Simulation 2

Central Columbia Hospital: Overview

Central Columbia Hospital was founded in 1889 as a nonprofit, community-

based health care facility in northeastern Pennsylvania. This 116-bed, acute

care facility employs 963 employees and is nestled along the Susquehanna

River’s northern branch in Briar Creek. The facility provides general medical

and surgical services to the surrounding community of approximately

70,000 people. The hospital is proud of its tradition of upholding its mission

to these communities by providing comprehensive health care services in

a compassionate, caring and cost-effective manner while maintaining the

highest level of professional excellence. The hospital is in the process of a

yearlong celebration commemorating its 125th anniversary by partnering

with the community for free monthly health screenings, hosting a summer

carnival on the hospital’s grounds and reaching out to local elementary

schools to provide free healthy lunches each week.

Dr. George Stiller has served as the hospital’s board chair for the past six

years and is an obstetrician/gynecologist (OB/GYN) in the community.

Stiller has lived and practiced in this community for more than 37 years

and has delivered many employees of the hospital. He is known for being

kind, gentle and truly caring, and can recall almost everyone in the hospital

by his or her first name. Employees often seek Stiller’s sympathetic ear

to express concerns about everything from staff-to-patient ratios to the

cafeteria food. Stiller takes a hands-on approach to his duties as chair and

voiced strong concerns about the hospital’s recent national search for a new

president and CEO. Stiller pushed to keep the search close to home and

cautioned the board of potential consequences to hiring a noncommunity

member into such a pivotal role. In the end, however, the board launched a

national search that resulted in hiring Anita Green. Green previously served

as the chief operating officer for two community hospitals in Michigan

and Indiana. Although Stiller plays quite a visible role in his position, the

balance of the board members see their roles as ones of governance, not

focusing on daily operations. As a matter of fact, most agree the day-to-

day decision-making should be left in the capable hands of Green. Green

knows that Stiller wanted to keep the president and CEO search at a local

level. This created some tension between them when Green arrived to

Central Columbia, and this tension still plays out occasionally during board

meetings.

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Green has been with Central Columbia Hospital for a little more than three

years. When she joined the hospital, it was financially hemorrhaging from

every service line. In the past three years, however, she and her team have

turned obstetrics, radiology, gastrointestinal, and out-patient laboratory and

surgery into revenue-producing service lines. Green is still concerned about

emergency services, general surgery, orthopedics and critical care services.

She knows that staffing these services with competent and experienced staff

is essential to getting these areas to perform at the levels needed to make the

hospital financially solvent.

Green knows that other areas of the hospital also need attention.

Compliance in this heavily regulated industry continues to create substantial

challenges, including a strain on the hospital’s human resources (HR). Green

feels the hospital is vulnerable to legal risks without a position completely

dedicated to addressing HIPAA (the Health Insurance Portability and

Accountability Act), Medicare issues, and regulations associated with the

Pennsylvania Department of Health and the Joint Commission’s criteria

such as staff educational requirements, orientation documentation, patient

care, and safety protocols and procedures.

Green has asked the board to approve a corporate compliance officer

position as a member of the executive team. The current risk manager,

William Toth, has said that he is not interested in expanding his scope to

encompass all compliance issues and prefers to stay focused on patient safety

goals. He has made great strides in the internal reporting procedures for

patient-care incidents, and although the numbers are higher than they were

two years ago, Toth sees this as a success because the hospital now has a

better understanding of the issues and has started processes to implement

appropriate changes.

Patient satisfaction has been on the rise, but it is still well below where

Green and her team would like it to be. With an overall patient satisfaction

rating of 78 percent, Green and her team know there is still a lot of work

to do to reach a 90 percent satisfaction rate (a goal that is 5 percent above

the national average), a target she set shortly after she arrived at Central

Columbia. Although many patients feel the care is competent, the hospital

still lags in satisfaction regarding communication of medical care to patient

and family members and timeliness of treatment. The executive team,

including the newly appointed vice president of patient care services and

chief nursing officer, Ann Romero, has suggested that these scores may

reflect a delay by nursing staff to inform attending physicians of a patient’s

status. Others on Green’s team are concerned that her patient satisfaction

goal is too lofty too soon, and they feel it has caused stress and morale issues

in several areas of the hospital.

Green set the 90 percent patient satisfaction rate goal as a result of a patient

and employee satisfaction survey conducted two years ago. Since then, the

hospital has continued to participate in the survey process on an annual

basis. These surveys have provided valuable data that have allowed Green

and her team to establish several operational and patient care improvement

initiatives. Green used the weeklong celebration of National Hospital Week

in May to share the results with employees during her town hall talks. Green

has used several occasions such as National Hospital Week to celebrate and

educate employees on the important work they do and the reasons why it

is necessary to continue to improve. Green has addressed several questions

regarding the rumors of mergers during these meetings, and she is always

candid about the real possibilities and the need for improvement.

