Malcolm Baldrige National Quality Award
2003 Award Recipient, Health Care Category

Saint Luke’s Hospital of Kansas City

• In 2002, Consumer’s Checkbook ranked SLH 35^th in the nation out of 4,500 hospitals evaluated.

• Since 1997, a study of regional health care providers by the National Research Corporation shows that patients believe that SLH has the best quality health care and the best doctors and nurses of the 21 facilities in the market area.

• SLH has 12 “Customer Contact Requirements” including “Address patients/guests by last name unless otherwise told,” and “Address all complaints within 24 hours or less.”
  
• SLH outperforms the Council of Teaching Hospitals top quartile in financial performance and ranks in the top 5 percent of hospitals nationwide in total margin.
  
  
  
  
  

Saint Luke’s Hospital of Kansas City

Type of Work: Founded in 1882, Saint Luke’s Hospital (SLH) is the largest hospital in the Kansas City metropolitan area. Affiliated with the Diocese of West Missouri of the Protestant Episcopal Church, it is a not-for-profit comprehensive teaching and referral health care organization that provides 24-hour coverage in every health care discipline. Other facilities include the Mid America Heart Institute, the Mid America Brain and Stroke Institute, an ambulatory surgery center, an outpatient care center, and a nursing college.

Revenue: $937 million
Workforce: 3,186 employees, 500 physicians
Location: Kansas City, Missouri

Quality and Performance Results:

• In its 2002 report, Consumer’s Checkbook, a consumer education organization, ranked SLH 35^th in the nation out of 4,500 hospitals evaluated. SLH received an overall score of 7669 compared to a national average of 5418. Consumer’s Checkbook rating for SLH physicians was 86 percent compared to a national average of 33 percent.

• SLH utilizes a broad-based Medical Staff Clinical Indicator Index to track 58 critical measures of clinical quality, such as readmitted patients, returns to intensive care unit, and returns to the operating room. The index denotes the number of indicators that fall outside of statistically allowed tolerances. In 2002, 95.3 percent of the 58 indicators were in control. The percent rate of Returns Following Ambulatory Procedures is significantly lower for SLH at 14.2 percent compared to 39.18 percent for national teaching hospitals with more than 18,000 discharges per year.

• The annual independent National Research Corporation (NRC) study of regional providers shows that patients believe that SLH delivers the best quality health care and has the best doctors and the best nurses of the 21 facilities in the market area. This top position has been sustained since 1997. Additionally, the study found that patients believe that SLH delivered the best cardiac, neurology, and orthopedic care and ranks among the top four in obstetrical care over the last two to three years.

• In 2002, SLH participated in measuring and comparing its performance in the areas of Acute Myocardial Infarction treatment and Surgical Infection with 10 best peer hospitals through the Voluntary Hospitals of America. SLH was best-in-class in surgical infection and second out of the 10 in Acute Myocardial Infarction. (VHA is a private, for-profit cooperative that serves not-for-profit health care organizations nationwide.)

• In treating ischemic stroke, a leading cause of death and permanent neurologic disability, SLH is leading the nation in the percentage of diagnosed patients receiving Tissue Plasminogen Activator (tPA) to help restore circulation and reduce permanent brain injury. Twenty-seven percent of SLH patients received tPA in the second quarter of 2003 versus a national average of 3 percent.

• SLH was in the top 5 percent of the national teaching hospitals comparative group for four of the eight Obstetrical and Perinatal indicators (e.g., rate of cesarean sections and anesthesia complications) and was in the acceptable range for the remainder of the indicators.

• SLH has demonstrated improving financial performance over a four-year period as represented by improvements in total margin and operating margin. SLH outperforms the Council of Teaching Hospitals (COTH) top quartile and ranks in the top 5 percent of hospitals nationwide in total margin.

• SLH has shown financial improvements over a four-year period in the areas of Days Cash On Hand (DCOH), from 215.9 days to 359.9 days, and Net Revenue per Case Mix Index (CMI) Adjusted Discharge from $10 Thousand to $14.5 Thousand. CMI normalizes data for the complexity of conditions treated. Sustained financial improvements in these areas have resulted in SLH exceeding hospitals with similar bond ratings for DCOH and achieving COTH top quartile performance for Net Revenues per CMI Adjusted Discharge. SLH has an A-1 Bond Rating from Standard and Poor’s and an A+ Bond Rating from Moody’s.

• SLH’s performance results for Employee Retention have shown continual improvement over the past four years. Organizational employee retention has consistently exceeded the Saratoga Institute’s median for the past five years and is approaching 90 percent.

