Delta Memorial Hospital: SRHT Project Well Under Way

Delta Memorial Hospital (DMH) is a 25-bed, not-for-profit, Critical Access Hospital (CAH), providing acute care, swing bed, obstetrics, emergency medicine, rehabilitation therapies, imaging, lab, surgical services and primary care to the residents of Dumas, Arkansas and surrounding communities. In addition to these services, DMH also operates:

• Two Rural Health Clinics (RHCs)
• Delta Health Service in Dumas
• River Valley Medicine in McGhee
• A home health agency

Carla Brock Wilber, Senior Consultant with Stroudwater Associates, worked with DMH in 2017, through the Small Rural Hospital Transition (SRHT) Project, on a Quality of Care and Transition of Care Project. Center staff spoke with Ashley Anthony, CEO, and Anita McTigrit, Case Management and Quality Manager, just six months after the implementation of the consultant recommendations to discuss their progress.

Q: What are some of the recommendations that you’ve implemented in these first six months, and what are your next steps?

A: “We started daily leadership rounding in May.” This is an opportunity to hear directly from the patients, while they are still in the hospital, about their experience and their needs. Information, both the good and constructive, is shared with staff. DMH has taken these rounds one step further. The leaders use this as an opportunity to “round” on staff to see how they are and what their needs are. If there are concerns about inter-department communication, the leaders can follow-up with the other departments. Initially, they were getting lots of staff suggestions on various needs or issues. They feel talking with staff has helped with morale.

DMH restructured their patient satisfaction committee and this group has been key in driving initiatives. To create momentum, this group met bi-weekly and now meets monthly. They review satisfaction scores and comments and have created and provided training to staff based on their findings. Patient discharge packets were created, patient follow up calls were implemented. This committee is also working on a staff recognition program. HCAHPS questions were reduced to include only those required so that patients would be more willing to provide feedback. Survey results and comments are shared monthly with all staff through email, are discussed in inter-departmental staff meetings, Department director meetings, medical staff meetings, and board meetings as well.

DMH focused on helping the patients be as prepared as possible for transitioning home. They have set up home health with CPSI process and now can review referrals online for consistency of information. When possible, home health staff meet with patients while still in the hospital to talk about physical therapy, home health visit schedule and other needs in preparation for the home visit.

DMH reorganized some duties in their clinic to ensure that operations run as smoothly as possible. An officer manager handles business operations and a nurse manages the clinical piece and they both meet frequently with the clinic director. This allows the director to work on bigger picture issues such as education for staff which helps with staff buy-in and engagement.

Increased attention is paid to data such as emergency department transfer numbers, appropriateness of transfers and completeness of patient information shared in transfers. All departments now submit monthly performance improvement studies and data and then meet quarterly to review as a group. This change has led to quicker course correction if an issue is identified.

A chronic care management program was implemented in August with much initial success. Providers are on board and promote it to patients. Medicare patients with two or more co-morbidities are eligible and staff follow up with them every month at a minimum. DMH finds that this is increasing medication compliance. Through electronic medical records, they can identify any of these patients who visit the emergency department and can proactively work with them to prevent a hospital admission and/or readmissions.

Next steps include implementing readmission risk tools and tracking. DMH will continue to provide customer service education for staff and plan to implement bedside report. They will continue to use follow up calls to proactively address quality of care issues. There will be more focus to share their successes with the community.

Q: What has been the impact of this project so far on DMH?

A: The measurable outcomes will be reported in six months. Non-measurable impact has already been clear and includes:

• Better communication among managers, staff and across departments
• Quicker course correction with issues
• Increase transparency in many ways
• More accountability and follow up of issues
• Better understanding of what satisfies a patient and how much more could be done
• Increased pride in accomplishments and ultimately improved morale.
• Better provider understanding about future payment models

Q: Lastly, how do you believe this project has helped you move forward in the newly emerging system of health care delivery and payment?

A: This project helped us to identify areas of focus to guide us in streamlining processes to improve overall efficiency and quality of care.  “I believe we are in a good position with the changes and all (we) are doing to be ready to transition to new payment models.”