Wellstar Paulding Hospital (WPH) is a community hospital providing inpatient and outpatient care and emergency services through an acute care hospital and two connected medical office buildings. It is part of Wellstar Health System (WHS), one of the largest and most integrated health systems in Georgia. With a net patient revenue of $160 million and a workforce of 997 employees (742 clinical, 255 non-clinical/support), 400 physicians, and 105 volunteers, WPH is located in Hiram, GA.
Within the national IBM Watson Health Top 100 Hospitals® index, WPH sustained top 10% performance for its mortality index.
WPH sustained a pressure ulcer rate of zero from 2018 to 2020, putting it in the top 10% of the national health care analytics Midas DV database.
WPH has achieved top 10% performance on several key measures of inpatient and outpatient engagement.
WPH achieved an overall score of 91% on the Great Place To Work (GPTW) Trust Index Survey from team members in FY19 (Fiscal Year), placing it at the Fortune 100 Best Companies To Work For benchmark in all participating industries.
From FY18 to FY20, outpatient performance for “doctors courteous and respectful” increased from 87% to 99%, “nurses listened carefully” from 87% to 92%, and “trust staff with care” from 87% to 91%, matching the NRC (National Research Corporation) 90th percentile benchmark.
Since 2017, WPH has received a Grade A from Leapfrog, a national hospital-rating organization focused on safety.
Health Care Results
Within the national IBM Watson Health Top 100 Hospitals® index, WPH sustained top 10% performance for its mortality index (the number of actual deaths in a group of patients by the total number of patients) from 2017 through 2020 (year to date [YTD]), improving from 0.56 in 2017 to 0.44 in 2019 and increasing to only 0.63 in 2020 (YTD) despite the COVID-19 pandemic. During this time, the IBM Watson top 10% performance level went from approximately 0.7 in 2017 to 1.4 in 2020. The index measures the actual versus expected mortality of a patient population, with 1 indicating the expected mortality.
WPH achieved IBM Watson Health Top 100 Hospitals® top 10% performance in its inpatient complications index (the number of complications in a group of patients by the total number of patients) from 2018 to 2020 (YTD), maintaining 0.50 in 2018–2019 and increasing to only about 0.60 in 2020 (YTD) despite COVID-19. During this time, the IBM Watson top 10% performance level went from 0.60 in 2018 to 1.6 in 2020. The index measures complications associated with medical procedures, with lower scores meaning less complications.
WPH sustained a pressure ulcer rate of zero from 2018 to 2020, putting it in the top 10% of the national health care analytics Midas DV database. WPH’s results support its mission “to enhance the health and well-being of every person we serve” and its core competency of patient safety.
WPH’s senior leaders are committed to supporting and reinforcing their Neighbors Caring for Neighbors (NCN) culture that guides the workforce to deliver “world-class health care to our neighbors.” Senior leaders actively participate in daily safety and voice-of-the-customer (VOC) huddles and visit frontline leaders and staff (i.e., leadership rounding). In addition, the hospital president personally leads WPH’s biannual town hall meetings and discusses the NCN culture and WPH’s mission, vision, and values during new employee orientation.
WPH’s senior leaders demonstrate a personal commitment to legal and ethical behavior. They collaborate with the WHS to develop and implement policies that support their NCN culture, personally review hotline issues and compliance audit findings, and use daily safety huddles to both focus on safety issues and recognize WPH team members for their courage in raising them.
Financial and Market Results
WPH increased its annual operating revenue from about $110 million in fiscal year (FY) 2018 to about $160 million in FY20. During this same time, it maintained about a 10% operating margin. On both of these key metrics, WPH exceeded the Moody’s Aa2 benchmarks, putting it in a strong financial position.
WPH increased its total inpatient market share in its primary service area (PSA) from about 20 to 30% from FY17 to FY20, with WHS maintaining a share of about 80% in the PSA. WPH’s closest competitor has about a 2% share.
WPH’s inpatient discharges and emergency services visits also increased during this same time (pre-COVID), from about 5,900 to about 8,100 and from about 68,300 to 72,100, both exceeding the national IBM ActionOI® database top 10% benchmarks.
Customer Process and Results
To share feedback from patients in different stages of customer engagement, WPH uses patient visits (i.e., rounding), including its piloting of a new rounding application created by Nobl, in conjunction with daily VOC huddles. Whiteboards showing current patient engagement levels support these activities, and these methods provide for timely feedback that leverages WPH’s value to “honor every voice.”
WPH manages complaints and grievances through its Lean Management System, daily VOC huddles, and leader rounding. Concerns and complaints discovered during rounding are reviewed in the VOC huddles to share service recovery actions and predict patient engagement, and WPH leaders visit patients whose complaints cannot be resolved promptly in order to re-engage the patients. These efforts are supported by WPH’s SaFER (a self-reporting system for safety concerns and “good catches” that is used for learning opportunities and best practices) application that enables the tracking of complaints, including time to resolution, and its rounding application that integrates patient complaints and patient engagement predictions.
