Skagit Regional Health Cancer Care Center Registered Nurses Kelly Turgeon, RN, left, and Melissa Haun, RN, sport their masks in the infusion center.
MISSION To continually improve the health of our communities serving with compassion and respect, one person at a time.
VISION Working together, Skagit Regional Health will transform healthcare by improving access, service, quality and efficiency in support of our goal of healthier communities.
VALUES
PEOPLE
We are committed to putting patients and their families first, dedicated to the success and wellbeing of our patients and guests, and will recruit and retain the highest quality care team. We are dedicated to collaboration with our communities to promote health and wellness.
QUALITY
We will demonstrate the highest level of care, safety, customer service and compassion at all times. We are committed to quality, innovation and serving as a leader in healthcare.
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STEWARDSHIP
We will responsibly manage our resources for the benefit of our communities and remain true to our mission.
RESPECT
We are mindful in our efforts to always show respect, dignity and kindness to our diverse communities, caring for their physical, emotional and spiritual needs.
DIVERSITY
We advocate inclusion and embrace the differences of the individuals with whom we work and the communities we serve.
Skagit Regional Health is on a journey and has an important story to tell about where the organization has been and where we are going. We have a call to action to every team member – staff, providers, Board members – to be a part of this voyage.
Path for the Future: 2021 is designed to share and explore A retrospective look back at the extraordinary year of 2020; we have so much to be proud of and celebrate, with a huge amount of gratitude for an amazing amount of hard work by all. Moving forward and an introduction to our healthcare system’s True North; we are moving in the right direction.
GARY BROWN, MD Otolaryngology Skagit Regional Health Ear, Nose and Throat
Charting our course and a look at Skagit Regional Health’s key projects and initiatives for 2021; we focus on continued growth, access and opportunity. The annual operating plan and key performance metrics; the detailed goals we share for 2021.
CONTENTS 4 6 8 11
Retrospective Moving Forward Our Culture Charting Our Course
PRINCIPLES
BARBARA GURNEY, RN Charge Nurse, Special Observation Unit Skagit Valley Hospital
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Quality and Safety
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Employee Engagement
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Patient Experience
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Growth and Access
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Finance
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RETROSPECTIVE
The winding road that was 2020 Before we launch into our plans and goals for 2021, it is important to reflect on the challenging trek and extraordinary year that was 2020, and the debt of gratitude owed to this healthcare team for a job very well done. While the year opened in a fairly normal fashion with winter snow and excellent results in our DNV survey, it took a hard left turn with the arrival of COVID-19 and the first confirmed case in the United States, right here in our region, on January 20, 2020, in Everett. After weeks of multidisciplinary meetings, preparations and a close watch on the growing pandemic, Skagit Regional Health operationalized Incident Command on March 2, 2020 and the PIO sent out the first daily email with COVID-19 updates for staff and providers. Our medical team kept a close watch on international, federal, state and local public health guidance, leading to an ever-changing understanding of testing, diagnosis and treatment of the virus and a focus on protecting our patients, employees, providers with visitation limitations, PPE, screening, masking, hand hygiene and precautions for all. The remaining months of the year featured peaks and valleys as the illness spread and surged across the country and in our service area. Our healthcare team was singularly focused on our patients and providing safe outstanding care. Planning for receipt and delivery of the COVID-19 vaccine for our healthcare team occupied the final weeks of the year.
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As the COVID-19 pandemic continued, 2020 also featured rewarding outcomes and progress at Skagit Regional Health. Some were related to the virus including the quick stand-up of Acute Respiratory Clinics, asymptomatic testing sites and rapid expansion of telehealth visits in a variety of specialties to serve our patients and communities. The organization continues to focus on growth and access with a variety of successes in 2020 including the reopening of the Arlington Surgery Center; recruitment of more than 40 providers; opening of Division Street clinic; the addition of Cascade Ear, Nose and Throat to the system; the Skagit Valley Hospital Foundation’s completion of a $2 million campaign to provide 3D mammography; and reestablishing primary care at the Smokey Point clinic. In a major advancement in response to employee feedback, Skagit Regional Health successfully transitioned medical benefits to Premera and, for the first time, offers an employer contribution for dependent coverage effective in 2021. All in all, a very busy and challenging, yet rewarding, year. Thank you for the team’s dedication and compassion.
