Sisters of Mercy Health System Report to the Community 2004

Reprinted with permission of the Sisters of Mercy Health System-St. Louis.

When Catherine McAuley, foundress of the Sisters of Mercy, and her followers ministered to the poor, uneducated and sick of 19th century Dublin, they touched lives – one by one. In so doing, they brought about a lasting change for a whole community of people.

Today, the Sisters of Mercy Health System (Mercy) carries on that tradition of making a difference by touching lives – one person at a time – on a much larger scale and in many more communities than envisioned by Catherine. One by one, patients receive quality care in Mercy facilities in seven states. One by one, underserved people benefit from our health and social service outreach efforts. One by one, Mercy physicians are given access to the medical technology and resources they need to provide excellent care to their patients. One by one, Mercy co-workers benefit from a work environment that offers safety, continuing education and training, and professional advancement.

Our ability to continue Catherine McAuley’s work is directly tied to the core values that have guided the Sisters of Mercy since their founding: dignity, service, stewardship, justice and excellence. The stories on the pages that follow illustrate how these values remain a vital part of Mercy today and how we continue touching lives one by one.

Dignity: We accept all persons as created in the image of God.

Fulfilling co-workers’ needs

Providing nursing care for chronically ill patients is hard work, physically and psychologically. Despite that fact, co-worker satisfaction is exceptionally high on the sixth floor medical/surgical nursing unit at St. John’s Mercy Medical Center, St. Louis, as measured by the Gallup satisfaction survey used across Mercy. The reason is emphasis on the Gallup action planning process combined with good, old-fashioned listening.

“I don’t provide direct patient care, and I haven’t for six years,” said Kimberly McGrath, RN, BSN, nurse manager. “The nurses and nurse techs are the experts at providing bedside nursing. The supervisors and I listen to what they need to do their job, and then it is our job to make sure they get it.”

For example, in response to specific issues identified by the survey, McGrath and her management team have worked to address supply and equipment needs, professional development and team communication.

“Communication goes beyond the monthly meetings and quarterly one-to-one meetings,” said Jennifer Rellergert, patient care technician. “Our supervisors make rounds every day and ask how things are going. They are good at finding out what we need.”

Karen Bosen, RN, a nurse for almost 30 years, has found her time on the unit the most satisfying of her career. “There’s a commitment to listening and treating people well,” she said. “Our managers make sure we have the tools we need. We bring out the best in each other, and that is reflected in the quality of the care we provide to our patients.”

Service: We respond with compassion to the needs of others.

A last anniversary gift

Sometimes exceptional service means simply paying attention and responding to unspoken needs. That’s what a small group of co-workers at St. Edward Mercy Medical Center in Fort Smith, Arkansas, did for an elderly patient with renal failure. The patient was very ill and close to death, but he continued to linger. He told Samantha Greene, RN, and JeanAnn Edwards, RN, that he wished he could see his wife, who was living in a local nursing home. The couple’s wedding anniversary had come and gone, and he hadn’t been able to give his wife the gift-wrapped package sitting in the corner of his room.

Green asked Donna Johnson, RN, clinical nurse manager, if there was a way to arrange a visit for the couple. Johnson called the nursing home and found that the patient’s wife was stable enough to travel to the hospital. The next morning on her way to work, Greene picked up the wife for a visit with her husband. The couple shared a few hours together and celebrated a belated anniversary.

That night, the patient died quietly, at peace that he was able to share a last anniversary with his wife. His final wish was granted because Mercy co-workers listened and responded.

Stewardship: We wisely use our talents and resources.

A far-reaching redesign of healthcare

The Genesis Project represents the largest and most sweeping redesign of the processes by which healthcare is delivered and managed in Mercy’s history. It dares to imagine an environment where every patient receives the highest quality of care and service possible, and where physicians and Mercy co-workers are equipped with the processes and tools they need to provide exceptional care and service.

“Ultimately, the promise of Genesis is a commitment to Mercy’s mission – to make a difference by touching lives,” said Ron Ashworth, Mercy president and chief executive officer. “The project’s goal is first and foremost to better serve our patients and their families. At the same time, we will improve the work environment for Mercy physicians and co-workers.”