WPH has achieved top 10% performance on several key measures of inpatient and outpatient engagement. For example, inpatient performance for “staff eased discomfort” increased from 73% in FY18 to 83% in FY20, exceeding the Centers for Medicare and Medicaid Services 90th percentile benchmark. Likewise, from FY18 to FY20, outpatient performance for “doctors courteous and respectful” increased from 87% to 99%, “nurses listened carefully” from 87% to 92%, and “trust staff with care” from 87% to 91%, matching the NRC (National Research Corporation) 90th percentile benchmark.
People Process and Results
WPH recruits, hires, and onboards new workforce members through its seek, employ, and engage process. As part of this approach, all potential employee team members take national traits assessments for leadership or insight assessments for frontline positions to understand candidates’ personality fits and skill levels needed to be successful in their positions.
WPH’s focus on its NCN culture begins with the Hire for Fit process to align employees with its culture and its mission, vision, and values. Expectations are further reinforced through “My team will/I will” statements that align each team member’s activities with WPH’s goals and values. During daily huddles led by the hospital president, team members are encouraged to share NCN stories, good catches, lessons learned, and safety concerns over the past or next 24 hours.
WPH’s GPTW engagement results support its NCN culture and core competency of team member engagement. WPH achieved an overall GPTW trust score of 91% positive for employee team members in FY19 (up from 84% in FY17), placing it in the top 100 of 1,800 organizations in all industries. During this same time, it increased its trust scores on credibility from 80 to 88%, respect from 78 to 86%, fairness from 77 to 83%, pride from 84 to 91%, and camaraderie from 84 to 89%, all matching the GPTW top 100 level.
WPH has earned several awards since 2015, such as Fortune 100 Best Companies to Work For, World at Work Seal of Distinction, and Diversity Best Practices Inclusion Index and MBA.
WPH uses a three-phase scan, plan, deploy strategic planning approach that aligns its strategies with the WHS’s strategies and True North (strategic objective) themes. WPH leaders and board members representing the community inform tactics and participate in the development of the organization’s strategy.
WPH’s bubble teams, made up of leaders and frontline workers, cascade the hospital’s strategies and action plans to all operational and workforce segments. These teams are supported via the active use of the Lean Management System (LMS), as well as multiple communication methods, such as visual management boards, town halls, daily huddles, new employee orientation, and Medical Executive Committee meetings. To ensure that action plan outcomes are sustained, WPH uses the LMS to align performance trends with the strategic objectives; data is reviewed daily, weekly, and monthly by team members and leaders.
WPH actively considers workforce capability and capacity needs in the creation of its action plans. Considerations include partnering with the health system and other business units, recruiting new team members, augmenting the training and education of team members, and reprioritizing the use of resources. As a response to the COVID pandemic, WPH reassessed its capability and capacity, reallocating staff when utilization was low and leveraging support agency staff during the rebound surge.
Citizenship Process and Results
WPH partners with the WHS to support and strengthen its key communities, leveraging the NCN culture and strategic advantage of strong community ties. WHS leaders identify areas of need via the system’s triennial community health needs assessment in conjunction with local boards, such as the Chamber of Commerce and Paulding County School District. Senior leaders and team members actively improve key communities through health and wellness programs, leadership in local organizations, student shadowing, donations, and sponsorships.
In 2019, WPH conducted 35 community events and more than 1,200 school health classes. It also participated in more than 40 local outreach events, including screenings, and sponsored 24 local events.
WHS utilizes its LMS to manage overall organizational performance. The LMS drives problem solving and continuous learning from the senior leaders to the frontline, and performance tracking using LMS tools—such as visual management lanes, daily huddles, and PICK (possible, implement, challenge, kiboch) charts—enables all team members to submit ideas and be problem solvers. The LMS also enables WHS to embed learning and to transfer knowledge through “standard work” across services and workforce segments.
Process Efficiency/Effectiveness and Results
WHS focuses on multiple aspects of patient care delivery to ensure patient, workforce, and community safety and to deliver world-class health care. WPH developed a Safety 4 building model that incorporates elements “to be the safest hospital in the world,” including a standby power system with high-intensity ultraviolet irradiation in the air-handling system to reduce transmission of infection and a geothermal heat pump that uses the earth as a thermal battery, resulting in zero building emissions. In addition, WPH’s NCN culture encourages all team members to speak up for the safety of patients, other team members, and themselves. Processes to enhance safety include safety huddles, SaFER Reporting, ongoing training, environment of care rounding, root-cause analysis, and acuity-adjusted staffing ratios.
WHS’s plan, do, study, act model is used to improve approaches to potential hazards and risks, prevent safety events, improve work and support processes, and reduce variability through multiple LMS tools, such as A3s, visual management, and standard work. For example, standard work for leadership rounding requires leaders to ask specific safety questions. Through its efforts, WPH has been able to improve its occupancy rate from 71% in FY17 to 79% in FY19 (and 87% in FY20-pre-COVID), surpassing the IBM ActionIO 90th percentile in FY19 and FY20.
Since 2017, WPH has received a Grade A from Leapfrog, a national hospital-rating organization focused on safety. During this time, the hospital has had only two serious safety events (SSE 1’s), while the other A-rated hospitals throughout the country had an average of 71 SSE 1 events.