North Mississippi Health Services (NMHS) is a nonprofit, community-owned, and integrated health care delivery system serving 24 rural counties in northeast Mississippi and northwest Alabama. The organization includes six hospitals, four nursing homes, and 34 clinics. It provides preventive and wellness services, hospital-based emergency and acute care services, post-acute care services, and a preferred-provider organization. The NMHS workforce of 6,226 employees and 491 physicians serve at health care facilities located in six Mississippi communities (Tupelo, Baldwyn, Eupora, Iuka, Pontotoc, and West Point) and one Alabama city (Hamilton). Net revenue in 2011 was $730 million.
North Mississippi Medical Center (NMMC), the flagship hospital and referral center in the NMHS system, was honored with a health care category Baldrige Award in 2006.
Weighted patient satisfaction results for the NMHS system have been at or above the Press Ganey Associates 90th percentile since 2008 (PGA is a national consulting firm focused on improving health care performance.). Scores from the Hospital Consumer Assessment of Healthcare Providers and Systems survey, a national, standardized, publicly reported poll of patients' perspectives of hospital care, were at or above the 90th percentile for one or more dimensions at all six NMHS hospitals.
NMHS utilizes an innovative “Ideas for Excellence” program to capture improvement suggestions from the workforce. The number of ideas submitted has more than doubled in the past five years to greater than 10,000 in fiscal year 2011, with approximately 40 percent accepted for implementation during that time.
The NMHS employee retention rate has been at or above 90 percent since fiscal year 2009, exceeding the Bureau of Labor Statistics’ benchmark for health care organizations by 10 percent. Survey results show that employee engagement was above 90 percent from 2008 through 2012, and that workers rated their job satisfaction as "best-in-class" in both 2010 and 2012.
Despite its location in what has been called “the nation’s epicenter of poverty,” NMHS is the only health care organization in Mississippi or Alabama with a Standard & Poor’s (S&P) AA credit rating, which it has held for the past 18 years.
High Standards = Better Health Outcomes
Efforts to create healthier populations in the communities served by NMHS have led to outstanding results. For example, outpatient management of diabetes has met or exceeded the National Committee for Quality Assurance (NCQA) top-decile benchmark since 2008. Colorectal cancer screenings have increased since 2009 and consistently exceed the standard set by the state's Medicare quality improvement organization. Additionally, data from NMHS's Community Health Assessment demonstrate that the number of smokers in the region has declined 7 percent since 2004 to 15.6 percent.
For 2012, the NMHS flagship hospital, NMMC, has demonstrated performance at the 100 percent level for Joint Commission-accredited hospitals in 26 of 30 Surgical Care Improvement Project core measures. (The Joint Commission accredits and certifies more than 19,000 health care organizations and programs in the United States.)
A strong focus on patient safety has led to no central line-associated blood stream infections in its intensive care unit for two years. Slips, trips, and falls are below the National Database for Nursing Quality Indicators mean for both inpatient and long-term care settings across the system in fiscal year 2012.
Weighted patient satisfaction results for the NMHS system have been at or above the Press Ganey Associates 90th percentile since 2008. (PGA is a national consulting firm focused on improving health care performance.) Scores from the Hospital Consumer Assessment of Healthcare Providers and Systems survey, a national, standardized, publicly reported poll of patients' perspectives of hospital care, were at or above the 90th percentile for one or more dimensions at all six NMHS hospitals.
Maximizing Service and Improving Performance
NMHS uses a variety of methods to reach various stakeholders and capture their feedback on areas for improvement. These include the "Careline" free phone line, regular leader visits to work areas, face-to-face interviews, Facebook comments received, and surveys. The system's customer service team reviews the data to identify where changes are needed.
NMHS shares performance results with its workforce, partners, patients, and other stakeholders through systematic, well-deployed performance score cards. Performance data and progress toward improvements are reviewed monthly by senior leaders. System-wide collaborative work groups share best practices on a regular basis.
