For leaders of Via Christi Health of Wichita, Kan., the opening of a new hospital has provided a rare gift: a blank slate on which they can map out new ideas — and determine whether the ideas work and could benefit other facilities in the system.
The 68-bed Via Christi Hospital on St. Teresa, which has all private rooms, opened in west Wichita a year ago. From the design phase forward, the system's leaders have viewed the facility as a demonstration lab for campus design ideas, protocols, practices and staffing models that are new to the system.
Located about 20 miles from Via Christi Health's offices and about 150 miles from the farthest of its 12 affiliated hospitals, Via Christi Hospital on St. Teresa has been a frequent subject at the quarterly meeting of its hospital presidents and at other senior executive meetings; and "many of the leaders from our executive team make routine rounds at Via Christi Hospital on St. Teresa, including members of the board of trustees," according to Melissa Evraets, the hospital's administrative nursing director.
At the presidents' quarterly meeting, according to Kevin Strecker, president and chief executive at the new hospital, they've been talking since plans began for the new hospital about what technology and processes could be deployed there and evaluated for use at other facilities.
It's not just top executives who have been keeping their eye on the hospital, Evraets said. "Leaders from multiple departments and other ministries around Via Christi consistently suggest ideas for our hospital."
The system's business development group also proposes ideas to be tested there and the staff work to accommodate the requests as they come in, Strecker said.
From the ground up
Strecker said that the Via Christi team that designed the new hospital questioned prevailing system and industry assumptions and practices on everything from campus layout to equipment selection to unit policies and procedures. Evraets explained, "We challenged every process to determine how it could be streamlined or made more efficient."
Planners also consulted patients and community members. "Our hope was to gain insight into what it feels and looks like when a process or system works well from a patient's point of view," explained Evraets.
This process resulted in a campus layout that is different from the setup at other Via Christi facilities. Units that work most closely together are near each other. So, laboratory testing and radiology services, for instance, are located closer to the emergency department than to the inpatient units that use the services in lower volumes. "This, in turn, decreases (emergency department) patient wait times, which increases patient satisfaction," said Evraets.
Via Christi leaders are enthusiastic about some of the new care approaches being tested at their hospital on St. Teresa.
For example, all the inpatient units use a multidisciplinary rounding technique that normally is in common use only in ICUs in other hospitals, according to Evraets. At the lab hospital, a patient's entire care team visits the patient as a group once a day. Nurses, pharmacists, physical therapists, case managers and doctors gather around their patients' bedside to discuss the patients' care and to answer questions. This addresses a common issue in hospitals: patients and family members having to track down multiple clinicians to have questions answered and to ensure the responses they get are in sync.
These rounding teams have developed scripts so that they can ensure they cover certain bases with every patient. The scripts include entry points to bring the patient into the discussion. "Clinicians often used to talk about patients," said Evraets. "Now they're talking to them."
The hospital is evaluating these practices so Via Christi can determine whether to export team rounding to other facilities.
Via Christi Hospital on St. Teresa's leaders are using a nonconventional support services model that equips employees to perform more than one job. Art Huber, vice president of facilities at Via Christi Hospitals Wichita, said the aim of the approach is to improve services to patients and to increase scheduling flexibility. In most facilities of its size, people in support service roles — housekeeping, security, hospitality, food services and environmental services, among them — have distinct responsibilities. At Via Christi Hospital on St. Teresa, security guards fill in on the cafeteria cash register and housekeepers may be tapped to staff the lobby security desk.
Before putting the model in place, support services leaders engaged graduate students from Wichita State University and their faculty advisors to break down each support service job into its component tasks and determine the training required to perform each task competently. "The purpose was to identify cross-training opportunities where education and/or complexity were not barriers," explained Huber.
He noted that there was some push-back initially from some managers in the support department — some people wanted to protect their turf and some questioned whether the model would work. Huber explained that "by analyzing the jobs and breaking them down to the task level, we were able to demonstrate the similarity in job tasks and the training requirements for each job.
"Change in general is difficult," he added, "and we made every effort to mitigate the stress around change and reassure staff of the benefits the model will provide to them as well."
He noted it was helpful that the support staff employees were starting fresh with the approach — since this was a brand new facility — and the employees knew from the start that they'd be expected to learn other roles. He said it might be more difficult to implement the model in a facility in which employees are accustomed to one distinct role.
Service with a smile
Another new protocol put in place at the hospital on St. Teresa was a service expectations list. The 18-point list of expected behaviors includes guidance like, "I address those I serve with a formal greeting such as 'sir' or 'ma'am' upon first greeting...," "I steward my environment by picking up trash and properly disposing of it ...." and "I help meet the needs of those we serve by pausing to ask at the end of a service interaction, 'What else can I do for you today?'"
