Running head: WOULD YOU RECOMMEND A FRIEND TO OUR HOSPITAL? 1

David M. Dowling
Operations Management I Southwestern College
20 January 2011
Week 3 – The Culture & Quality at Arnold Palmer Hospital

Running head: WOULD YOU RECOMMENT A FRIEND TO OUR HOSPITAL? 2

Abstract

In this paper I will demonstrate the importance of instilling a culture of quality in employees and

why it’s essential to establish a concise mission statement, code of ethics, procedures and

processes that employees can utilize in order to carry out the hospitals philosophy and mission.

I will also show what systems and processes I would set up in a new hospital to achieve a

culture of quality in a hospital. The paper will also show some of the processes that the Arnold

Palmer Hospital in Orlando, Florida uses to achieve such a high success rate in customer

satisfaction. The bottom line of this paper is that it’s easy to claim or make the statement that

a hospital provides a quality service. It’s another thing to deliver. Learned and

established techniques from this text will help an operations manager achieve the desired goal for

establishing an environment of quality, excellence and profitability.

Running head: WOULD YOU RECOMMEND A FRIEND TO OUR HOSPITAL? 3

INTRODUCTION
My Name is Dave Dowling and I am a new employee at the Arnold Palmer Hospital in Orlando, Florida. After graduating from Southwestern College I was looking for a company that I could exercise my new talents as an Operations Management graduate. I was drawn to Arnold Palmer Hospital because of their dynamic structure and their compassion and care for children. First I would like to give you a little background on the Arnold Palmer Hospital and why it is such an appealing place to work. It was founded in 1989, the Arnold Palmer Hospital (A.P.H.) is sanctuary of hope and healing for many sick children. It has grown to be one of the largest women’s and children’s hospitals in the United States. A.P.H. is a top level 1 children’s trauma facility. The hospital provides tangible services such as neonatal and pediatric intensive care services, pediatric oncology and cardiology. It also provides specialized service such as care for high risk pregnancies and maternal intensive care. The hospital is very proud of its new multi building facility that covers 676,000 square feet and houses some of the finest advanced state of the art medical equipment on the market today. This awesome facility houses 2,000 of the most compassionate and dedicated doctors, nurses and administrators found in any hospital in the United States.

WOULD YOU RECOMMEND A FRIEND TO OUR HOSPITAL? 4
As part of the management team I was introduced to many of the processes that have been put into place at A.P.H. They have built a culture of quality that is focused on the patient and their family. The mantra at A.P.H. is “Quality is not just taking care of the patient, but also taking care of the family”.
Why is it important for Arnold Palmer Hospital to get patient assessment of health care quality. Does the patient have the expertise to judge the health care he or she receives?
In order to feel the pulse of the hospital and truly be able to assess what services need to be added, deleted or modified. Administrators need to know how patients truly feel about the experience they had at the Arnold Palmer Hospital. A powerful tool that A.P.H. has been using is the comprehensive survey that captures a patient’s honest assessment on their experience. Administrators review the assessments on a daily basis. This tool will allow administrators, doctors, nurses and employees adjust processes to provide patients better services. If patients and families are unhappy about treatment, facilities, parking, finding their way around the hospital, the management and hospital administrators need to know. They need to know on a daily basis. The executive staff level at A.P.H. review assessments as they are loaded into the executive dash board on a daily basis. They look at four quadrants of the hospital operation. Services, Quality, Human Resources and Finances. The results of the survey’s allow corporate officers to move assets, resources , personnel and changes to that functional areas that need the change. The results can help hospitals learn how to treat patients the way they expect to be treated.

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Addressing the question, Do patients have the expertise to judge the health care he or she receives. According to (Drain, 2010) “Patients do judge the quality of clinical care they receive. However, they base their judgments on far more than the technical interventions, many of which they are unaware. The sweeping overhaul of the U.S. health care system likely will result in increased patient volumes for hospitals and medical practices. As the nation moves toward value-based purchasing, patient satisfaction will become an increasingly important measure of quality. In a 2009 HealthLeaders Media survey, nearly a third of health care executives said that the patient experience was their top priority; another 55% said that it was in their top five. All reported that patient experience would be a priority in five years. In a 2004 study of five clinical conditions, two dimensions of patient-centered care stood out: emotional support and respect for patients’ values, preferences and expressed needs. Simply, put, providing support and involving patients in decision making are associated with better outcomes. Good communication between patients and care providers drives positive patient experiences and compliance, which lead to positive outcomes. Patient satisfaction is not about making patients “happy”; it is about improving the patient’s experience to facilitate health and medical outcomes. When patients are satisfied, trust is enhanced. When patients trust their physician, they are more likely to disclose information, follow advice and adhere to treatment plans”. It is very difficult to answer this question, regardless if you feel that people have the expertise to judge physicians and hospital on the care they receive or not. One must keep in mind that most people just want to feel that they are receiving the best medical care possible and they want to be informed and feel that they are cared for and have a clear roadmap on what is going on with their treatment.

