northstar health system - hospital addition and renovation

TRANSFORMING A CRITICAL ACCESS HOSPITALNORTHSTAR Health System - Hospital Addition and Renovation

A Miron Construction Case Study

WHAT WILL IT TAKE? Every healthcare organization aspires to attract and retain patients. Appealing websites, public awareness and outreach e!orts market key services. Announcements of awards, praise and other c linical recognition let potential patients know of your success. But does any of this impact decision-making?

Research says no. New research indicates that patients and physicians are increasingly likely to base their choice of hospital on non-clinical aspects of their visit—like the overall patient experience (McKinsey & Company Quarterly, 2009). Yet, few hospitals have the marketing skills, key organizational structure or the strategic approach to deliver a distinctive experience in ways similar to those of retail and hospitality companies.

HOW DO PATIENTS DECIDE WHERE TO GO FOR CARE?Conventional thinking has long held that most patients base their hospital choice on clinical reputation, its location, or their physicians’ recommendations. Recently, hospital executives have begun recognizing that patients also consider non-clinical factors, such as comfortable rooms, surgical education and convenient registration procedures, when choosing where to seek treatment.

NORTHSTAR Health System (formerly Iron County Community Hospital) understands just how important non-clinical factors have become. “Our opportunity is immense. While this facility has served the Iron County [Michigan] community well for 35 years, we had to change,” states Bruce Rampage, CEO of NORTHSTAR

Health System. Shrinking marketshare and a desire to stay up-to-date with emerging patient needs necessitated change. Rampage went on to state “our goal was to [envision] the hospital of the future. To think di!erently than before—that is how marketshare will be [gained]. Our clinical outcomes are superb, [but] we have to connect on the non-clinical elements of the experience.” Rampage was faced with this challenge and couldn’t help but get excited about NORTHSTAR’s new opportunity. Early in 2008, Rampage launched an effort to “re-imagine” the critical access hospital experience. He and his team hired Miron Construction Co., Inc. to develop and construct an addition, which encompassed 25,000 square feet of new space, and complete the renovation of 13,000 square feet of existing space.

“Being a great hospital was not enough for us,” explained Rampage, who joined NORTHSTAR less than three years ago. From day one, he says he focused on “creating a unique environment for patients and their families. Building four walls wasn’t enough. Miron was selected because they look at projects di!erently.”

Understanding that each patient is unique was at the core of the NORTHSTAR strategy. “Most hospitals apply a ‘one-size-fits-all’ mentality to understanding the patient experience. We recognize that patients no longer want a ‘one-size-fits-all’ approach to healthcare” asserted Rampage.

SETTING THE STAGEFrom the beginning of the project, it was important to align the experience to NORTHSTAR’s overall strategic plan. “We realized that to simply build was not enough,” commented David G. Voss, Jr., CEO of Miron. “Twenty-five percent of a patient’s experience has to do with the outside walls; the rest is influenced by what happens inside the facility. Successful projects encompass more than schedule, budget, quality and constructability.”

In the ever-changing world of healthcare, it is as vital to consistently deliver on promises, as it is to stay on the cutting-edge of technology.

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CHALLENGE

NORTHSTAR Health System (formerly Iron

County Community Hospital) was struggling

to remain relevant with an outdated facility.

Although the hospital had excess capacity,

they were unable to provide the cutting-edge

services that the surrounding community

demanded. NORTHSTAR recognized the

need to reposition themselves by re-imagining

the critical access hospital of the future.

F!"# $%& "'(, NORTHSTAR )"*+,($ "' “creating a unique environment for patients and their families. Building four walls wasn’t enough.

Miron was selected because they look at projects di!erently.”

BRUCE RAMPAGE CEO of NORTHSTAR Health System

Before you can exceed patient expectations, you must thoroughly understand what those expectations are. For NORTHSTAR, re-imagining the patient experience began with the organization defining and setting a project vision, creating project drivers, and determining expectations and desired outcomes. "e ultimate goal was to link the new facility to patients’ unique needs and align people and behaviors to deliver new solutions.

