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FirstHealth of the Carolinas

In a note attached to the Patient Satisfaction Survey he completed after five days in FirstHealth Moore Regional Hospital last summer, Pinehurst resident Colin W. McKenzie was very clear about the quality of care he had gotten.

“I can’t say enough about the great care I received during my five days with you,” he said. “I was a very sick man. (Gastroenterologist) Dr. Tom Swantkowski and (internist) Dr. David Hipp were great. I’m on the mend thanks to your staff and doctors.”

A retired soldier and current chairman of the Moore County Board of Commissioners, McKenzie is known as a man of opinions who isn’t shy about expressing them. His positive comments about the hospital, its staff and its physicians were welcomed by FirstHealth CEO Charles Frock, who responded with his own message:

Col. Colin McKenzie with Cindy McNeill-McDonald, FirstHealth’s vice president for quality.

“While we pride ourselves on delivering the highest level of patient care, it is gratifying indeed to receive comments from our patients that we succeeded in meeting their health care needs. Our patients are very special, and I am pleased that you experienced the caring attitudes and professionalism of our staff. I am very proud of the great staff we have at FirstHealth Moore Regional Hospital and will certainly pass along your words of praise and gratitude.”

Consumers have long expected quality in their homes, their cars and their computers, but quality is a relatively new buzzword in health care. Although continuously expected and, hopefully, just as continuously delivered, it has rarely been a part of the routine patient/provider discussion.

Health care transparency has historically been just as rare, but things are different now. Late last winter, FirstHealth of the Carolinas joined the ranks of hundreds of the nation’s hospitals and health care systems by beginning to post quality indicators (measures) for Moore Regional, Richmond Memorial and Montgomery Memorial hospitals on its Web site (www.

The Centers for Medicare & Medicaid Services (CMS), which says that nearly all of the nation’s eligible hospitals have begun reporting data on the quality of care that they deliver, calls this move toward greater health care transparency “a vital first step in improving patient care.”

“Quality is a top priority for FirstHealth of the Carolinas, which is committed to quality and excellence throughout our organization,” says Frock. “Our goal for our physicians, hospitals, employees and business entities is to systematically improve customer outcomes by continuously improving all of our key health care processes. Our goal for our customers is to keep them informed about these improvements.”

FirstHealth’s quality program now has an administrator—Vice President, Quality, Cindy McNeill- McDonald—and a name: QualityFirst. Its goal, McNeill- McDonald says, is to ensure the delivery of “optimal care”—care that is safe, effective, patient-centered, timely, efficient and equitable—to every customer.

When you’re sick and in the hospital, the cost of your treatment is probably far from your mind. It’s different, though, when you’re feeling better and the medical bills begin arriving in the mail.

You expect those bills to be accurate and timely.

Two FirstHealth Hospital employees have been working on a project aimed at improving the accuracy and timeliness of patient bills. Their project is a part of a training program aimed at helping them and several other FirstHealth employee teams acquire skills to help improve hospital processes.

Six Sigma Green Belt trainees Billy Tatum and Christine Keyton-Utley.

Billy Tatum, the assistant director for Patient Accounts, and Christine Keyton- Utley, a financial systems analyst, took on the project as part of their Six Sigma Green Belt training. Six other Green Belt teams are working on projects that range from Emergency Department throughput to the discharge process. Two of the projects are specific to Montgomery Memorial or Richmond Memorial hospitals.

The focus of the FirstHealth billing project is a simple one. “We want patients to receive an accurate bill in a short period of time every time they visit us,” Keyton-Utley says.

Tatum and Keyton-Utley started their project by surveying patients visiting the Outpatient Registration areas at the three FirstHealth hospitals to determine their expectations. The evaluation covered every process that takes place from the time the decision is made that a person needs hospitalprovided medical care to the time that person gets his or her bill in the mail.

“All of these processes must work together to ensure that the necessary information is obtained for an accurate bill to generate,” says Tatum. “A significant amount of data is being gathered for statistical analysis as well. Based on this analysis, we will develop a strategy to implement an enhanced registration and billing process. We hope to make the billing process the best it can possibly be.”

Green Belt training is part of FirstHealth’s Six Sigma approach to quality improvement. An acknowledged problem-solving approach for improving business and organizational performance, Six Sigma sets ambitious objectives and measures performance in a way that forces accountability.

The effort is geared toward minimizing mistakes and maximizing value by recognizing that every mistake has a cost – a lost customer, wasted time or material, lost efficiency or squandered productivity.

“It’s a quality methodology that takes quality to a new level,” says Suzanne Riley, director of FirstHealth Corporate Education and one of FirstHealth’s first three Green Belt-trained employees.

Tatum, Keton-Utley and other members of the 2007 Green Belt program participated in training conducted over eight full days between May and July by instructors from N.C. State University. Other participants and their projects included Jody Brewer, Beth Walker and Michelle Yarboro, ED Throughput at Montgomery Memorial Hospital; Nancy Caulder and Matt Thompson, Congestive Heart Failure Core Measure at Richmond Memorial Hospital; Steve Pierce and Jennifer Thomason, Customer Satisfaction – Call Bell Response Times at Moore Regional; Cindy Henderson and Drusi Smith, Radiology Throughput at Moore Regional; Jayne Lee and Melissa Martin, Discharge Process at Moore Regional; and Linda Cooke, Cindy McNeill-McDonald and Tabitha Stewart, OR Start Times at Moore Regional.

