The Christiana Care Way: A Focus on Culture, Collaboration & Community

On the Road with Christiana Care Health System – November 2016

by Deanna Frings & Natalie McKay

As part of our Regional Roundtable event in Delaware last month, we had the opportunity to go On the Road with the team at Christiana Care Health System. It was an honor visiting with the Patient Experience Team and learning about their patient experience journey, but what stood out the most was their focus on culture – not only on building connection among each other as employees and team members, but through collaborating with community members and partners within Delaware.

As a not-for-profit health system, Christiana Care includes two hospitals with more than 1,100 patient beds, a home health care service, preventive medicine, rehabilitation services, a network of primary care physicians and an extensive range of outpatient services. Their mission is service through what they model “The Christiana Care Way” – a promise to patients, families and to each other:

“We serve our neighbors as respectful, expert, caring partners in their health. We do this by creating innovative, effective, affordable systems of care that our neighbors value.”

And this was exactly what we encountered during our visit – Christiana Care exemplifies a relationship-centered culture of employees who respect each other and the patients and families they serve every day.

An Integrated Culture
The day was guided in conversation among various team members that all play different but vital roles in achieving patient experience excellence: Patient Relations, Volunteer Services, Patient and Family Advisers, Clinical Solutions, Performance Improvement and Data Analysis. In meeting with our host Shawn R. Smith, MBA, Vice President, Patient Experience, Christiana Care takes an integrated approach towards patient experience through aligning services at all touch points of care – efforts that parallel and work alongside each other rather than apart. The group met frequently to discuss, share and analyze both qualitative and quantitative findings from patient feedback, industry trends and project goals. The strength of connection among each department did not go unnoticed as they all share a common goal to be change agents and influencers in the work “they get to do.”

At Christiana Care, there is a system-wide initiative to focus on the joy and well-being of its employees so that they in turn reflect joy in the interactions they have and the relationships they create daily. The organization continues to find ways to provide the best in experience for their patients and families, but that could not be achieved without establishing and reinforcing a strong, vibrant and positive organizational culture. This culture and act of service to one another as team members caring for patients and families together, and not alone, is truly embedded in the interactions both within and beyond Christiana Care’s walls.

Partnering with Patients, Families & Volunteers
The Director of Patient Relations, Denise Barbee, MJ, BSN, RN has not been in her role long but in her short tenure has made tremendous strides positioning her team for success. Located in the front of the hospital by the main entrance, Patient Relations helps set a warm and welcoming environment. Denise immediately expresses the joy she has in her team in how they exemplify The Christiana Care Way. Anyone who understands the role of the patient relations department can appreciate that much of the day can be partnering with the care staff and leaders managing difficult situations when things don’t go as planned. At the time of our visit, the team of six patient relations representatives working hard and with great purpose consistently achieve a resolution of patient complaints within seven days 76% of the time. This metric is outstanding and one not many organizations the size of Christiana Care share. When I asked her how they made it happen, she simply said, “I put a stake in ground, challenged the team and they took it from there.”

The team also has responsibility for rounding in the Emergency Department (ED). They have developed great relationships with their ED colleagues and are a welcomed site to the physicians and nurses. Their primary focus is to help ensure patients who are waiting to be admitted are kept comfortable and informed until they are transferred to an inpatient bed. This is but one effort that has clearly helped build a culture of caring not only for patients but also for each other. Denise continues to view her work as an extension of being a nurse: “I still take care of patients.” A powerful purpose she carries with her every day.

Margarita Rodriguez-Duffy, MSW, CAVS, Director of Visitor and Volunteer Services, is one of the veterans on the Patient Experience Team and continues this philosophy of partnership. She oversees 1,300 volunteers who have volunteered over 80,000 hours annually. In addition, she has on boarded 510 new volunteers this past year alone. These numbers are impressive but equally impressive is the joy and passion Margarita brings to work every day. The focus she has, as well as her team of volunteers, is that everything they do is about the patient and family experience and they have many programs in place to deliver on their promise. “Volunteers are our voice. They extend our brand. We’re all partners in care together,” said Margarita.