Table 1. Patient Satisfaction—Most Recent Annual Report (Compared to Peers, State and National Average)

Percentage of patients who: Central

Columbia Competitor A Competitor B

State

Average

National

Average

Reported that staff “always” explained

medicines before administering. 59% 57% 63% 62% 64%

Reported that their room and bathroom

were “always” clean. 65% 70% 73% 73% 73%

Reported that the area around their

room was “always” quiet at night. 54% 52% 48% 54% 61%

Reported that yes, they were given

information about what to do during

their recovery at home.

86% 86% 87% 86% 85%

Gave their hospital a rating of 9 or 10 on

a scale from 0 (lowest) to 10 (highest). 62% 66% 75% 69% 70%

Reported that yes, they would definitely

recommend the hospital. 62% 69% 78% 69% 71%

Overall 78% 81% 71% 84% 85%

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Table 2. Selected Results from the Most Recent Cultural Assessment—Survey of All Central Columbia Hospital Employees

Question Previous Year Current Year

I would recommend employment here. 66.0% 62.3%

I am proud to work for this organization. 73.2% 71.6%

I often leave work with a feeling of satisfaction. 82.4% 83.1%

I have considered leaving during the past six months. 47.8% 51.5%

I feel there are opportunities for long-term growth at the hospital. 62.3% 60.4%

I would recommend the hospital to others considering health services. 78.2% 77.0%

In addition to the changes Green is suggesting in the compliance area, she

is also working closely with the current HR manager, Frank Scott. Scott has

been with the hospital for 26 years and has been successful at processing

the transactional work required to meet employee demands. It has become

evident to Green, though, that Scott does not possess the knowledge and

leadership skills needed to move this function to a more strategic level.

Green is hoping to convince her executive team that it is time to begin

a search for an individual who can move the HR function from being

reactionary to one that will be instrumental in transforming the hospital.

Scott currently reports to Jeff Curry, chief financial officer, but Green’s

vision is to have the vice president of HR report directly to her. Green’s

short list of issues for HR seems to grow longer every day, and she needs

that function to partner with her to ensure success. Compensation, hiring

practices, retention, talent identification and development, and diversity

are just a few of the items that Green knows need to be addressed by the

hospital to remain competitive.

This freestanding community hospital has also been faced with maintaining

its independence while being surrounded by two larger, growing health

care systems. Although the hospital has been successful to date operating

independently, the increased demand for specialized services and the

shrinking reimbursement and payment for services are forcing Central

Columbia to evaluate two possible moves to assist in providing the most

comprehensive short- and long-term health care possible to the communities

for which it cares.

Figure 1. Hospital Organizational Chart

Board of Directors

George Stiller,

M.D.

Chairman

Hospital President/CEO

Anita Green

V.P. of Patient Care

Services/CNO

Ann Romero

Chief Financial Officer

Jeff Curry

Business Officer

Manager Melissa Stong

Nurse Managers

Amy Harding,

CC;

Rob Willis,

Med Surg;

Kristy Hope,

Emergency

Admissions

Human Resource Assistant

Jane Griggs

Human Information

Manager Gary Willis

Employment Specialist

Amber Gold

Employee Health

Specialist Megan Denato

Patient Care Educators

Christian

Steiner,

Julia Kramer

Director of Nursing

Jillian Frease

Risk Manager William Toth

Director of Radiology

Oliver DeFinis

Physician Recruiting

Carol Cook

Facilities Manager

Sylivia Winthrop

Volunteer Services

Coordinator Vickie Miller

Dining Services Manager

Edwin Straus

Community Relations Manager

Teresa Sullivan

Environmental Services Manager

James

Newcomber

Medical Staff Members

Payroll Manager

Patricia Means

Human Resource Manager

Frank Scott

V.P. of Ancillary Services

Janet Hillard

V.P. of Medical Staff

Dr. David Huhn

Executive Assistant

Suzy

Hemmings

Patient Care Coordinator

Stephanie

Logan

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Table 3. Employee Count by Ethnicity and Gender

Total Number of Full-Time Employees: 963

Ethnicity Number of Employees Percentage

White (Not Hispanic) 788 81.8%

Black (Not Hispanic) 95 9.8%

Hispanic 64 6.7%

Asian/Pacific 16 1.7%

Gender Number of Employees Percentage

Female 541 56.2%

Male 422 43.8%

Job Classification Number of Employees Percentage

Exempt 433 45.0%

Nonexempt 530 55.0%

Players

• Ann Romero, vice president of patient care services and chief nursing

officer (CNO)

• Frank Scott, HR manager

• Jane Griggs, HR assistant

In the hospital’s large conference room (Thursday, 7:30 a.m.)

Ann Romero is leading the weekly patient care leadership meeting. The

patient care managers are discussing the difficulties they face retaining

qualified nursing staff. Several managers have raised this concern privately to

Romero. Now that the entire team is assembled, it is clear that the retention

problem is much larger than Romero had originally believed. Green’s very

public goal of a 90 percent patient satisfaction rate is only adding to the

stress.

