Embracing Unique Cultures and Practices within an Integrated System

On the Road with Sentara Healthcare – October 2018

by Stacy Palmer, CPXP

Our latest On the Road allowed us to spend time in three of the twelve hospitals in Sentara Healthcare, an integrated, not-for-profit system that includes four medical groups, Nightingale Regional Air Ambulance and ground medical transport, senior care, home care and hospice, nursing rehabilitation centers, ambulatory outpatient campuses, advanced imaging and diagnostic centers, a clinically integrated network, the Sentara College of Health Sciences and the Optima Health Plan. Providing care throughout Virginia and northeastern North Carolina, Sentara is strategically focused on clinical quality and safety, innovation and creating an extraordinary healthcare experience for patients, residents and members and is a recent system-level member of The Beryl Institute.

Our host for the visit was Cherika Britt, MSN, RN, System Director, Patient Experience. Britt shared the Sentara experience structure is intended to support each of their 16 divisions (and the unique sites that make up each) while reinforcing the system-level commitment.

“Each of our 16 divisions has a customer experience lead,” shared Britt. “We also have a System Customer Experience Workgroup where we have a culture of sharing internal and external best practices and we work to arrive at system initiatives, education and programs to support key categories that impact customer experience.” Included in those categories are patient and family engagement, member of the team engagement, leadership engagement and effective data use.

Note: The customer experience vs. patient experience vernacular is consistent throughout Sentara. Britt noted the system uses ‘customer’ as a universal term for those served throughout the system and acknowledged the importance of patients and families, as well as areas of the organization, such as Sentara’s health plan and senior services, where the terms member and resident are used respectively. Sentara also incorporates a System Customer Experience Executive Task Force serving as a governing body and providing strategic direction to enrich the overall experience of care. The Executive Task Force identifies and removes barriers that might impede achievement of experience outcomes and promotes a culture of employee appreciation and celebration of customer experience aims.

As a system, Sentara has established several key commitment statements that all team members are expected to acknowledge and adhere to. These commitments help create consistency in expectations for the 28,000 employees who live out the Sentara mission each day.

As a member of the Sentara team, I am committed to your well-being and creating an extraordinary healthcare experience. My commitments are to:

ALWAYS keep you safe
ALWAYS treat you with dignity, respect, and compassion
ALWAYS listen and respond to you
ALWAYS keep you informed and involved
ALWAYS work together as a team to provide you quality healthcare

“We are one healthcare system and team members throughout Sentara share a commitment to delivering quality care and creating an extraordinary healthcare experience,” shared Genemarie McGee, Corporate Vice President and Chief Nursing Officer and Sentara’s Executive Sponsor of Customer Experience. “But with that, we acknowledge each division has its own culture and we have to allow that culture to grow.”

Maintaining system consistency while also honoring the individual cultures and personalities of multiple sites can be a challenging endeavor, but it is an area in which Sentara appears to excel based on the three hospitals we visited. The three sites were chosen based on their consistent ability to deliver exceptional patient experiences as evidenced by positive patient feedback. Each holds a strong respect for the Sentara Customer Experience framework and has succeeded at integrating that framework into their unique cultures.

Sentara Leigh Hospital (SLH)

A Focus on Safety and Quality to Drive Experience
Located in Norfolk, Virginia, Sentara Leigh Hospital has built its experience focus around the correlation between experience and safety. In fact, our visit began in their daily safety huddle where each unit shared both their safety and experience data, reinforcing the commitment to transparency at SLH. Team members were encouraged to share stories that reinforced the safety/experience connection. SLH nurses and pharmacists are also encouraged to have a questioning attitude. When any medication error occurs, the team looks to find the root cause and ways to prevent recurrence. This reinforces the power in transparent dialogue to drive change.

Throughout the safety huddle there was a tremendous feeling of support and appreciation for team members. It was inspiring to see leaders come together to provide encouragement (and often, solutions) to best serve patients and families. For example, census is a consistent challenge at SLH, and team members brainstormed ways in which they could reallocate space and staff to best serve the volume of patients for the day. I also enjoyed watching coworkers cheer for each other as they shared improved scores and/or positive experience stories.

