In a recent San Diego Business Journal editorial, the question was asked, “Can a year make a difference?”
As representatives of the 2,500 physicians, 10,000 employees and administrators that make up the Scripps family, we think a year makes a huge difference! Here at Scripps, the past year has been one of stabilizing the organization and rebuilding , rebuilding relationships, trust, and communication.
Without a doubt Scripps has faced its share of challenges, so it isn’t surprising that we have yet to win back the full confidence of every one of our patients and even some of our own physicians and staff. But we wouldn’t be writing this if we didn’t believe that our optimism, hope and commitment to working together to provide excellent patient care are indicative of the tenor here at Scripps.
From the perspective of physicians working at Scripps’ five hospitals, one year ago the system was in distress. Now the perception is radically different.
The current Scripps administration has listened to its physicians, nurses and ancillary caregivers; decision making has been pushed out to the clinical facilities; and the focus on patient care has been reestablished. Scripps has reached out to all constituents to provide support and encouragement and has leveled the playing field for contracts with Scripps-affiliated physicians.
The creation of a Physician Leadership Cabinet, to review strategic decisions and act as a conduit for organizational concerns, has created a strong and credible connection between elected physician leaders, nursing leadership and administration.
Perhaps the greatest change in the past year, however, has been the re-establishment of trust between the physicians of Scripps and its administrators. Both at the local hospital level and with our new CEO, Chris Van Gorder, physicians feel that their voices are heard and that their priorities are validated. The physicians of Scripps acknowledge and applaud Scripps for its efforts to help us move forward.
Implementing STAR
As Scripps employees, and particularly as caregivers, our ability to impact the way in which we care for our patients has never been greater. To provide quality care, employees have been empowered to make decisions at the point of service, redesigning our processes and streamlining work so that we can spend more time with our patients.
Considered a success in progress, STAR, or Scripps Teams Achieving Results, is the process improvement effort that has driven the development of solutions at a very local level. Once developed and tested, solutions are then communicated systemwide and implemented as needed in other facilities.
There are several major projects under way that involve patient documentation, a new core clinical computer system, new acuity tools and a redesign of the patient admission process. These are huge undertakings and, in some cases, they will take one to two years to complete , but they will revolutionize the way Scripps operates.
The most important aspect of STAR, however, is every project has actively recruited “rank and file” employees for their input and unique perspective, with the open acknowledgement that those of us closest to our patients know best how to improve patient care.
So far, $5.5 million has been saved, despite the fact that STAR has yet to launch in some departments. Much of the money saved has been used to fund salary increases for our employees and will enable us to continue investing in our programs and hospital improvements. Additionally, we have set up an aggressive compensation review process to keep our staff salaries equitable in the market.
Seeking Feedback
To measure our efforts, Scripps conducts ongoing patient satisfaction surveys with about 12,000 patients annually. In the past year, we initiated one-on-one interviews with patients on many units so that their feedback can be acted upon immediately. We are also listening to the community and soliciting feedback from our community advisory boards and our newly formed employer advisory panel.
For administrators and managers, there is now a balance in terms of local and system-wide decision making. Management responsibility for each of our five hospitals is more decentralized.
Hospital decisions are made locally, enabling us to move faster and develop better solutions. Understanding that each campus has its own personality, needs, and unique community to serve, management teams are being rebuilt to allow for this increased local authority and the accountability that must follow.
Just as physician involvement has increased dramatically, Scripps has made a concerted effort to recognize the value of professional nursing and encourages participation by nursing leadership at all levels in the organization. Nursing leadership participates in the Physician Leadership Cabinet and attends each of the Board of Trustees meetings to ensure that nurses are represented in major decisions.
We are also helping to develop leadership skills from within the organization and have created a leadership academy with an inaugural class of 21 employees. Additionally, a values-based management training curriculum has been developed for implementation in July.
Searching For Solutions
As an organization, Scripps will always be evolving to create new ways of providing more effective patient care and efficient service. But the challenges of health care are enormous and we would be the last ones to tell you that things are perfect.
We have a nationwide nursing shortage. We have one of the highest percentages of uninsured in the country.
Medical groups are foundering under restrictive contracts. And unfunded mandates, like new seismic requirements, strain even the most financially sound hospitals. In a field that changes constantly, to say we are doing things “perfectly” would mean that we have settled for today’s answer instead of striving for tomorrow’s solution.
Can we say that we have all the answers and have found the “cure” to the many challenges that face the health care industry in San Diego and across California? Realistically, we recognize that there will always be opportunities for improvement. But Scripps , its physicians, nurses, other staff and administrative leadership , is committed to attaining our goal of always providing the highest quality patient care possible. Today, we feel we are in an excellent position to reach that goal.
A year can make a difference. Now we’re looking forward to seeing what two years will bring.
Dr. Shaw is chief of staff at Scripps Mercy Hospital; John Boucher, R.N. is patient care manager at Scripps Green Hospital; and Cindy Mayo, R.N., M.S.N. is assistant administrator and chief nurse executive at Scripps Memorial Hospital Chula Vista.
