Minnie Hamilton Health Care Center (MHHCC) is an 18-bed, not-for-profit Critical Access Hospital (CAH), providing acute care, emergency medicine, rehabilitation therapies, imaging and related outpatient ancillary services to the residents Grantsville, West Virginia and surrounding communities. In addition, MHHCC operates a rural health clinic (RHC) in Grantsville and an FQHC in Glenville, WV along with various community programs including dental services, and 24-bed long-term-care facility. MHHCC is one of two Federally Qualified Health Centers (FQHC) in the United States that operate a CAH. Their mission is to provide personalized, high-quality care on an as-needed or preventative basis. They proudly state, “We have created a practice that we believe in and choose for our own family members.” Carla Brock Wilber, Senior Consultant, with Stroudwater Associates, worked with MHHCC in 2017, through the Small Rural Hospital Transition (SRHT) project, on a Quality of Care and Transition of Care Project. Center staff spoke with Stephen Whited, CEO; Sandra Ellis, Director of QI, Risk and Patient Safety; and Brittany Frymier, Administrative Assistant, 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: Regarding the Emergency Department (ED), MHHCC closely tracked time on “Decision to admit to time of ED departure.” They educated ED providers concerning details of the measure and they provide the data monthly to providers and nursing staff so they can see each individual patient times and provider and nurse information. This has decreased from pre-project measure of 122 minutes to a recently low of 57 minutes. Currently they are at 74 minutes, very close to the goal of 70.
Previously, daily huddles to discuss discharge planning were held three days a week and they now conduct them five days a week and strongly encourage providers to participate. In preparation for this change, administration shared ideas with their providers about with this topic. Participation is tied to incentives. The huddles also include representatives from pharmacy, physical therapy and other disciplines relevant to individual cases. Recently the discharge planner implemented LACE tool. This is a new strategy for MHHCC and they are closely evaluating patients for risk for readmit in 30 days. This has been very important since it’s been difficult to identify readmissions to other facilities. Internally, their readmission rates are very good (0 for 12 months) but they are most interested in preventing external readmissions. Another strategy to reduce readmissions has been to enhance their swing bed program. They developed brochures for this program and communicate this service to patients before they are transferred from the ED. They plan to increase marketing to other hospitals for referral back to MHHCC and track transfers so that the discharge planner can follow up with the receiving hospital to discuss a referral back.
MHHCC believes their biggest accomplishment on the SRHT project is the improved education of providers and staff on data. The board quality committee is very involved and HCAHPS training is conducted for all supervisors. Each supervisor receives a monthly dashboard of current data to post in their departments.
Q: What has been the impact of this project so far on MHHCC?
A: The measurable outcomes will be reported in six months. Non-measurable impact has already been clear and includes:
• Improved information and data sharing with supervisors and then driving information down to staff
• The addition of quality as a topic to staff meeting agendas
• More transparency as they create a culture of quality and safety
• A desire to continue to improve even though they are doing well in comparison to peers
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: “Things are working; we are getting there. Ready to have conversations about raising the bar without settling. All the documentation and quality impacts reimbursement and we have a better understanding of this now. Understanding better how to meet patient needs and prevent readmission while impacting wellness.”