February 26, 2015

Transformation of Atlanta Health System Topic of MHA Alumni Luncheon Lecture

M H A Program Director Stephen Bowman P h D, M H A and Rhonda Scott P h D, R N, C S at Master of Health Administration Alumni Lecture Luncheon

MHA Program Director Stephen Bowman and Rhonda Scott.

The 2015 Master of Health Administration Alumni Lecture featured Dr. Rhonda Scott, Chief Nursing Officer and Executive Vice President for Patient Care Services at Grady Health System in Atlanta. Her talk, “Transforming Grady: The Courage to Lead – An Unwavering Commitment to Excellence,” told the story of how Grady Health System transformed from a near bankrupt and low quality organization to the current profitable and high quality system. The February 6th event was hosted by the MHA Alumni Association at the UAMS Fay W. Boozman College of Public Health.

Recruited in 2004 to help save the declining health care system, Dr. Scott is seen as a key player in the successful transformation. When she took the job, Grady was deeply in debt, employee morale was poor, and ratings for quality of care and patient satisfaction were near the bottom in rank compared with other large public, academic health systems across the country. Today, Grady is financially sound and is able to boast of strong employee engagement and top scores for patient satisfaction and quality of care.

What were the elements of this miraculous turn-around that occurred in less than 10 years and what can other public academic health systems learn from Grady?

Grady Hospital was founded in 1892 to provide health care to Atlanta’s poor. For more than a century, it has done just that, even as it operated with a growing burden of debt and outdated facilities. Its emergency department averages 130,000 patient visits annually and serves as Atlanta’s safety net for the uninsured. Raising the needed $100 million to modernize facilities seemed impossible under the previous model and governance.

As Atlanta residents, business leaders and other area hospitals contemplated what their city would be like without Grady, talk of closing its doors turned to “What would we do without Grady?” With that collective epiphany came a determination to save the hospital. In 2008, a coalition of state and business leaders established a non-profit corporation to more effectively administer Grady. The newly formed board of directors with strong representation from the business community embarked on a fundraising campaign that brought a tsunami of philanthropic support that kept the doors open, paid for renovations, and built new specialty care centers.

The change in governance and infusion of cash were pivotal in turning Grady from being an underfunded, unappreciated, urban indigent care facility to a state-of-the-art health care system that also attracts insured health care consumers seeking a good patient experience and quality care. But there is much more to the story, Dr. Scott says.

It was a vision for excellence, courage to do things differently and a new approach to management and employee engagement that have made Grady a success.

The new leadership set its sights on being the very best, adopting a new vision statement: “Grady will become the leading public academic healthcare system in the U.S.” By 2011, the transformation was fully underway.

Renovating the patient experience has been as important as updating old buildings, beds and equipment. Every hospital room is now private, every patient gets a handheld mobile phone for a direct line to their nurse, and nursing rounds are now hourly.

At first, there was some resistance to hourly rounds, but in time “nurses found that they were actually going in more than every hour,” Dr. Scott said. “It has made a world of difference in quality and satisfaction.”

A campaign on standards of excellence in service was also implemented. Each month, a different standard is highlighted, posted on units, and talked about at staff meetings. Examples of words and deeds help clarify how each standard is operationalized. In December, the focus is on teamwork. Staff are reminded to drop negative language (“That is not part of my job.”) and adopt more positive alternatives (“Consider it done!”).

A close eye is kept on metrics of all kinds – patient satisfaction; “never” and “always” events and other measures of quality of care; and performance of all employees from the top of the organization on down. A pre-hire assessment of competencies becomes the baseline for an employee’s future evaluations, professional development and career coaching.

Expectations are high, but so too are recognition and reward for top performers. The red carpet is rolled out especially for the nurses who stand out. The individual selected nurse of the year gets the royal treatment – a gift package that includes not only a crystal trophy but also red roses, two airline tickets, a full spa day, and a $500 cash award.

The 93 percent response rate on employee engagement surveys is a sign that Grady has indeed changed for the better, Dr. Scott said.

“That is because we make changes based on their feedback,” Dr. Scott said. “We listen.”

Since 2006, Grady has been using Press Ganey, a national consulting firm that provides surveying and reporting for more than 7,000 U.S. health care services, to monitor its patient satisfaction. At first, Grady’s patient satisfaction scores were abysmally low, when compared to other public health systems across the country. In 2012, on nine of 10 domains, Grady scored below the 40th percentile, with half in the lowest quartile. Two years later, scores in nine of 10 domains were at the 70th percentile or above, with four in the 93rd percentile or higher. Nurse communication, which two years previously ranked nationally at the 30th percentile, now was at the 97th. Environment, which had ranked at the 27th, was at the 96th.

So once Grady bumps against the 99th percentile on all domains of Press Ganey, then what? Dr. Scott has already thought about that and delivers her answer with a smile. Rather than compare Grady to other public health systems, she would like to compare Grady to private hospitals and systems nationally. Grady just might outshine them too.