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Transforming Wright Medical Center: A Case Study in Quality Improvement

At a Glance . . . When Steve Simonin began his duties as CEO of Wright Medical Center (WMC) in late 1996, he took the helm of a small, rural hospital known for poor communication and a negative work environment. Word on the street was that the hospital’s nursing staff “ate their own,” and employees wouldn’t rec- ommend the medical center to family or friends. It wasn’t uncommon to find local residents driving 50 to 75 miles to seek medical care elsewhere. Fast forward to the present and the transformation is astounding: WMC flourishes as a regional healthcare destination and continues to capture state and national quality accolades.

WMC, built in 1951, is located in the small town of Clarion and serves a rural, agricultural area in north central Iowa. This 25-bed facility is a critical access hospital, a designation that provides the opportunity for Medicare reimbursement, allowing many of the state’s rural hospitals to keep their doors open. Owned by the town of Clarion, the hospital employs more than 300 people and offers a variety of services, including acute and surgical care, emergency services, family practice and obstet- rics, orthopedics, many specialty clinics, and therapy options, as well as hospital and retail pharmacies. Gaining a Fresh Perspective on Quality in Healthcare Soon after arriving in Clarion, Simonin gathered a group of trusted leaders and they immediately focused on improving staff communication and creating a more positive work environment. Some success followed, but it wasn’t until a family member in another part of the state became seriously ill that he began leading WMC’s real quality journey. “When I was on the other side of the hospital bed I began to appreciate healthcare from a different perspective,” explains Simonin.

At the same time, Simonin and his leadership team learned of the Studer Group, a consulting firm that helps healthcare providers focus on compassion and caring with the belief that positive financials will follow. The team appreciated the balanced approach that Studer advocated and soon WMC adopted the pillar system, which provides a foundation for setting goals and evaluating progress toward those goals. As illustrated in Table 1, the pillar system incorporates five focus areas for performance improvement at WMC: quality, service, finance, growth, and people (a sixth category, community, was added later). The hospital began “hard-wiring” the improvement processes into daily activities at WMC to ensure these processes turned into habits.

Simonin explains that the pillar approach helps the hospital to engage employees in forming, execut-ing, and evaluating goals on three levels: personal, departmental, and organizational. The pillar system provides the infrastructure to ensure that the hospital’s overall action plan measurement system covers all key departments and stakeholders.

To increase market share, leaders at WMC began looking at the reasons why people were leaving the community for their primary healthcare needs rather than utilizing the services of the local hospital. The leadership team carefully studied patient and employee surveys and ultimately decided to introduce a that patients may contact him with comments at any time. The hospital encourages its senior leaders to play active roles in community organizations such as the chamber of commerce and churches. “People are very comfortable coming up to us in the grocery store and talking about their ideas for quality and ser- vices,” reports Simonin. Following the PDCA Model.

Utilizing survey data and customer comment information, lead-ers conduct root cause analysis and apply the plan, do, check,act (PDCA) model to guide performance improvement initia- tives. For example, when patients gave low scores and negative feedback about the lack of privacy in the outpatient surgery and emergency room areas, members of the service pillar team took action. They contacted the patients who had expressed concerns, and after gathering and analyzing feedback, the team helped develop new, private waiting rooms.

Another example of responding to patient feedback involves the creation of a “pain team.” Charlie Hammel, quality coordinator and co-leader of the quality pillar, recalls that WMC’s patient satisfaction scores relating to pain management fell sharply from  he 90-percent range to between 40 and 50 percent after the hospital expanded its orthopedics services and began performing several joint replacement surgeries each week. “We studied the data and formed a multi-disciplinary team and eventually devel-oped pain protocols, brochures, and recommendations on how manage a patient’s pain,” Hammel explains. The hospital’s pain management scores improved dramatically and are now typically at 99 percent for orthopedics.

The PDCA model is such an integral tool that WMC uses it prior to launching all new services and work processes. “It’s become so engrained into the culture that most employees don’t even realize they are using it,” Hammel says.Increasing Satisfaction Scores and Market Share By focusing on open communication and accountability as wellas offering additional services such as orthopedic surgery, the hospital improved patient satisfaction scores substantially while also growing its market share. Figure 1 illustrates noteworthy gains in patient satisfaction scores, which are consistently above 95 percent, and Figure 2 depicts a steady rise in the number of residents from the county who select WMC for outpatient ser- vices. The hospital’s market growth in recent years is 13 percent for inpatient and 8 percent for outpatient visits.
•  WMC received Summit Awards from Press Ganey in 2006 and 2007 for inpatient satisfaction scores that reached the 99th percentile nationally.
•  In 2007, WMC earned a bronze award in the Iowa Recognition for Performance Excellence (IRPE) program, which is  based on the Malcolm Baldrige Criteria for Performance Excellence. A year later the hospital captured a silver IRPE award.
•  Also in 2007, HealthLeaders media named WMC to the Top Leadership Team in Healthcare for small hospitals.
•  The Studer Group honored WMC with its Fire Starter Award in February 2005 to recognize the hospital’s performance improvement results and in June 2005 with the “What’s Right in Healthcare” recognition.
Patterned after the luxurious Ritz-Carlton hotel chain, Wright Medical Center (WMC) offers spa-like amenities delivered with small-town, friendly care to help increase market share. Orthopedic patients at WMC can relax during their choice of a free massage, hairstyling session, or facial before checking out of the hospital. All patients can enjoy the following amenities designed to offer a more comfortable, resort-style experience:
•  Wireless Internet access 
•  Softer lighting
•  Complimentary long-distance phone cards
•  In-room video/DVD machines
•  Warm, spa-like robes
•  Five-star food on demand ordered from an in-room menu
•  Free meal passes for family members
•  Warm cookies served daily
•  Softer sheets and blankets
•  Carpeted hallways
Read this case study about the continuous improvement and innovation at a rural hospital. The case study discusses “spa-like amenities to increase market share.” Is it possible for every hospital to achieve this? What would be the challenges from the perspective of the administration, doctors, patients, and staff? Discuss with reasoning.

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