Nurturing a crop of top-quality health care professionals

When you ask Greg Paris, M.H.A.’98, what Monroe County Hospital and Clinics (MCHC) were like just over a decade ago, his eyes widen and his smile fades. “We were a remarkably different hospital,” he says.

The chief executive officer isn’t exaggerating. In 2001, the Albia, IA, hospital faced 26 percent employee turnover and had just come off the worst financial year in its history. Patient satisfaction was in the 17th percentile. Paris was contemplating a career move.

Fate intervened in the form of Quint Studer, who spoke that year at the annual meeting of the Iowa Hospital Association. The founder of the Studer Group, a company that helps health care organizations achieve and sustain better outcomes relatively quickly, told Paris and his colleagues to “recruit better people, write some thank-you notes and move low performance out of the organization,” Paris recalls on the MCHC website. “What did we have to lose?”

Poor performance indicators, for one thing. In 2012, just one of MCHC’s 160 employees left voluntarily. Patient satisfaction is now above the 95th percentile. Since 2008, the organization has won nine Press Ganey Summit Awards in areas including outpatient and emergency satisfaction. In the past three years, Modern Healthcare Magazine has named MCHC to the top 100 best places to work, including as the 22nd best place in 2010.

What happened?

“We strategically talked about what do we want to be when we grow up?” Paris says. “We felt like we could be world-class in service. All that starts with your people.”

Getting the right people on staff became and remains a top MCHC priority. The hospital’s senior team drafted tactics to improve service and commitment to patients, employees and physicians. That included defining nine standards with specific “behaviors” to fulfill each one.

Today, any person who wants a job at MCHC is required to commit to those standards of behavior before they’re allowed to complete an application.
“For example, one of the behaviors is if you see a piece of trash in the hallway, pick it up,” Paris notes. “That means we have 160 housekeepers.”

Jenny Klyn, MCHC radiology manager, says another behavior is to walk each hospital guest to his or her destination. “It’s a privilege for me to be able to leave my area to do that,” she says. “Those behavioral standards lead to good employee satisfaction and patient satisfaction.”

Another strategy in hiring the right people: Each interviewee is vetted by a trained “peer group” in addition to his or her prospective supervisor. Peer group members are fully empowered to express whether they believe applicants share the organization’s culture and standards.

“It’s not just a rubberstamp,” Paris says. “When a junior staff member can tell the CEO ‘No, don’t hire that person,’ that says something about our process.”

Those peer groups also underscore MCHC’s mission of delivering the best patient care and service, says Heather Cain, chief financial officer and chief information officer.

“We talk a lot about how none of us alone could provide the type of experience we want to deliver to our patients. It takes a team,” she says. “We do such a great job of connecting everyone to our mission. Even though I don’t have much direct patient contact, I’m able to help give my colleagues the tools and resources they need to deliver great care for people in our community. I know I can come to work every day and really make a difference.”

That goes for all staff, Paris adds. “Everybody matters here,” he says. “Our custodial staff have more patient touches than almost anyone; if we don’t train them to help patients, we can’t fulfill our mission of service.”

Training is a big part of MCHC’s culture. In the past two years, the organization has provided its 160 employees with more than 7,000 hours of training in a variety of topics and formats. They include regular off-site leadership and team development “institutes” and frequent on-site “crucial conversations” on topics like manager-to-employee and employee-to-employee communication and strategies for resolving disagreements.

“This hospital does more training than any other hospital I know,” Klyn says. She and Cain are both students in DMU’s master of health care administration program. “It keeps everyone on the same page.”

“We talk a lot about how none of us alone could provide the type of experience we want to deliver to our patients. It takes a team… I know I can come to work every day and really make a difference.”

It’s also designed to move low-performing employees either up or out. “We will not allow low performers to suck the life out of this organization,” proclaims the MCHC website. That conviction is visionary according to authors of the influential 2011 tome Tribal Leadership, who say hiring for cultural fit over competency benefits productivity and that one bad hire can poison morale and, ultimately, the bottom line.

“If people see colleagues who are not being held accountable, that brings your high performers down,” Cain says. The opposite effects – high performance and retention of staff who are delivering it – are a “tremendous financial benefit for the organization,” she adds. “We estimate it costs an average of $26,000 for each position we have to fill in terms of recruiting, getting other staff to cover duties and so on.”

Losing the life-suckers doesn’t give MCHC a suffocating, hard-core, high-pressure atmosphere, however. MCHC emphasizes that fun is key to a successful workplace, especially in an industry that’s regularly stressful. In the summer, hospital staff erect a large tarpaulin in the parking lot and open a small concession area for free movie nights for hospital employees and their families. During a recent staff theme party, Cain and her colleagues came costumed as the cast of “Gilligan’s Island” to kick off their electronic health records implementation.

“Everybody matters here. Our custodial staff have more patient touches than almost anyone; if we don’t train them to help patients, we can’t fulfill our mission of service.”

“We do very serious work, but it’s very important we relax and have fun, too,” she says. “It’s fun to bring the families into it. It builds relationships and helps keep things in perspective.”

In a hallway in the Monroe County Hospital hangs a map of the United States peppered with pins marking cities, from Maine to Washington to Texas, where MCHC staff have given presentations about the organization’s culture and high performance. Paris estimates they’ve talked in at least half of Iowa’s 118 hospitals, too.

“We want to share what we’ve learned with others. We want to make health care better for everyone,” Cain says. Paris adds: “I’ve got two daughters. What if one of my kids ends up in the ER in Centerville? Plus we didn’t invent any of this.”

True that – but MCHC has created a highly professional, team-oriented and congenial atmosphere that exemplifies rural America’s hard-working, neighborly image. That atmosphere also counters some of the “misconceptions” about rural medicine, Paris says.

“Physicians might worry they have no support, but we’ve got a full array of doctors,” he says. “Yet the relationships you can develop with patients is incredible. As one of four doctors in a town of 8,500, you can make such a difference.”