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The 1999 Twelfth Annual Management Excellence Awards
Sponsored by: Certus Corporation
TOP HONORS
HONORABLE MENTIONS
TOP HONORS
Performance Improvement in Nursing Recruitment,
Retention & Education
Riverside County Regional Medical Center
The Inpatient Mental Health Treatment Facility (ITF) at Riverside County
Regional Medical Center serves severely mentally ill clients who have
a host of complex nursing care demands. In addition to the nationwide
nursing shortage, Riverside County faced internal barriers that delayed
the recruitment process, which frequently resulted in prospective nurses
accepting jobs elsewhere. As a result, the facility often relied on
the use of registry nurses, an option which is not only more costly
but also less desirable from a continuity-of-care perspective. To address
this problem, Riverside established a three-part strategy to improve
its nursing recruitment, retention and education efforts. First, the
county established the Temporary Assistance Pool (TAP), which dramatically
reduced the hiring time frame from 90 days to 3 days. TAP has produced
cost savings by eliminating the heavy reliance on registry nurses. It
also provides more consistent staff on a daily basis and gives nurses
the option of being hired as permanent staff after successfully working
for ITF for three months. Second, the institution of a mandatory mental
health nursing orientation and continuing education program for all
regular and TAP nurses has helped to better meet the needs of mental
health clients, as evidenced by nursing-care client-satisfaction ratings
of 94%. Finally, the implementation of a nursing internship program
in collaboration with the community college nursing school has greatly
aided recruitment efforts, with 100% of interns opting to transition
to full-time employment.
The Checks are Larger Than They Used To Be
San Mateo County Division of Hospitals &
Clinics
When the San Mateo County Health Services Agency’s Division of
Hospitals and Clinics took over operation of the North County Clinic
located in Daly City in 1998, there were concerns about how the revenue
and collections experience at the clinic would be integrated into the
hospital. A team was established to identify issues related to the clinic’s
accounts receivable and to develop, among other things, a plan for integrating
them with the hospital’s accounts receivable. While the Division
of Hospitals and Clinics had traditionally absorbed responsibility for
all revenue collection within the hospital-based billing unit, the team
recommended that a biller be permanently deployed to the North County
Clinic to manage the accounts receivable on-site. Because there were
no funds available to hire additional staff, a biller from existing
staff was transferred. In order to make this placement successful, the
traditional schism between front-office registration/admitting staff
and back-office billing staff had to be overcome. An accounts receivable
plan was developed and clinic staff was consulted regarding their role
in improving the clinic’s revenue collections. Since placing the
biller on-site at the clinic, cash collections have increased 113.6%
and clinic staff has integrated the billing function into their everyday
operations. The results have been so successful that there are now plans
to place on-site billers at other large outlying clinics.
UC Davis Telemedicine Program
UC Davis Health System
UC Davis has assumed a role as a major provider of tertiary care to
22 rural counties in Northern California. With this role comes a duty
to provide community outreach, which has been most recently facilitated
through telecommunications modalities, namely interactive video conferencing.
Following the success of a rural pilot established in Colusa Community
Hospital to provide fetal monitoring, UC Davis developed a rural telemedicine
network in 1997. Project implementation started with a visit to the
remote sites to determine access issues and needed medical services.
Intensive training was provided at startup to address equipment operation
and troubleshooting, patient presentation and scheduling, with ongoing
technical assistance provided thereafter. To date, telemedicine consultations
have been provided in 28 different specialty areas, providing relief
to local rural health care facilities that have few or no medical specialists
to take patient referrals. The participation of local clinicians in
telemedicine also serves a continuing-medical-education function and
reduces feelings of professional isolation among rural physicians. An
early review revealed that the most common telemedicine consultations
requested were for nutrition (mainly for diabetic and lipid disorders),
dermatology and behavioral health/psychiatry. Satisfaction with the
program is high among patients and primary care physicians alike. In
the last year, the UC Davis Telemedicine Program has also partnered
with Blue Cross to increase access to pediatric subspecialty services
in new rural communities.
HONORABLE MENTIONS
Guest Relations Program (“CHARM School”)
Arrowhead Regional Medical Center
Prior to the opening of the new Arrowhead Regional Medical Center,
patient satisfaction survey results at its predecessor, San Bernardino
County Medical Center, were low and revealed an overall impression that
the staff showed a general lack of concern for patients. This perceived
attitude was not limited just to staff-patient interactions; it also
extended to staff interactions with each other and with outside providers.
While the outdated facility was viewed as a contributing factor to the
negative attitudes, the new Arrowhead would soon eliminate the outmoded
physical plant as an excuse, and it became clear that interaction of
staff with patients, their families and with each other needed to improve.
The CHARM School was implemented in five stages to increase staff awareness
of the value derived from a proactive customer service program. The
key to the customer service school is the word CHARM, an acronym for
Caring (and Courteous), Helpful, Acknowledge, Respectful (and Responsive),
and Meet Your Customer’s Needs. An outside consultant was hired
to evaluate needs, recommend improvements and facilitate the program.
