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Dirk Dusharme @ Quality Digest

Health Care

Baldrige Winner Sutter Davis Hospital Pursues Outstanding Patient Experience

An interview with Sutter Davis CEO Janet Wagner

Published: Thursday, January 23, 2014 - 11:32

This past November, three winners of the 2013 Malcolm Baldrige National Quality awards were announced, one in education and two in healthcare. Quality Digest Daily is fortunate that one of the winners, Sutter Davis Hospital (SDH) is practically in our back yard. This gave us an opportunity to meet with Sutter Davis CEO, Janet Wagner, to talk about what it means to win the Baldrige and, more important, what the Baldrige journey does for applicants.

Sutter Davis is a 48-bed hospital in Davis, California, located about 30 minutes from the capital in Sacramento and home to University of California, Davis. SDH is a nonprofit, acute-care facility that offers care in four primary areas: medical-surgical and intensive care, birthing, emergency care, and surgical services. It is the only acute care facility in Davis, and one of only two in its county. SDH operates as part of a regional structure within the Sutter Health System. Its workforce consists of 385 employees and 394 medical staff members supported by 100 volunteers. The hospital operated in 2012 on nearly $95 million in revenues.

This is the first time we have had a chance for a one-on-one interview with a Baldrige winner, and although this is just a single data point, it really drove home just what kind of organization it takes to win the Baldrige.

First, and most obvious, is leadership. And not top-down leadership, but leadership where those in charge are part of the process, not delegators. For this to work, leaders must be accessible. As an example, while shooting our video interview with Wagner, we did a little walk-and-talk down a hospital corridor. An orderly saw Wagner and me walking, and joked with her that she had the walk all wrong. “You gotta walk like this,” he said. And then did a swaggering John Wayne, “I’m bad” walk to illustrate. In my opinion, any place where employees can joke with the CEO on a first-name basis has at least got some of the leadership part in hand: visible and accessible.

The full interview with Wagner will be presented as a two-part video in our Profiles in Quality series. You can view both parts below. But I wanted to highlight a few bits of our Q and A that I think not only illustrate the Sutter Davis journey (you will hear that word a lot), but also gives you a feel for what the Baldrige itself is trying to promote.

Profiles In Quality with Sutter Davis Hospital CEO, Janet Wagner: Part 1

Profiles In Quality with Sutter Davis Hospital CEO, Janet Wagner: Part 2

Part of SDH’s journey began in 2003 with the realization that although it was technically competent in patient care (the hospital consistently ranks in the top 10 percent in various national patient-care measures) it wasn’t that competent in the overall patient “experience” or patient satisfaction. If it was going to give the best-of-the-best in patient care, it had to look at the overall patient experience, not just clinical measures. So SDH began by looking at staff behaviors at the bedside.

“Our foundation was really understanding [staff] behaviors that patients found to improve their experience when they were in the hospital,” explains Wagner. “We married those behaviors with the technical things we were doing that provided really good [clinical] care.

“Once we realized that we understood the behaviors that would get results in the patient-satisfaction arena, we started to look at how we could improve on even a larger scale in terms of leadership. What kind of leadership did we need that would really continue to provide us with five-pillar leaders and keep us in the top decile of the country for healthcare overall? And that is when we started to look at the Baldrige Criteria.”

The other step was to involve leaders in the Baldrige examination process. Rather than hire professional Baldrige coaches or consultants, Wagner sent all her managers to Baldrige examiner training so they could understand the process through an examiner’s eyes.

“Every [Baldrige] application we wrote was written by the employees,” says Wagner. “We never had it edited. So that part was very organic. Once we understood our behavior and once we really started to understand the criteria... and as we became more experienced in examining our own organization, we began to answer the questions in the criteria a little more specifically.”

I asked Wagner what part the employees play. Is the Baldrige journey a strictly leader-driven, top-down approach, or are employees an integral part?

“It’s about half and half,” says Wagner. “The Baldrige journey does require everyone in the workforce to participate, the physicians, the workforce, and our volunteers. We had to get our messaging down all the way to the front line and back. The way we accomplished that at Sutter Davis Hospital was to ensure that in every department our employees are informed, they know what’s important, they know what the priorities of the organization are, and they know how to contribute to those priorities.”

The biggest shift in thinking for Wagner and her staff was to understand their part in contributing to the patient’s overall emotional experience. It’s here that you see the spark that motivates Wagner. She came up through the trenches and knows what it’s like to be an emergency-room nurse, work long hours on your feet, and still remain focused on patient care, even when you’re exhausted. She told us she promised herself that as she progressed from direct patient care to administration, she wouldn’t lose sight of what it means to be a nurse and provide the best possible care for patients. Integrating the idea of overall experience was a natural extension of that.

“What [the Baldrige journey] has changed is how our team ensures that a patient has a reasonably good experience while they are in our hands,” explains Wagner. “Keep in mind, our patients come to us with illnesses and injuries, and sometimes they’re traumatic. So we were thinking about the entire patient experience. Using the Baldrige Criteria, and really self-assessing our organization and how we approached patients and families, we began to realize that we did in fact have control over the environment more than we thought we did, and that we could make the experience better for the patients.”

And who better to define what a customer experience is than Disney or two-time Baldrige winner Ritz Carlton? SDH drew on best practices from both.

“We progressed from our patients being just satisfied to having an experience,” says Wagner. “And who provides an experience? Well, Disney does. Disney provides an experience that people remember and that they want to go back to. So we looked at what’s involved in that experience, that climate, that environment that would make people remember it in a pleasant way.

“And then we took it even a step further. What can we do beyond simply creating an experience? And you know who does that? Ritz Carlton. So we started to look outside healthcare. Ritz Carlton’s approach is to anticipate their customers’ needs. We know what happens in a hospital. We can anticipate what people might be fearful of, what they might need, what they might appreciate while they’re here. So we started to look at that whole Ritz Carlton approach and ask what can we do in our environment that would be equal to or even better than what the Ritz Carlton is doing, and it’s what people don’t expect when they come to a hospital.”

The question has been asked and answered many times: Would the journey be worth it even if you didn’t win? Not surprising, Wagner asserts that the very act of working together to improve, the discovery of what you are as an organization (good and bad) is worth every bit of hard work that goes into it.

“There is no question in my mind that every year we got stronger and stronger,” says Wagner. “The whole climate within our hospital, the esprit de corps, the idea that we were getting stronger, that we were taking the feedback, that we were improving. The most important thing is living our mission, improving the care at the bedside. And we were doing that, year over year over year.... The entire journey has just been a pleasure.”


About The Author

Dirk Dusharme @ Quality Digest’s picture

Dirk Dusharme @ Quality Digest

Dirk Dusharme is Quality Digest’s editor in chief.


Patience Xperience

No more words than Bee Gees': "it's only words ..."

Healthcare Quality Done Right

Thanks for the great interview Dirk. It shows what kind of ruthless compassion and persistence is required to endlessly improve clinical and operational quality.

Patient safety is still pretty scary. Recent numbers I've seen show that healthcare is the third leading cause of death in the U.S. with about 500,000 preventable deaths each year from medication errors, surgical complications and infections.

If one trillion dollars of the 2.5 trillion dollars spent on healthcare is for waste and rework, significant reductions could pay for Obamacare and reduce the national debt. It's great to see champions like Janet Wagner and Sutter Davis Hospital demonstrate what can be done.