At Presentation Medical Center: Culture Impacts Success

July 2018
National Rural Health Resource Center (The Center)

Presentation Medical Center (PMC) is a 25-bed, not-for-profit Critical Access Hospital (CAH), providing acute care, emergency medicine, swing bed, rehabilitation therapies, imaging, lab, surgical services and primary/specialty care to the residents of Rolla, North Dakota and surrounding communities. PMC is an affiliate of Sisters of Mary of the Presentation (SMP Health System), a Catholic healthcare system based in Fargo. Founded in 1939 as Rolla Community Hospital, PMC continues to provide quality care to generations of families. “At PMC we provide our patients with the best care possible at a local level, making sure our patients receive the needed help, preventive measures, and necessary services to live a healthy lifestyle and grow within a healthy community.”

Matt Mendez and Lindsay Corcoran, consultants with Stroudwater Associates, worked with PMC in 2017, through the Small Rural Hospital Transition (SRHT) project, on a Strategic, Financial and Operational Assessment (FOA). Center staff spoke with Chris Albertson, CEO; Wade Burgess, QI Director; Mandy Swain, Administrative Assistant; Lori Martinson, CNO; Sarah Gailfus, Clinic Manager and Nicole Wilkes, Director of Care Coordination, at six and twelve-month post project to discuss the implementation and outcomes of the consultant recommendations.

Pictured front row: Mandy Swain, Administrative Assistant, Chris Albertson, CEO, Lori Martinson, VP of Patient Services, Paula Wilkie, CFO; back row: Sarah Gailfus, Clinic Coordinator, Nikki Wilkes, Director of Care Coordination; not pictured: Wade Burgess, VP of Quality

Senior leadership is guided by the principle that progress is most effectively accomplished by starting with a strong and engaged leadership team. This team firmly believes that the culture (how we do things and who we are) impacts outcomes so a thriving and caring culture is of utmost importance. The leadership team is responsible for shaping this culture. Chris Albertson, CEO, has experienced this for over 17 years. Taking over as CEO in October 2017, he started at PMC in 2001 as a respiratory tech. His focus as CEO is to create a warm and welcoming culture which values all staff while still expecting accountability. He laid out a vision for the future and talks about vision and values a lot! He uses these to make decisions daily.

Q: Tell us about the implementation of this project and what kinds of things you found to be successful.

A: This is a team that believes “execution is the key to success.” Each Thursday, leadership review progress and next steps for different projects and the SRHT project is a focus one Thursday a month.

PMC focused to elevate quality as an imperative in their culture. Knowing that staff has a direct impact on patient experience, everyone…leadership and staff, are invited to attend a monthly HCAHPS webinar series. Quality is a standing topic in town hall meetings, monthly newsletters and new employee orientation. Departments share their quality dashboards with staff. Follow up phone calls to patients approximately 24 hours post discharge focus on “exit care” for discharge and discuss follow up appointments, taking medications, etc.  Pharmacy reviews medications prior to discharge with patients in an effort to increase understanding and compliance. The CEO rounds on new patients. The hospital’s electronic message board includes quotes on quality and is also a vehicle to encourage patients to complete HCAHPS surveys, “help us to help you.” PMC created a new position for a quality director. Knowing that collection and sharing of information is critical to quick course correction, dashboards were created and that info is shared quarterly with medical staff and board of directors. PMC plans to join an ACO January 2019.

A second focus is growing the swing bed program. PMC reports noteworthy progress, moving from a pre-project average daily census (ADC) of 0.7 to post-project ADC of 5.5 patients. They accomplished this by involving their director of care coordination in outreach. They revised the program brochure, increased local and mass marketing, held formal and informational conversations with providers and continue to engage their own medical staff in this goal. The community is fortunate to have more choice to receive this care locally since the hospital is now able to accept more complex patients. Their next focus is to remove transportation constraints for this group of patients.

To reduce reliance on agency nursing services, PMC focused on improving the culture for the current staff. They believe their renewed focus on quality and creating a helpful and welcoming environment is impacting both the retention of current staff and recruitment of new staff. A first step was to adjust the nurse wage scale in hopes of receiving new applications; they recently had two applications after having none for years! In addition to hiring full-time time nurses, they are cross training so that nurses are nimbler and can meet patient demand of the med-surg and emergency department. The CEO reached out directly to prospective nurses to come back to the hospital. They bought out some travel nurse contracts and hired them as their own. They recently held a pizza party for being travel nurse free!

Expansion of clinic services to better meet the community is another focus. PMC addressed operational efficiencies by creating some scripting for key interactions, more labs completed prior to seeing providers, scheduling routine exams one year out and creating standard follow-up sheet. They also increased marketing and utilize Facebook, radio advertising and community presentations. They continue to recruit providers and are considering extended and Saturday hours.

To support the growth of the hospital, more attention is paid to management and provider accountability. They now hold department operating reviews to look at variances. The clinic provider dashboard is shared with CEO monthly and there is consideration of implementing RVUs. Future possibilities include setting a budget at beginning of the year with a goal of profitability which could result in a bonus for all staff and exploring ways to hold managers more accountable for quality scores.

Q: What are the ways this project has impacted your hospital culture?

A: The non-measurable outcomes include:

  • Moving the culture in the right direction
  • Increased accountability of leadership
  • Utilizing the SRHT action plan as an ever-evolving roadmap for the future

Q: What progress did PMC make on measurable outcomes?

A: PMC reports progress on all measurable goals. Total margin increased by almost 3% and net patient revenue increased by more than 2.5%. Days cash on hand increased by 14 days. While not on Hospital Compare, patient experience scores, for "rate the hospital" and "willingness to recommend" both improved, meeting their set goals. 

Q: How has this project assisted PMC to move forward in the emerging model of health care?

A: “Understanding that we have to focus on quality and focus on making it a part of our culture and the focus on services such as swing bed.”

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