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From Stuck to Star-Struck — How a Struggling Hospital Gained Stable Ground and a 5-Star Overall Quality Rating

by Tom Sledge, North Texas Medical Center CEO

Five years ago, the discussion about North Texas Medical Center in Gainesville, Texas, was primarily focused on the hospital’s financial struggles. Now, the hospital and community are buzzing after NTMC earned the highest quality and patient satisfaction ratings possible from the Centers for Medicare and Medicaid Services. CMS annually assigns Star Ratings for its consumer website so patients can compare and choose hospitals based on key performance indicators.

NTMC received a 5-Star Overall Rating and a 5-Star Patient Survey Rating, making it one of only nine other hospitals in Texas to earn the highest mark in both categories in 2023. Zooming in for a closer comparison, NTMC is one of only two acute care, non-specialty hospitals that garnered 5-star ratings in both categories.

Not so long ago, earning 5 Star Ratings seemed as unattainable as the distant stars. When the hospital was struggling to restore its fiscal health and reputation after coming out of bankruptcy in 2018, the new leadership group had to rapidly identify and prioritize the areas that needed the most improvement. While strengthening the financial position was important, the emphasis was placed on improving the quality of care delivered and increasing patient satisfaction. As the strategies to improve the patient experience took hold, the hospital’s volumes grew and the hospital’s financial situation stabilized and began an upward trend.

For NTMC, continual improvement efforts transformed the rural facility from an underestimated feeder hospital to a first-rate healthcare provider positioned for growth as the nearby Dallas-Fort Worth area continues to expand.

Accomplishment & Sustainment

NTMC’s transformation over the last five years was due to narrowing the focus to resolve issues that were preventing delivery of the best care possible. As these obstacles were overcome, sustaining and refining the accomplishments became the emphasis.

It takes a cultural shift and a total team effort to achieve the desired results. The process requires collaboration and engagement of employees across all levels of the organization to identify root causes of issues and implement solutions. NTMC fosters a culture that openly discusses opportunities for improvement. Front-line workers are encouraged to bring problems forward and entrusted to implement solutions. The leadership team routinely visits each department and includes the night and weekend shifts in rounding to make sure all employees’ needs, concerns and ideas are heard.

NTMC employs a multidisciplinary team approach to help identify and resolve issues and make sure day-to-day operations stay on track. Just as a fresh pair of eyes can spot errors in the written word, team members from various departments bring a fresh perspective and often devise solutions that have eluded their colleagues simply because they’ve been staring at the problem for so long.

Initially, the rate of hospital-acquired infections (HAIs) was an area of focus. The multidisciplinary team tasked with reducing HAIs included the hospitalist, the nursing director, infection- and quality-control specialists, front-line staff and housekeeping, as well as a newly appointed educator who developed training to rectify gaps in knowledge and processes that the team had identified. The concentrated and concerted effort paid off. As of this writing, NTMC has gone more than 330 days without a single HAI.

Once the HAI reduction objectives were met and other issues became the priority, the team implemented processes and protocols to ensure long term success in reducing the opportunities for HAIs to occur. Ongoing training prevents problems from recurring and reinforces the staff’s commitment to high-priority initiatives.

Along with the improvements in quality, other notable accomplishments at NTMC include doubling the average monthly total of primary care outpatient visits and significantly increasing emergency department and inpatient volumes. New service lines have been added, including wound care and cardiac-related imaging services, and new physicians have joined, with three more coming by the end of 2023.

These accomplishments would have been much more difficult to achieve without the support of Community Hospital Corporation and other CHC-affiliated hospitals. For example, when the time came to switch to a new electronic medical record system, NTMC utilized the expertise of the CHC Information Technology staff to help with the transition. The hospital also called on other CHC hospitals who had recently moved to the same EMR system for advice. Being able to work closely with other facilities who had recently gone through the process and had developed training protocols and resolved technical issues was very beneficial.

Celebration of a Job Well Done

The 5-star status won’t come as a surprise to patients who have chosen NTMC since continual improvement efforts shifted into high gear, but NTMC hopes that the 5 Star Ratings will help convince new or misinformed community members to let the hospital earn their business and trust. The hospital will be celebrating and sharing the news via newspaper articles, social media postings and a billboard in a prominent location in the community.

As employee recognition is a critical component to building a stable and successful team, it was only fitting that NTMC had a week-long celebration for the staff for earning the 5 Star Ratings. The fun and activities served as a reward for the staff, as well as a powerful marketing tool for the hospital in a tight-knit community. When employees take pride in the positive changes happening at the hospital, they will spread the word. NTMC employees celebrated each day in style with a series of star-themed events such as Rock Star dress-up day and the “Stars Come Out at Night”. The week was capped off when the Mayor Pro Tem presented the hospital with a certificate acknowledging August 4, 2023 as North Texas Medical Center Day in Gainesville, TX.

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