St. David's Medical Center in Austin, Texas has undergone a cultural transformation to improve performance on value-based purchasing metrics like core measures and HCAHPS scores. They evolved from focusing only on reporting metrics to developing an organizational culture where everyone takes accountability for living the values of patient excellence. Tactics used include staff education, process improvements, physician engagement, and emphasis on accountability at all levels. As a result, St. David's saw improvements such as reducing core measure misses to near zero and increasing HCAHPS scores over 4%. Sustaining this culture will be key to higher performance and financial rewards under value based purchasing in the future.

1. Value Based Purchasing:
Value Based Purchasing: St. David s Medical Center (SDMC) located in Austin, Texas, is part of St.
St David’s Medical Center (SDMC) located in Austin Texas is part of St
David’s HealthCare, one of the largest health systems in Texas. St. David’s
From Rule to Reality Medical Center includes a 351 bed acute care hospital and a dedicated 64
bed Rehabilitation hospital. St. David’s Medical Center is a Primary Stroke
One Hospital’s Journey Center and Certified Chest Pain Center.
Susan Griffin, RN, MSN, CENP
Chief Nursing Officer
St. David’s Medical Center
Austin, Texas
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THE SDMC JOURNEY: SDMC CORE MEASURE COMPLIANCE SAMPLE TACTICS:
From 2003 Deficit Reduction Act Detailed nurse leader and staff education on rule and how to accomplish
– Pay for reporting mindset – Core Measures compliance
To Final Rule May 6, 2011
– Currently encompasses Innovated use of nursing status board in nursing EMR to flagging Core
• Year 1 Measure patients and issues
70% Core Measures
30% HCAHPS
30% HCAHPS Core Measure patient census report auto prints twice daily for charge nurse
Core Measure patient census report auto prints twice daily for charge nurse
• Year 2 oversight
20% Core Measures
30% HCAHPS Flow charts created and posted in every OR on Beta Blocker and timely
antibiotic administration/selection
50% Other Mortality(AMI,HF,PN), Patient Safety Indicators, HAC’s
• Years 3 – 8
Misses shared in unit huddles/staff meeting
Readmissions included
Witholds increasing to 6%
Every staff member involved in miss meets with CEO/CNO
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SDMC BIGGEST IMPACT: CORE MEASURES
Measure CMS Top Quarter 1 Quarter 2 Quarter 3 Quarter 4
Success tied to culture and accountability at every level 10% 2011 2011 2011 2011
“It’s the right thing to do for our patients”
Acute
Myocardial
Evolved from a quality department owning culture to an everyone owning 100 100 100 100 100
Infarction
culture (AMI)
– CNO/CMO presence and actively involved in weekly Core Measure mtg
/ p y y g
Heart Failure 99.64 98.7 99.02 99.02 99.57
with quality/nursing/CMO
– Physicians engaged Pneumonia 98.84 99.68 99.3 98.29 100
• Hospitalists Surgical Care
• Anesthesiologists Improvement
99.16 98.97 99.62 99.87 99.85
Program
– Staff Engagement (SCIP)
Goal: Reduce Misses to ZERO:
– 38 misses in 2010
– 25 misses 2011
4 – 5 misses 1st quarter 2012 5
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2. SDMC HCAHPS “ODYSSEY” 2006 ENGAGED STUDER GROUP
HCAHPS QUARTER TO DATE SUMMARY
HCAHPS Quarter to Date Summary
Tools for Service Excellence HCAHPS Top Box
Ntl Ntl Ntl
– AIDET HCAHPS Summary Measures Avg 75th 95th
Q1 11 Q2 11 Q3 11 Q4 11 CHG
Communication with Nurses
– Key words at key times 76% 80% 86% 79% 84% 79% 82% 3%
Communication with Doctors 80% 84% 89% 86% 84% 82% 82% 0%
– Managing Up
Responsiveness of Hospital Staff 64% 70% 81% 60% 69% 64% 68% 4%
– Service Recovery
Pain Management 69% 72% 78% 78% 77% 78% 76% -2%
– Rounding Communication About Medicines 61% 65% 73% 65% 67% 67% 68% 1%
– Bedside Reporting Discharge Information (% Yes) 82% 86% 89% 87% 89% 87% 91% 4%
– Service Validation Cleanliness of Hospital Environment 72% 76% 85% 72% 74% 70% 74% 4%
• Leader Rounding – All Levels Quietness of Hospital Environment 58% 65% 77% 64% 66% 68% 69% 1%
• Discharge Phone Calls Overall Rating of this Hospital 68% 73% 83% 76% 81% 79% 80% 1%
• HCAHPS Willingness to Recommend this Hospital 70% 76% 86% 78% 85% 81% 81% 0%
Grand Composite (Avg of 10 domains) 70% 74% 81% 74.5% 77.6% 75.5% 77.1% 1.6%
Tools/tactics/accountability are good but to achieve an “always” culture requires
sustained cultural transformation
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OUR I‐CARE VALUES, MISSION, VISION, GOALS AND BEHAVIORAL CULTURE EATS STRATEGY FOR LUNCH BUT STRATEGY +
STANDARDS : DEFINE THE CULTURE > DTC CULTURE = WINNING COMBINATION
Now, we must live the culture > LTC
Investing Time in Culture Development Yields Tangible Benefits:
“Unless we hold one another – Our words and actions line up with our
I‐Care values and behavioral standards
accountable for living our
culture, we will not sustain We also must manage the culture > MTC • Focus – aligns organization
p
patient satisfaction – We hold one another accountable for living
our culture in our actions
lt i ti
excellence” and words • Motivation – builds loyalty and pride
Our Expectation: Leaders and peers are
empowered to correct poor performance
quickly and on the spot if necessary • Connection – builds Team cohesion
Susan Griffin
Chief Nursing Officer
St. David’s Medical Center • Spirit – shapes behavioral consistency
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CULTURE SETTING TACTICS:
What an excellent culture can yield in valued based
New Employee orientation and training on culture and
expectations purchasing
New employees meet Executive Team and cultural Example: 300 Bed Hospital
expectations reinforced by CEO 1% withhold at risk $500,000
Potential Earn back $760,000
Leader Rounds Net Improved Earning $260,000
Employee Meetings
Hire and exit employees around cultural expectations
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3. CLOSING THOUGHTS:
Questions or Comments?
Higher performing hospitals will be rewarded
Lower performing hospitals will be penalized
Nursing’s role is central to all value based purchasing outcomes
N i ’ l i l ll l b d h i
A culture of excellence is imperative for sustaining excellent
results
CNO’s play a key role in driving cultural transformation
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