Nearly a decade ago, when David Fox assumed the role of president and CEO of Advocate Good Samaritan Hospital, Downers Grove, Illinois, the Malcolm Baldrige National Quality Award-winning hospital held a somewhat moderate quality ranking. Employee satisfaction ranked in the 46th percentile and its physician hospital organization (PHO) was paying its practitioners 85% of Medicare.
Although the overall quality of the hospital was perceived as good, patient satisfaction rates were in the seventh percentile, nursing care suffered on the weekends, and the hospital’s facilities and technologies were quickly falling behind other providers in the market. “I realized that we would be unable to thrive in the future if it kept to its status quo,” Fox shares.
When it became clear that parent company Advocate Health Care hadn’t allotted Good Samaritan a budget to finance the improvements needed to make it a viable contender among the affluent hospitals in the area, Fox took his concerns to his hospital’s team of medical executives, and asked, “What can we do to make a better future for ourselves?” A quality and process improvement campaign was implemented, dubbed “Moving From Good to Great.”
“A few people on the team thought maybe it was a slogan initiative,” Fox recalls. “You know, a new CEO, a new slogan, but we had good people, good employees, a very diverse and loyal medical staff, and an OK payor mix. Why couldn’t we really figure out how to work together and deliver better outcomes?”
Physician-focused Initiative
A key strategic decision was to make the initiative physician-centered. Fox believed that by creating physician partnerships and cultivating physician loyalty, the effort could transform Good Samaritan into the best place for physicians to practice, associates to work, and patients to receive care. The team created a strategic intention to be the best place for physicians, associates, and patients. “The operative phrase is: to be the best,” Fox states.
Loyal physicians can play a key role by increasing referrals and admissions, refusing to consider other work options, and taking the time to engage with the administration to improve the quality of operations, Fox explains. (Good Samaritan currently boasts a staff of 950 physicians, about half of whom are so-called splitters, or doctors who work at more than one hospital.)
“We really want to concentrate on creating a powerful context for our physicians, and felt that if we could take what was an antagonistic or ambivalent relationship with our physicians, and convert it into a high-quality relationship and partnership, that would really open the gateway into doing much more powerful things with them,” Fox says.
One of the physicians’ requests was for the hospital to run more efficiently. “Sometimes, at new employee orientation, I will say, ‘We’re lucky, we punch a clock, and if we have a good day, we get paid; if we have a bad day, we get paid, but if you’re a physician, you only get paid when you do stuff. So, what can we do to make the organization honor the time of the physicians, so they can either see more patients, or go home to see their families a little bit sooner?’”
Another physician request, one that was somewhat surprising to the team, was the physicians’ desire to be part of an organization that was doing something for the greater good, and creating a more positive future. Additional requests were for a safe practice environment; good nurses; an administration that will ask questions, listen, and respond; and the ability to have faith in the future of the hospital.
Improving Clinical Outcomes
The administrative team based its performance improvement initiative on the physician staff input in a concerted effort to make it the best place for physicians to practice, with a focus on improving clinical outcomes. “We invested more resources into a quality infrastructure, so that we could actually take data and turn it into information, and feed it back to our doctors, then make improvements,” Fox shares. “We actually set out to become a magnet hospital. Not that magnet itself is the end all and be all, but magnet status represents an organization that is committed to quality nursing care, and the engagement of nurses and professionals.”
Fox’s goal to forge a strong relationship between Good Samaritan’s administrative and physician staffs was successful. Not only does the administrative staff involve the physicians in strategic planning processes, but there is now a formal physician recognition system in place. “We have a very robust recognition system, including a monthly physician-recognition board where we put physicians’ names and quotations,” Fox says. “I see doctors with their parents and with their children in front of the recognition board, with pictures being taken, because of the honor of being recognized in a staff of 950 doctors.”
Several other initiatives launched in the past decade have been a factor in positioning Good Samaritan for ongoing success, Fox believes. In 2004, Advocate Health Care and its individual hospitals’ PHOs launched a pay-per-performance program called Clinical Integrations, which is now in its ninth year. Good Samaritan also began one of the country’s first commercial accountable care organizations with Blue Cross almost three years ago, and it’s been successful, Fox reports.
Market Share Gains
As a result of the Moving From Good to Great initiative, Good Samaritan Hospital has garnered national recognition for its programs and outcomes. “We built a very good track record of great performance, became a better organization, and then began to get recognized for it,” Fox reports. In addition to the Malcolm Baldrige National Quality Award, the hospital received positive marks in Healthgrades®, a high ranking in the Delta Group’s list of hospital clinical outcomes, as well as recognition in Physicians World.
The hospital also has earned market share. “One of the truisms in American health care is that market share doesn’t change unless you buy a competitor’s health group and then tell them to move the business,” he says. “By and large, most people go to the same doctors and the same hospitals, unless they have a disease or they move. In our market, where we have been outspent on capital by a factor of five—or 10 to 1, since 2004—we’ve done something that isn’t done very often in health care. We have grown a market share of 17 points in a very outstanding quality market for health care.”
He continues, “We have hospitals all around us; their markets coming to our markets, our markets overlapping to their markets, and over the last five years, we’ve done a good job of growing market share. We’ve done it not by acquiring more physicians—these are all independent physicians who have decided to move more of their business to Good Sam hospital.”
In wrapping up, Fox adds, “A physician’s life is a 24/7 life. It’s a life of tremendous responsibility. I’ve had the greatest respect for almost every physician I’ve known—for their commitment to quality and to doing the right thing.
“At Good Samaritan Hospital, we know that we cannot only be as good as our doctors, but as good as their willingness to work with us to create great care for their patients, and a great environment for themselves.”
Rogena Schuyler Silverman is a contributing writer for Health CXO.