Ozarks Medical Center Focuses on How Patients Define Quality Care

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When Thomas Keller began his tenure as president and chief executive officer of Ozarks Medical Center in West Plains, Mo., on Feb. 17, 2014, he brought with him one simply worded question that would serve as the foundation of his first year: How does the patient define quality care?

“One of the things hospitals always have to do is to make sure that we have a culture of safety, that we have a safe environment for patients,” he said. “Hospitals are not just an inpatient facility anymore. We’re kind of half and half.”

This is especially true of Ozarks Medical Center (OMC), which has physician-based clinics spread throughout seven counties in addition to the main hospital campus. With such a wide footprint, Keller said it’s important that the provider team understands how patients define quality.

“For every single patient who comes in contact with OMC, whether it be in an outpatient department of the hospital or a clinic or in the hospital, it’s important that they get great care every single time they interact with us.”

Increasing rounding visits and reducing fall-outs

In order to improve OMC’s quality, Keller set in motion several initiatives, beginning with an approach to hard-wired rounding that requires both nurses and leaders to go into a patient’s room and receive feedback on the care they’re receiving.

“Rounding visits are done not only by nurse managers, but by directors and vice presidents,” Keller said. “It’s a way to engage patients in a conversation about what they want.”

These conversations include keeping patients informed as to why certain processes, such as drawing blood at four in the morning, are being done. The conversations are also designed to give patients a sense of control, realizing how helpless some feel in a hospital.

“We use words and language in hospitals that most people aren’t used to,” Keller said. “So we want the staff to slow down and listen to the patients, then ask the patient if they understand what’s being done and how long it will take, so the patients feel they have some control every step of the way.”

Reconnecting the hospital with its purpose

In 2013, fall-outs from core quality measures happened an average of 21 times each month. When Keller arrived, he felt this was one weakness that needed to be addressed.

“Just because we fall out doesn’t mean the patient received bad care,” he said. “It could be that the documentation didn’t get put in the right spot.”

Keller decided to approach this issue from a perspective of purpose.

“Always in healthcare you have to remind people why they choose a career in healthcare, talking to people about great care for every patient every time and making it a very human thing with them,” he said. “But I also would say accountability is a huge part of it and that starts with the board of directors and me saying, ‘Every patient every time.’ It’s me saying, ‘We can.’ It’s me making sure that people understand that it’s a priority that we focus on this culture of safety and having a safe place for patients. It’s all of us talking about it whenever we get a chance to talk about it in staff meetings, between the nurse leader and the individual nurse, talking about the importance of it and why we do it.”

Keller implemented an operational huddle every morning at 8:30. Between 20 and 25 leaders attend daily to discuss various issues that are confronting the hospital that day. They discuss core measures and identify patients who may need extra care or may pose a fall risk.

Showing this kind of attention to detail is especially important for a community hospital like Ozarks Medical Center, he said, because the town is very involved in its daily operations. After all, the hospital is a vital part of West Plains’ livelihood.

“Memories are long in a small town and people are there for a long time,” Keller said. “Everybody that lives here has somebody that either works at or has worked at the hospital or has been a patient here.”

By stressing daily communication among departments, OMC was able to reduce its fall-out rate by 62 percent from April 2014 to December 2014. Compared with 2013’s average of 21 times each month, the fall-out average is now fewer than eight.

Keller is confident his team can reduce these fall-outs by another 50 percent in 2015.

“The question for us is, ‘Can we approach zero?’” he said. “There are not many that do this, but can we approach zero all the time? And I think we can and that’s what we’re working towards.”

Leading the charge and setting goals

Along with its many accomplishments last year, OMC’s financial outlook also improved.

“It’s possible to have great quality, great patient satisfaction, and to have improved financial results as well,” Keller said. “In 2013 we had a less than zero percent operating margin. Now we have an over four percent operating margin.”

However, such changes can only be achieved through fearless leadership from leaders who are willing to put themselves at the forefront, he said. They have to be the ones who are saying, “We can do it.” Above all, leaders must be the ones who are asking questions and exploring new ways of achieving goals.

“It’s never been an ‘I’ thing in healthcare,” Keller said. “I’ve never done anything that didn’t involve a whole bunch of people. It’s a ‘we’ thing, but the leader has to be out there in front saying, ‘We’re going to change this drastically.’ And I think most people, if they’re connected to purpose and why they got into healthcare can immediately wrap their arms around it and believe and be engaged 100 percent.”

-by Pete Fernbaugh

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