efforts that provide healthcare to the neediest in their communities, both at home and abroad. It’s a way that they can take their unique skills and make a difference for people who otherwise might never have even basic healthcare services, and the opportunity means a great deal to those who participate. Other trips take that focus on healthcare and broaden it to include providing clothing and other quality-of-life services that also enrich the local communities. Take Samantha Lacey, an implementation specialist in HCA’s Clinical Services Group. She is involved with Live Beyond, an organization providing on-the-ground medical services in Haiti. Her work with the group has led to the first of many planned mission trips and a commitment she says will last a lifetime. “A few colleagues donated to support the trip I took last fall, and HCA allows employees Samantha Lacey, left, says her work with to use their volunteer hours for something like Haitian children (above and below) is a this,” she says. “You can donate those hours commitment that will last a lifetime. anywhere, as long as you are working with a 501(c)3 organization.” On this trip, Lacey and her fellow travelers brought musical instruments for children in local orphanages, as well as thousands of pairs of shoes for children and adults. “We brought food, bags of rice and beans, because many of these people would die if they did not get this kind of support,” Lacey says. “We also provided medication and whatever else they might need in the areas we visited, even if it’s just toiletries and the basics we take for granted here. I hope I can go back at least every other year, because the need is so great. It is wonderful that HCA helps by providing the volunteer hours, so that myself and my colleagues can be of service in our communities, elsewhere in the country and even overseas.” 2016 | you spring 17
HCA Hope Fund continues strong growth thanks to employee donations and support
When Joshua Schade took a job closer to home, it was good news to wife Jennifer and their five sons. He’d 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 with a pressurized hose,” says Schade, a medical office specialist at Northern Utah Cardiovascular. “But there was an explosion, and the acid melted right through the clothing. He was covered head to toe.” Joshua’s accident took place in early 2015, and he suffered third-degree burns over 70 percent of his body and was hospitalized for months. His condition was touch and go for several weeks, including six weeks in a coma. Over the first few months of his rehabilitation, he underwent more than 14 surgeries, as skin grafts and other procedures are performed, literally inch by inch, to re-cover his body. “The process is really long, because he’d do well with physical therapy in between the surgeries, and then another operation would slow him down again,” Schade told the Hope Fund in August 2015. “He’s now tube-free, and making great progress. The doctors are thinking that soon he can go to 18 you spring | 2016
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.” Jennifer had to take time off from work, and 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. I eventually just called the number.” That call made a world of difference, Schade says. “The person I spoke with was so kind,” she recalls. “Someone from out here had been in touch with them and said I would be calling, so she was ready to answer my questions. It really was something: I was only calling to see if I would qualify, and here I’ve got this nice woman telling me that people there had been praying for me.” Within a few days, the Hope Fund had processed her application, and the money was in her checking account.
“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.”
Employees helping employees In 2015, the HCA Hope Fund: • Helped 2,500 employees and their families • Provided $5.5 million in assistance • Received donations from more than 28,000 employees To learn more about how to help, visit hcahopefund.com
HCA Graduate Medical Education Program • 311 programs with a total enrollment of 2,178 residents • 9 programs launched in July 2015, 276 residents • 22 programs planned for July 2016, adding 576 residents HCA is working with medical schools through its Graduate Medical Education programs, which will help address physician shortages by offering internships, fellowships and other training.
• Goal for 2025: 500 programs, 4,700 residents
Teachable moments HCA expands its graduate medical education programs that train new physicians When healthcare industry experts look into the not-too-distant future, one disturbing trend stands out: There will not be enough doctors to meet demand. A physician shortage of up to 90,000, across all specialties, is projected for 2025. HCA is intensifying its efforts to alleviate that shortage by building up its Graduate Medical Education (GME) programs, where new doctors get the supervised, accredited training they need in order to be licensed to practice medicine. These programs include residencies, internships, fellowships and subspecialty training. “HCA has sponsored and participated in GME for quite a while, but generally at a local level,” says Bruce Deighton, PhD, vice president of Academic Affairs/Graduate Medical Education for HCA. “What we are attempting to do now is organize all GME programs across the company to provide support, assure best practices are in place, and to see where we can use our scale to reduce costs and improve quality. But the key is to develop new programs and expand the scope of the existing GME programs.” New physicians tend to stay in the area where they do their residency, so these HCA-trained doctors will most likely remain connected with the company. And if they do want to move to another area, HCA has opportunities with hospitals all over the country. “We are training medical staff for the next
decade, and want to be sure that each one of our graduates is confident with patient safety and quality care methods and metrics,” explains Dr. Deighton. “So when graduates come on to our medical staff we have physicians who are tuned in to those measures, which are so important for patient care.” The first organizational step was bringing GME under the Physician Services Group, to best enable coordination and support across HCA hospitals as new programs were implemented.