NEXT STEPSTo begin the process, Miron scheduled ‘Innovation Sessions’ for all 350 employees as a way to jumpstart the process of re-thinking and understanding what was important to patients, the community and the NORTHSTAR staff. “From the beginning, Bruce challenged the entire team. We used the non-traditional approach of reverse-outcome modeling,” explained Steve

Tyink, Miron’s Vice President of Business Innovation and one of our Experience-Based Design team members. “Reverse outcome modeling actually begins with understanding the outcomes that occur at every patient attach point within the hospital setting.”

E x p e r i e n c e - B a s e d D e s i g n ( EB D ) in healthcare focuses on capturing and understanding patient and caregiver needs, not simply their view of the process—for instance, the e#ciency and speed at which they travel through the system. Instead, it deliberately sets targets and establishes benchmarks for subjective outcomes: personal feelings a patient and caregiver experience at critical points along the care pathway.

“Our healthcare services team and Experience-Based Design experts work collaboratively with design partners and owners to create unique and ideal experiences for patients, sta! and the community,” Tyink elaborated.

"e EBD process begins with the formation of Innovation Teams in which current sta! and physicians serve as co-creators of the experience. Employees selected from various disciplines were brought together to answer questions such as: Why does NORTHSTAR exist? What makes our hospital unique? What are we going to be famous for? If we disappeared tomorrow, would we be missed and why?

Innovation Team members identified and created an experience that is original and relevant to the Iron County community. “Here is the truth,” added Rampage “we can’t be something we’re not. "e hospital has been here for a long time. Our beliefs, truths and cause are di!erent than that of our competitors. "e community knows us as a trusted guide and partner. We had to create the experience around who WE are.”

Miron explored and challenged what employees and patients really wanted and what they really needed. The team watched, listened and understood not just the words, but the behaviors. “Too often when

SOLUTION

At the core of the NORTHSTAR transformation

were seven non-negotiable ‘Guide Lights’ that

NORTHSTAR and Miron Construction used to

help lead the organization through re-design

and construction efforts. “We never wavered

from the core guiding lights. At every step

of the transformation process, we asked

ourselves: does it align with the strategy?

Does it align with the [guide] lights?” stated

Tyink.

Seven Guide Lights:

1. Intentionally design the

patient experience.

2. Understand the ideal patient ecology.

3. Involve every level of the organization

in the creation.

4. Research best and innovative practices

(both inside and outside the healthcare

industry) and use them.

5. Choose wisely what you measure

and hold people to it.

6. Listen to patients, but more

importantly, watch what they do.

7. Define the standards that will

set us apart.

Evidence-Based Design Accreditation

and Certification

Throughout the design and construction

process, Evidenced-Based Design principles

were followed. This process bases design

decisions about the bui l t environment

on credible research to achieve the best

outcomes. Critical to the NORTHSTAR mission

was designing a facility that: A) reduced

patient slips & falls; B) Lowered nosocomial

infections: C) Eliminated inaccurate prescription

medication D) decreased nurse attrition rate

(through the elimination of steps) E) minimized

patient transfer rates; F) reduced noise and

improve air quality. Most importantly, we

developed single patient rooms and access

to nature and natural lighting.


understanding the voice of the customer, healthcare organizations think they ‘know’ what is desired. Why then do we still use a hospital gown that everyone hates, one that was invented in the early '20s?” asks Tonya Dittman, a Miron EBD Leader. “Innovation Teams bring newly created experiences to life, and ensure they continue long after they are developed because the solutions belong to the NORTHSTAR team, not to Miron. A complete cultural transformation occurs, one that is organized to deliver the ideal patient experience.”