Margarita also manages an extensive Emergency Department program. The ED at Christina Care is the 20th busiest ED in the country and the ED Volunteer Program fosters a culture of collaboration, partnership and a true commitment to support each other across department lines. The concept of the program was developed after 9/11. Employee volunteers started to come in during their off hours to do what they could during the busiest times in the ED. The program continues today and has evolved to include specially trained volunteers from the community. It is interesting to note that employees also continue to be very involved in the program signing up for an on-call shift, typically 2 hours each month. The final element of the program is The Rapid Response Team. A dedicated group of employees that are deployed from within the hospital during peak times or times of great need, much like a Code Blue Team, but with a different focus.

These programs led by Denise (Patient Relations) and Margarita (Visitor and Volunteer Services) send a strong message that we are all in this together and have resulted in positive staff morale and comradery. It doesn’t matter if staff work in a particular department or on a specific unit, they go where and when they are needed.

Building Relationships Beyond Hospital Walls
A critical component of Christiana Care’s promise to serve others includes the relationships they’ve created within the community through patient and family advisers (PFAs), Junior Board auxiliaries and the University of Delaware. Ann-Marie Baker, MSN, RN-BC, Senior Program Manager, shares how their PFAs are integrated in Christiana Care’s work. PFAs go through a day of orientation, which instills a sense of ownership and creates an engaged group of individuals choosing to give back. PFAs share their personal experiences for councils, teams and committees at Christiana Care and provide feedback and input on projects or task-specific team or work groups. Ann-Marie also shares how proud the PFAs are when they receive badges identifying them of their unique role, similar to employee badges. In addition, the organization has a logo representing PFAs seal of approval that is printed on documents and collateral that states the task and/or project was created in partnership with patients and families.

Through Ann-Marie’s leadership, she coordinates over 200 PFAs by connecting them to a variety of department advisory groups and involving them in pathway projects. Partnerships with different departments creates specific areas of need for PFAs, such as cancer care, patient support for women/children, LGBTQ voice, rehab advisory group and more. “There is always a patient/family voice at the table in our advisory groups and it’s about listening to them tell their story,” said Ann-Marie. “Advisers have experienced a personal experience, either as a patient or a family member, and a caregiver is able to hear their stories and understand the ‘why’ of their work.”

Broadening the pull from the community, Christiana Care also has a Junior Board providing additional ways for volunteers to connect with the organization. Managed by Natalie Dyke, Patient Executive Liaison, the Junior Board members give their time and talents, raising money by reaching out into the community, volunteering at both hospital campuses and participating in fundraising activities. During our visit, Junior Board volunteers greeted us at the main entrance of the hospital in their distinct pink jackets. In her role, Natalie continually exercises the mission to service by connecting community members who seek to get involved, whether it be within the Junior Board, executive boards or patient and family advisory councils. “The growth of the relationships we form within the community are results from a positive word-of-mouth experience of our volunteers,” said Natalie.

Also in partnership with the University of Delaware, the organization provides another layer of patient experience education to the university’s hospitality classes. During our visit, we met some of the volunteers who are part of the internship program. These students commit to volunteering for an entire semester greeting at the information desk, escorting patients and guests to any location in the hospital and answering questions family members might have as they wait for their loved ones to come out of surgery.

In addition to the internship program through the University of Delaware, Christiana Care has also partnered with the university to offer a 10-week course through a program called Patient Experience Academy. Part of the patient experience curriculum of the Value Institute Academy, the course takes proven customer service and engagement strategies from the hospitality industry and adapts them to a healthcare setting. Patient Experience Academy is experience-based learning that teaches expectations of patient experience through staff and patient and family engagement. After graduating, there are two follow-up sessions at 30-days and 60-days. Coordinated by Jennifer Czerwinski, Senior Program Manager, the pilot program began in 2014 with 40 graduates from Christiana Care’s frontline staff and guest services team. Currently, there have been over 250 people who have engaged in the Patient Experience Academy.

