Malcolm Baldrige National Quality Award
2017 Award Recipient, Health Care
Adventist Health Castle (AHC) is a community hospital system that provides inpatient and outpatient care to people who primarily live on the windward side of the Hawaiian island of O’ahu. It is one of 20 hospitals within the nonprofit, faith-based, Adventist Health system headquartered in Roseville, CA. Employing 1,046 people, AHC’s main hospital is in Kailua, HI, with two professional centers and a rural health clinic also located on the windward side of the island. The Center’s services include 24-hour emergency care, inpatient acute care, the Vera Zilber Birth Center, a Joint Care Center, inpatient behavioral health services, multi-specialty surgical services, cardiovascular services, neurological services, the Hawaii Center for Metabolic and Bariatric Surgery, outpatient services, chemotherapy clinic, imaging services, and the Wellness and Lifestyle Medicine Center.
- AHC boasts rates from below 1 percent to zero for common hospital-acquired infections, as well as patient falls. AHC has been a top performer nationally for having had zero catheter-associated urinary tract infections (CAUTI) in its inpatient units for the last three years and 5 months. AHC’s intensive care unit (ICU) is performing in the top decile of ICUs nationwide, having maintained a central-line-associated blood stream infection (CLABSI) rate of zero for four of the last five years.
- AHC has met or surpassed top-quartile levels—improving its performance by 12 percent from 2014 to 2016—on composite measures of patient safety, evidence-based care, and mortality related to its clinical care processes. AHC’s rates of compliance for evidence-based practices to improve outcomes for venous thromboembolism, stroke, and sepsis, as well as elective delivery guidelines for AHC Birth Center patients, have achieved or surpassed top 10 percent performance levels in national comparisons in recent years.
- For the past three years, AHC has performed in the top 3 percent of the nation’s health care organizations for inpatient care results reported to the Centers for Medicare and Medicaid Services (CME) for Value-Based Purchasing.
- AHC’s levels of physician engagement are also in the top 10 percent of national results. For three Gallup survey questions that are considered key dimensions of physician engagement—in which respondents are asked about the health care organization for safety, as a place to practice medicine, and for quality of care—AHC is currently in the 95th, 97th, and 97th percentiles, respectively, on these measures.
A Tenacious Pursuit of Quality Improvement
- Adventist Health Castle demonstrates a tenacious pursuit of quality improvement for the benefit of its customers, “chasing zero” harm to its patients. As a result, it boasts rates from below 1 percent to zero for common hospital-acquired infections (i.e., CAUTI, CLABSI, surgical site infections [SSI], and Clostridium difficile bacterial infections), as well as patient falls. AHC has been a top performer nationally for having had zero CAUTI infections in its inpatient units for the last 3 years and 5 months. AHC’s ICU is performing in the top 10 percent of ICUs nationwide, with a CLABSI rate of zero for four of the last five years.
- Benchmarking its performance against high-performing U.S. hospitals in Premier Inc.’s Quest data-sharing collaborative, AHC has met or surpassed top-quartile levels—improving its performance by 12 percent from 2014 to 2016—on composite measures of patient safety, evidence-based care, and mortality related to its clinical care processes. AHC’s rates of compliance for evidence-based practices to improve outcomes for venous thromboembolism, stroke, and sepsis, as well as elective delivery guidelines for AHC Birth Center patients, have achieved or surpassed top 10 percent performance levels in national comparisons in recent years.
- AHC interactions with patients and other customers are guided by the organization’s embrace of the Hawaiian spirit of aloha (which means love) and ohana (family). AHC clinical and associate employees communicate and build relationships with patients and other customers through such practices as rounding, share cards, care boards, and a service recovery program. Interdisciplinary/interdepartmental teams collaborate to meet customer needs. AHC’s cross-functional Patient Experience Council meets regularly to evaluate and refine customer-focused practices and results.
- Demonstrating the faith-based organization’s identified core competency of “Love matters,” AHC’s patient satisfaction results (as measured by third-party-administered surveys on health care providers and services) are in the top 25 percent or better of national comparisons, with many in the top 10 percent.
Mission-Focused and Accountable Leadership
- AHC’s senior leaders guide the organization by modeling a deep commitment to the faith-based mission of “Living God’s love by inspiring health, wholeness and hope.” Senior leaders reinforce that mission and demonstrate the organizational values of integrity, respect, compassion, and excellence through such actions as the CEO’s detailed presentations during employee orientation on ethics and training on service recovery; launch of the “In Their Shoes” empathy-fostering program; and establishment and leadership of daily safety huddles by the chief nursing officer.