At project inception, Miron facilitated various workshops with NORTHSTAR team members using the Seven Guide Lights, their project vision and drivers, an Innovation Team summary, and EBD tools to guide the experience process. "e following is an outline regarding how the ‘Guide Lights’ made an impact on the transformation:

1 Intentionally design the patient

experience. Too often the entire experience is overshadowed by more pressing

clinical outcomes. Without intentionally designing the experience, you leave the entire encounter to chance. How should the experience go? What types of feelings are we trying to elicit? What do patients say about NORTHSTAR after their first encounter? “We would never leave a diagnosis or surgical

procedure to chance. Why on earth does the healthcare industry leave the experience to chance?” questioned Rampage. To his point, following is a snapshot of a patient’s typical experience at a hospital:

You hide in the parking lot until your appointment. Next, you walk inside and provide your name. A receptionist asks for your insurance card. Your name is called and you’re brought into a small, cold and sterile room. Someone you have never met asks you to remove your clothes and hands you a paper gown with an exposed backside. "en you are left to stare at a wildlife photo on the wall. You wait, and wait, and wait a little more while paging through a House Beautiful magazine. After at least a fifteen minute wait, you are finally greeted by your doctor. "is type of experience is no longer acceptable.

Our teams identified 32 experience action items when the project commenced, all of which needed to be incorporated into the new facility. To bring these innovations to life, 11 Innovation Teams (see right) were

“The changes that have occurred at the Hospital, in both our

services and physical facility, have been tremendous. From

the beginning, the team set out to create a critical access hospital that was unique and focused on reducing stress and anxiety for

every patient and their families while improving their clinical

outcomes. I can't say enough about the transformation.”

ROBERT W. POSSANZA, SR. Former Board President

NORTHSTAR Health System


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formed to facilitate the implementation of the ideal experience. Guided by the Miron Reverse Outcome Modeling Tool, impression areas and attach points were understood at each intersection with the NORTHSTAR brand. To begin the innovation experience, outcomes were understood first and process issues second.

2 Understand the ideal patient ecology. How did we begin to

understand patients? We listened. We learned that each patient comes to our facility with a di!erent set of expectations, requirements and needs. We listened to compliments, complaints and concerns from the patients at key interaction points during the traditional hospital experience. We knew, through our research, that the expectations of a perpetual patient di!er greatly from the expectations of an elective patient who has little time for testing, treatment and healing. We conducted focus groups to better understand what the expectations of occasional, elective, perpetual and complex critical patients were. Our ultimate goal was to ensure that the elective patient, who literally has numerous surgical options available to them and will only endure one poor experience before finding a new hospital, would be satisfied with our facility and services.

Finally, our team listened and integrated the thoughts, beliefs and feel ings of NORTHSTAR sta! members. "rough the utilization of 12 Experience-Based Design tools including Innovation Teams (iTeams), the team was able to understand the current state and, more importantly, the ideal state. "e behavioral, informational, and physical components through which any experience is delivered must be modified to support and deliver the newly constructed experience. We needed to determine how to model, create and ultimately replicate these experiences through process changes in order to repeatedly bring the NORTHSTAR experience to life.

3 Involve every level of the organization in the creation

of the ideal patient experience. New healthcare research underscores just how important non-clinical elements have become. An online survey by McKinsey & Company of more than 2,000 US patients with commercial insurance or Medicare regarding their attitudes toward the patient experience revealed that most of them are willing to switch healthcare providers for better service and amenities (McKinsey & Company Quarterly, 2009). In fact, many have already asked their physicians to refer them to specific facilities specializing in providing this type of care. In a separate survey, doctors revealed that they are often willing to accommodate a patient’s request for a referral to a healthcare organization that o!ers a positive experience—sometimes even if it has a lesser clinical reputation.

Staying ahead of the competition was critical to the long-term vision and success of NORTHSTAR. Creating innovative solutions that did not yet exist in healthcare was the challenge. NORTHSTAR’$ iTeams, comprised of individuals f rom ever y department in the hospital, were provided with the knowledge, research, and tools to determine where the discrepancies lied between the current and ideal state in order to create a new and ideal experience for patients. Who better to create the ideal patient experience than those who live, eat and breathe hospital life? These are the individuals who best understand patient needs and desires because they’ve spent their careers interacting with them. Empowering team members to share thoughts, ideas and solutions is the best way to encourage ownership of altered processes and systems.