ROLLING UP A SLEEVE: Ben Lucas-Roberts, MD, an Emergency Medicine physician at Skagit Valley Hospital, celebrates receiving a COVID-19 vaccination.
TIME FOR A CHECKUP: Ashleigh Adkins, ARNP, a Family Medicine provider at Skagit Regional Health – Smokey Point, examines a young patient.
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MOVING FORWARD
Journey to become a high reliability organization Skagit Regional Health’s journey continues in a very positive trajectory. This voyage features our commitment to become a high reliability organization (HRO) by providing consistent excellence in quality and safety as a healthcare system. This trek toward becoming an HRO is a shift in our culture that will span the coming years and involve every member of our healthcare team: Our staff, providers, leaders and Board of Commissioners. This is a truly collaborative venture for our system and essential to our future and, most importantly, our ability to continue to provide access to outstanding healthcare services for the people of our communities.
HRO aligns perfectly with our five Guiding Principles: Quality and Safety; Employee Engagement; Patient Experience; Growth and Access; and Finance. The foundations of HROs are based in consistency, teamwork, communication, safety in raising concerns and asking questions, respect, accountability, improvement and learning. The outcome, as set out in our goals, is zero harm. I very much look forward to continuing to travel this road with each of you. I am counting on our team to join the journey and help impact positive change for the benefit of our patients, team and community. We are Safe. Sound. Skagit.
BRIAN K. IVIE
Chief Executive Officer
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RICHARD LEONE, MD, PHD, FACS Thoracic Surgery Skagit Regional Health
NATASHA ROUNDS, RN Clinical Nurse Educator Skagit Regional Clinics
KIRSTEN HENDERSON, RN Staff Nurse Progressive and Critical Care Skagit Valley Hospital
ZAKARIA SHARIF, MD Internal Medicine Resident Skagit Regional Health
KENNETH BROWN Security Officer Skagit Regional Health
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OUR CULTURE
Setting our direction
As we work to change our culture and become a High Reliability Organization (HRO), we will align all our work, training and communications around the principles of HRO by fostering a professional culture of respect, consistency and continuous improvement, aiming to provide safe, reliable and effective care, with the outcome of zero harm in support of our True North.
Our True North We are committed to our mission of continually improving the health of our communities serving with compassion and respect, one person at a time. We commit to work collaboratively as a system to lead a culture that is focused on high reliability by promoting safe and reliable activities at all times while celebrating and supporting the diversity of our team members.
SAFE. SOUND. SKAGIT.
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DENNIS MILLER, MD Emergency Medicine Chief of Staff Cascade Valley Hospital
We are SAFE. • We align our actions with our dedication to zero events of preventable harm to our patients and team members • We respond to concerns swiftly, with empathy and understanding • We design processes and systems to build situational awareness and manage both the expected and unexpected • We learn equally from our successes and shortcomings • We rebound and are resilient by innovating, challenging norms and leaning on our expertise
EDWIN STICKLE, MD Family Medicine with OB Chief of Staff Skagit Valley Hospital
We are SOUND. • We refine operations to create consistent and standard work • We encourage open forums for idea development and sharing • We use data to inform decisions and elicit innovative ideas We are SKAGIT • We inspire each other daily with confidence and genuine feedback • We seek and re-recruit all team members every day by investing in our constant commitment to dependability and safety • We share openly in a spirit of transparency
We conduct ourselves in a PROFESSIONAL , RESPECTFUL manner. • We ground our approach in fair outcomes and practice a just culture • We respect and acknowledge differing cultures, values and opinions • We treat everyone with courtesy and honesty, even in challenging situations • We listen with curiosity and patience; we speak with clarity and honesty
We champion shared
ACCOUNTABILITY where every team member has a duty to participate and contribute to our improvement. • We speak up when we experience or witness actions that threaten our reliability • We set clear expectations, are trustworthy and take responsibility for our actions
SKAGIT REGIONAL HEALTH’S BOARD OF COMMISSIONERS from left, Julie Blazek, Peter Browning, Jeff Miller, Gary Shand, Frei Burton, Bruce Lisser and Dale Ragan.