- Senior leaders engage employees and foster a workforce culture promoting engagement and high performance through a variety of systematic communications with physicians, associate staff members, volunteers, patients, community, and suppliers and partners. For example, senior leaders conduct regular visits of hospital departments and personally present awards and write thank-you notes to employees and volunteers. Targeted communications include a magazine for physicians and discussions at Medical Executive Committee meetings. As a result, measures of senior leaders’ engagement of employees show exemplary performance levels and trends.
- AHC’s senior leaders and governing board members are held accountable for their performance through an annual evaluation process that is integrated with the organization’s strategic plan and budget process. All leaders and managers (from the CEO to frontline directors) are continuously measured and held accountable for strategic objectives and enterprise-level metrics through the tracking of 90-day action items in their individual Leadership Evaluation Manager plans.
- The Joint Commission (TJC) annual assessments of accountability measures show that AHC has far surpassed a composite requirement of 85 percent, achieving above 99.5 percent and thus earning recognition as TJC’s top performer on key quality measures for the last three years.
Strong Financial and Market Performance
- For the past three years, AHC has performed in the top 3 percent of the nation’s health care organizations for inpatient care results reported to the Centers for Medicare and Medicaid Services (CMS) for Value-Based Purchasing, in which reimbursement increases for higher-quality care on a set of core measures. This high performance has contributed to the nonprofit organization’s operating margin of approximately $2 million.
- Since 2009, AHC has sustained a dominant market share of over 60 percent for the overall inpatient market, with its women’s and cardiac care service lines accounting for 60 percent and nearly 70 percent of their markets, respectively.
High Employee Engagement and a Focus on Caring and Wellness
- To support a compassionate workforce culture, AHC developed “Always Behaviors” to guide interactions among workforce members in relation to “caring for each other,” “caring for our patients and their families,” “communicating with a positive attitude,” “growing professionally,” and “maintaining a safe and clean environment.” Specific behaviors in each area are reinforced through communications in weekly huddles as well as meetings and awards for associate employees. Departmental/unit Top 5 Dashboards are displayed in work spaces to share and improve engagement results.
- AHC’s results for overall workforce engagement surpass the performance of all other facilities in the Adventist Health system and meet or exceed the top quartile of Gallup national comparison data. In addition, AHC results show year-over-year increases in volunteer hours and volunteer satisfaction levels above 80 percent.
- AHC’s levels of physician engagement are in the top decile of national results. For three Gallup survey questions that are considered key dimensions of physician engagement—in which respondents are asked about the health care organization for safety, as a place to practice medicine, and for quality of care—AHC is currently in the 95th, 97th, and 97th percentiles, respectively, on these measures.
- Reflecting practices and policies that promote wellness and safety (e.g., reduced health insurance premiums for employees who actively participate in the organization’s wellness program and an all-vegetarian cafeteria for employees), AHC was designated “Healthiest Place to Work in Hawaii” by Pacific Business News, earned the American Heart Association’s Fit Friendly Gold Award, and became the first Blue Zone employer in the state of Hawaii. In addition, AHC health care workers’ vaccination rates surpass benchmarks and the Healthy People 2020 goal of the Centers for Disease Control and Prevention.
Providing for Community Needs
- AHC’s vision is to transform health care experiences by improving the physical, mental, and spiritual health of its community members. The organization manages people’s health to help make care more affordable through an ongoing transition from a fee-for-service model to a focus on population health, with a related investment in promoting community wellness. Besides offering a wide range of outreach services such as health education and wellness classes, AHC provides community-based primary care in an underserved area of the island through its rural health clinic.
- AHC demonstrates top-decile results in National Committee for Quality Assurance comparisons for disease prevention and treatment programs, sustaining performance for measures of its charitable contributions, community wellness offerings, and attributed life growth. AHC has managed (attributed through primary care physicians) 33 thousand lives saved from annual and necessary screening, prevention, and wellness activities.
- Driven by its mission and vision—and regardless of financial gain or loss—the medical center operates one of only two inpatient behavioral health units on the island to help meet the community’s mental health needs. The unit supports patients through offerings such as meditation and yoga, as well as traditional counseling and medication management, and a comprehensive program to transition patients back to living in the community.
- AHC’s safety and emergency-preparedness system provides an additional community benefit, by assigning various risks to corresponding actions. Rounds by a multidisciplinary team are conducted weekly, with findings addressed within 30 days. In the first three quarters of 2017 alone, AHC held seven emergency-preparedness drills in partnership with the community, the local Marine base, and Adventist Health’s corporate-level IT department. The drills are designed to improve responses to such emergencies as an explosion, a pesticide incident, a cybersecurity breach, a hurricane, a bus crash, and a terrorist toxic-gas attack.
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