4 Research best and innovative practices (both inside and

outside the healthcare industry) and use them. Some very special companies, such as Southwest Airlines, Apple and Panera Bread, focus their e!orts on creating


PROCESS

Innovation Teams were created around

the following key interaction points with

patients:

Patient Education & Registration1.

Patient Welcoming & First Impressions2.

Hospice & Home Healthcare3.

Patient Discharge4.

Follow-Up/Home Health5.

NORTHSTAR Tour & Wayfinding Story6.

Food Service 7.

Oncology8.

Imaging9.

Branding10.

Housekeeping11.

attachment with their customers as a natural order of business. With NORTHSTAR, we knew we had to look from the ‘outside in’ to create a new model for the experience. We looked at things from an entirely new perspective, for our inspiration. We wanted to learn how the best-of-the-best command space within their market. What is it that created their uncontested space? Was it pricing, advertising, marketing, facilities, innovation, or service? We toured numerous organizations in order to gain an understanding of what they were doing to di!erentiate themselves from the competition (in some cases gaining five to seven times the market share of their rivals).

Here is what we found. Each organization understood the outcome of their customers’ experiences before they ever occurred. "rough the assistance of Experience-Based Design tools, they intentionally recreated those ideal experiences to elicit those same emotional outcomes, time after time.

5 Choose wisely what you measure and hold people to it. In order to

be successful, you can’t merely copy what other successful organizations are doing to ensure quality care. Measuring outcomes involves understanding what best-in-class organizations’ goals are and how they have achieved those goals through process and operational improvement. Once you have that information, you have to determine how to achieve comparable results given the unique internal and external conditions of your organization. And once changes are made, it is vital to the success of the organization to continue to measure outcomes to ensure every patient is receiving quality service every time they step foot in your facility.

Instituting quantitative and qualitative measurements encourages accountability. If you measure it, they will respect it. NORTHSTAR established checks, balances and processes to ensure continuity in the delivery of their services. "is is critical to guaranteeing that

a complete cultural transformation occurs within your organization.

To ensure that the measurement process is on-going, NORTHSTAR leadership created "e PACE team (Promoting a Culture of Excellence) staff initiative. The initiative is led by the PACE UP group comprised of department managers. The initiative is charged with keeping the culture alive and holding team members accountable for not only continuous improvement activities, but the metrics associated with system deployment activities as well.

E m p l o y e e r e c o g n i t i o n i s k e y f o r transformational success at NORTHSTAR. To recognize sta! members for their great patient care and process improvement activities, the 'Shining Star' program was created. Each month patient care stories are recognized and highlighted for other sta! members to learn from.

6 Listen to patients, but more importantly, watch what they do.

Few healthcare organizations systematically seek to understand what patients value in the non-clinical aspects of their hospital visits. We needed to understand the process, systems and impression areas that create the ‘Ideal Patient Experience’ before we designed and constructed the new facility. Perceptions of service providers, including hospitals, are formed the moment the experience begins. "erefore, from the beginning, we studied desired outcomes to determine their influence on the overall patient experience, and we diagrammed the progression and flow of the experience exchanges within the facility. In doing so, the vision for each area could be understood and then be designed to meet that goal. Understanding the impression areas allowed us to analyze movement sequence, spatial integration, patient interchange and emotional connectivity. We were then able to identify service gaps and reinforce consistency within the organizational brand experience.

Everyone can identify with positive and negative service experiences. For example, you’ve walked into a health club where you feel energized and excited to start, or continue on, your journey toward achieving a healthy lifestyle. And you’ve no doubt walked into one where the receptionist is on the phone, you can’t find a towel, or the locker room is a disaster area. Most likely you leave with a horrible impression of the facility and, in turn, the organization.