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How would you build a culture of quality in an organization such as Arnold Palmer Hospital?
As an operations manager I would break down my plan to develop a culture of quality into three categories, management, personnel and facilities. In order to properly take an organization to “A Culture of Quality” It is important develop a plan at the management level first.
The first step is to establish a code of ethics, mission statement and leadership philosophy for management and first line supervisors. Although Arnold Palmer Hospital empowers all employees to make decisions. A foundation of standards needs to be established in writing as a source document for all employees from the top down. This will make it very clear that there is specific behavior that is expected from every employee from the CEO to food service.
The next step I would take is to establish a mission for the hospital. The goal is to provide quality health care and make the patient experience as pleasant and comfortable as possible. Establish with every employee that each patient is an individual and must be respected as a person. People and families tend to not be themselves when they are sick. Every employee needs to rise above their own feelings and focus on why they are in the health care business. Establish in the minds of employees that every patient has the right to comprehensive, compassionate family centered health care service. Every patient and family has a right to be heard with the concerns they have about the care they or their family member is receiving. I would establish a patient bill of rights in order to serve as a guideline for employees to follow and understand. Once rules and policy is established I would then implement and put into place the following processes in order to give our employees the means and tools to carry out the desired missions of the hospital board of directors and administrators.
WOULD YOU RECOMMEND A FRIEND TO OUR HOSPITAL? 7 The first step is to establish a department that will construct a comprehensive survey the patients can fill out in order to capture what their experience was like at the hospital. I would then have the department establish an executive web site that this department can post reports, flowcharts, checksheets, Scatter Diagrams, cause and effect diagrams and various statistical reports. This will allow leaders at all levels see what patients like and dislike about their experience. This will allow top levels of management properly direct what processes need improvement and change and what assets need to be re-directed to those weak functional areas or processes. In order to ensure that your employees are on board with the hospital philosophy rules and policy must be established to empower employees to make decisions without being promoted to act. And work everyday with the goal of continually striving to improve processes and their specific job duties. I would also establish process improvement teams by department. These are the teams that ensure that data is being captured as problems arise with processes or employees and also reacting to customer surveys and tackle what patients see as a problem. And finally I would establish some type of awards program that would reward employees for making the effort of making our hospital a better place to work and a place the patients feel at ease with getting well.
As mentioned in the prior paragraphs, I would establish a training program that will instill the culture of quality in every employee. Encourage them to own it and live it. To continually strive to improve processes and that there is always room for improvement. I would also instill that communication is key. Ensure that employees understand that keeping customers informed
WOULD YOU RECOMMEND A FRIEND TO OUR HOSPITAL? 8 is the number one priority. If you don’t have the answer, you will find someone who has the answer.
The facility and equipement is also a very important concern when establishing a culture of quality within your hospital. As an operations manager you must ensure that the hospital has the best quality and up to date state of the art facilities and equipment that you budget will allow. Continually work with doctors, nurses, technicians and staff to ensure that operations is doing everything it can to ensure that processes are properly equipped and that patient rooms, surgical rooms and all facets of the facility are properly supplied, illuminated, marked, and safe. The bottom line is that you need facilities that are state of the art facilities, processes that provide quality healthcare, programs and measures that capture the patients like and dislike about your hospital. But most of all you need to mentor your employees about all the task that need to be accomplished in order to achieve “a culture of quality”. Constant analysis and caring employees is what make this happen.
What techniques does Arnold Palmer Hospital practice in its drive for quality and continuous improvement?
The number one technique that A.P.H. utilizes is their comprehensive surveys. Patient survey capture the customer’s assessment’s of there experience in the hospital. These survey’s will assess customers expectations of the medical services that the hospital is offering. This survey will be in-depth and will ask a wide variety of questions from the quality of food, staff, accommodations and medical treatment. The most important question is “Would you recommend A.P.H. to your friends?” Once the surveys are done they are posted they are posted on the