“Patient Experience Academy aims to hardwire behaviors, creating a layer of customer service towards healthcare through culture change – focusing on emotional connections and interacting with patients on a different level,” said Jennifer.

The importance of community partnerships and relationship building to Christiana Care represents their commitment to engage all voices in driving comprehensive, systemic and lasting solutions by looking beyond clinical experience of care and focusing on all interactions and touch points. The success of these partnerships is a testament to their commitment.

Understanding Patient Feedback
A singular focus for the Patient Experience Team is that all patients and family members receive consistent, high quality and compassionate care. “It’s all about decreasing experience variation,” shared Shawn. He has put an innovative, sophisticated and integrated system in place that guides the team in process improvement project selection and communicates the demonstrated outcomes achieved across the continuum of care.

Pamela Boyd, MSN, RN, CNOR, Senior Program Manager, leverages her relationship building skills in tandem with her analytical skills working with teams to narrow the performance gap in the execution of targeted initiatives such as nurse leader rounding using mobile technology. As a surgical nurse by background, she truly enjoys supporting the nursing staff. She explains that with any implementation effort, it’s critical to first build a relationship. Being a nurse herself, she establishes an immediate rapport. “I know their world because I lived it,” said Pamela. Her approach is simple – she works in partnership providing resources, education and listening to their feedback which is instrumental in evolving the process to the point it becomes the staff’s and not just another initiative coming from leadership. It’s then that consistency in the rounding effort is possible and the stated goals and outcomes we all agree are important is achieved.

The data, both qualitative and quantitative, are also integral in the success of nurse rounding. The value of having real-time patient feedback provides a great opportunity for immediate service recovery. The positive patient comments reinforce to the staff why rounding is so important and are used by leaders for staff recognition and the outcome data show an improved patient experience. The data is now being analyzed to identify the next targeted initiative in other areas such as the Surgical Center, Medical Group Practices and Outpatient Heart, Vascular and Imaging Areas.

Danielle Modzelewski, Senior Data Analyst, participated in our roundtable discussion the day we visited. Her work and that of her analytics team empathize the value Christiana Care, Shawn and his team place on providing experience data at all levels in the organization and on the critical importance of making data-driven decisions. She gave us a brief tutorial of the sophisticated, integrative experience dashboard she is responsible for maintaining. It was quite impressive to see how easily one can navigate from looking at high level organizational data to drilling down to the details of a specific unit or service line. It was during this discussion we realized how impactful and powerful their system is.

One example is how they found a correlation in satisfaction levels of patients with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) to the respective clinical pathway used to treat them when admitted to the hospital. Another example shared was looking at the pain experienced by women after giving birth. The data was aggregated by those that did and did not have a C-section. They were ultimately able to improve the clinical pathway for those patient’s having a C-section and are now seeing an improvement in their management of pain to the same level as those patients that did not have a C-section.

Christiana Care looks at the data differently from many other organizations. They have worked diligently to view the experience across the continuum of care and have three metrics that are each a composite of all the questions rolled up into on metric for inpatient, outpatient and physician office setting respectively.

We are ALL the Patient Experience
Christiana Care’s integrated approach to patient experience includes being data-focused and data-driven, but, first and foremost, being people-focused. This includes their employees, the patients and families within their walls and the community partners beyond – a true testimony of how all roles matter in patient experience. “Patient experience is about shifting the mindset,” said Shawn. “It is about having an uncompromising commitment to fulfill the needs of all the people we serve.”

In closing, we are motivated and inspired by Christiana Care’s commitment to building a strong organizational foundation and culture of employee value that influences their patient and family engagement and relationships. The team synergy among the conversations and interactions within our visit is an important reminder that we are all not in this work alone. As they look to each other for encouragement in the roles they influence across the patient experience movement, we hope that you also know, as part of the Institute’s patient experience community, there are many others you can count on for support and information sharing. We are ALL the Patient Experience!