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The 2000 Thirteenth Annual Management
Excellence Awards
Sponsored by: Certus
Corporation
TOP HONORS
HONORABLE MENTIONS
TOP HONORS
San Joaquin General
Hospital & Health Plan of San Joaquin
Healthy Parents Program
Since 1996, San Joaquin General Hospital and the Health Plan of San
Joaquin have partnered to enroll children and families in the state’s
Medi-Cal Managed Care and Health Families Programs. The trend over the
past two years has been that Medi-Cal coverage has decreased faster
than job-based insurance has increased, leaving a higher percentage
of the population uninsured. Without health insurance coverage, individuals
will utilize the health care system on an episodic basis, when medical
problems have developed into acute medical concerns. As more parents
are falling into the uninsured gap, San Joaquin General Hospital is
taking steps towards a local solution. San Joaquin General Hospital
staff has developed a pilot program for parents or guardians of children
enrolled in Healthy Families through the Health Plan of San Joaquin.
The newly created pilot program is called “Healthy Parents”
and is available to qualified parents who are not otherwise eligible
for employer-based insurance, Medicare or Medi-Cal. Healthy Parents
is designed as a health and wellness program—it is not an insurance
program. Members are required to receive all their services at San Joaquin
General or one of its clinics located throughout the county. For a $5
co-pay (and no premiums) eligible parents receive the same comprehensive
benefits as their children who are in the Healthy Families Program.
The target for the pilot project, which will continue until June 2001,
is to enroll 1,000 parents and to achieve the following goals: improve
access to health care, emphasizing primary care and health education;
improve utilization by reducing emergency room visits and inpatient
admissions; simplify and reduce administrative costs for billing and
collection of services for uninsured patients; create an incentive for
enrollment of children in Healthy Families; and develop data collection
and utilization management capabilities for future expansion of managed
health care programs for uninsured populations.
Santa Clara Valley Medical Center
Express Admission Unit
In early 1999, the Executive Management Team at Santa Clara Valley
Medical Center created an institutional goal to improve patient access
and reduce patient wait times in the Emergency Department (ED). By reducing
patients’ stays in the ED, the hospital sought to achieve the following
objectives: 1) improve overall access to the ED; 2) ameliorate patient
dissatisfaction with long, uncomfortable assessment and work-up processes
in the ED and 3) increase inpatient revenues by reducing the number
of patients who are waiting for an inpatient bed at midnight. To meet
these objectives, a multidisciplinary team—representing staff from
the ED, Department of Medicine, Department of Nursing and ancillary
services—evaluated the problem and recommended the establishment
of a new Express Admission Unit (EAU). The team worked together to develop
a streamlined admission and assessment processes, establish protocols,
identify appropriate physical space, order equipment and supplies and
get the new unit up and running—all within a six-month timeframe.
The overall impact has been tremendously positive. The time from the
decision to admit the patient to the time the patient is admitted has
been reduced from nearly fours hours to less than one hour. Patient
satisfaction with the Express Admission Unit is overwhelmingly positive
and patient complaints related to the long, uncomfortable ED stays are
non-existent. Both physician and nursing staffs report that the new
patient admission processes and the new unit have improved their ability
to complete tasks more timely. Moreover, the increase in reimbursement
resulting from the increase in the number of patients who are admitted
by midnight more than offsets the costs associated with maintaining
the unit. One unanticipated benefit derived from the design and implementation
of this unit is a new sense of teamwork between the physicians in the
ED and in the Department of Medicine and between the ED staff and the
inpatient nursing staff.
