The Situation

For any hospital, regardless of size, leadership, staff satisfaction, and performance go hand in hand. When one area goes unchecked, other areas potentially suffer. As the saying goes, “Complacency is the enemy of progress,” and all hospitals must be vigilant about the risks associated with operating at a place of “business as usual” rather than focusing on continuous improvement.

ContinueCARE Hospital at Hendrick Medical Center, a long-term acute care hospital (LTACH) operating within Hendrick Medical Center, felt the effects of this mindset firsthand as they found themselves disconnected from the host hospital and not operating at an optimal level. The turnaround facilitated by CHC ContinueCare helped address key areas for improvement to put the LTACH back on track.

Background

CHC ContinueCARE is a division of Community Hospital Corporation (CHC) that owns and manages LTACHs. ContinueCARE Hospital at Hendrick Medical Center is a not-for-profit 23-bed LTACH located within the Jones Building of its host hospital, Hendrick Medical Center, Abilene, Texas. The LTACH serves Abilene and surrounding counties within a 90-mile radius from Midland and Odessa to the Dallas/Ft. Worth area. The hospital was awarded three-year accreditation by the Center for Improvement in Healthcare Quality (CIHQ).

In its current location since 2014, the LTACH serves patients with medically complex conditions, especially those needing extended recovery times—a hospital stay that’s often 25 days or more. After care in an LTACH, many patients then transition to acute rehab, skilled nursing, or they return home. Services at ContinueCARE Hospital at Hendrick Medical Center include a pulmonary program for ventilator weaning, a medically complex program for patients requiring intensive care, and a long-term wound care program.

As a “hospital-within-a-hospital,” ContinueCARE Hospital at Hendrick Medical Center is a separate yet fully licensed hospital connected to the host hospital. However, in order for both entities to thrive, they need to work together.

By 2018, it became clear that the LTACH was struggling. Largely in debt to the host hospital, the LTACH was only filling around 13–14 of its 23 beds. Area hospitals were referring patients elsewhere due to slow response times and poor communication. Employee recruitment and retention rates were down, and 75–80% of nursing staff were contract labor who were less invested and more costly than full-time nurses. Multiple factors challenged leadership to transform operations, workflow issues, staffing and a culture of inclusiveness.

“LTACH is an ever-changing industry, changing from one month to the next, but I don’t feel like I need to go to every single conference or read every single journal because we can turn to CHC. It’s almost like ongoing mentoring.”

Brian Bessent, Chief Operating Officer, Hendrick Medical Center South

The Plan

Built on the foundation of a solid partnership and commitment to success, CHC ContinueCare began the turnaround effort by making leadership changes at the hospital level. Meri Combs began as CNO in May 2018, bringing her expertise and experience as Critical Care Nurse Manager at the host hospital, Hendrick Medical Center, where she previously led operations for the 24-hour Critical Care Unit. Later that year, Holly Powell, Regional Vice President for Post-Acute Services at CHC, took the reins as the Interim CEO.

The team “started from scratch,” according to Powell, and took an “out of the box,” approach to address areas for improvement focusing on two key areas: employee satisfaction and service quality as outlined in the following initiatives.

Focus on employee retention & recognition

CHC partnered with Human Resources to develop and implement an action plan to boost employee retention and satisfaction, including:

• New leadership model: Implementation of a Transformational Leadership Model, focused on providing staff with an arena to voice concerns and offer input.

• Recognition program: Creation of a recognition program to celebrate birthdays, name an employee of the quarter, and show employees they are a vital part of the team.

• Internal training: Establishment of an internal training program for ICU nurses instead of using an external agency as had been done previously.

• Workflow updates: Examination of workflow issues, taking into account nurse and physician feedback about tools, skills, and working environments they need to be successful.

New commitment to quality service

In addition, the LTACH launched a quality initiative centered on improving service by taking the following steps:

1. Met with regional hospitals in the area to learn how to better serve them and then redesigned processes and procedures based on this feedback.

2. Formed the Early Mobility Program, a program focused on getting patients out of bed as quickly as possible. The nurse-driven plan freed up rehab staff and gave patients access to therapy seven days a week rather than five.

3. Established an internal wound care program rather than outsourcing to an external provider.

Increased communication

Lastly, the hospital made the following communication improvements:

1. Began involving employees in order sets and other decision-making processes to help the team understand the issues and help identify solutions.

2. Provided information to staff about the critical importance of prompt response to referral requests and patient admission.

3. Established monthly staff meetings to increase employee involvement.

4. Shared more patient success stories with physicians and the referral team.

5. Improved communication across the admissions team, clinical liaison team and case management teams.

The Results

As a result of these initiatives, the LTACH reports that employee satisfaction rates are the highest they’ve ever been. No longer in debt to the host hospital, the LTACH is on a continuous improvement path, operating efficiently and with an improved census average.

“Employees are your foundation of whether you’ll be successful or not. Nurses are happy now, and it shows.”

Joe Roberson, CEO, ContinueCARE Hospital at Hendrick Medical Center

Measurable improvements

The hospital has reported the following measurable improvements in 2020:

• Average monthly admissions increased from 19/month in 2019 to 26/month in 2020
• Contract employee hours decreased from 1,000 hours per month to 600 hours per month
• Caring for higher acuity patients as indicated by an improvement in Medicare Case Mix Index from 1.15 to 1.18
• Decreased length of stay for managed care patients from 25 to 23.2
• The mix of Medicare patients increased from 61% to 67.4%
• Total operating costs per patient day decreased by 6.6% from FY 2019 to FY 2020
• Better management of accounts receivable improved cash flow; outstanding AR days decreased from 74 to 40 in one year
• EBIDA margin improved from a negative (3.3%) for 2019 to a positive 6.9% for 2020.

“Our employees wanted the hospital to be successful. They were part of the solution, and they are proud to be part of the ContinueCARE Hospital at Hendrick Medical Center care team.”

Holly Powell, Regional Vice President for Post-Acute Services at CHC