CLEAN AND SAFE: Environmental Services Technician Graciela Murillo is part of the team at work to make sure Skagit Valley Hospital is clean and safe for patients and employees.
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STAYING CONNECTED Chief Medical Officer Connie Davis, MD, right, chats with Ben Winkes, MD of SeaMar Community Health Clinic and Marie Benfit, RNC, BSN during rounds in the Family Birth Center at Skagit Valley Hospital.
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CHARTING OUR COURSE
Initiatives and projects for 2021 COVID-19
NEW SERVICES
We will continue to navigate the challenges presented by the COVID-19 pandemic in 2021. As the Skagit Regional Health team provides care to the people of our communities, we also will stay on the leading edge of public health guidance, science and safety with a watch on a path on a path to support vaccinations, emerging treatments and testing options to best meet the needs of our team and patients.
Expanding Skagit Regional Health’s array of services continues to be important in meeting the expectations of our patients. In 2021, an orthopedic/spine service line will open; telehealth options will increase and the focus continues on regionalization and collaboration within our growing system.
ROUNDING 2.0 Leadership rounds are a key component for high reliability organizations as a way to focus on the well-being of managers and team members, to discuss safety and improve the patient experience. Rounds provide a one-on-one forum for staff to share feedback while charting a course to build trust and rapport.
RECRUITMENT Building and maintaining an outstanding healthcare team is a consistent initiative for Skagit Regional Health. Our team members, including staff and providers, are central to our ability to provide safe, exceptional care. The journey to become a high reliability organization and our True North are designed to create opportunity for continuous learning; build confidence; instill professional fulfillment; and create pride in our team and organization as an outstanding place to work.
DIVERSITY, EQUITY AND INCLUSION Skagit Regional Health recognizes that the communities we serve and our workforce represent a widely diverse population. A Diversity, Equity and Inclusion Committee is at work seeking to understand and break down the walls of inequity. The group, in concert with people across our system, seeks to create cultural awareness throughout the organization through communication, enhanced patient care, education, training and identification of care gaps.
AMBULATORY SURGERY CENTER (ASC) To support volume growth and patient demand for surgical and endoscopy services, planning is under way for a 60,000-square-foot ASC on the main Mount Vernon campus. Anticipating completion of a definitive agreement and lease in first quarter of 2021 with completion in Fall 2023.
MEDICAL OFFICE BUILDING AND URGENT CARE To expand access to services, including Urgent Care, planning is under way for a 30,000-square-foot medical office building on Kincaid Street, just west of Interstate 5. Construction is due for completion in late 2022.
MANAGING EXPENSES Facing unknowns on reimbursement, COVID-19, and other financial drivers, managing our expenses across the system is imperative.
JUST VACCINATED: General Surgeon Peter Wolff, MD shows off his bandage after receiving his first dose of COVID-19 vaccine at Cascade Valley Hospital.
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2021
operating plan
Foundational Principles for Skagit Regional Health
NEXT STEPS
A message from Danny Vera In the preceding pages, we have described our focus on safety and becoming a high reliability organization (HRO) and we outlined several of our key projects and initiatives for the coming year. In this chapter, we turn our attention to Skagit Regional Health’s specific priorities and goals in our 2021 operating plan. For the third year, this plan is built on our five guiding principles: • Quality and safety • Employee engagement • Patient experience • Growth and access • Finance
As we move into 2021, the priorities presented in the operating plan and the Key Performance Metric (KPM) goals to support them bring additional focus and measurement in keeping with our overarching work on HRO. We know that the COVID-19 pandemic will continue to create an ever-changing challenge for us in the months to come. However, we are making the decision to lay out our goals and present our shared vision as an ongoing commitment to our efforts to continuously improve, create access and care for our patients. We pledge to regularly report on our progress to the Board of Commissioners, our leaders and healthcare team as the months unfold and, as always, invite your feedback along the journey.