Attendance at the two-hour CHARM School is a prerequisite to working
at ARMC; employee participation is 100%. A reward and recognition program
allows employees to earn “charm bucks” that can be redeemed
at ARMC’s café and gift shop. Customer service now constitutes
40% of employees’ annual work performance evaluation. Results of
the CHARM School are evident throughout the Medical Center, and patient
satisfaction scores have improved.
Baby-Friendly Hospital Designation
San Luis Obispo General Hospital
On October 30, 1998, San Luis Obispo General Hospital became the 15th
hospital in the United States—and the first public hospital—to
receive the “Baby-Friendly Hospital” designation from the
World Health Organization and UNICEF. The designation is part of an
initiative launched to encourage hospitals to adopt practices that fully
protect, promote and support exclusive breastfeeding from birth. The
effort is prompted by findings that breastfeeding is not only the best
way to nourish an infant, but also provides powerful health benefits
to the mother and child. Over a period of five years, San Luis Obispo
General transformed its delivery of care to newborns and their families
by creating new policies and procedures, engaging in intensive education
and cross-training of staff and practitioners, and eliminating all formula
advertising and products. The results of this multi-disciplinary team
effort has increased the in-hospital breastfeeding initiation rate from
70% in 1993 to 92% in 1998. The practice of supplementation and use
of pacifiers for breastfeeding infants has been discontinued except
when medically indicated, and quality performance indicators to measure
breastfeeding initiation within one hour of birth have been developed.
A written breastfeeding policy that was communicated to all county maternal-child
health care facilities was developed, and staff is educated in breastfeeding
and lactation management. With its Baby-Friendly Hospital status, low
Caesarian section rate and high breastfeeding initiation rate, San Luis
Obispo General Hospital now occupies a unique position in the health
care community and is able to promote the service excellence of its
obstetrics department.
Creating a Values-based Customer Service Program
Santa Clara Valley Medical Center
After Santa Clara Valley Medical Center (SCVMC) completed five years
of process reengineering designed to reduce costs and increase efficiency,
the organization’s priority turned to improving customer service.
SCVMC has undertaken a sweeping initiative to create and implement a
values-based customer service program, the goal of which is to create
and sustain the energy, commitment and infrastructure necessary to improve
the quality of the patient/customer experience. More than a simple “smile
program,” the project strives to change the culture of the organization
by redefining priorities and relationships. More than 200 employees
representing a cross-section of the organization helped to develop the
organizational values statement. Projects to foster the commitment to
and demonstration of the values include management training, rewards
and recognition, intern/resident orientation, union sign-off, manager
training, and leadership development. A special evaluation tool allows
departments to define behavioral expectations within the framework of
the values and to assess staff performance. The values statement and
information about the redesign of customer service were introduced to
more than 2,500 employees during small group sessions that provided
an opportunity for staff to express concerns and provide feedback. Establishment
of a fully-staffed customer service department supports ongoing customer
service improvements, and a redesigned complaint management process
has allowed SCVMC to resolve patient concerns within a two-week timeframe.
Other activities include the development of hiring standards and a policy
on dress and appearance, housekeeping improvements, assessment of internal
and external survey processes and numerous amenities aimed at enhancing
the environment for staff and patients.
Space Sharing Agreement with the Veterans Administration
ValleyCare Olive View-UCLA Medical Center
The absence of a county-operated community-based clinic in the Sepulveda
region of the San Fernando Valley meant that a large number of indigent
and Medi-Cal eligible residents living in the area lacked access to
health care services. At the same time, veterans living in the Antelope
Valley region of Los Angeles County were required to travel long distances
to receive care at the Sepulveda Veteran’s Administration Medical
Center campus, located in the San Fernando Valley. In an unprecedented
move that was sanctioned through an Act of Congress and approved by
the Los Angeles County Board of Supervisors, a space-sharing agreement
was reached between the Veteran’s Administration and the county
to expand access to care for both veterans and the low-income and uninsured
residents who rely on the county for their care. In exchange for 3,000
square feet of space at the Sepulveda VA Medical Center campus, Los
Angeles County provided 2,585 square feet of space at its High Desert
Hospital in the Antelope Valley. The arrangement allowed each entity
to operate its own geographically appropriate outpatient clinic to improve
access to medical care for their respective patient populations. The
space and provision of utilities, housekeeping, security and building
maintenance services at each location were estimated to be approximately
$5,000 per month, which resulted in no new net cost to the county. ValleyCare
Olive View-UCLA provides staffing and other support to establish the
clinic for the county, which accommodated more than 2,735 patient visits
during its first year of operation. As a result of this effort, access
to ambulatory care services has improved for low-income and uninsured
residents of the San Fernando Valley, as well as for veterans in the
Antelope Valley.
CONGRATULATIONS TO OUR WINNERS!
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