HSHS St. Anthony’s Memorial Hospital’s Award-Winning Process Improvements in Healthcare

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Standardized approach is essential to lasting outcomes and value.

By Michael A. Janis, Executive Director of Outpatient and Ancillary Services and previous Interim President and CEO, HSHS St. Anthony’s Memorial Hospital.

The need to improve performance throughout your healthcare facility has never been greater. Patients are rating your facility online, good employees are hard to find, you have to do more with less, and competition is intensifying. But where do you start? How do you identify the processes that need the most attention, and the improvements that will deliver the most impact? And how can you sustain high performance over time?

These were some of the questions the leadership team at HSHS St. Anthony’s Memorial Hospital asked ourselves when we started our journey of process improvement. In this blog, I’ll share the answers to these questions and explain how our methodology is helping us improve financially and structurally, and is strengthening our leadership team.

Also, our documented outcomes from our process improvements have earned the hospital numerous awards including two bronze and one silver award from ILPex (Illinois Performance Improvement) which leverages the vigorous Baldrige Excellence Framework to guide Illinois organizations to higher levels of performance; and the Press Ganey Guardian of Excellence award.

Standardized approach is critical to complex problem solving

The most important point I want to share is that it is absolutely critical for the entire organization to follow a structured and standardized way to solve complex problems. Adhering to the methodology – and the process of learning that will come from it – is the path to improving as a healthcare organization.

A healthcare operation is complex. You have multiple leaders and they each have varied experiences and different leadership styles. When it comes to problem-solving and process improvement, leaders fall back on what is comfortable for them and what they know. Their individual processes are not always the most effective, and the lack of uniformity impedes the organization’s progress.

Having a standardized process and tools help everyone get better at problem-solving. The standardization also creates a focused intention on objectives and efforts so that everyone is driving toward the same desired outcomes. Additionally, having common tools and terminology increases understanding and engagement among all hospital staff. Our front-line colleagues can better understand our objectives and their roles in our journey of continuous process improvement.

One notable achievement that resulted from our standardized approach to problem solving is the ability for patients to pre-register for outpatient testing from the comfort of their homes. This drastically cuts down on the front-end process of an outpatient visit. Our electronic health record (EPIC) allows patients to complete much of their registration before a visit, reducing wait times and nearly eliminating waiting rooms depending on the time of the day the patient arrives. Registration ahead of the visit provides additional confidentiality for the patient and a quicker visit, resulting in an improved patient experience.

Step 1: Standardize on a process improvement system

Start by selecting and standardizing on one process improvement system that is designed specifically to address complex problems. We selected SBAR, a system that breaks a problem down into focused and concise information around four areas: Situation, Background, Assessment and Recommendation. We selected it because it works well for us. There are other tools available.

After we work a problem through the SBAR framework, we move into the PDCA model (Plan, Do, Check, Act). Many healthcare leaders are familiar with this model for process improvement.

Step 2: Identify processes that need the most attention

Every individual department could come up with multiple quality initiatives. Radiology might propose improving start and stop times; purchasing might suggest new software to streamline their processes. But how do you know which process improvements to focus your limited resources on?

My recommendation is to align your decisions with your Strategic Plan. We have five “pillars” in our strategic plan: Mission Integration, Quality, Care Integration, Develop Our People and Stewardship. When our leaders propose difficult problems that need solving, we weigh them against the pillars in our Strategic Plan. If a problem does not align with a pillar, then we are not going to focus our attention and resources on it at this time.

The next step is to get an understanding of the significance and reality of the problem. This is the “Assessment” phase of SBAR. We review external benchmarking resources for performance, like Press Ganey, when they are available. We also elicit external feedback from patients’ family and community members who serve on a committee created for this purpose. This external feedback really improves our ability to see where we are as an organization and help uncover our blind spots. In some instances, we’ve learned that we are farther along and doing better than we thought.

Other factors that are taken into consideration in this Assessment phase are the initiative’s strategic fit, time to completion, ease of completion, return on investment, and the resources required to accomplish it. In some cases, we agree that the process needs improvement, but we won’t pursue it if we don’t have the right people, resources and bandwidth in place to be successful. Or we might realize that the results of an initiative will have minimal savings for the hospital or for patients, and thus it is not worth the effort required. These discussions are part of our weekly “Innovation Tuesday” meetings attended by our leadership team.

Step 3: Achieve and sustain high performance

I mentioned that the leadership team meets weekly on Tuesdays. However, problems – and opportunities to solve them – come up every day. So four times a day, every day, we gather for Safety Huddles with the purpose of problem-solving the day’s current and potential problems. Every department sends a representative to each huddle. This includes radiology, nursing, lab, wound center, materials, maintenance and others. Within 10 to 15 minutes, we cover relevant topics in all departments in our 133-bed hospital. In each huddle, we follow a structured process to discuss:

• What is going well
• What could go better
• What is needed
• Staffing levels
• Opportunities for harm
• Ways to help each other

Within these huddles, we are truly solving problems for that day. For example, we learned that areas that were slow were sending people home when other departments could use their help. Now we reassign people as needed. One week we had a large number of orthopedic cases scheduled for surgery. In the huddle, we learned that our materials department was shorthanded due to illnesses. We shifted other people to the department to restock shelves with orthopedic implants and supplies so that surgery had the tools they needed to stay on schedule. If radiology says they have a high number of outpatient cases for the day, we might shift available nurses there to manage post-procedure care. As I have cross-trained in phlebotomy, I’ve drawn blood on the floors to help our nursing staff when they were short-handed.

Additionally, learning from the experiences of other departments can help reduce the impact of a similar situation when it happens elsewhere. Everyone gains knowledge from our information sharing.

I realize that the idea of having four daily Safety Huddles sounds time consuming. And early on, several people expressed concerns that the huddles would be a waste of time. But time and again, we have seen the value of these meetings throughout the day. In addition to addressing potential issues in real time, the huddles help keep the focus and momentum on our bigger process improvements. This helps avoid the number one reason that many initiatives fail: lack of communication. Information that is discussed in the huddles is available to all employees through an online platform. They can click on any topic to see what was discussed. We’ve also gotten very efficient in our huddles.

Key takeaways for achieving process improvements

First, I’ll emphasize again that it is critical to have a standardized structure and process to solve complex problems. Second, it must be adopted throughout the organization. This is why getting active support from leadership at the onset is essential. As with most big change initiatives, leadership buy-in and backing are essential.  

Third, be prepared to make adjustments. As you can imagine, selecting our methodology and then incorporating it into our daily workflow took considerable time and adaptability. Be prepared to be nimble in this process and understand that it will evolve over time.

Complex problem-solving and continuous process improvement have become an integral part of our daily operations at St. Anthony’s. Our next step in our process improvement journey is to achieve the IMEC Gold Award which will give us entry to apply for the Malcolm Baldrige National Quality Award.

Thank you for reading. I hope you found value from hearing about our experiences.

Michael A. Janis, MBA, RT(R)(CT)(N)CNMT, is Executive Director of Outpatient and Ancillary Services and served as Interim President and CEO at HSHS St. Anthony’s Memorial Hospital in Illinois. Mr. Janis delivered a presentation on this topic at AHRA 2021.