Synergy

Redesigning the Patient Experience Organization

The Vision

In early 2010, Joe Stough, Administrator/Vice President for Mobile Infirmary, looked at support services
and wondered whether they were being given the flexibility they needed to help achieve the hospital’s vision of becoming the #1 choice for healthcare in the region. Stough brought his support services managers together and asked a simple but profound question: “If you started from scratch, how would you design a program truly focused on the patient?”

Crothall Healthcare was performing Environmental Services (EVS) and Patient Transportation (PT), while Crothall’s sister company, Morrison Healthcare Food Services, handled Food & Nutrition Services (FNS). All three departments used a specialist model that ensures quality by allowing experts to focus on their particular disciplines. In February 2010, Crothall RVPs Jon Chase from EVS and Kevin Yon from PT, and Morrison RVP Lenny Scranton came together to design a cohesive working unit. Leveraging Compass Group corporate resources, they devised an innovative strategy to unify all levels of management across all services and created a plan to implement the specific changes that would be required. It meant breaking silos and changing the mindset to serving patients as a single team. “Look at your workforce,” said Stough. “Support service workers are second only to Nursing in patient interaction. If you can’t engage them, patients will come away with a bad experience.”

Breaking Down Barriers

Around the same time, Suzanne Bird was named the new CNO. Bird brought to the hospital the fresh—some might say radical—attitude that support service associates are just as important as nurses to patient care. Bird believed that everyone must be unified as a team around a single mission: “What is best for the patient?” The biggest obstacle was getting people to trust and view each other as partners. According to Rosemary White, Nursing Support Services Director, it goes well beyond remembering names. “It is more than just giving a pat on the back. It means knowing you have each other’s back.” Building trust and communication requires ongoing focus and effort from everyone, beginning with leadership.

Each department had always been successful sticking to what it did best: EVS cleaned, PT moved patients, FNS prepared and served food, and Nursing provided clinical care. Getting everyone to think as one unit was a foreign concept. “This hospital is 101 years old,” said Bird. “The silos were thick and tall.” The team needed to balance the operational advantages of specialization with the need for a unified approach to patient care. Over many weeks, Stough encouraged the departments, led by Crothall Resident Regional Manager Ender Waltman, to reinvent the patient experience model.

The Synergy Model

Synergy respects the advantages of specialization. Discipline-specific operations managers maintain responsibility for day-to-day oversight of operational issues. Front-line staffing has been slightly adjusted to ensure a consistent team on the floor from day to day. This instills accountability in workers to “their unit” as well as familiarity and teamwork with nurses, who see the same faces every day. EVS and PT discharge staff are dedicated to a specific nursing unit. And Morrison introduced Catering to You, which dedicates an associate to the same nursing unit and patients throughout the day.*  Synergy’s real innovation is in its approach to patient experience.

An organizational structure focused on patients is layered over all departments. Every two nursing units are grouped into a patient experience zone, led by a single zone leader, who is an Operations Manager from any one of the support services. All associates within the zone, no matter what department they represent, are accountable to their zone leader. They huddle every morning solely to discuss patient issues, and zone leaders must personally meet with every single patient within the zone at least once.

No More “Not My Job”

“There is nothing more annoying to a patient than asking for something and being told, ‘It’s not my job,’” said Bird. With Synergy, associates are expected to focus on the patient’s needs, no matter what they are. An EVS worker will clear a used food tray instead of ignoring it, and if he notices the tray has been untouched, he is empowered to raise the issue with FNS to make sure there are no nutritional problems. Focusing on patients instead of tasks makes everyone responsible for solving problems on the floor.

It goes beyond service tasks. PT is introducing enhanced scripting to become true ambassadors of the hospital, communicating vital information about the hospital and care team. It helps set high expectations from the start and tells patients they are being cared for by a unified team.

The Real Key: Nursing Support

The most important and challenging barrier to integration was the addition in August 2011 of Certified Nursing Assistants (CNA) to the Synergy team. 97% of the CNA staff, including the Regional Staffing Pool CNAs, were trained by the Synergy focus team. CNAs now fully participate in the huddles and are accountable to zone leaders. “We had to overcome a major cultural taboo,” said Stough. “Having EVS managers lead nurses on patient experience was unheard of.” Nursing leadership and support are essential. Thelma Jones, RN Educator, and White attend the huddle meetings, and attendance has become part of the performance evaluation for CNAs. White believes a real cultural shift is occurring.

High Expectations

“We have only begun to see how effective Synergy will be,” said Bird. The program has only been in effect for 15 months, and it has been a continuous learning process. Many changes have been made to adapt and improve along the way. The team is now planning for a dedicated patient experience position to move among the zones with a specific focus on patient satisfaction scores.

HCAHPS scores for cleanliness have trended up since program inception, from 61.65 in January 2010 to 71.55 in September 2011. Time will tell whether this positive change is sustainable. The model is in place, the team is motivated, and patients are well served. The rallying cry of the entire Synergy team was coined by one particularly inspiring EVS worker named “Miss Happy,” aka Deborah Jones: “It will work if you work it.”

* For more information about Catering to You, see the article in this issue of Celebrations.