The Healthcare “Complete Package”
Much of the success in reinforcing an integrated safety/quality/experience message at SLH is attributed to Jennifer Kreiser, Vice President, Patient Care Services. I had the opportunity to sit with her and several of SLH’s other leaders to learn more about what Kreiser refers to as the Healthcare “Complete Package.” Through a presentation she’s shared with much of the SLH team, Kreiser passionately reinforced the relationship between patient experience, safety and quality and outlined the hospital’s journey to align efforts.

Critical to that journey was helping physicians understand that patient experience is part of the safety journey. She acknowledged it wasn’t easy, but they were able to show the correlation and even enlisted several physician ambassadors to spread the word. Through peer influence and transparency of sharing safety and experience data, SLH administration has developed a strong physician partnership to help drive efforts.

Kreiser also reinforced a focus on SLH becoming a high reliability organization, sharing that in moving towards that, safety must be viewed as a precondition of operations. Team members must be committed to getting things right each time and leaders must think and act differently. Supporting this is also the notion that every meeting starts with a safety moment, either safety or experience-focused, to build on the narrative.

A Commitment by Leadership
Leadership support is a key to SLH’s experience success. I had the opportunity to sit-in on a new hire orientation session led by Joanne Inman, President. Inman shared the hospital’s strategic plan around clinical excellence, quality, safety, customer centricity, growth and innovation. But even more powerful is how she framed the session. She began by asking the class to close their eyes and think about themselves or someone they love in a healthcare situation. She described a very abrupt, impersonal encounter and then shifted to the same situation with a more intentional, compassionate human touch. Her scenario was an impactful way to make the topic personal and reinforce the opportunity each team member has to impact experiences for patients and families.

Inman also prepared team members for what they can expect with leadership rounding from her and other SLH leaders. “How will we know what’s going on in the organization if we don’t talk to you?” she asked, reinforcing leaders’ intent is not to quiz but to understand.

“My job is to serve you,” said Inman. “Ninety percent of the time mistakes happen because the system failed, not a person.” She reinforced that leaders want to understand how staff work as a team to deliver exceptional care and help find ways to eliminate any barriers in the way.

A very charismatic presenter, Inman also shared what she called “Leighisms,” a few key phrases that define and direct the culture at SLH. From the idea that ‘what you permit, you promote’ to the expectation of ‘mess up, fess up’ and the hospital’s open door policy, she described what it means to be part of SLH’s “FamiLeigh.”

Inman explained that every team member is instrumental in sustaining the organization’s culture and reinforced the servant leadership model practiced by the executive team to provide the most supportive atmosphere possible.

SLH recently implemented a program to ensure the momentum created at new hire orientation continues through their onboarding. Referred to as the Gold Standard of Caring, all new employees are required to attend a class at 30-days post hire where they role play Sentara values and commitment to patients and review expectations around safety, culture and patient experience. The two-hour class is intended to help frontline staff get to know each other and learn more about the SLH culture.

From the moment I walked into SLH and saw the welcoming two-story lobby with beautiful open spaces, artwork and a player piano, I sensed an environment with a strong culture and history and that was reinforced through each conversation with the SLH team. Before leaving I had a final opportunity to sit down with team members, all instructors of the Gold Standard of Caring Program, to learn what makes this organization so special in their eyes. The resounding response was empowerment of teams at the bedside to not only deliver care, but to do whatever they can to create meaningful experiences for the patients and families they serve. One team member referred to it as ‘care without boundaries’ citing the benchmark “if you would do it for your mom, you can do it for your patient.”

Creating Meaningful Experiences
The group enthusiastically shared examples of this mantra in action:

• A patient who was very confused and distraught asked for a teddy bear, so a nurse made one out of towels.
  To help alleviate anxiety, team members decorated an autistic patient’s room in purple.
• A dying man’s family requested he be able to go outside. Team members were able to work through several barriers to make that happen and the patient was wheeled outside where family surrounded him and read to him.
• On multiple occasions team members have helped patients pull off last-minute ceremonies in the chapel, from weddings to vow renewals and other celebrations.
• One of my favorite stories was of a hospice patient who had a request to see her dog. Team members were able to coordinate a visit and while there, the Great Dane climbed into bed with her, prompting someone to remark that the dog was “as big as a horse.” The comment led the patient to share that she also owned a horse she would like to see. Upon hearing that, Sentara nurses and palliative care physicians developed a plan to enable the patient, who was medically frail and receiving high-flow oxygen breathing support, to see her horse, Romeo, in the hospital’s healing garden. Staff from her stable walked Romeo off a trailer and into the garden, where he laid his head in her lap and nuzzled her hand for apples while her extended family gathered around. Laughter, tears and gratitude signaled success.

