SSM Health Care shares its best practices

As part of St. Louis-based SSM Health Care’s (SSMHC) "Clinical Collaborative" process, physicians work with other caregivers, administrators, and staff to make rapid improvements in clinical outcomes.

Selection of clinical collaboratives occurs in alignment with system goals, such as improving patient outcomes and satisfaction and improving patient safety. SSMHC has undertaken six collaboratives involving 85 teams in 2002, up from 14 teams in 1999. The results for SSMHC’s clinical collaboratives for patients with congestive heart failure and ischemic heart disease demonstrate levels that approach or exceed national benchmarks.

In addition, CARE PATHWAYS, protocols, and standing orders are used to outline a standardized plan of care for SSMHC’s patients. These tools are designed with patient input and are intended to create partnerships with physicians to improve patient care.

SSMHC collaborative hospitals have maintained a high level of Coumadin treatment for patients who have congestive heart failure and atrial fibrillation to prevent blood clots.

More than 80% of SSMHC patients are on Coumadin treatment compared to the benchmark of 60%. Also, SSMHC has attained national benchmark levels of patients receiving lipid-lowering agents to decrease morbidity and mortality in patients who have suffered a heart attack.

AA Credit Rating

For the fourth consecutive year, SSMHC has maintained an investment grade rating in the "AA Credit Rating" category (published by the two national rating agencies — Standard & Poor’s and Fitch). This rating is attained by less than 1% of U.S. hospitals.

The SSMHC systemwide "Healthy Com-munities" initiative was launched in 1995 to leverage the system’s resources with those of the communities it serves.

SSMHC requires each of its entities to actively engage in one or more community projects such as free dental clinics and campaigns to reduce smoking and drinking among teens. It encourages and supports employees at all levels of the organization to participate on teams involved in identifying opportunities for community outreach.

In addition, SSMHC provides a significant amount of charity care to improve the health of the communities it serves.

Since 1999, SSMHC has exceeded its charity care goal of contributing a minimum of 25% of its operating margin from the prior year.

Currently, SSMHC is providing in excess of 29% of the previous year’s operating margin to provide care to communities that are economically, physically, and socially disadvantaged.

SSMHC’s Strategic, Financial, and Human Resource Planning Process (SFPP) is comprehensive and begins with the board of director’s review of vision and mission statements and corporate planning’s survey of the key participants from the previous year.

The process extends over a 12-month cycle and involves all of the organization’s networks, entities, and departments. Three-year (long-term) and annual (short-term) planning horizons are used. System management sets and communicates systemwide goals to each entity and provides standardized forms and definitions to ensure a consistent format and alignment of plans with the system’s overall goals.

Department goals are further cascaded to the employees, with individual "passports" reflecting individual goals that support the department goals.

Every three years during the SFPP, environmental scanning is used to identify and plan for potential customers, customers of competitors, and future markets. The scan includes market research, analysis of market share by product line, population trends, and an inventory of competitors, which includes their market share trends and competitive positions.

In addition, data from annual medical staff surveys, patient satisfaction surveys, physician contacts, literature searches, telephone surveys, and focus groups of competitors’ customers are used.

SSMHC’s share of the market in the St. Louis area increased over each of the past three years to 18%, while three of its five competitors have lost market share.

SSMHC has established formal and informal listening and learning tools for former and current patients and their families; surveys are customized for each of the key segments.

Tools include:

  • satisfaction surveys;
  • market research;
  • comment cards;
  • complaint management system;
  • patient follow-up calls;
  • Internet response system.

In addition, SSMHC assesses potential patients and future markets through a variety of tools.

SSMHC uses an automated system to make clinical, financial, operational, customer, and market performance information available to all of its sites. For example, SSMHC makes data available to physician partners from any location via multiple devices, including personal computers, personal digital assistants, pagers, and fax machines. Connected physicians have increased steadily from 3,200 in 1999 to 7,288 in 2002.

SSMHC uses a continuous quality improvement (CQI) process design model to design its key health care, support, and business processes.

A CQI process improvement model is used to make improvements to existing processes. For example, employee satisfaction data, internal customer feedback, and outcome and in-process measures are used to facilitate rapid identification and correction of potential problems.

SSMHC tailors employee benefits to provide flexibility and respond to women employees who make up 82% of its work force.

The health system also offers:

  • flexible work hours;
  • work-at-home options;
  • long-term care insurance;
  • insurance coverage for legally domiciled adults;
  • retreats;
  • wellness programs.

Tuition assistance and student loan repayment programs are highly regarded as significant benefits differentiating SSMHC from its competitors. SSMHC’s turnover rate for all employees has improved from 21% in 1999 to 13% as of August 2002.

SSMHC has maintained a continuous focus on increasing the number of minorities in professional and managerial positions. Minorities in professional and managerial positions increased from almost 8% in 1997 to 9.2% in 2001, considerably better than the health care industry benchmark of 2%.