Processes:

• SLH designs and redesigns clinical pathways for high-volume, high-cost diagnoses. (Clinical pathways are a treatment protocol designed to standardize care and reduce variation.) A team approach is used in the design process to review the best practices found in the medical literature and then restructure and redesign clinical care. SLH has 134 widely deployed clinical pathways that apply to 60 percent of SLH patients. The patients get their own version in a format that allows both the patient and family to understand and track what will occur during treatment.

• SLH has translated its understanding of how patients want to be treated and involved and has established a clear set of 12 Customer Contact Requirements. Requirements include “Address patients/guests by last name unless otherwise told,” and “Address all complaints within 24 hours or less.” This information was incorporated into a new patient-focused care delivery model and all health care team members are trained in these contact requirements. All employees receive a VIP (Very Important Principles) card with these requirements and they are posted throughout the hospital.

• SLH has aligned its operations from top to bottom, using the Strategic Planning Process (SPP), the Balanced Scorecard (BSC), the Process Scorecards, the Performance Management Process, and the Performance Improvement Model. Deployment is achieved using both departmental 90-day action plans and an individual performance management process. This creates an environment in which informed and empowered employees can act as leaders in support of the hospital’s vision. In 2002 and 2003, nearly 90 percent of departments had action plans supporting the SPP.

• SLH uses a seven-step SPP to set strategic direction and performance expectations, deploy strategic plans, allocate necessary resources, and manage the organization throughout the course of the fiscal year. SLH executes a series of annual leadership retreats (Customer Retreat; People Retreat; Growth and Financial Retreat; Clinical and Administrative Quality Retreat; Deployment Retreat) led by the BSC Perspective Leaders and attended by the Hospital Leadership Group (HLG) to evaluate different categories of information that are then incorporated into the SPP.

• SLH has a human resource planning system responsive to both current and changing health care needs. The system includes a "Workforce Planning and Assessment Tool,” a detailed staffing analysis for all departments supporting patient care, and human resource action Plans that are created based upon the strategic plan.

• Factors that determine employee well-being, satisfaction, and motivation are uncovered through formal surveys, open forums with senior leaders, targeted focus groups, senior leader “walk rounds,” “staying” and “exit” interviews and the Peer Review Grievance Process. Employee satisfaction results gathered through surveys are segmented by unit level, job type, shift assignments, and ethnicity, to provide SLH leadership with information that can be acted upon to enhance satisfaction and motivation.

• SLH systematically uses its Performance Management Process (PMP) to reinforce its values of quality/excellence, customer focus, resource management, and teamwork. Through the use of the PMP, primary customers are defined for each position/person, expectations are set, position-specific competencies are defined, personal commitments which contribute to SLH’s values are identified, and feedback is used to reinforce core values.

• SLH has identified Centers of Excellence within its clinical products and services, and has focused its resources on them. These centers have been recognized regionally and nationally. They represent a partnership with the hospital’s physicians and provide an opportunity to further the hospital’s commitment to research. By partnering with its staff physicians and the University of Missouri, SLH has been able to endow nine research chairs focused on the specialty care provided in the Centers. The SLH research program has more than tripled in size in the past five years. SLH is also partnering with seven other public and private institutions to form the Kansas City Life Sciences Institute.

Leadership/Social Responsibility

• SLH has a community education program as one strategy to impact the health of its communities. The level of financial commitment to community education has steadily increased from $9.6 million in 1999 to $12.7 million in 2002. During this same period the satisfaction of the community with educational services has stayed constant, at more than 97 percent.

• SLH defines diversity very broadly, using the theme, “the difference makes the difference.” Diversity systems include multidisciplinary teams, employee satisfaction surveys containing diversity-related questions, four hours of diversity training for new employees, periodic “lunch and learn” sessions about diversity-related topics, and toolkits in each unit with materials designed to help staff respond to an increasingly diverse patient population. Additionally, the percentage of minority mangers shows a positive trend since 1998, increasing by 3 percent to 9.4 percent.

• Senior management is accountable to the Board for SLH’s performance. The Board reviews the BSC, independent and external audits and evaluates the CEO based on their findings.

• The Organizational Ethics Statement, distributed to all key stakeholders, describes how the organization operates based on its core values. The Ethics Advisory Committee (EAC), which is a Board level committee, considers any issue brought to them by patients, family members or providers, and provides a forum in which the community and professionals can talk about ethical issues.

• SLH has won recognition from numerous local, state, and national awards programs for clinical excellence, patient and employee satisfaction, and overall quality. Some 2002-2003 examples and their sponsors are: Best Kansas City Metropolitan Hospital, Ingram’s Magazine; Cardiac Care Award, Women’s Heart; Best Place to Work, CIO Magazine; 2002 Consumer Preference Award, NRC; the Paragon Award for Human Resources Excellence, Human Resource Management Association; and the Missouri Quality Award, Governor of Missouri.

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Created: 11/25/03
Updated: September 17, 2004
Contact: inquiries@nist.gov