Why is it that some places connect with us and some don’t? "e answer: If you understand that the front steps to your facility are as important as the person greeting patients at the front door, you get it. If you think your ad budget is more important than your parking lot, you don’t. Your parking lot is where people first connect with your facility. Make it memorable. Rethink the signage. Consider ease of navigation. Plant flowers for visual interest. Tell a story and be unique. It’s all about customer attachment.

7 us apart. Integrating new hospital standards into our overall plan was critical to the success of the project. Documenting and standardizing processes ensured nothing was left to chance. “Department leaders worked hard throughout the design and construction phase of the project to standardize many areas of the new hospital,” commented imaging team leader, Eric Beauchamp.

One example of an impression area where a new standardized process had a great impact on the sta! and patients was the registration process. "e registration team measured the amount of time it took to travel through the registration process. "e team’s initial plan to ‘speed up’ the process did not provide them with the outcome they had originally expected. They found that making the registration process as short as pos s ib l e inc rea sed anxiety in patients. Therefore, although speed and e#ciency were important, it was

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also vital to ensure patients felt comfortable and calm. Not only was the registration process changed, but it was standardized so that each and every patient who enters the doors has the same positive experience.

Other areas that were standardized at NORTHSTAR include: inpatient room tours, radiology services, housekeeping, surgical education, discharge planning, food service, ICU preparation, hospice, and the list goes on. Every interaction point and area of service was evaluated to increase e#ciency and heighten the patient experience. Now that these standards have been established, it is up to the team to continually confirm that they are consistently delivered in order for NORTHSTAR to bring the ideal patient experience to life on a continual basis.

To help create the ideal patient experience, m a n y i n n o v a t i o n s w e r e a d d e d t o NORTHSTAR including: pre-warmed, discrete mammography robes; iPods and DVD players for inpatient and outpatient rooms; customized “Catering to You” room

service for meals; First Impressionist position; elimination of overhead paging; new forms of communication including sta! pagers and phones; patient pagers; electronic scheduling and waiting patient identification practices; and free discharge follow-up for all elderly patients by Home Health.

IN CONCLUSIONIn the sea of healthcare sameness, transforming a critical access hospital begins at the top, the bottom and everywhere in between. Creating the ideal patient experience for NORTHSTAR Health System was truly a team e!ort, and it will take the commitment of everyone on the team to continue to bring these ideal experiences to life.


RESULTS

NORTHSTAR has already experienced amazing

results due to the organizational changes the

team made. Highlights include:

2010 Michigan Rural Health Qual i ty

I m p ro v e m e n t A c h i e v e m e n t Aw a rd

for overall customer service in inpatient,

outpatient and ED services.

INCREASE IN MARKET SHARE

11% OUTPATIENT

48% ORTHOPEDICS

30% CARDIOLOGY

82% VASCULAR

97% HEMATOLOGY

Miron is committed to building more than just buildings. We believe wholeheartedly in partnering with our clients to develop solutions that deliver business results. For many, that means increasing their bottom line, or enhancing their ability to recruit and retain the best and brightest. For others, it’s giving them a competitive edge. Our Experience-Based Design services offer our clients the ability to distinguish themselves in an increasingly competitive marketplace. That is why we are committed to collaborating with owners and

design partners to create unique, differentiating experiences that exceed client expectations. We know it is no longer enough to simply satisfy. At the end of the day, it’s all about helping our clients be successful. Experience-Based Design is just one way we’re helping clients deliver on their promises.

Simply stated: our commitment reaches beyond construction; our passion brings dreams to life!

CONTACT: Steve Tyink

920.969.7047

[email protected]

miron-construction.com

"The entire Miron team operated like an orchestra or well-choreographed ballet. They touched every inch of our facility without one disruption to our

patient or staff. They left a piece of art, they were amazing."MARK TOUSIGNANT

Chairman of the Board NORTHSTAR Health System