The discussion seems to be focused not only on retaining newly hired staff

but also on the clinical preceptors (the tenured employees responsible for

the clinical skills training provided on the nursing floors for recently hired

staff); the clinical preceptors are also feeling overwhelmed and frustrated.

The patient care managers are concerned that if this trend continues and

the clinical preceptors do not receive much needed relief, they too may be

looking for employment outside the hospital. Romero knows that the loss

of these experienced and tenured nurses could put the entire hospital in

jeopardy.

In the hospital cafeteria

As Frank Scott enters the hospital cafeteria, he notices Romero in the corner

finishing up a conversation on her phone. Romero had asked Scott to meet

after her management team meeting this morning. Romero greeted Scott as

he approached the table.

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“Good morning, Frank. I appreciate you meeting with me for coffee on

short notice. I had a meeting with my patient care management team this

morning, and they shared that our clinical preceptors are overwhelmed.

As a matter of fact, they told me that they no sooner get a nurse off the

orientation program than the individual leaves the hospital. I think it was a

bit of an exaggeration, but it certainly feels that way to them,” she said.

“Hmm, I knew we were doing a lot of hiring in your area, but I didn’t

realize how much of an issue retention has been. Are there reasons why

there is so much turnover now?” asked Scott.

Romero thought to herself for a moment that the HR manager should not

be asking such a question, but instead offered possible reasons along with

solutions to address this ongoing challenge.

“Well, that’s why I asked to see you this morning,” said Romero. “I would

like your office to pull a report on the turnover breakdown for the past 24

months for the critical care unit. I believe these data would be helpful for

all the units, and we should provide these reports to them on a monthly

basis, at least for the next few months until we can get a handle on what is

really happening.” Romero continued, “We can’t turn these units into the

high production service lines that Anita and the board want if we can’t see

the real picture.”

Scott responded, “I got it, Ann, I can have the report to you by the end of

the day today.”

Shortly after they concluded their conversation, Scott headed back to his

office to discuss the turnover report with Jane Griggs.

In the HR department

Scott returned to the office and told Jane Griggs about his conversation with

Romero. “Jane, Ann Romero asked for a turnover report on the critical care

unit for the past two years,” he said.

“OK, that shouldn’t be very difficult to pull from the payroll system. I’ll

work on it right away and should have it to you in a half an hour,” Griggs

responded.

Less than 30 minutes later, Griggs handed the report to Scott. The report

contained tables A-E (see pages the follow):

Table A. 24-Month Turnover Report (Patient Care Services)

Turnover Presented by Job Classification

and Generation

RN = 202 Nursing Assistant/

Technician = 97

Voluntary Involuntary Voluntary Involuntary

Baby Boom (1946-1964) 4 0 6 2

Generation X (1965-1979) 7 2 5 2

Generation Y (1980-2000) 14 11 7 4

Turnover Totals 25 13 18 8

Turnover by Percentage 18.8% 26.8%

National Average Turnover 16.4% 27.8%

Turnover by Specific Unit—Medical Surgical

RN = 88 Nursing Assistant/

Technician = 45

Voluntary Involuntary Voluntary Involuntary

18 7 4 1

Turnover by Percentage 28.4% 11.1%

National Average Turnover by Unit 24.1% 17.3%

Turnover by Specific Unit—Critical Care

RN = 23 NA/Techs = 9

Voluntary Involuntary Voluntary Involuntary

3 6 3 0

Turnover by Percentage 39.1% 33.3%

National Average Turnover by Unit 14.8% 14.8%

DEMOGRAPHICS (PATIENT CARE SERVICES)

Table B. Number of Employees

Total Registered Nurses (RNs) 202 Nursing Assistants/Technicians 97

White (Not Hispanic) 161 White (Not Hispanic) 74

Black (Not Hispanic) 23 Black (Not Hispanic) 12

Hispanic 12 Hispanic 9

Asian/Pacific 6 Asian/Pacific 2

Table C. Employee Age Categories

Total Registered Nurses (RNs) 202 Nursing Assistants/Technicians 97

Age 25 or Younger 19 Age 25 or Younger 6

Age 26-35 46 Age 26-35 24

Age 36-45 41 Age 36-45 26

Age 46-55 56 Age 46-55 29

Age 56-65 35 Age 56-65 12

Age 65 or Older 5 Age 65 or Older 0

Table D. Generation

Total Registered Nurses (RNs) 202 Nursing Assistants/Technicians 97

Generation Y (1980-2000) 42 Generation Y (1980-2000) 30

Generation X (1965-1979) 120 Generation X (1965-1979) 54

Baby Boomer (1946-1964) 38 Baby Boomer (1946-1964) 13

Traditionalist (before 1946) 2 Traditionalist (before 1946) 0

Table E. Years of Experience

Years of Experience < 1 year 1 year or >

RN 24 14

NA/Techs 15 11

By Unit: Medical Surgical

RN 11 14

NA/Techs 2 3

By Unit: Critical Care

RN 7 2

NA/Techs 1 2