These are just a few of the many stories shared about teams going above and beyond to create great experience for patients. All are shared to reinforce the empowerment teams have and to inspire others to find ways to best support patients and families.

Sentara Princess Anne Hospital (SPAH)

Driving Experience through Culture and Community Involvement
Sentara Princess Anne Hospital is a 176-bed acute care hospital that serves Southern Virginia Beach, as well as the neighboring Chesapeake and northeastern North Carolina communities. Similar to SLH, SPAH has a very welcoming atmosphere with an open lobby, friendly staff greeting patients and a modern feel.

Our visit began with a meet and greet with several hospital senior leaders and SPAH’s two patient advocates. Proud to share the many awards the hospital has received and their consistently high patient satisfaction scores, the team acknowledged the keys to their success are culture and a focus on community. The hospital opened in 2011 following the closing of Bayside, another nearby Sentara hospital, but leadership was very intentional to avoid a straight transfer of staff from one building to the next. Recognizing an opportunity to help shape the culture at SPAH, all team members were required to reapply for positions and only the best of the best were invited on the journey.

All members of the medical staff were required to sign a Sentara Princess Anne Hospital Medical Staff Compact, and that acknowledgement of expectations is still intact for new team members today. It clearly outlines roles of medical staff and hospital administration, highlighting specific expectations such as responsibilities to:

Provide Superior Patient Care
Treat All People with Respect
Take Ownership
Change – For medical staff, this refers to embracing transformation of care and innovation efforts to continuously improve patient care and organizational effectiveness. For hospital administration, it’s about communicating the organization’s strategic plan and priorities and managing the impact of change.
Educate – For medical staff, this refers to fulfilling the role of teacher for staff and future healthcare professionals as well as investing time in developing selves as medical staff leaders. For hospital administration, it’s a commitment to support and facilitate learning opportunities.

“Our medical and executive teams are the key to sustaining our culture and experience success,” said Caroline Rawls, Manager of Customer Experience and Volunteer Coordinator acknowledging the significant contributions of Joani Brough, SPAH’s Vice President and Nurse Executive. Brough is known for her commitment to modeling leadership rounding, consistently spending time with team members and patients.

When asked to share examples of SPAH’s experience efforts, Brough quickly acknowledged that it’s not the big things. “It’s the little things that make a big difference. Patients remember that someone took a minute to hold their hand, brought them a pillow and showed genuine care and concern about their well-being.”

Healing Therapies
One example of where SPAH goes above and beyond to provide compassionate care is the hospital’s healing therapy program. I had the opportunity to meet three of the volunteers, sweet ladies dressed in their signature lavender tops, who provide aromatherapy, reflexology, guided imagery and healing touch to help comfort patients, families and staff. The volunteers take five levels of classes on the functions of healing touch and provide complimentary services throughout the hospital.

The ladies shared several stories of the impact the therapy has on patients. One volunteer shared the story of a “cranky old man” who was unable to sleep. “He reluctantly agreed to try the therapy saying it wouldn’t work, but he was asleep within 10 minutes.”

They demonstrated the healing touch technique of “brushing” on a few of us visiting. Despite the name, the volunteers never actually touch the patient, instead they are trained to assess the energy field with hand motions and scan the energy field of the person in treatment to detect sensations and imbalances. Next, they use motions (near the body, but with no actual contact) over various areas of the body to clear the energy field. The volunteers shared that hospital staff especially appreciate this therapy and may request it before or after stressful shifts.