Of significance is the fact that a team of 80 to 100 full-time Mercy co-workers from around the System – supported by many more individuals serving in various capacities – is driving the multi-year effort. Mercy’s goal in creating this structure was to include co-workers who are forward-thinking, innovative and eager to use their knowledge and skills to build a better Mercy system. The team’s design supports the idea that existing co-workers are the ones who best understand Mercy and have a commitment to improving our work processes. The structure of the project makes the most of that expertise.

Justice: We honor each person’s rights and responsibilities in light of the common good.

Supporting career goals

In recent years, the shortage of nurses has been an ongoing concern for health providers throughout the country, including Mercy. In Springfield, Missouri, St. John’s Health System developed a unique loan program that encourages certified nurse assistants (CNAs) to get their nursing degrees at St. John’s School of Nursing. Each semester, students receive $3,000 to use toward their tuition and school expenses. Once they graduate, for each year they work at St. John’s, $3,000 of the loan is written off.

Toni Messenger, RN, is one of several CNAs to take advantage of the loan program. Messenger started working as a CNA at St. John’s in 1996, immediately following high school.

“My dad always told me to go to college so I would have a way to support myself,” said Messenger, who received her nursing degree in May 2003. “My aunt was a nurse, and I always admired her. I knew I wanted to help people, and I think nursing is a noble way to do that.”

Although the loan program wasn’t the reason Messenger decided to go to nursing school, her ability to do so was made much easier by St. John’s. “For people who are unable to afford school, this program is really a stepping stone,” she said. “It gives them the edge they need to make a better future for themselves.”

Excellence: We strive to attain high standards of performance and proficiency.

Protecting the rights of patients

Mercy Meds, a comprehensive medication transformation initiative developed by Mercy and implemented systemwide, is designed to ensure the five “rights” of medication safety: The right dose of the right drug through the right route at the right time to the right patient.

“Research shows the highest percentage of errors are intercepted when drugs are prescribed, while only 2 percent are caught when drugs are administered to patients,” said Kelly Turner, PharmD, senior consultant/manager, pharmacy services. “We saw that we had to devise a strategy to impact those occurrences.”

Mercy Meds spans the entire process of dispensing medication, from warehouse to patient. At Mercy’s Consolidated Services Center, a centralized distribution facility located in Springfield, Missouri, medications are packaged in unit doses, bar-coded and distributed to Mercy facilities. Pharmacists at the hospitals stock computerized drug dispensing cabinets located in patient care areas. Nurses use the cabinets to call up patients’ medication profiles and select the appropriate drugs for dispensing. At the patient’s bedside, nurses scan their own name badges, the patient’s hospital identification bracelet, and the medication’s bar-coded packaging. The computer system matches all the data to verify that the correct medications are administered appropriately.

In addition to providing safeguards for patients, Mercy Meds allows nurses to spend more time at the patient’s bedside, and transitions pharmacists from a role of dispensing drugs to becoming an integral part of the patient care team.

Strategic Initiatives

Genesis project sets course for Mercy’s future

Mercy’s commitment to touching and improving lives encompasses not only what we do in the present but also how we will serve our patients and communities in the future. Consumers throughout the country have made it clear what they want from healthcare providers: streamlined, well-coordinated, error-free, accessible and cost-effective care.

We are addressing these needs through six strategic initiatives: the personal and clinical components of Mercy Service, resource optimization, revenue management, fundraising/development and information technology. Our activities in each of these areas are described on the pages that follow. The newest of these activities, part of our information technology initiative, is being shaped through an innovative effort called the Genesis Project.

The future begins

The Genesis Project began in late 2003, when Mercy undertook the exciting and ambitious challenge of transforming our clinical and business work processes and enhancing our information systems. The project is designed to significantly improve patient safety, simplify work processes and enhance the flow of information across the continuum of care.

Unlike single-focused initiatives, the Genesis Project is a far-reaching, three- to four-year commitment of resources, technology and dedicated Mercy co-workers. The five goals of Genesis are to improve safety, clinical outcomes and customer service for patients; enhance physician satisfaction and productivity; enhance co-worker satisfaction and productivity; attain better business and operational outcomes; and advance the sense of “Systemness” and teamwork across Mercy.