WOULD YOU RECOMMEND A FRIEND TO OUR HOSPITAL? 9 executive Dash Board which allows continuous monitoring of the problems and the measures the hospital staff are taking to correct the problems. It is important for key leadership and senior administrators to review survey each and every day in order to keep their pulse on the climate of the hospital and its patients. The survey asks specific questions such as respect, access, quality of care and medical staff, was the care coordinated, were you given a thorough explanation of your condition and follow on care. This information will assist employee, supervisors and administrators refine processes to improve the quality that is provided to patients. The new measure are pushed down to the individual department levels to ensure changes are made were the problems exist. A.P.H. management will also take these assessments and compare the against a national benchmark comparison in order to provide the best health care possible. Data is available on how other hospital might handle a similar issue or chanllenge. As mentioned prior, The A.P.H. executive dashboard is a crucial tool in assessing customers opinions about their experience at A.P.H. In order to truly know were we really stand with customers we must capture extremely accurate information on how our patients and their families fell about the care that we have provided. It doesn’t matter what we think, The only opionion that truly counts is the patients and their family.
Another method is benchmarking. Benchmarking in order to ensure that standards are set in order to establish and maintain specific standards in the specific medical services that it will offer its customers. The specific services that they focus on are pediatric and neonatal intensive care, pediatric oncology, labor and delivery and care for high risk pregnancies. As mentioned prior, the business of caring for people is the business of having highly trained physicians and
WOULD YOU RECOMMEND A FRIEND TO OUR HOSPITAL? 10 state of the art equipment. This is your service. If you fail to contiunually update processes and benchmark. You will not survive, patients will simply go to better hospitals. Without benchmarking quality of service could slip causing customer dissatisfaction.
Another interesting and unique technique that A.P.H. uses is giving senior leadership cell phone and they can monitor and get directly involved with patients and families if there are significant challenges or patients are unhappy or concerned about the service they are receiving. The senior management has taken call on the most trivial issues. The unique part of this story is they don’t see these small issues as trivial. This is probably why they rank so high nationwide in customer satisfaction.
The hospital also uses various charts. I will briefly discuss the uses of each. The flow charts & Pareto charts are used to give staff and personnel a quick overview of what is happening in the hospital and nationwide. The Pareto charts also focus on critical items and leave less important issues off. This is a good chart to find out what the major problems are. Benchmarking is critical in showing where opportunities exist for improvement.
Develop a fish-bone diagram illustrating the quality variables for a patient who just gave birth at A.P.H.
Another tool that can be used by operations managers is cause and affect diagram or fish-bone chart. This can assist department heads such as those who are in charge of a post natal unit in a hospital. This chart can help doctors, pediatricians and pediatric nurses take care of mom and baby in a more efficient manner. It chart will identify potential causes to problems that that may have occurred in the past. Knowing what causes problems will give employees the ability to
WOULD YOU RECOMMEND A FRIEND TO OUR HOSPITAL? 11 identify these problems. These charts should be updated as new problems arise and new equipment is introduced to the post labor or neo natal units. Charts like these help us document mistakes and learn from others . Below is a chart I developed to help the nurses and doctors identify potential causes of the most common post natal problems that hinder quality care for mom and baby.
Material: Quality rooms designed for post natal patients PATIENTS HAVING TO ENDURE CRAMPED ROOMS COMPLAINTS ABOUT OLD EQUIPMENT AND SUPPLIES
Method: Processes & classes to prepare parents to go home
SPECIAL DESIGNED ROOMS
ROOMS THAT ACCOMMODATE MOM & BABY
WELL LIGHTED ROOMS BASIC INFANT CARE CLASSE POOR PARENTING SKILLS
ACCOMODATIONS FOR LONG TERM STAYS MOMS MEETING MOMS CLASSE NO SUPPORT
QUALITY MEDICAL SUPPLIES BIG BROTHER BIG SISTER CLASSES KIDS NOT COPING PARENTAL BREASTFEEDING CLASS NOT UNDERSTANDING

EDUCATED PARENT PREPARED TO TAKE BABY HOME
Hospital cant provide care because lack of state of the art equipment NEONATOLOGIST INEXPERIENCED PEDIATRIC EMERGENCY UNIT
PEDIATRIC NURSES LACK OF SPECIAL SKILLS PEDIATRICS INENSIVE CARE UNIT
PEDIATRIC SPECIALISTS NICU CANT DEAL WITH NICU UNITS
Manpower: Quality Doctors, Nurses and specialists
Machine: State of the art equipment & Services EMERGENCIES PEDIATRIC INPATIENT UNIT

WOULD YOU RECOMMEND A FRIEND TO OUR HOSPITAL? 12 REFERENCES 1. Drain, M., MA. (2010). How patient satifaction correlates with clinical quality, Retrieved from http://www.pressganey.com/improvinghealthcare
/improvingHCBlog/blogPost/10-04-12/How_Patient_Satisfaction_Correlates_With_
Clinical_Quality.aspx