Volunteer Support

Healing Therapy is only one of the areas supported by the over 350 volunteers who give their time and energy to support SPAH each year. Volunteers also run the gift shop, organize fundraisers and serve in patient care areas such as the information desk and registration. SPAH relies on the community to help drive their mission, and almost 25% of volunteers are students. To encourage student involvement, SPAH’s auxiliary committee offers 14 scholarships each year to student volunteers, and many of those students eventually become Sentara team members.

SPAH also enlists volunteers to serve on its Patient and Family Advisory Council (PFAC), co-chaired by Rawls and George Davis, former patients and active community members. Formed shortly after the hospital opened in 2011, the council includes 15 volunteers, seven of which are charter members. Monthly PFAC meetings always include a member of the hospital’s leadership team, something Davis believes has been a key to their success.

PFAC members serve on a variety of work groups and act as hospital ambassadors within community organizations and civic leagues, which led them to a recent realization. As ambassadors of SPAH, patients and families in the community constantly come to them with Sentara experiences to share – some good and some bad, but they realized that feedback was getting lost. To help PFAC members capture that feedback and bring it back in a way that can help drive improvements within the hospital, they created a Patient Experience Record. The record is a simple form to collect necessary information to make comments actionable. This supports SPAH’s commitment to engage the community as they consider new things and focus on how to best serve the customer.

Members also act as “environmental scouts” within the walls of the hospital, periodically rounding to check cleanliness, white board usage and attention to call lights.

Commitment to Well-Being
A cornerstone of SPAH’s experience focus is its commitment to support wellness within the community. Francie Golden, Director of Mission, who also oversees the healing therapy program, shared details on the hospital’s community garden operated in partnership with Virginia Beach Community Gardens. The garden concept is based on modern, urban gardening techniques and is intended to provide a considerable crop yield for distribution to those in need in Virginia Beach. It’s been so successful since its launch that plans are underway to expand it to a full production garden to support the local Jewish Christian Community Center.

Other programs intended to support well-being for residents of Virginia Beach include free heart screening events for the community with a 12-lead EKG reading, cholesterol test, blood pressure check and heart risk evaluation. Each participant receives screening results on a pocket-sized card with an image of their EKG on the back. Sponsored by the PFAC, Davis and Rawls shared that the EKG card program has been credited with saving at least two lives to date.

SPAH regularly hosts other community events with offerings such as free food, flu shots, educational sessions, meet and greets with EMS and Sentara staff and the popular “Brown Bag” Pharmacy where residents are encouraged to bring in all their current prescriptions and a pharmacist will review them and answer any medication questions.

Dean Ornish Program
In 2016, further demonstrating their commitment to encourage well-being for patients and the community, SPAH was the first healthcare organization in Virginia to offer the Dean Ornish Program for Reversing Heart Disease.

“We felt there was more we could do for our cardiac patients to achieve our Sentara mission to improve health every day,” said Dr. Gunadhar Panigrahi, a cardiologist with Sentara Cardiology Specialists. “The Ornish Reversal Program, with its emphasis on exercise, healthy eating, mindfulness and group support, is an ideal way for patients to be proactive.”

The nine-week program is based on more than three decades of research showing that lifestyle changes can treat and reverse the progression of coronary artery disease and other chronic conditions. Groups of eight to 15 participants meet twice a week at SPAH for four-hour meetings that include one hour each of exercise on monitors, meditation and/or yoga, a lunch and learn session featuring nutrition education and group support therapy. Chris Manetz, Director of Patient Services (Cardiology/Radiology) stated the remarkable results of this program.

Over 140 patients have participated in the program at SPAH since its inception, and staff continue to report results in line with the belief that the program can help patients have more energy, less stress, more emotional support and greater physical endurance. Staff believe that by sticking with the program, participants may reduce their risk of a heart attack, lower their need for medication and avoid serious interventions such as bypass surgery.

Sentara Martha Jefferson Hospital (SMJH)

Driving Experience Improvements through Patient and Family Engagement
Sentara Martha Jefferson Hospital’s mission has always been to improve the health of the community. Since its founding more than 100 years ago, SMJH has evolved to meet the diverse healthcare needs of the patients. Today, their vision remains to set the standard for clinical quality and personalized healthcare services.