DANNY VERA, PharmD, MBA
Regional Vice President Chief Operating Officer
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PRINCIPLES
QUALITY AND SAFETY OWNER: Chief Quality Officer Joshua Griggs, MD PRIORITY: We will be a high reliability organization dedicated to zero events of preventable harm for our patients and team members.
KPM #1 - ZERO PATIENT HARM: On our journey to become
a high reliability organization, our goal is to increase the quality of care we provide for all of our patients. To measure our success, we have created a Zero Harm composite which includes the following: • C. diff: Hospital-acquired infection of the large intestine caused by the bacteria Clostridium Difficile. • Severe Hypoglycemia: Hospital patients who have severe low blood sugars. • Falls: Department of Health reportable, unplanned descent to the floor with or without injury. • CLABSIs: Hospital-acquired Central Line-associated Blood Stream Infections. • CAUTIs: Hospital-acquired Catheterassociated Urinary Tract Infections. • Opioid Reversal: Toxicity due to excessive opioids administered by the hospital.
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• Post-op DVTs: Deep Vein Thrombosis (blood clot) following a surgical procedure. • HAPIs: Department of Health reportable Hospital-Associated Pressure Injuries (bed sores) that occur when patients have limited mobility. As we reduce the incident rates of these events, we move closer to our ultimate goal of doing no harm.
KPM #2 - TEAM MEMBER SAFETY - TOTAL CASE INCIDENT RATE (TCIR):
In addition to our commitment to patient safety, equally important is the safety of our team members. With a focus on preventing employee harm, we will reduce our Total Case Incident Rate (TCIR) which is a ratio of all OSHAreportable safety events in relation to total employee worked hours. Using this standard measure (TCIR) allows us to compare ourselves to a national benchmark.
SUPPORTING METRIC LENGTH OF STAY: We improve
quality of care when we appropriately match the care setting to the patient’s needs. We care that a patient’s stay in the hospital is for the appropriate amount of time based on their clinical condition. In addition, research shows that the longer a patient remains in the hospital, the greater likelihood they will incur Hospital-Acquired Infections (HAIs) and other incidents of harm. To optimize care delivery and improve outcomes, we will focus on improving our patient length of stay as a supporting metric.
NEW GENERAL SURGEON: Jimmy Barger, DO, FACOS, joined the team of General Surgeons at Skagit Regional Health in 2020 and practices at Cascade Valley Hospital.
PRINCIPLES
EMPLOYEE ENGAGEMENT OWNER: Chief Executive Officer Brian Ivie PRIORITY: We will be the employer of choice in the communities we serve by fostering a culture of inspired and empowered team members.
KPM - EMPLOYEE AND PROVIDER ENGAGEMENT INDEX: This index provides
an average score based on SRH employee ratings of the following four Engagement Survey questions: 1. I am proud to work at Skagit Regional Health. 2. I intend to stay with Skagit Regional Health for at least 12 months. 3. I would recommend Skagit Regional Health as a good place to work. 4. My work gives me a feeling of accomplishment.
SUPPORTING METRIC VOLUNTARY TURNOVER RATE: This measures the number of
employees who chose to leave SRH as a percentage of total employees. This is a strong indicator of our progress toward becoming the employer of choice in our communities.
SHOWING RESPECT: Staff members line the hall of the Progressive and Critical Care Unit at Skagit Valley Hospital in an Honor Walk to pay tribute to organ donation patients and their families.
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PRINCIPLES
PATIENT EXPERIENCE OWNER: Regional Vice President and Chief Operating Officer Danny Vera PRIORITY: We will be a patient-first organization, serving with compassion, ensuring safety and honoring patient individuality.