We are working to accomplish these goals through four tracks, each of which has a dedicated team that will collaborate with Mercy co-workers across the System to design, develop and implement process improvements. The Genesis team is supported by Information Services co-workers who will help design and deploy the technology necessary to support new work processes. The four tracks and specific work or functional areas that will be enhanced by Genesis are:

• Clinical – nursing, radiology, laboratory functions, pharmacy, emergency, cardiology and intensive care (ICU).
• Revenue – scheduling, admitting and registration, charge description master (CDM), charge capture, medical records, billing and accounts receivable.
• Enterprise Resource Planning (ERP) – human resources, payroll, account payables and financial reporting.
• Supply Chain – purchasing and management of supplies and equipment, including capital projects.

The influences leading to Genesis

In recent years, public interest groups, lawmakers and healthcare consumers have focused on the quality shortcomings of the U.S. healthcare system. Demands for improvement, especially regarding patient safety and consumer choice, have grown steadily. The complexity and inefficiencies customers experience within the healthcare environment frustrate them. As customers’ expectations and concerns grow, healthcare providers are increasingly being compared to other segments of the service industry and found lacking in not only quality but also convenience and ease of use.

Despite its ranking as the largest U.S. industrial sector, healthcare remains highly fragmented and inefficient compared with many service providers such as banks and retail establishments. Unlike these and other industries, healthcare providers have limited experience with automating their core business – taking care of patients. Many experts believe current quality and cost concerns in healthcare can be addressed through clinical and business transformation – the systematic modernization of healthcare based on new and evolving clinical/business information systems.

That is the aim of Mercy’s Genesis Project. We are undertaking the challenge of rethinking and redesigning the processes by which we deliver and manage patient care, thus transforming the way we do business.

Technology: reliable, responsive, easy to use

While technology is an essential component of the project, the Genesis Project is not simply an information technology initiative. Rather, technology is a tool to improve Mercy’s business processes. The combined focus on process improvement, organizational change and technology will ensure we deliver better, safer patient care.

Today, Mercy’s Strategic Service Units (SSUs) have applications to support many operations, but there is little coordination across facilities or departments. The Genesis Project will help to serve the Mercy mission by building the best information system once and then using it across the organization. This new structure will allow the organization to focus more on clinical and business processes, with the goal of positively impacting patient care and customer service.

In addition, Mercy’s Information Services team will ensure reliability by upgrading hardware, networks, servers and other associated services. A back-up data center or “hot site” with full redundancy will be available around the clock to assure availability of the new systems.

The promise of Genesis

The promise of the Genesis Project is a safer, more efficient and user-friendly system for patients, physicians and co-workers across Mercy. From automating physician orders to streamlining diagnostic tests and patient charts, Genesis will dramatically improve our ability to deliver care. Physicians, nurses and other clinicians will have targeted and timely information at key decision points along the path of diagnosis and treatment, facilitating more effective, higher-quality care. New systems with embedded safety measures will catch errors before they ever happen. Patient information will be immediately available to clinicians in specialty areas such as imaging services.

And these are just the clinical improvements. Streamlined patient registration and billing, improved accounts payable processes, reduced patient accounts paperwork, and easier co-worker access to benefits information are just a few more of the benefits to be realized through the Genesis Project.

Perhaps most important of all, the changes and improvements flowing from Genesis mean physicians will have more time to do what they do best – face-to-face contact with patients – and nurses will have more time for hands-on patient care. They will be touching lives, one by one.

Revenue and Resource Optimization Initiatives

Improve Processes, Address Financing Challenges

For several years, two areas of strategic focus for Mercy have involved enhancing our revenue management processes and optimizing the use of resources across the organization. Our achievements in these areas demonstrate the importance of collaboration and the strength of Systemness.

Educating patients, eliminating uncertainty

One of the most personal topics for individuals or families is the state of their finances. Today, healthcare consumers across the country are often questioned about their financial “health” as changes in coverage escalate – from cuts in Medicare and Medicaid to employers shifting payment responsibility onto their employees. In addition, the number of uninsured Americans has increased by 40 percent since 1990.