Santa Clara Valley Medical Center
Violence Intervention Program
Although current law mandates health practitioners to report incidents
of domestic violence (physical and sexual abuse) to law enforcement,
health care workers often report that they are reluctant to ask patients
questions about abuse and are unsure of how to proceed when there is
a positive response. The Violence Intervention Program (VIP) at Santa
Clara Valley Medical Center was created in September 1998 in recognition
of the critical role that health care providers play in intervening
in the spiral of domestic violence and family abuse. The program is
a collaborative effort between SCVMC and a community-based organization
dedicated to addressing domestic violence, called Next Door. The VIP
comprises a team of specially trained registered nurses and advocates
who respond to the hospital within 30 minutes, 24 hours a day, when
there is a suspicion that a patient may be experiencing abuse by a partner
or family member. The forensic nurse is specially trained to interview
and examine patients who are victims of domestic violence, provide thorough
documentation and complete all necessary reporting. The nurse also explores
lethality risks and initiates safety planning. The advocate is able
to provide emotional support, follow-up counseling, emergency shelter
assistance and legal advocacy, including assistance in obtaining a restraining
order. Since the program’s inception, VIP nurses and advocates
have responded as a team to over 700 SCVMC patients who were identified
as victims of relationship and/or family abuse. Prior to the establishment
of VIP, social services workers were receiving one or two referrals
for domestic violence each month. VIP currently offers services to an
average of 30 patients each month, and the number continues to grow
as more education is done. Over 1,100 staff members have participated
in extensive training sessions given by VIP about abuse reporting and
recognition. All have expressed overwhelming support and enthusiasm
for the VIP program.
HONORABLE MENTIONS
Martin Luther King, Jr./Drew
Medical Center
Halting Elder/Dependent Adult Abuse Response Team (HEART)
Over the past several years, the number of reported cases of domestic
elder abuse and neglect in the United States has increased dramatically.
New reporting requirements in California are anticipated to increase
the number of abuse reports for elderly and dependent adults by as much
as 25 percent. In order to meet the anticipated demands, the Martin
Luther King, Jr./Drew Medical Center has formed a multidisciplinary
team to coordinate care planning for this population. The Halting Elder/Dependent
Adult Abuse Response Team (HEART) is a partnership of the medical center’s
Division of Geriatrics and Los Angeles County’s Community Senior
Services and Adult Protective Services. The team is housed in the Department
of Internal Medicine and comprised of physicians, physician assistants,
nurses, social workers, physical therapists, occupational therapists,
dieticians, pharmacists, community workers and community-based organizations
that have developed strategies for the recognition, prevention and treatment.
Protocols have been established to screen all patients 65 years of age
and above as well as dependent adults 18-64 years of age who have physical
or mental limitations that make them at risk of abuse. If the screen
is positive for risk of abuse, HEART is consulted for full assessment,
intervention and treatment. Intervention by way of education, services
(social, medical, legal, etc.), and information about safety networks
assures reliable care planning and ensures the return of victims to
safe, suitable environments. These services are delivered in the hospital,
clinic, home and community free of charge. By increasing the ability
of Adult Protective Services to handle additional cases of abuse and
neglect, the HEART program helps to provide a greater degree of safety
and protection for victims of abuse, decrease utilization of emergency
room services and ensure a greater quality of life for elder and dependent
adults.
UC Davis Medical Center
Child Safety Seat Committee & Program
The number-one cause of injury for children admitted for trauma at
UC Davis Medical Center is motor vehicle collisions. Although the use
of seat belts and car seats for children are required by law and the
rates of seat belt use and car seat use are high, car seat inspections
and trauma data indicate that the misuse of car seats is also very high.
In some areas of Sacramento this misuse rate can be as much as to 100
percent. The Child Safety Seat Committee and Program at the UC Davis
Health System was developed to address this problem and is the culmination
of concerted efforts by concerned staff and others in the community.
The committee raises funds for and promotes car seat education, develops
and distributes videos and brochures in multiple languages, helps to
distribute low-cost car seats and provides assistance to families in
the multidisciplinary departments of the hospital. In addition to developing
a protocol for teaching patients about child passenger safety, the program
offers special trainings on the law and car seat safety for interpreters,
nurses and other health care providers at the hospital, including family
practice residents, emergency physician residents and pediatric residents.