KPM - PATIENT EXPERIENCE “RECOMMEND THE HOSPITAL/PROVIDER” SCORES: The Centers for Medicare
and Medicaid require that we survey all patients regarding their healthcare experience. The following questions provide us with a measurement of our overall patient experience:
• Recommend the hospital (SVH and CVH) • Recommend the provider office (SRC)
There are key driver composites that influence the “Recommend Hospital/ Practice” question (eight composites – a collection of targeted questions - for HCAHPS or hospital stays and six composites for medical practice). These key driver composites measure areas such as doctor and nurse communication, staff responsiveness, communication about medications, care transition, discharge information, access, moving through your medical visit, etc. Using “Recommend the Hospital/Practice” questions as our KPM shows our commitment to the overall patient experience.
SUPPORTING METRIC PATIENT EXPERIENCE KEY DRIVER QUESTION SCORES:
Each year, our patient experience survey partner, Press Ganey, utilizes statistical analysis of SRH’s patient survey feedback to determine the greatest opportunities for improving “Recommend the Hospital/Practice” scores. The following questions are identified as key drivers for 2021:
• Communicate in a way you understand (SVH and CVH). • Care provider concern for questions and/or worries (SRC).
LISTENING: Pediatrician Lizette Antig, MD, of Skagit Regional Health – Arlington Pediatrics, listens to the heart of a young patient.
IN TRAINING: A dozen thirdyear medical students from Pacific Northwest University of Health Sciences in Yakima started two years of rotations and Education at Skagit Regional Health in July 2020.
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PRINCIPLES
GROWTH AND ACCESS OWNER: Chief Physician Officer Mary Ann Hink, MD PRIORITY: We will be the choice for healthcare services in our region by providing care when and where our patients need us.
KPM #1 - PRIMARY CARE THIRD NEXT AVAILABLE APPOINTMENT: This is the third
open space in a provider’s schedule. This is a standard metric used in the healthcare industry to measure access within a provider’s schedule. This is used rather than the next actual appointment because it provides a more accurate representation of true appointment availability. Monitoring third next available allows us to determine if we need to increase access based on patient need.
KPM #2 - SYSTEM SURGICAL CASE VOLUME: A key component of
our goal to build healthier communities is to improve access to healthcare services. As more individuals and families move into our communities, there is an increased need for surgical care in our region. To meet this need, we will increase our surgical cases to allow our patients to receive high-quality surgical care, close to home.
SUPPORTING METRIC EXTENDED HOURS: As the
industry continues to adapt to patient care preferences, we are seeing greater demand for patients to connect with their healthcare team outside of traditional business hours. To meet this need, we will extend in-person clinic hours as well as increase the number of telehealth visits we provide to our communities.
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PRINCIPLES
FINANCE OWNER: Chief Financial Officer Paul Ishizuka PRIORITY: We will be patient-focused by continually improving performance and managing costs, allowing us to generate capital to execute our mission.
KPM - NET INCOME: One of the most telling measures of an organization’s sustainability is net income. Strong performance on this financial metric allows Skagit Regional Health to continue to reinvest in organizational growth, capital and our employees, providing exceptional healthcare to our local communities.
SUPPORTING METRIC COST PER CASE MIX INDEX ADJUSTED DISCHARGE: This
metric is a useful method of determining the cost of providing care for our patients. It is determined by establishing the average cost per discharge, adjusted for the acuity of patients. By improving our Cost per Case Mix Adjusted Discharge over time we are able to provide more affordable, patientcentered care.
$2 MILLION GIFT: CEO Brian Ivie, CFO Paul Ishizuka and Skagit Valley Hospital Foundation Board of Trustees members Barbara Jensen, Holly Nielsen, Bobbi Fisher and Zach Barborinas, celebrate the Foundation’s completion of a $2 million capital campaign to purchase 3D mammography equipment for the new Women’s Imaging Center on the Skagit Valley Hospital campus.
3D MAMMOGRAPHY: Radiology Tech Donna Marler shows off the new 3D mammography unit at Cascade Valley Hospital. The advanced technology generates high-resolution images of the breast and improves detection of cancer.
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