Dosher Memorial Wants to be the Friendliest Hospital in N.C.

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Tom-Siemens-thumbTom Siemers, FACHE, President and CEO, Dosher Memorial Hospital

by Patricia Chaney

As many hospitals across the country redefine their mission statements to reflect the importance they are placing on quality-driven care, one critical-access hospital has united its physicians and employees around the simple mission of being the friendliest, most patient-centered hospital in North Carolina.

Creating a sense of community

Dosher Memorial Hospital, located in the coastal town of Southport, has strong quality scores on all core measures. About two years ago, its leadership felt the hospital should focus on creating a stronger sense of community between its patients and caregivers.

In late 2012, Tom Siemers, FACHE, became president and chief executive officer of Dosher and immediately turned his attention to redefining the organization’s culture, starting with its mission statement and leadership.

“Like many organizations, Dosher had a complicated mission statement full of bullet points no one could remember,” Siemers said. “We simplified it to one sentence everybody can remember, and the staff has embraced it.”

To achieve its goal of being the friendliest, most patient-centered hospital in North Carolina, the 10-5 rule was implemented immediately: Smile at someone within 10 feet and speak within five feet to make sure everyone is greeted when they walk the halls.

Preparing for growth

As reimbursement continues to contract, Dosher has positioned itself for growth through a variety of projects, the most extensive of which is an $11.5-million renovation and expansion of its patient-care unit to provide a more modern setting for inpatients. The new unit will offer 25 private inpatient rooms with enhanced technology, security, and comfort for patients and families. The project includes a 12,000 square-foot renovation and 6,000 square feet of additional space.

The hospital has also opened an urgent care center, which operates with extended hours and on weekends. Being a coastal town and the ferry point to a popular vacation island, Dosher sees tourists as well as residents, and urgent care is another way in which the hospital can meet the needs of its patient population, both permanent and transient.

In November, the hospital will open a new Wound Center that will include two hyperbaric medicine chambers with full-time coverage by physicians trained in wound management.

But the foundation for growth always begins with the medical staff, Siemers said. Even before the hospital embarked upon the critical step of recruiting new physicians, he recognized the need to unite the medical staff and to establish programs to build relationships between the hospital and providers as well as among the providers themselves.

Siemers started a working group of specialists and primary-care physicians who met regularly to talk about what they have in common. He said one specialist remarked to him that it was the first time in two years he had engaged in conversation with the primary-care physician who had been referring patients to him.

The working group also assisted in the establishment of a platform for employing primary-care physicians. Dosher now employs five primary-care doctors and two mid-level providers, with plans to add five more physicians and four nurse practitioners or physician assistants this coming year.

Furthermore, Siemers set up medical staff meetings in a community center a couple of times a year, where physicians could socialize and break down silos to talk effectively about challenges.

Engaging staff in cost containment

With high quality scores, a focus on patient-centered care, and physician alignment in place, managing costs is Dosher’s most recent priority. The growing number of retirees moving into Brunswick County also means a steadily increasing percentage of Medicare patients and the need to operate as lean as possible.

Rather than implementing vast, sweeping changes from the leadership, Dosher sought to engage all hospital employees in its financial efforts. Employee engagement has been part of the cultural change at Dosher, which adheres to the Studer model, along with evidence-based medicine and what Siemers calls “evidence-based leadership.”

During quarterly employee forums, the Dosher leadership shares the hospital’s financials and quality scores and discusses challenges within the organization.

This communication led to the development of the Three Teams, One Goal project, the mission of which was to find ways to save $600,000 in operating costs in one year. All of the ideas were suggested by the employees, Siemers said.

To create the teams, the hospital’s three senior leaders chose two directors for each team and tried to combine administrators with clinical directors. Then the leaders assigned department heads and staff members to the teams. Teams would meet as a group and work through ideas for saving money.

“It was eye opening to find out what people knew and didn’t know,” Siemers said. “We started talking about the differences between balance sheets and income statements and how some ideas were good, but didn’t necessarily translate into a reduction in operating costs.”

Siemers said the employees found $3,000 in savings by changing coffee creamers and saved $20,000 by eliminating the delivery of bottled water to most areas. In all, the employee’s ideas generated more than $615,000 in savings.

Making tough decisions for the future

Despite the success of the cost-containment initiative, it became increasingly obvious that Dosher’s cost structure was not sustainable.

According to a North Carolina Hospital Association study of the state’s 20 critical-access hospitals, Dosher had 47 more FTEs than the median of all other hospitals.

After extensive analysis and consideration, in late August the hospital’s trustees made the difficult decision to offer early retirement to qualified hospital employees, cut back on the number of part-time and contract staff, and reduce the hours of several other employees.

Staff reductions are tough for employees and the community, Siemers said, but making the difficult decisions now will allow the hospital to pursue its long-term plans for growth and continued service to the communities it serves.

“In today’s world, you have to be able to compete financially and in quality,” he said. “You have to team build and bring in the right people to advance the organization. There’s no simple way to success. The simple answers are gone from all of us.”

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