The class at Montgomery Community College looked like an exercise in cultural diversity.

The 14 students included one African-American, four Asians (Laotian and Hmong) and nine Latinos, all enrolled in a program designed to teach them how to help members of Montgomery County’s ethnically diverse population find their way through the local health care system.

These Patient Navigator classes—a second is scheduled for early 2008—are outgrowths of FirstHealth Community Health Services’ Reaching Out project. The Kate B. Reynolds Charitable Trust provided funding for Reaching Out, a program intended to strengthen the mental health safety net for Hmong, Laotian and Latino children and families in Montgomery County.

Two specially hired Patient Navigator instructors lead the students through the class, and guest speakers from throughout the community discuss the various services that are available to Montgomery County residents. Hopefully, the students will eventually get jobs in the community that will allow them to share their knowledge of its resources with other members of their cultures—many of whom are illiterate in their native language.

The Patient Navigator program is a pilot that may be offered to community colleges throughout the state. “We developed the curriculum, working with Montgomery Community College and using Kellogg Community Voices projects in Denver and then customized it,” says Barbara Bennett, administrative director of FirstHealth Community Health Services.

In Fiscal Year 2007, FirstHealth Community Health Services applied for 27 grants and received funding for 15, which provide $3,177,419 to support community-focused programming. Among others, they include:

  • North Carolina Department of Health and Human Services: Resident Elective Rotation Program, a partnership with the Greensboro Area Health Education Center to develop medical student rotations in rural settings, $66,831 (a six-month request); and operational funding for FirstHealth Richmond Memorial Hospital, $100,000 (six-month request)
  • American Legacy Foundation: Priority Populations Initiative, a project to provide tobacco-cessation services to lowincome populations through a collaborative relationship between Community Health Services and FirstHealth Home Care, $100,000 (one year)
  • Kate B. Reynolds Charitable Trust: Healthy Living in the Mid- Carolinas, a project to provide tobacco-cessation, Healthy Eating Every Day and Active Living Every Day services to low-income residents of the Mid-Carolinas, $1,473,080 (seven years); and Reaching Out (see above), $279,555 (three years)
  • Richmond Community Foundation: physician recruitment support for Richmond Memorial Hospital, $1,000,000 (four years)
  • Robert Wood Johnson Foundation: transitional funding to expand FirstGarden and establish similar gardens in low-income elementary schools in Moore County, $50,000 (one year)
Trained “patient navigators” will guide ethnically diverse patients through the Montgomery County health care system.

Employees of the FirstHealth Regional EMS System have a good reason to be proud of their new ambulances. They designed them. “The staff designed and chose what they needed,” says Regional EMS Director David Carter. “We involved the staff from day one.”

Faced with an aging fleet that was not only costly to maintain but also expensive to fuel, the EMS staff started the project by considering what made sense in terms of patient care, safety, efficiency, maintenance, expense and comfort. Paramedics, mechanics and administration alike had a voice.

Paramedics, mechanics and administrators alike had a say in the design of 12 new ambulances for the FirstHealth Regional EMS System.

Topping their list of priorities was a safe and smooth ride. That meant vehicles that were shorter, narrower and, therefore, easier to handle on backcountry roads. Another essential was an air conditioner that would cool the vehicle on hot summer days, even when it wasn’t running, so supplies and medications could be kept on board at all times.

At the beginning of the project, the staff took note of research confirming information that seemed obvious— that an ambulance crew is safest during a transport when seated and seat-belted. “This sounds like common sense,” says Carter, “but paramedics can’t access equipment and supplies to take care of their patients while seated on most of the ambulances designed today.”

To address this crew safety issue, paramedics lobbied for a patient care compartment that would allow easy access to high-priority equipment—resuscitators, cardiac monitors and the like—from a seated position. Mechanics wanted a chassis with a good track record, an efficient electrical system and low-maintenance running lights among other features.

The 12 new ambulances that were added to the EMS fleet during 2007 have all of these features and more. In each, all of the equipment necessary during a transport is positioned within easy reach of the seated paramedic. A GMC Savannah chassis has just what mechanics sought in terms of reliability, body, engine, transmission and brakes. The air conditioning system works on a 100-volt Shoreline battery when the vehicle is parked, and there are easy-access points for electronics maintenance as well as low-maintenance but super-bright LED (light emitting diode) running lights. Backup sensors and cameras were installed to make it easier and safer to back an ambulance out of tight spots, and grant funding allowed the addition of a GPS unit to each vehicle.

Even though the new ambulances are visibly smaller on the outside, the patient care compartment is actually larger. Design efficiency provided a gain of 2 to 4 inches of width for patient care in the space where it counts the most.

Finally, at a time when FirstHealth spends about $10,000 a week to fuel its EMS fleet, the improved mileage—from the previous seven to eight miles a gallon to the current 11 to 12—is a considerable plus. “It’s a big jump,” Carter says. “We’ll probably save $100,000 in fuel just this year.”