As the unemployed, uninsured and underinsured populations grow, Mercy is called upon to meet their needs by providing additional options for payment and financing. Through a variety of new revenue management tools and processes, co-workers across Mercy are addressing this complex issue as a means to better serve our customers and manage our payment streams.

No one would agree to buy a car after being told, “We’ll get back to you in a few weeks about the final sticker price.” Yet historically, healthcare customers were expected to do just that – wait weeks or even months to find out the final amount of their hospital bill. In 2003, a team of Mercy co-workers joined together to develop a process aimed at helping patients understand and meet their financial responsibilities. The point of service (POS) initiative, which has been rolled out across the System over the past year, eliminates uncertainty by emphasizing communication. Prior to services being rendered, patients are provided with an estimate of charges, a clear explanation of their responsibilities for payment, and assistance in making decisions regarding how payment will be made. Making this information available and easy to understand increases patient satisfaction with our services, and reduces payment questions and concerns months later.

Critical to the success of the POS initiative is its integration with our core values and mission. We believe our dedication to maintaining that relationship distinguishes us from other health providers. Respecting patients’ dignity, providing excellent service to those in need, not making assumptions about patients’ ability to pay, and using our resources wisely are all key elements to the point of service program.

Improving satisfaction and removing barriers

In addition to point of service, Mercy’s revenue management team has undertaken the development of a work plan to improve documentation and coding across the Health System. This work is designed to improve the accuracy and timeliness of documenting services and supplies used in patient care, and to ensure that Mercy is reimbursed appropriately for the services we provide.

Work also is under way toward the development of a Mercy solution to patient access – simply put, improving the way we register and admit patients. The multidisciplinary team’s focus is to develop and implement “best practice” processes, provide exceptional customer service, and achieve greater accuracy in patient access procedures.

Mercy’s revenue management activities provide solid evidence of the power of teamwork. By working collaboratively, sharing optimal solutions, and being open to new ways of addressing needs, the revenue management team is removing some of the barriers to patient satisfaction and truly touching lives – one by one – in a positive and profound way.

Optimizing products, processes and people

Mercy’s need to better manage our revenue is impacted by another reality of healthcare – rising costs. It is our responsibility to ensure that the products, services and processes we use are the best and most economical, ensuring the wise use of resources for those we serve.

This responsibility is fundamental to the purpose of Mercy’s Resource Optimization & Innovation (ROi) operating division. The past year proved to be one of transition as ROi took the steps necessary to expand its responsibilities in procuring and managing supplies, medications and equipment across the System.

ROi’s group purchasing team leverages the System’s buying power to lower the cost of supplies, drugs and equipment. Over the past year, achieving that goal has meant eliminating “middleman” charges – the mark-ups incurred by using an external group purchasing organization (GPO) to manage Mercy’s supplier relationships. ROi transitioned $170 million worth of purchases to Mercy’s recently created GPO during fiscal year 2004, exceeding its internal revenue goal as well as savings goals for Mercy’s SSUs.

By June 2005, the GPO aims to expand its portfolio coverage from one-third of Mercy’s external contracts to two-thirds. In addition, the GPO team is working to develop a strategy whereby physicians and clinicians Systemwide will participate in selecting preferred brands of “high-preference, high-cost” products that represent the best quality and value. Reducing product variation and vendors is another means of practicing good stewardship for the benefit of our patients and Mercy.

Software simplifies capital management, clinical engineering

Another means for Mercy to make the most of its resources is through capital management, which encompasses capital planning, budgeting and implementation, clinical engineering and construction oversight. The Systemwide adoption of Mezzia capital management software in FY 2003, and stabilizing its implementation in FY 2004, brought ease and expediency to requests for capital purchases. Implementation of the AIMS clinical engineering software tool began in FY 2004 and will be completed across Mercy in FY 2005. Both tools serve to eliminate paperwork and ease work processes associated with capital and engineering projects. Additional improvements to capital management, including a more coordinated approach to construction management, are planned in the coming year.

Strengthening a Culture

Of Personal Service and Clinical Excellence

Mercy Service – the desire to truly help and care for others on a personal level – is the foundation of Mercy’s culture and mission. Its goal is twofold: Providing those we touch with a service experience that is both personal and of exceptional clinical quality.

