Healthcare in the United States is the most costly in the world and experiencing a cost-driven margin challenge with record cost growth since 2009. And reimbursements from government funded programs such as Medicare and Medicaid are now tied to patient satisfaction and quality and safety outcomes. To remain relevant and compete with new and pioneering competitors, health care organizations must reduce the cost of operations and identify new ways to deliver care.
Atrium Health has local, regional, national and international competition for patients. Yet, as a not-for-profit health system, we treat anyone who seeks care regardless of their ability to pay. We strive to provide a consistent experience no matter where or how patients access our care. With more than 40 hospitals and 900 care locations, reducing variation and ensuring consistency in service and quality will ensure our success.
This case study represents Atrium Health's submission to the i4cp Next Practice Awards. The awards were presented at the
i4cp 2019 Next Practices Now Conference.
Top quartile performance in Quality and Safety, Patient Experience, Teammate Engagement and Efficiency and Throughput is critical to our mission and vision. However, each of these areas, led by separate departments, were operating in silos and had great variation in performance across the System. For example, a facility in the southern region would rollout one version of a customer service model and a facility in the north would rollout a completely different model. This resulted in variation in patient experience and quality scores. Existing education content was also silo’ed, with content focused solely on the topic it covered – Quality and Safety or Patient Experience, as examples. Existing education was also duplicative and time consuming for our team members with the most important job – taking care of our patients.
Senior leadership brought together an executive council representing each area to address performance in these key metrics, reduce redundancies and conflicting work. One of the top areas and early wins identified as benefiting standardization was education.
The Learning and Organizational Development (L&OD) team was brought in to analyze the current state of education in these four areas, identify gaps and build content to fill those gaps. What we uncovered through the review of existing content, metric performance, focus groups and stakeholder interviews was tremendous duplication and lengthy content. Many of the processes and skills identified as critical were not documented or easy to find. Teammates were overwhelmed and frustrated.
The L&OD team spent 3 months (Oct-Dec 2017) building a curriculum of 37 on-line mini-courses to fill the gaps and standardize the content. Each mini-course is 5-7 minutes and mobile-enabled for ease of access on the job. These courses focus on skills and behavior needs and so are applicable to all areas, and daily work, too. A centralized webpage houses all the tools, education and resources to give teammates one place to go that deep-links to our LMS. Competing education was also removed from existing locations. To motivate our largest patient-facing population, we added nursing contact hours. This was a tremendous win as nurses, like many credentialed professionals, are required to complete contact hours to maintain their certifications.
We learned from focus groups and interviews, education alone would not be enough to change behavior and results. Education needs to be coupled with an accountability system and adoption of continuous improvement mindset, behaviors and tools. We therefore also provided the following continuous improvement education and tools to help drive the change.
- Identify the Root Cause of a Problem
- Use PDSA for Process Improvement
- Minimize the 8 Wastes through Continuous Improvement
- Apply the 5S Process to Minimize Waste
- Education rollout Huddle Guide: leaders use to launch the education, resources and tools with their teams. Includes a Game Plan prioritization tool that assists leaders and teammates through the PDSA process.
- Quick Coaching Guides: one-page content summaries of each mini-course to include - evaluation rubrics and coaching and discussion questions for leaders to use after the team completes the course.
We also offer a first of its kind virtual coaching program for front-line nurse managers working in our hospitals – our audience with the broadest responsibility for achieving goals in the four areas. This 6-month engagement provides 1:1 virtual coaching support to each nurse manager participating. The coach assists the nurse manager in the PDSA process for up to three goals using the tools and resources. This program has been invaluable to these nurse managers. It has helped keep them focused on addressing barriers (including personnel) and promoting bright spots.
The education launched in January 2018 with one 20-minute eLearning required for all leaders and team members that provides an overview of how the four areas of Quality and Safety, Patient Experience, Teammate Engagement and Efficiency and Throughput are connected. From there, leaders use the tools provided and work with their teams to identify the skills they need to build.
Prior to the launch, we offered webinars to HR business partners that further explained the “What” and “Why” of this initiative. During the launch, we offered similar webinars to leaders and met with the executive teams at many of our hospitals.
The 20-minute elearning is also assigned to all new hire leaders and team members.
At Atrium Health we use a Scorecard to measures our progress toward our goals. Leaders can view organization level results and can also drill into the scorecard to see their specific results. Or someone else’s results, this tool provides transparency we haven’t had in the past. This scorecard is one of many tools available to leaders to help them identify their focus area for their Game Plan.
In the first 3 quarters of 2018, the 37 mini-courses have been accessed more than 57,000 times. Variability in education is down 400 percent and we have improved our patient experience scores from below target to now exceeding our stretch goals.
The education tools and resources continue to be utilized to build skills and behaviors. All new leaders at Atrium Health attend a one-day workshop where they learn what it means to lead at the organizational level and receive information about tools and resources available to help them navigate our systems – one such tool being this education.
We continue to add mini-courses as needs are identified. Example: when the Scorecard tool was launched with our leaders minimal information about it was communicated. L&OD created two mini-courses which provide education about how to use the Scorecard toward continuous improvement and how to navigate the tool.
Additionally, and based on feedback, we tweaked the virtual coaching program to include the leader of each nurse manager in the kickoff coaching call to build ownership and buy-in. We also introduced group sessions as an opportunity for the nurse managers to collaborate.