Wyoming Medical Center: Vickie Diamond, Chief Executive Officer

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As a tertiary care facility, serving a large, rural geographical area, Wyoming Medical Center focuses on providing safe, quality care while always being conscious of improving efficiency. The 207-bed hospital sees the majority of trauma cases in the state, providing helicopter service to reach people in remote areas. The hospital is centrally located in Wyoming and has 44 specialties including open-heart surgery. It also has joint ventures with physicians and a multispecialty physician group, Wyoming Health Medical Group.

“Our organization is made up of people from all areas of the country, yet we maintain a small-town philosophy,” said Chief Executive Officer Vickie Diamond. “We value quality, knowing we are taking care of our friends and neighbors. Our staff and leadership are involved in community activities and making our community better.”

For Diamond, part of this small-town philosophy has been remaining transparent with staff.

“Whatever the outcomes or consequences, we are transparent with leadership and staff,” she said. “We work together to make things better. My goal is to be transparent about the organizations’ goals and outcomes.”

Improving safety

Diamond feels being transparent has been a key to success, especially throughout a safety initiative the health system has initiated. The organization used the Health Performance Improvement approach by the Center for Health Transformation. This group conducted interviews with staff and performed an organization cultural assessment. Wyoming Medical Center also evaluated its safety, leadership and areas of patient harm. They used these factors to create three or four patient safety behaviors staff must do.

“We educated staff on the behaviors and use our own data to evaluate success,” Diamond said. “We log sentinel events online to see what’s really happening here. We publish a monthly updated that talks about safety stories, good catches, and whether there was any harm and the cause of it.

We have measured safety events each day, and in the past year, we have reduced our total safety events by 58 percent and tripled the time between safety events.”

The safety initiative is ongoing with further staff education and development of safety coaches in each unit.

Efficiencies in design and capital spending

Diamond said the health system is always putting capital dollars into technology, but it maintains a realistic approach to ensure its limited funds are going toward investments that will bring about the most return for patients and the hospital.

“We try to do our homework up front,” she said. “Everybody would like every bell and whistle, but we have to look at whether each bell and whistle will add value to care. Will we get a return on investment? What resources and training will be needed? We have to make sure when we put this in place, we have the resources so it doesn’t just become a piece of equipment you hang your hat on.”

Technology the hospital has implemented are barcodes for medications, which it has had for nearly 10 years, and a daVinci Surgical System. Diamond said Wyoming was concerned about buying a daVinci robot and not using it, but after doing homework and getting stakeholders to buy in, the technology is regularly used. The hospital has also begun to implement CPOE and has all clinical staff using an electronic health record.

Currently, Wyoming Medical Center is renovating part of its emergency room and expanding the hospital. The first four phases are complete, with one phase remaining.

“We took where our cafeteria and production kitchen are now and are expanding the emergency room into that area,” Diamond said. “We are moving those services to a new building that will be attached by patient rooms and a lobby.”

Wyoming has been working with the design firm HDR on the first four phases. The new emergency department will have a pod configuration, which allows the hospital to open pods as volumes go up, and close them when volumes go down in an effort to improve efficiency. The renovation will also have separate trauma rooms and beds from a fast track emergency room.

“We want to be efficient in getting people in and out of the emergency department,” Diamond said.

Looking toward the future in light of reform

As all healthcare organizations in the United States, Wyoming Medical Center is evaluating its processes and trying to determine how it will adapt to the changing healthcare environment. The health system has been working on controlling costs and evaluating efficiencies in the system. One effort has been working with physicians in the neurosurgery department to negotiate prices. Diamond said they saw savings almost overnight by bringing in physicians.

With healthcare reform, the system is trying to determine how an accountable care organization would fit with Wyoming’s market. However, safety remains the health system’s primary focus.

“We are planning ahead and trying to figure out how to link projects, build organizational reliability and improve safety,” Diamond said. “Part of safety is building highly reliable systems and understanding human error so that you can build systems to prevent errors.”

-by Patricia Chaney

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