PinnacleHealth: Phil Guarneschelli, COO

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Hospitals have always been dedicated to providing high-quality, safe care to their patients, but as they look toward a future of payment for performance, keeping patients — and family members or caregivers — happy has become just as important as quality. Most healthcare organizations are adjusting to this with patient and family-centered care initiatives and a focus on HCAHPS scores.

PinnacleHealth System, a non-profit healthcare system in central Pennsylvania, has been working hard for the past three years on initiatives that will prepare them for the future of healthcare delivery. PinnacleHealth System consists of three hospitals with about 600 beds and a teaching hospital with eight residency programs.

In 2009, the system began a cultural change to improve quality and safety, with a focus on the Centers for Medicare and Medicaid Services (CMS) core measures and other state and federal-quality indicators; improving communication among staff, physicians, and patients; and improving patient satisfaction.

Implementing continuous improvement initiatives

Beginning in 2009, PinnacleHealth saw drastic improvement in quality indicators such as infections and core measures for heart failure, pneumonia, acute myocardial infarction, and surgical care. For most measures, PinnacleHealth has met or exceeded the national average.

Achieving improved quality is more than just decreasing infections or attaining certain scores on core measures. It involves the coordinated efforts of all hospital employees and physicians from leadership to housekeeping. Improving communication among staff was a necessary step toward improving quality.

PinnacleHealth leadership implemented communication projects, including hand-off communication, medication reconciliation procedures, rapid response teams, and documentation. Staff began using SBAR when transitioning patient care. SBAR is a technique used by many hospitals and stands for situation, background, assessment, and recommendation. In addition to larger initiatives, PinnacleHealth recognized that confusion also occurs in documentation, and simple guidelines, such as using approved abbreviations and working on legibility, improved patient care.

Finally, the system has been looking toward the future and making huge strides in patient satisfaction. Some initiatives include enhanced wayfinding, a patient and family-centered care team, an emergency department customer perception workgroup, and employee focus groups. With help from the Studor Group, PinnacleHealth initiated AIDET, a guide for patient communication that stands for acknowledge, introduce, duration, explanation, and thank you.

“Everything we do at PinnacleHealth is focused on patient care and quality,” said Phil Guarneschelli, COO. “We recognize that finances are important, but that stability comes with a quality-driven healthcare system and one that puts patients first.”

These initiatives all support the key values of PinnacleHealth’s leadership–transparency, accountability, and collaboration.

Moving beyond implementation

After a few years of noticed improvement throughout the system in these initiatives, PinnacleHealth has been able to expand and focus on capital projects, as well as physician alignment.

Last year, the Harrisburg Campus opened a new emergency department. The hospital sees more than 58,000 emergency-department visits per year, and the previous facility was designed to accommodate about 40,000. With the new emergency department, the hospital has focused on ways to lower wait times and improve throughput.

PinnacleHealth has been using a number of Lean Six Sigma projects to increase productivity throughout the system and has encouraged all staff to get involved in training. Four employees have completed black-belt training, more than 60 have completed green belt, and more than 100 employees have attained yellow belts.

Other projects in progress are a new cancer center, which opened in the spring of 2011 on the Community Campus, and upgraded women’s services at the Harrisburg Campus. The women’s services project will focus on antepartum patients, creating all private rooms on a separate floor. In all, construction projects are budgeted at $60 million.

Another major focus at PinnacleHealth is physician alignment. Many healthcare organizations are examining ways to bring physicians into the organization through integrated systems. Guarneschelli said that PinnacleHealth is looking at ways to align physician-outpatient visits with the hospitals.

“We have an outpatient business and a hospital business,” he said. “There has been a shift toward more outpatient care, and we need to change our business model to one of integrating our physicians into the healthcare-delivery network.”

Cardiology is one area in the works to do this. Two of the region’s most experienced cardiology practices, Moffitt Heart and Vascular Group and Associated Cardiologists, joined PinnacleHealth’s Cardiovascular Institute in 2011.

“We are trying to keep everyone aligned as we move toward our goals,” Guarneschelli said. “We have been successful so far and have a great team of people.”

-by Patricia Chaney

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