Each month, the program holds two-hour classes on child passenger safety
(one in English and one in Spanish) open to the community. In the past
year alone, more than 1,000 car seats were distributed through these
classes. In addition, child safety seat inspections are held at various
times and locations throughout greater Sacramento county. The committee
and program is an essential component of the efforts of the nurses,
physicians and other health care workers to raise awareness about the
importance of proper car seat use and to prevent unintentional injuries
to children in motor vehicle crashes. It will also play a key role in
the development and implementation of the California Health Care Safety
Net Institute’s new $1.5 million Child Passenger Safety Initiative
that was recently funded by the state’s Office of Traffic Safety.
UC Irvine Medical Center
Improving Organizational Satisfaction
One of three major goals at UCI Medical Center is to improve patient/customer
satisfaction. In the fall of 1998, this goal was communicated to all
faculty, staff, volunteers and students, and a Customer Satisfaction
Steering Committee was established to plan and initiate the process,
select measurement tools, and ensure effectiveness of the defined mission.
Nine committee members were selected from physician leadership, senior
management and department leadership including nursing, quality management,
ancillary and support services, human resources, marketing/community
relations and education. Nine subcommittees were established which included
Leadership, Education, Communication, Human Resources, Performance Measurement,
Recognition, Service Recovery, Guest Relations and Physician Communication
Skills. Each of the nine subcommittees developed and implemented various
aspects of the program based upon its defined responsibilities. The
customer satisfaction initiative was launched in November 1998 with
an entire week dedicated to various customer satisfaction presentations
and activities, including a full-day fair for leadership, faculty and
staff. Full implementation of the UCI Medical Center Customer Satisfaction
Initiative began in January 1999 and included, among other things, the
following activities: physician and staff education and communication,
education of front line employees on personal interaction; implementation
of a guest shuttle; implementation of measurement practices such as
patient surveys, employee opinions surveys, redesign of employee evaluations
to include customer service, an employee recognition program, an employee
incentive program and manager surveys. Recent survey results suggest
that the program has made a major change in the patients’ perceptions
of the institution as well as the employees’ attitudes toward serving
patients and their families. Employees have accepted the changed “culture”
because they feel a sense of ownership and responsibility for the program
and its success and are enthusiastic about the positive response from
patients.
ValleyCare Olive View-UCLA Medical Center
Patient Flow Redesign
While efficient, timely patient care is essential to ensure effective
operations at Olive View-UCLA Medical Center, the process has been complicated
by a complex appointment system; a lack of coordination, collaboration
and appropriate communication at patient contact points; inappropriate
skill mix and staffing per clinic; inconsistencies in patient flow;
and difficulty in scheduling and retrieving results from ancillary services.
The results of a patient flow analysis for minutes-per-service (including
wait times) reflected that patients at Olive View spent an average of
four-and-a-half hours waiting for and obtaining clinical services. When
other services were added to the equation, such as applying for financial
resource programs, filling prescriptions, and obtaining laboratory and
radiology tests, patients spent more than seven hours for a visit. To
address this problem, the Ambulatory Care Design Team was charged with
the task of improving the patient flow in scheduled clinics by reducing
the total time for outpatient visits while maintaining the quality of
care and delivering an excellent customer-oriented service. In June
2000, a pilot was implemented in one of the clinics, decentralizing
patient processing and clinical care. The process is designed to 1)
reduce patient waiting times—both in the clinic and for an appointment—to
a more competitive level, 2) increase patient satisfaction by developing
a more patient-oriented environment, 3) decrease the number of steps
that do not add value, and 4) improve employee satisfaction through
equalized standards, adequate skill mix and appropriate clinic-specific
functions. Clinic waiting times following implementation were improved
by as much as 47 percent in some areas. Immediate improvement was evidenced
in patient satisfaction and reduction in the wait for the next available
appointment, and all aspects of the pilot are being evaluated on a quarterly
basis. This extensive project is viewed as a significant improvement
in the manner in which business is conducted at Olive View and further
expansion to other clinical areas within the hospital is underway.
CONGRATULATIONS TO OUR WINNERS!
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