Six areas of focus

How we advance our ability to provide exceptional clinical quality was a central theme in FY 2004, as interdisciplinary teams worked on six areas of focus identified in FY 2003:

• Clinical safety
• Disease management of chronic conditions
• The medication distribution and dispensing process
• Computerized physician order entry (CPOE)
• Outcomes measurement and reporting
• Creating a “framework for quality” that enables quality improvement teams to work in an efficient, collaborative and results-oriented manner

One of these areas, CPOE, is being addressed as part of the Genesis Project. Work continues, with several notable achievements, toward the fulfillment of the other five areas of focus.

Transforming medication safety

Celebrex is an anti-inflammatory drug; Cerebyx is a seizure-disorder medication. The similarity of these pharmaceuticals’ names illustrates why adverse medication events are on the rise. Figure in the number of new drugs introduced each year – up to 60 are added annually to Mercy’s inventory – and it’s clear why clinicians are challenged to keep up with information on new medications.

Realizing the importance of increasing the safety of the medication-use process, Mercy proactively designed and introduced Mercy Meds, our comprehensive medication initiative, before passage of the Food and Drug Administration (FDA) ruling requiring drug manufacturers to bar-code prescriptions by April 2006. According to the FDA, only about 2 percent of U.S. hospitals have installed bedside bar-coding systems – and we are in that small percentage.

Mercy Meds brings an enhanced level of patient safety to the medication-use process by incorporating a number of elements. Advanced technology includes unit-dose, bar-coded packaging; medication dispensing cabinetry; and bedside bar-code scanning capabilities. Mercy’s Consolidated Services Center, a centralized distribution facility in Springfield, Missouri, manages bar-coding and unit-dose packaging of medication and serves as pharmaceutical distributor for all Mercy facilities. Through strategic partnerships, Mercy purchases medications from AmerisourceBergen, the country’s largest pharmaceutical wholesaler; uses software from Bridge Medical that accesses patient information and verifies the bar-coded medications; and uses Omnicell dispensing cabinets to store and dispense bar-coded medications.

While Mercy Meds represents a tremendous investment, we believe the benefits far outweigh our commitment of resources and time. It is, in fact, critical to meeting the needs of our patients in today’s increasingly complex healthcare environment.

Reporting quality measures

In an effort to provide information on those whose lives we touch and how, Mercy has embarked on an aggressive approach to changing the way we report quality measures. The audience for these measures also is expanding. Rather than providing information only to internal recipients such as senior administrative and clinical leaders, Mercy is working to broaden our reporting of quality measures and other clinical quality information to include all co-workers, physicians, government and regulatory agencies, and the public at large.

Several factors are driving our proactive plan for sharing outcomes. First, we believe an open exchange of information will allow us to identify and support best practices in the care we provide. In order to do this, we need broad involvement from co-workers and physicians across the System. Second, government and regulatory agencies are requiring increased data reporting. A recent example is the National Hospital Quality Initiative, which has a goal of providing a framework for identifying and using a standard set of valid, reliable and comparable hospital quality measures. All of Mercy’s hospitals have voluntarily agreed to submit data. Third, consumer watchdog organizations have identified areas of concern within healthcare and have proposed solutions.

In addition to these factors, individual consumers are taking more responsibility for learning about healthcare providers’ quality of care. We want to make sure that information is readily available to those we serve.

Realizing that an electronic reporting system is key to Mercy’s ability to gather and analyze data, our Outcomes Measurement Team developed a plan for using Mercy’s intranet and external Web sites to provide information outcomes measures for both clinical services and patient satisfaction. The intranet approach, launched in 2004, provides high-level information targeted to all co-workers as well as detailed data aimed at leaders across the System.

The external Web-based reporting initiative is focused on providing outcomes information to the general public through Mercy’s corporate and SSU Web sites. This approach, to be piloted on the corporate Web site and by Mercy Health System of Oklahoma by the end of calendar year 2004, will provide an opportunity to go beyond statistics and provide consumers with a more in-depth look at Mercy, our values and our commitment to exceptional quality care.

