Rural facility receives Baldrige for 2006
Rural facility receives Baldrige for 2006
Culture of 'Servant Leadership' at core of success
Quality leaders at North Mississippi Medical Center in Tupelo say the creation of a culture of "Servant Leadership" is one of the main reasons it has become the first rural health care facility to win the prestigious Malcolm Baldrige National Quality Award, earning the 2006 distinction for organizational performance excellence in the health care category.
Servant Leadership encourages individuals to serve first and then lead as a way of expanding service to others. It is what the facility calls "a no-secrets, no-excuses, open communication environment."
"Jim Hunter is the current leader of this thought process and has been here leading our effort, so that all our leaders adopt attitudes of humility, of being good listeners, and of trying to meet peoples' needs rather than their wants," explains Karen Koch, PharmD, MHA, director of research. (Hunter is the head of J.D. Hunter Associates, LLC, a leadership training and development firm.)
"It takes the employees who thought they were at the bottom of the barrel and puts them in a position of influence," adds Jan Englert, RN, director of clinical outcomes.
A servant leader listens and shares authority and empowers their staff, Koch adds.
This approach, in turn, has led to the sharing and dissemination of ideas.
A computer-based program called "Idea for Excellence" allows individuals to make suggestions for improvement. "Every idea is read by the president and disseminated," explains Englert. "So, for example, if you look at our complication rates in any given area, these things pop out at you and you ask yourself what can be done to improve them. Then, you realize it may not apply just to one specific population but to all populations."
Care-based management
The facility's mission, vision, and values are translated into measurable actions through five critical success factors: people, service, quality, financial, and growth.
These success factors are then organized into service lines. The quality leaders also have coined a phrase to describe their process improvement approach: Care-based management.
"For years, people have looked at managing costs by looking at the cost of personnel, capital equipment, and supplies, and doing all they can to manage those costs — i.e., reducing capital expenditures, supply costs, and so forth," notes Koch. "What we've done is control or manage costs not by those changes, but by improving processes, reducing variation and complications. By doing that, we are able to actually provide better care — with reduced costs."
In terms of quality, she says, that means examining processes and making sure that whatever they do is state of the art and evidence-based.
Showing real results
The team at North Mississippi has undertaken a number of initiatives that have demonstrated the use of Servant Leadership and care-based management to both improve processes and reap financial rewards. One such initiative involved deep vein thrombosis, or DVT.
"A patient can be at risk for developing DVT just because they are in a hospital; and there are other risk factors as well," notes Englert. "Our front line people, including one of our pharmacists and nurse outcomes managers, developed a process to hardwire both screening patients for their risk of DVT and then putting into action a process whereby the patient's physician would have to respond to a finding that their patient had high risk factors."
In other words, she explains, the physician had to either say what their treatment would be or put in writing why a given treatment was contraindicated.
Engaging physicians
"In the first eight months, there was a 65% decrease in the incidence of DVT," says Englert. "The team associated about $760,000 worth of cost savings with that decrease; this is making the business case for quality."
The initiative also demonstrated the value of Servant Leadership, she continues. "In a traditional organization, a person at the caregiver level can have a great idea for how to do something different, but it may never get above their team of co-workers," says Englert. "In this organization, that particular idea was tremendous and came from a front-line pharmacist; these were small teams that got together. It actually started with stroke patients, but it was such a good idea it became the standard for all patients."
Despite all the process changes that have been implemented at North Mississippi, Koch feels this level of success would not have been possible without physician engagement. "Without the docs on board and wanting that comparative information on how they are doing, we might not have a quality program, but just a lot of nurses and pharmacists running around with notes to remind them what to do," she says.
Koch and Englert agree that Ken Davis, MD, the chief medical officer, is behind this success. "Engaging physicians was his forte," says Englert. "For successful engagement, you need a physician champion; then, you need reliable data, and someone with some clinical expertise and respect presenting it to the physicians. Dr. Davis says that throwing in a meal and playing on their competitive spirit doesn't hurt, either."
Englert says the physicians are shown their own performance data, how they compare with other physicians, and what the standard of care is for a given population. "We talk about it, and it's amazing how much they want to do better," she says.
They also are sometimes surprised by the data, Englert continues. "One of our physicians was blown away by his data; he had no idea he was only prescribing ACE inhibitors 39% of the time. He would have told you he was doing it 100% of the time, because he thought he was," she observes.
Koch agrees that data are the key to physician engagement. "The data makes it personal and a little competitive," she notes. "They do not want to be left behind."
Koch says that any facility can replicate these accomplishments, and that the Baldrige award will help underscore that point. "We really feel a humility and a blessing in the fact that we are a rural health care facility, and that [the award] gives other folks the message that you don't have to be in a big city or have a lot of resources at your fingertips, to have a quality health care system," she says. "One of the greatest things about the Baldrige honor is that folks can say, 'If people in Mississippi can do it, we can, too!'" she concludes.
For more information, contact:
Jan Englert, RN, Director of Clinical Outcomes, Karen Koch, PharmD, MHA, Director of Research, North Mississippi Medical Center, 830 South Gloster Street, Tupelo, MS 38801. Phone: (662) 377-3000. E-mail: [email protected].
Quality leaders at North Mississippi Medical Center in Tupelo say the creation of a culture of "Servant Leadership" is one of the main reasons it has become the first rural health care facility to win the prestigious Malcolm Baldrige National Quality Award, earning the 2006 distinction for organizational performance excellence in the health care category.Subscribe Now for Access
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