Resident programs support hospital staff In July 2015 nine new programs, with 276 resident positions, launched. Programs in development will align with growth in many key HCA clinical service lines such as neuroscience, women’s services and trauma programs. Many also will focus on specialties where recruiting is difficult, such as psychiatry, pulmonary critical care and general surgery. “We are starting more new programs than anyone else, by far,” says Dr. Deighton. “The real success in that growth is the high levels of accreditation achieved. On measures such as Intraining exams, scores of HCA residents are higher than the national average. Some residents from our new internal medicine program at Aventura Hospital took
first place in a research competition for the Florida chapter of the American College of Physicians this year. We have a lot of positive things going for us.” Though preparing for the future drives the growth of HCA’s GME programs, attention also is being paid to the status of existing physician training. Combined with the GME program expansion, residency programs greatly enhance patient care and improve the patient experience. A number of studies show that teaching hospitals provide higherquality care, for example, most likely because there are more doctors at the hospitals so patients get more time with a doctor. Any HCA hospital incorporating a new residency program will go through a learning curve of how to interact with residents, but they also get more hands on deck to handle cases. On the physicians’ side, the GME programs spend a lot of time on improving communications and professionalism, as well as systems-based practice, so that residents complete their training with both a deeper understanding of how to provide compassionate patient care and a more in-depth bank of medical knowledge. “They start with us in residency and we want them to partner with us for life,” says Mary Beth Titsworth, GME program director. “Everything in our training model is driven by quality because we expect to retain them for a long time.” 2016 | you spring 19
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THE HCA WAY
Care without borders Nurse transforms wound care in Vietnam by sharing her skills and training providers When Ann Nguyen was studying for her MSN degree in 2011, she didn’t plan on revolutionizing wound care in her native country. But following an introduction to Dr. Gregory Crow and her subsequent involvement with the Vietnam Nurse Project (an academic-service partnership between the University of San Francisco School of Nursing & Health Professions and healthcare providers in that country) that’s exactly what happened.
Nguyen, who is clinical nurse manager of the Wound Care Center at Regional Medical Center of San Jose, went to Vietnam in 2011 and worked mostly with neonatal departments. She soon realized there was a huge need for wound care, and that time was of the essence in order to save lives. “Every single place we went, we’d see patients with wounds and staff that didn’t have the information they needed to provide better care for those patients,” says Nguyen, who grew up in Vietnam and came to the United States in 1998. “When I came back to the United States, I began working with Regional’s staff at our Wound Care Center on how to help them.” Those early efforts led to multiple trips to Vietnam to work with nurses and providers on the basics of wound care, as well as inviting Vietnamese physicians to Regional Medical Center to learn about their wound-
care program which includes a consult panel of five physician specialists. By 2015, a wound care association was developing within the Vietnamese healthcare system, complete with recommended guidelines, processes and procedures. And last fall, Nguyen was invited to address the first Vietnam National Institute of Burns congress meeting, the first nurse to be so recognized at a high-level, national medical event in Vietnam. Soon after, she addressed the Vietnam Nurses Association, both milestones in terms of wound-care and nursing visibility. She has been invited back in 2016, and also made an executive member of the congress. “Her work has been monumental, and will have an impact for decades in Vietnam,” says Dr. Crow, who established the Vietnam Nurse Project in 2007.
Increasing nurses’ visibility As nurses become better educated, not just on wound care but in general, they will play a more prominent role in Vietnamese healthcare. That’s a seismic shift for that country, Dr. Crow says. “Very recently, nurses were still referred
to as servants, and that was due in part to the fact they didn’t have a lot to offer,” he says. “As we have helped with curriculum and training, and Ann has worked with them, that is changing. We’ve made videos, she’s done demonstrations, and it’s all working toward building a sustainable wound care program, but also growing the stature of nursing in Vietnam.” In the midst of it all, however, Nguyen has also done what all great nurses do — provide excellent patient care. “Part of our work with the project has been to provide caretakers with iPads, so they can take a photo of wounds and send them to me so I can arrange a consultation with Ann or another provider in the United States,” Dr. Crow says. “A gentleman was suffering from necrotizing fasciitis, the skin-eating disease. Ann’s consult literally saved his life — he was missing skin down his side and arms when she got involved, and three months later he was sitting up and reading the newspaper. Ann’s work helps people here, and people in an entire other country. I know that man was one of many people who are grateful to have Ann Nguyen on the other end of the line.”