For Mercy, making our outcomes more visible and accessible to a broader audience focuses our attention on how well we’re doing, which in turn increases institutional accountability. Our ability to report positive outcomes is strong evidence of quality care that will strengthen consumer confidence in Mercy.

Fundraising and Outreach Activities

Demonstrate the Value of Relationships

Faith-based healthcare providers such as Mercy are most often viewed as providing care and support to those in need, with a particular focus on individuals and families who are most vulnerable. Out of our Mercy tradition of service has come a variety of outreach ministries in communities across our seven-state service area and beyond.

But we have also developed an appreciation for receiving help from those we serve. Fundraising, as one of our areas of strategic focus, provides a significant means of enabling capital projects, funding charity care and community outreach efforts, and providing support for other strategic initiatives.

Building friendships

In recent years, Mercy’s ability to touch lives has become more dependent on the generosity of organizations and individuals within the communities we serve. Declining revenue from healthcare payers, rising supply and capital costs, and a slow economy have all contributed to a greater need for donated funds.

Recognizing how important the generous spirit of donors is to Mercy’s continuing success, last year we launched a fundraising initiative different from any others in our past. Our new strategy centers on procuring gifts that have a significant impact on our ability to carry out our service mission. Key to these efforts are standardized materials and educational modules that aid fundraising teams in each Strategic Service Unit, and a two-year fundraising plan for each SSU. Technology is also an element, with a new e-philanthropy capability that allows SSUs to use their existing Internet sites for online giving.

Although these tools are important, we realize that fundraising is as much about building relationships and telling the Mercy story as it is about securing income. Donors give to organizations and individuals they trust and with whom they have developed a relationship. Our goal is to continue telling the story of how Mercy touches lives so that others will come to share and support our vision.

Opening windows during times of change

“When a door closes, a window opens” is a familiar adage that often rings true in times of change. At Mercy, difficult decisions to withdraw from acute healthcare in communities long served may have seemed like shutting a door. However, out of these situations have come new and exciting opportunities for us to continue touching the lives of people we’ve walked with and among for decades.

One of the most difficult decisions for Mercy in recent years was the sale of Mercy Health Center in Laredo, Texas, to another healthcare provider in fall 2003. Even though the transfer of ownership was the most economically responsible action for the System to take, connections were too strong to consider withdrawing from ministry in Laredo. The Sisters of Mercy’s presence in the community spanned 110 years.

Instead, Mercy developed a new type of Strategic Service Unit for the community. Mercy Ministries of Laredo, a non-profit organization, encompasses a variety of outreach services in the area, with particular emphasis on meeting the needs of people who are economically poor. Net proceeds from the sale of the hospital have helped fund the outreach programs during the SSU’s start-up phase.

The new SSU continues three well-established ministries previously operated from Mercy Health Center – Mercy Casita, a food bank; Casa de Misericordia, a shelter for women and their children who are victims of domestic abuse; and Primary Healthcare Services, a provider of faith-based medical services for uninsured and underinsured residents.

In addition to continuing these services, Mercy Ministries of Laredo’s progress to date includes appointing a CEO, selecting a board of directors, and establishing articles and bylaws. A community assessment is planned to provide information on the areas of greatest need, which will be used in considering new opportunities for service.

A successful forerunner

Mercy’s ability to establish Mercy Ministries of Laredo stems from our experience with Sisters of Mercy Ministries, which includes a number of outreach services and programs in New Orleans and Mississippi. Initiated more than a decade ago in communities where Mercy previously owned hospitals, today the ministries range from a senior center and mobile health van to grade school educational programs, housing initiatives and outpatient behavioral health services.

To ensure the continuing success of these endeavors, in FY 2004 the ministries’ leaders met to discuss strategies for the future. That effort laid the groundwork for developing an organizational structure for the ministries that allows for succession planning. A future goal is to provide the ministries with the operational tools they need and to strengthen long-range funding resources.

Despite their organizational differences, Mercy Ministries of Laredo and Sisters of Mercy Ministries have much in common. Both continue to provide services in areas where the Sisters of Mercy have a long history. Both provide aid and comfort to those most in need. And both are exceptional examples of how Mercy touches lives, one by one.