Pender Community Hospital (PCH) is a 21-bed, not-for-profit, Critical Access Hospital (CAH), providing acute care, swing bed, emergency medicine, rehabilitation therapies, imaging, lab, surgical services, and primary care to the residents of Pender, Nebraska and surrounding communities. In addition to the services listed above, PCH operates four rural health clinics (RHCs) and a robust specialty care clinic. PCH has a sister organization that operates the nursing home, assisted living, retail pharmacies, and child development center.
Carla Wilber and Lindsay Corcoran, consultants with Stroudwater Associates, worked with PCH in 2017 through the Small Rural Hospital Transition (SRHT) project on a Transition of Care and Quality Improvement Project. Center staff spoke with Melissa Kelly, CEO, in September 2018 and again in February 2019 to discuss the implementation of the consultant recommendations.
Q: Tell us about the implementation of this project and what kinds of things you found to be successful.
A: To move quality forward, PCH chose to create and hire a chief operation officer (COO) position. The hospital has experienced much growth following participating in a Financial Operational Assessment (FOA) in 2015, so there was a need to regroup as a team. He will oversee quality, rehab, ancillary, and other areas. Now that he is onboard, the administrative team has a little more breathing room. They feel that refocus on improving discharge composite of HCAHPS and developing ways for quick and frequent feedback to staff. They complete more frequent audits as needed to get the results they want to get. Beginning to see good results in patient experience and other areas. Plan to continue with frequent feedback until they get this hardwired.
PCH has worked diligently this past year to obtain Patient Centered Medical Home (PCMH) status. They recently completed final documentation for 4 of the clinics and there is an indication that the Pender clinic passed but haven’t received the final certificate. Remaining three clinics are pending but are expected to be fine. PCH revamped many processes, especially around closing the loop on referrals. They formalized the more informal processes and tightened documentation.
An additional focus for the QI Project involved electronic health record (EHR) functionality improvements. PCH has conducted a strong campaign to increase enrollment in the patient portal to allow additional conversations with providers. They are beginning to see more engagement through younger providers: panel enrollment increased from 25 % to 35% and the goal is 45% by June 30.
The team continues to address discharge issues. They plan to re-evaluate questions asked for post-discharge phone calls. One effort to improve discharge scores is the creation of “Managing My Health” which is in their medical record and summarizes pivotal tasks such as dressing changes, appointments, and medications. During follow up appointments, the provider can easily view this form, so they can ask patients about it. PCH is currently overhauling discharge folders. Additionally, they are using teach-back methods in all areas. They provided house-wide training for clinical and non-clinical staff. They are using this method as a process to be used any time they are training someone, clinical or not. They consistently ask themselves, “How can we use this in other settings? For example, we look for ways to use with retention or for new employees to teach a task.”
Q: What are the ways this project has impacted your hospital culture?
A: Melissa Kelly states, “Like with the FOA, this project will be ongoing. Finishing one piece creates new initiatives. We don’t say ‘we can’t’anymore. We just figure out ‘why not.’” One exciting success for PCH is the recent acquisition of the da Vinci robot! They are the only CAH in Nebraska to have one. Prior to SRHT projects, Kelly states that they would not have believed something like this would be possible.
PCH measurable outcomes in this project include several measures that are better than the national average:
- Readmission rate is 2.5%; national average is 15.3%
- HCAHPS composite score “Patients who Strongly Agree they understood their care when they left the hospital” is 83.5%; national average is 53%
- HCAHPS “rate the hospital” is 93.5%; national average is 75%
- HCAHPS “recommend” is 95%; national average is 74%
Non-measurable outcomes include:
More buy-in from providers since they are seeing positive results of more individuals using portal; able to respond to them more quickly
“Accountability piece with staff and how this builds momentum. Staff step up and it builds on itself. Once you find a little piece to make improvement on, it’s amazing the things staff come up with to continue the improvement.”
Staff are more active participants in improvement and become engaged in making better things happen. For example, many staff focused on process mapping of discharge huddle identified a couple small things they could improve. For instance, they changed the time of huddle to accommodate one person who couldn’t attend and that’s made all the difference in the world.
Q: Lastly, how do you believe this project has helped you move forward in the newly emerging system of health care delivery and payment?
A: “Push for PCMH will propel PCH forward. That will be key to being paid for value. Feel better prepared for conversations with other providers about our high level of quality which might surpass other’s quality or if not, will request information about how we can improve.”