We were able to see that mission in action during our visit as guests of their Patient and Family Advisory Council (PFAC) meeting where 13 members and SMJH Nurse Executive, Johnsa Morris, acknowledged staff successes, reviewed patient and family feedback, and discussed opportunities to further engage patients and families to drive improvements throughout the hospital.

Act of Caring
The meeting kicked off with recognition of an SMJH staff member receiving the “WOW! Moments” award for the previous quarter. The “WOW! Moments Electronic Employee Recognition Program” is a way for members of the team to recognize colleagues across the system for heartfelt and compassionate care for the patients/customers they serve, as well as the kindness they show each other. Many team members through Sentara are acknowledged through the program and each PFAC selects the quarterly top recipient for their division.

Malcolm Wheeler from SMJH’s Dietary Services was named the recipient based on a nomination stating he went above and beyond his duties by taking the time to make a Get Well Soon card for a patient who had recently lost her husband and was in the hospital with a broken hip and elbow. This patient truly was touched and with tears in her eyes told how Malcolm brightened her day by making this card for her. She took it with her to rehab and showed it to anyone who entered her room.

Enhancing Diversity with PFACs
PFAC members had great discussion on ways to increase patient and family feedback, specifically looking to address the need for additional feedback from diverse populations through a potential e-Visors program that would enable virtual patient and family participation. The Council was very passionate about this subject and agreed to continue discussions. They were also very interested in the analysis of HCAHPS data to drill to demographic information to learn more about how to optimize the patient experience for diverse populations.

The meeting also included a presentation on the SMJH Foundation, providing updates on annual giving, charitable gift planning, special events and community stewardship. In addition, the Council was excited to discuss efforts associated with a new Family Caregiver Center at the next meeting.

Following the meeting we had the opportunity to tour SMJH and learn about the many ways the community was engaged on design of patient rooms and how to make the overall hospital environment more welcoming and engaging for patients and families. It was inspiring to see hospital leaders so excited about (and welcoming of) patient and family feedback. It was clear the leadership team truly values contributions from the PFAC and others and understands the significant impact that feedback has on helping the organization focus on its mission to improve the health of the community.

Modeling Exceptional Patient Experience
While we only had an opportunity to visit three hospitals in the Sentara Healthcare system, we were encouraged by the system-wide focus on customer experience that was expressed through staff at the individual sites as well as those addressing experience improvement at the system level.

“The three hospitals are amongst the best of the best at Sentara,” shared Britt acknowledging opportunities for all divisions to learn from each other. “These hospitals are at the table and lead by example by modeling exceptional patient experience and sharing what works best at their sites for the benefit of all.”

Sentara has many forums in place to share best practices, and Britt pointed out many initiatives have already launched, some of which were based on the experiences of these three hospitals that are benefiting the entire system in Sentara’s key categories of customer experience. Some examples include:

Patient and Family Engagement
PFAC members now actively participate on various councils and committees throughout the system.
A system expectation was established requiring all system patient and family education materials be reviewed by PFACs for input before release.

The “WOW! Moments Electronic Employee Recognition Program” was rolled out across the system as a simple and meaningful way for team members to recognize colleagues.
A nurse bundle toolkit was released aimed at instilling best practices by educating nursing staff on the purpose, process, and expectations related to use of Bedside Shift Reporting, Hourly Rounding, and Whiteboards.
A standard Customer Experience presentation highlighting expectations of every member of the team was integrated into all new employee orientation sessions.
Leadership Engagement

A four-part video series, Rounding at Sentara, was rolled out across the system emphasizing the purpose of rounding and demonstrating effective and purposeful techniques associated with executive, leader and nurse hourly rounding.
A leader guide was published providing guidance on having meaningful conversations with team members around expectations related to an exceptional customer experience.
Effective Use of Data

HCAHPS Summary STAR Ratings of all experience-based questions on the HCAHPS survey are regularly reviewed. Note: On the most recent publicly reported perspective (October 2016 – September 2017) seven Sentara hospitals received a summary STAR rating of “4” (SLH, SPAH, and SMJH were among the seven).
As a community of practice dedicated to improving the patient experience through collaboration and shared knowledge, the Institute applauds Sentara for its transparency in acknowledging opportunities, willingness to share successes and commitment to provide the best in outcomes for those in their care.