Hospital leaders created the list of service expectations by bringing together about a dozen exceptional employees and talking with them about what they do to make the culture of the facility welcoming. "They aren't groundbreaking ideas — they are common sense," Strecker said of the list.
Evraets added, "If you treat each other with kindness, it affects patient satisfaction and how we treat each other."
Strecker said that now that many of these new ideas, technologies and approaches are in place, Via Christi's business development team is developing metrics for assessing how successful they are in order to decide which ideas will move out of its west Wichita learning lab and into other sites. Strecker said that many of the metrics likely will include patient satisfaction surveying and staff surveying.
He said the ultimate goal is to find ways to make health care ever more patient-centric. "Our goal is to improve the patient experience," he said.
Via Christi Hospital on St. Teresa service expectations
- I address those I serve with a formal greeting such as "Sir" or "Ma'am" upon first greeting. After the first greeting I ask for their preferred greeting, and, if they are a patient, I write it on their whiteboard while explaining why I am doing this.
- I have a professional demeanor that promotes confidence in, and support of, my colleagues and me, using language that displays courtesy and respect.
- I keep those I serve informed of who I am by providing my name, how I serve, explaining what I will be doing, and asking if they have any questions at the start of a service interaction. I provide names and numbers of key individuals, including Registered Nurse, Certified Nurse's Aide, and Hospitality Associate. I explain procedures and processes and the reason for them before I do them in terms the people I serve understand.
- I promote a positive work environment and speak positively of my coworkers and workplace. I will refrain from being a party to rumors and gossip.
- I lead others who appear to need directions to where they are going by stating "I will take you there" and walking them to their destination.
- I promote a sense of ownership by finding solutions and state things like "I don't know the answer, and will find out for you." I will not pass blame or ignore issues. I will not say "It's not my job" or "I don't know."
- I clearly communicate with the patients, visitors and employees I serve to keep them informed of important functions as discharge planning, medications, care plans, etc.
- I provide a welcoming environment by making eye contact, smiling and verbally greeting each person as I come within 10 feet.
- I steward my environment by picking up trash and properly disposing of it, recycling when possible, reporting maintenance needs in a timely fashion, and ensuring an atmosphere of pleasantness and cleanliness.
- I help meet the needs of those we serve by pausing to ask at the end of a service interaction, "What else can I do for you today?"
- I promptly answer a call light no matter what my role is at the ministry.
- I create a sense of privacy for our patients by keeping curtains pulled and doors closed, when appropriate, and stating "I am closing this for your privacy." I knock prior to entering a room or office.
- I create a collaborative environment by directly addressing others in a timely manner when an issue arises, using positive problem solving skills to come to a resolution.
- I keep the customer informed by providing an explanation of the estimated duration of wait times and a brief explanation of why the wait time is occurring.
- I use good manners when using the elevators, including allowing people to exit the elevator before I get on and allowing patients and visitors to enter or exit the elevator before me.
- I demonstrate professionalism and patient focus by using my cell phone with responsibility, including refraining from personal calls and messaging with the exceptions of when they are cleared with my supervisor.
- I promote Human Dignity by displaying openness and responsiveness when interacting with patients, visitors and employees. I will refrain from using headphones and music players when I am in a patient care of public work area.
- I positively represent Via Christi on phone and email using good manners, answering all calls within four rings, and using standard greetings and wearing name badge above the waist.
Adapted for Catholic Health World.
Trying out technology
Via Christi Health also is using Via Christi Hospital on St. Teresa as a testing ground for technology that is new to the system.
The hospital's planning team members selected equipment that is on the leading edge — but not necessarily the "bleeding edge" — of health care. For instance, they decided to use radio-frequency identification tagging on all equipment. This enables clinicians to track with electronic tags where each piece of equipment is placed. That cuts down on time-consuming searches for missing equipment. The Via Christi system is listening to staff members' reviews of the tagging system and will use that feedback to determine whether to put it in place at other Via Christi facilities.
Also, the planners chose a call light system and related smart phone system at St. Teresa that direct patient calls to specific staff members based on the patient's particular need. The patient uses a remote with buttons labeled "water," "nurse," and "bathroom" for instance. This way, a request for toilet assistance goes directly to a nurse assistant, a food request goes to the kitchen. The system can handle voice calls, texts and emails. Call systems used at other Via Christi locations rely on staff members to route calls and messages to the appropriate team member, which takes more time and diverts their attention from the needs of other patients. While this type of technology is becoming more common at hospitals around the U.S., it has not yet been deployed throughout Via Christi, and so the system's leaders plan to document how well the technology works at St. Teresa to determine whether to use it elsewhere in the system.
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