Faxton-St. Luke’s Healthcare Transforming the Way it Delivers Care
It was the winter of 2004, and Faxton-St. Luke’s Healthcare was in turmoil.
The troubled organization was a product of a merger four years earlier between two of the three hospitals in Utica, NY—166-bed Faxton Hospital and 266-bed St. Luke’s Memorial Hospital.
As Scott Perra, President/CEO of Faxton-St. Luke’s, recalls, “The two hospitals were less than a mile from each other but 900 miles apart in cultures.”
“It was always us against them,” recalls Pat Roach, Senior Vice President/ CNO of Faxton-St. Luke’s. “There was a lot of frustration and conflict.”
“We were a fractured organization,” says Roach. “We needed a model of care delivery that could unify usa model of care that would do nothing less than transform our culture.”
Enter Relationship-Based Care
The job of identifying that unifying care delivery model fell to Faxton-St. Luke’s new Chief Nursing Officer, Pat Roach. “I researched the subject and discovered several models,” recalls Roach. “The one that really caught my eye was Creative Health Care Management’s Relationship-Based Care. It was so simple, but it was exactly what we needed.”
As its name implies, the premise of Relationship-Based Care is that great patient care is all about relationships—the relationships between staff and patients, the relationships between staff and each other.
“Thanks to Sodexo, some of our support service departments were already emphasizing the importance of relationships,” says Roach, “but we wanted to apply relationship-based principles throughout our organization—all 3,500 employees.” So, in 2005 Faxton-St. Luke’s turned to CHCM, the chief proponent of Relationship-Based Care, to help it implement the model across the entire enterprise.
Hospital leadership made sure that both clinical and non-clinical staff were onboard from the start by naming two people to lead the change process: Tracy Hildebrand, a nurse manager, and Matt Marchbanks, a Sodexo employee who is now Senior General Manager of all Sodexo-managed services at Faxton-St. Luke’s, including Patient and Retail Dining, Environmental Services and the hospital’s Service Response Center.
“We already had engaged support staff on the floor,” notes Marchbanks. “When the hospital began its Relationship-Based Care journey, we were able to hit the ground running.
Faxton Hospital and St. Luke’s Memorial Hospital merge.
Faxton-St. Luke’s adopts VHA’s Tomorrow’s Work Force Initiative and begins working with VHA consultants.
Physical restructuring. Faxton campus becomes outpatient facility, St. Luke’s campus becomes inpatient facility.
Senior leadership decides to adopt Relationship-Based Care as model for delivering care.
First units begin Relationship-Based Care training. Go Live date: October 2006.
Next units and departments, including Environmental Services, begin training. Go Live date: April 2007.
Next units and departments, including Food & Nutrition, begin training. Go Live date: October 2007.
Next units and departments begin training. Go Live date: March 2008.
Final hospital units and departments begin training. Go Live date: December, 2008.
Last wave consisting of Continuing Care personnel. Go Live date: December, 2009.
“We love working with a hospital that has Sodexo,” says Susan Wessel, a CHCM senior consultant involved in the Faxton-St. Luke’s implementation. “They have wonderful tools for inspiring their employees. Things go much faster with Sodexo involved.”
“We have similar missions and values,” notes Dudley Abbe, Vice President, Sodexo Health Care. “Like CHCM, we put patients at the heart of everything we do—in our hiring, in our training and in our operations.”
“We enhance each other,” continues Abbe. “CHCM brings their expertise in nursing; we bring our expertise in support services. It’s a case of one plus one equaling three.”
Faxton-St. Like’s entire workforce is going through Relationship-Based Care training in waves (see below). The sixth and last wave will be completed in December 2009. In the words of CEO Perra, “Our challenge then will be to sustain our gains.”
New Spirit of Collaboration
The most obvious change at Faxton-St. Luke’s is the way people interact. “Our support service employees are treated with respect and consideration as part of the healthcare team,” says Marchbanks, “and they have responded by going out of their way to make things better for their colleagues, patients and other departments.”
For example, Environmental Services went to nursing and asked them, “Why are you making the beds? We are already in the room at discharge, why can’t we do this? It would be one less thing preventing you from spending more time with patients.” And now ES makes the beds.
Environmental Services also went to Food & Nutrition and said, “Why don’t we go ahead of your Ambassadors and clean off and sanitize the patient’s side table so the Ambassador can put the tray down on a clear, clean surface?” And now this is being done.
The very idea of having Ambassadors—that is, a single person who takes a patient’s meal order and then delivers it to them—came from Food Service hourly staff. Sodexo came up with capital to change the model, and the hospital adopted Personal Choice Dining.
“We only have two job descriptions at Faxton-St. Luke’s,” sums up Mary Beth Dowling, the system’s Relationship-Based Care Coordinator, “one for people who take care of patients and one for people who take care of the people who take care of patients.”
Dramatically Better Outcomes
This change in attitude is reflected in the statistics. Since 2004 employee satisfaction has moved from the 14th percentile to the 60th percentile, with other leading indicators up significantly as well (see chart on previous page).
Turnover is down, and so are vacancies. In fact, the nursing vacancy rate is down to 4%.
Patient safety has also improved and improved dramatically. In the words of CNO Pat Roach, “We are blowing the harm rate out of the water.”
“I am pleased with the results,” says CEO Scott Perra, “but not yet satisfied. For example, we are not where we want to be with patient satisfaction yet. But we’ll get there.”
“Part of the problem goes back to a poorly designed Emergency Department expansion we did in 2004,” continues Perra. “A few weeks ago, support services went to the ED and asked them, ‘What can we do to help?’ With that type of attitude, there’s nothing we can’t accomplish.”
“Our goal is to get all of our employees to think of themselves as owners of the place,” says Perra. “We want them to keep asking themselves what can I do to make things better.”
“Our vision is to be the premier healthcare system in upstate New York,” says Roach, “and we are on track to realize that vision. In fact, I doubt if there is any other hospital in the nation that has 60 departments functioning at the level we do.”
Faxton-St. Luke’S Healthcare
- Not-for-profit healthcare system serving residents of Mohawk Valley in upstate New York
- Two campuses:
- Faxton Campus—Outpatient services
- St. Luke’s Campus—Inpatient services and continuing care
- 346 acute care beds
- 2007 Thomson Reuters Top 100 Hospital for Performance Improvement