Happy hospitals make happy patients

ANN ARBOR, Mich., 10 feb 2009---Imagine a hospital where morale is high, employee turnover is low and patient call buttons rarely go unanswered---and if they do, you can call the hospital's CEO.

That's exactly the type of culture and service that "delights" patients and makes for the most successful community hospitals in the country, as rated by caregivers and patients, says John Griffith, professor in the University of Michigan School of Public Health.

In a newly published report, Griffith examined the attributes of 34 community hospitals in nine states that have earned the Health Care Sector Malcolm Baldrige National Quality Award, a nationally recognized quality benchmark for various industries.

Griffith's findings suggest that the single-biggest factor in patient satisfaction is hospital employee morale, which starts with outside-the-box thinking at the very top management levels.

These community hospitals had the happiest patients and caregivers, but only because these hospitals departed radically from traditional hospital management, Griffith says.

For instance, at the Florida hospital where patients receive a welcome letter with the CEO's signature and home phone number, they're also paid a visit by their unit's nurse manager, who also leaves cell and office phone numbers.

This personal service doesn't come cheaply, yet the hospitals kept costs low enough to thrive financially on standard Medicare and insurance payments, despite paying employees "extremely well," Griffith says.

"They reward a good job, both with celebration and financially with cash," he said. "One of the interesting things about these places is they don't have any nursing shortages. They have enough nurses, well-trained nurses and well-motivated nurses."

Bronson Methodist Hospital of Kalamazoo is the Michigan recipient. Oakwood Healthcare System and Henry Ford Health System received the Michigan Governor's Award for Excellence in 2008, a state-level competition based on similar criteria.

Griffith's report finds that the 34 hospitals emphasized a broadly communicated mission, a supportive learning culture, universal measurement and benchmarking, and systematic process improvement. Traditionally, hospitals emphasize static domains of authority and don't formally measure performance, goal setting or continuous improvement, the paper said.

The shift in management thinking has astonishing results in worker and patient satisfaction, Griffith says.

"The key issue for the patient is the answer to two questions, 'Will you return and will you refer?'" he said. "A loyal patient will do both. These places got that in 90 percent of patients. The usual answer is a little better than half."

The 34 hospitals scored in the top 50 percent in nearly all quality and satisfaction measures and were frequently in the top 10 percent of national rankings, the study shows. They also spend lots of time training employees. Bronson, for example, offers more than two weeks of full-time training to every full-time employee. The national average is no more than one week.

"Although the recipients are community hospitals, not large teaching and research hospitals such as the U-M Health System, the set is broadly representative of American health care," Griffith said.

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The study, "Finding the Frontier of Hospital Management," appears in the Journal of Healthcare Management.