Defying Logic, Until Now

Last Friday, I was in the Triple Aim Coordinating Council meeting and we were reviewing patient satisfaction results for Home Care.  The results were excellent and we have been awarded a five star rating for Home Care at WMHS. (Great job on everyone’s part in Home Care!)  

What had defied logic was the percent satisfied for the “would you recommend this service to your friends and family” question. The results of every previous question were over 90% extremely or very satisfied; the "recommend" question result was 85%.  We see the same pattern with our hospital satisfaction survey results; the great majority of results are so much better than the results for the "recommend" question.  

The Council members were scratching their heads and saying that this defies logic.  Dr. Steve Smith raised his hand and said he knew why patients answer that question the way they do.  He continued, “the great majority of patients don’t want to be in the hospital, in Same Day Surgery or being visited by Home Care nurses. They are not extremely satisfied, very satisfied or even somewhat satisfied that they are in the condition that they are in." 

Obviously, they are pleased with the care as reflected in the other patient satisfaction results.  However, in this case they are not recommending a hotel, a car dealership or a restaurant, they are saying you don’t want to have heart disease, cancer, hypertension, diabetes and the list goes on.  Hmmm, great answer! Dr. Smith solved a long standing conundrum for those of us who look may be too close to look at the results objectively.  Thanks, Steve!

Remaining Relevant

The other day, I had a conversation with an employee who was complimenting me on ensuring that WMHS has remained relevant in this ever changing field.  My response was “it takes a team of people to accomplish what we have at WMHS and you are an integral part of that achievement.”  I meant every word of my response as it is so very true.  Leadership can have a vision for the organization, but it takes a board of directors to support that vision and a team of managers, providers, staff members, volunteers, contractors, students and others to execute that vision. 

When I arrived at work this morning, there was an article on what is the most important characteristic in a CEO that had been emailed to me overnight .  According to the article, it is ensuring organizational relevance.  Very timely.  The article talked about ensuring that the organization is in a better place as we deal with a resistance to change and an uncertain future in health care.  

At WMHS, we have certainly overcome any resistance to change.  First, there was the formation of the health system almost twenty years ago.  With the average tenure of a WMHS employees, many of us have been an integral part of that very historical change.  It was certainly a very challenging time for everyone involved, but it was certainly the right thing to do for the preservation of health care in western Maryland.  

Then there was building of the new hospital.  There was the recognition that continuing to operate two aging hospitals, Memorial and Sacred Heart, was not in the best interest in the future of the health system.  Many would have questioned our sanity if we would have put close to $200 million into a facility that was over 40 years old or even more money into one that was landlocked on seven acres and whose oldest campus structure opened in the 1920’s.  By having a new state-of-the art facility located on a site different from Memorial or Sacred Heart also eliminated any opposition from those who were against the affiliation from the start and were expecting us to use one of the existing campuses.

Shortly after the new hospital opened, we then transitioned to value-based care delivery……….talk about change, wow!  We virtually changed every aspect of how we deliver care.  That change took a while, but eventually our staff got on board and now change is embraced system wide.

For all health care providers, the uncertain future is still in play, but at WMHS, we are working every day to ensure that we remain relevant well into the future.   We are continuing to preserve and grow our market share, which is a requirement of the Total Patient Revenue payment methodology established by the HSCRC.  There are several providers from outside the area who are flexing their strategic muscle in an attempt to move market share away from us and in their direction.  As revenues continue to decline, such encroachment will continue, but it is up to us to ensure that doesn’t happen. 

Remaining relevant has never been more critical for hospitals and it is up to all of us to ensure that we are both focused and optimistic about our future.  As I told the complimenting employee, it takes a team and I can’t think of a better group of people to make sure that we continue to be relevant well into the future.

We Have Become the Donald Trump and Bernie Sanders of Health Care

In the most recent issue of Hospitals & Health Networks magazine, there is an article entitled, “Should Hospitals Learn from Donald Trump and Bernie Sanders?”  I love this article that was written by Stanley Hupfeld because it puts into perspective what Western Maryland Health System has become.  We have done what Trump and Sanders have successfully accomplished so far in this year’s presidential election.  They are not the traditional presidential candidates; and in this upcoming election, a traditional approach pretty much counts for nothing.  

At WMHS, we are no longer the traditional hospital.  Sure, we still do surgery, we deliver babies, we have an Emergency Department and we care for patients who are acutely ill.  But we are also the safety net for our region, we deliver care based on value instead of volume and more care is being delivered in alternate settings outside the acute care setting than ever before.  We are delivering care in nursing homes, we provide coordination of our patients' care in physician offices, we provide follow-up care at no cost to patients in an effort to keep them out of the hospital and we grow fruits and vegetables for those who are most vulnerable in our community.  

The two charts below depict how care is delivered in the traditional hospital, which is pretty much the great majority of hospitals across the country (although change is coming) and how it is delivered at WMHS.  More care is now being delivered in partnership with others, many of whom were previously our competitors.  We have reduced readmissions, unnecessary admissions, ED visits, ancillary utilization and short stays on the Observation Unit.  

Six years ago when we started value-based care delivery at WMHS, there were over 1,970 patients accounting for $140 million of our cost each year.  Last year, it was 1,300 patients accounting for $80 million of our cost.  Our patients are being cared for better and many who are the sickest of the sick are now experiencing a better quality of life.  Moving away from the traditional approach has certainly benefitted Trump and Sanders so far.  We have been bucking the traditional approach to care delivery for the last six years and our patients and our health system have certainly benefitted.