NMHS utilizes an innovative "Ideas for Excellence" program to capture improvement suggestions from the workforce. The number of ideas submitted has more than doubled in the past five years to greater than 10,000 in fiscal year 2011, with approximately 40 percent accepted for implementation during that time.
Use of NMHS's Integrated Community Health Record by both employed and affiliated physicians, including remote log-in capability from their homes when on-call, ensures access to needed patient data and information during transitions from home to the Emergency Services Department to inpatient status and back to outpatient status.
Caring for Caregivers: Employee Satisfaction a Priority
The NMHS employee retention rate has been at or above 90 percent since fiscal year 2007, exceeding the Bureau of Labor Statistics' benchmark for health care organizations by 10 percent.
To engage its workforce, NMHS links rewards and recognition to its EXCEL performance management system and the organization's critical success factors. Survey results show that employee engagement was above 90 percent from 2008 through 2012, and that workers rated their job satisfaction as "best-in-class" in both 2010 and 2012.
NMHS's core competency of "People Who Provide a Caring Culture" recognizes the role that the workforce plays in achieving the organization's mission to "continuously improve the health of the people of our region." Through its innovative "grow-our-own" strategy, NMHS employs a full-time career counselor to assist employees in identifying opportunities for career progression and provides tuition reimbursement for advanced education and training that approached $450,000 in fiscal year 2011.
Senior managers at NMHS have created a culture that emphasizes "people first" among its critical success factors. This "servant-leadership" philosophy enables managers to model the organization's values and build trust with employees, sustaining an empowered, accountable, and high-performing workforce. Open communication and recognition are achieved through a "No-Secrets" culture and open-door policy, weekly e-mails from the chief executive officer, and regular rounds by senior leaders throughout the system.
NMHS's physicians serve as key partners who are actively involved in the organization's business strategy. In collaboration with staff and the administration, employed and independent physicians work together to develop the organization's strategy, implement and improve its work systems, and accomplish its goals.
To support physician leaders in the organization, NMHS has developed an intensive Physician Leadership Institute. Graduates expand their leadership roles as advocates, mentors, and performance improvement champions. Physician leaders share operational responsibilities by participating in annual planning retreats, service line management, and supporting clinics and community hospitals across the system.
NMHS's Live Well Employee Incentive Program educates and rewards employees for healthy and safe behavior choices on and off the job. The program has contributed to a trend where the annual increase in premiums for the employer-sponsored Live Well Health Plan dropped from 12 percent in calendar year 2009 to 2 percent in calendar year 2011.
Sound Management is a Prescription for Financial Health
NMHS leads its primary competitor in market share by 13 percent and all other hospitals combined by 8 percent. In addition, for selected procedures (e.g., cardiac catheterizations and open-heart surgeries), NMHS has led all other competing hospitals in market share from 2008 to 2010.
Despite its location in what has been called "the nation's epicenter of poverty," NMHS is the only health care organization in Mississippi or Alabama with a Standard & Poor's (S&P) AA credit rating, which it has held for the past 18 years.
"Days cash-on-hand," a financial indicator of available revenues used by organizations to plan future spending, has steadily increased since 2008 to 256 days in 2011, outperforming competitors and other S&P AA-rated organizations.
An Active Commitment to Healthier Communities
Dollars spent for charity care at NMHS rose to $80 million per year in 2010 and 2011. Employee contributions to United Way—providing meals, prescriptions, clothing, and utility assistance to the citizens of northeast Mississippi—increased from $475,000 in 2007 to nearly $600,000 in 2011.
To address the challenge of maintaining a highly qualified staff, NMHS has financially supported local schools of nursing, a pharmacology program at a local university, and created the Family Medicine Residency Program. NMHS builds relationships with students beginning as early as elementary school and offers a paid Physician Shadowing Program for college students.
NMHS community and regional outreach includes obesity prevention services, school health centers that provide nurses to 22 schools in six counties, the free Nurse Link Call Center, and free fairs for preventive screenings and health care promotion, including blood pressure checks, flu shots, and childhood immunizations.