Coteau des Prairies (CDP) Health System: Improving Quality of Care

Coteau des Prairies Health System (CDP) is a 25-bed, not-for-profit Critical Access Hospital (CAH), providing acute care, swing bed, primary care, emergency medicine, surgery, rehabilitation therapies, imaging, lab, nutrition and pharmacy services to the residents of Sisseton, South Dakota and the surrounding communities. Their mission is to provide “Quality Care with a Personal Touch, Close to Home.”

Carla Brock Wilber and Lindsay Corcoran, consultants with Stroudwater Associates, worked with CDP in 2017-18 through the Small Rural Hospital Transition (SRHT) project on a Quality Improvement and Transition of Care (QI) project. Previously, CDP completed a Financial Operational Assessment in 2015. RHI staff spoke with Greg Weaver, Interim CEO and COO in October 2018 and again in March 2019 to talk about their progress.

Measurable Outcomes:

• Improved HCAHPS score for “Patients who reported YES, they would definitely recommend the hospital” from 55% to 90% (national average 75%)
• Improved transition of care processes for “Patients who Strongly Agree they understood their care when they left the hospital” by 17%
• Increased net patient revenue from $15,708,000 to $18 million
• Increased days cash on hand from 11 to 21
• Reduced days in net accounts receivable from 58 to 55

Q: What are some of your hospital's successes regarding the implementation of your consultant’s recommendations?   
A: CDP immediately began working on improving their quality infrastructure and quality improvement (QI) accountability. Their Quality Assurance & Performance Improvement (QAPI) plan was approved by the Board for the first time. Getting that top-down buy-in from the Board was the first step in beginning to share information throughout the hospital. Next, the medical staff approved the plan. Staff receive a copy of HCAHPS scores regularly and they discuss quality issues in team meetings and create action plans for deficiencies as well as monitor scores and quickly look for solutions.

Posting quality metrics throughout the hospital helped employees understand and be more aware of their impact. CDP created “Action Q”, a process that documents quality issues for better tracking and metrics as well as increases the ability to track progress. They now have a new quality director and are looking at hospital-wide compliance checks. More recently they added a dedicated quality nurse which is making a significant different.

In an effort to improve patient satisfaction, CDP implemented hourly rounding. They created discharge folders that patients receive upon admission and that include FAQ tabs for sections such as discharge and medication. CDP rolled out bedside reporting and are using scripting and whiteboards consistently. CDP is working on increasing the return rate of surveys and saw an increase from 47 in 2017 to 61 surveys in 2018. They have begun to post the survey results in staff areas and hope to begin to post results publicly in the future.

CDP is working to increase overall internal communication. To improve staff satisfaction and patient care communication, leadership rounds weekly with staff to check in. A handoff tool is being used from surgery to floor and a tool is being developed for transfer from the floor to radiology. In an effort to communicate more information and transparency hospital-wide, CDP is sending weekly emails to all staff that include updates about things such as QAPI.

To address physician documentation, CDP realized they could review compliance through their EHR and while they planned to hire a scribe to assist with compliance, they decided not to do this. Days in final billing has gone up and cash flow has improved. CDP is now doing peer reviews by providers in hopes to positively impact accountability around quality.

Q: What are some ways this project impacted your hospital and community?
A: Non-measurable outcomes include:

• Better staff and provider awareness of HCAHPs
• More awareness for all about quality status of metrics
• Improved employee engagement and accountability
• Improved staff morale as leaders are more visible
• Increased staff engagement in task forces such as patient and staff safety