Inspiring Excellence Everyday - Natchitoches Regional Med Center By Kirk Soileau, MHA, FACHE, CEO, Natchitoches Regional Medical Center
USA March 13, 2018
Yisrael Safeek: Welcome Mr. Soileau. Since 2013, you have served as CEO of Natchitoches Regional Medical Center, a 227-bed health system serving the Louisiana North Western Parishes of Natchitoches, Sabine, Winn and Red River Parishes. You also have over 36 years of healthcare experience in the public, for-profit, not-for-profit and faith based organizations and was also the founder of an international healthcare consulting company traveling to over 21 countries. You was initially appointed by Governor Jindal and subsequently re-appointed by Governor Edwards currently serving on the Radiologic Technology Board of Examiners for the State of Louisiana. In addition, you are President Elect for the American College of Healthcare Executives Louisiana Chapter, and one of 16 National Malcolm Baldrige Fellows for 2017-2018. And, your hospital has made 100 SafeCare Hospitals multiple times. Thank you for doing the interview. When did your interest in healthcare begin? Kirk Soileau: My interest in healthcare began when I was a freshman in college. I started as a business major but switched to nursing. My next-door neighbor was a CRNA, and I thought, that’s a job I could do, and that I really could do it well. Then halfway through nursing school, I realized instead of pursuing the track as a CRNA, I really liked primary nursing. And so, I stayed with it, and then as a nurse, I quickly advanced up in hospitals through clinical leadership to executive leadership. So, at the end of the day, my interest in business coupled with my love of nursing and patient care has created a unique career path that I truly enjoy. YS: You are a Malcolm Baldridge fellow. Can you explain to our healthcare leader readers what a learning organization is? KS: When I arrived here April 1st, 2013, nearly five years ago, we set three goals: 1) be in the top five percent for patient experience; 2) become a top 100 hospital; and 3) earn a Baldrige Quality Award within five years. Just as you mentioned, Baldrige really is the pinnacle of what exceptional quality in a learning organization is. A learning organization is really about a culture where you are continuously transforming yourself and becoming a different organization and responding to the needs of your community or your constituent group. In healthcare, we believe it’s an opportunity for us to deliver exceptional care to the community we serve. So, that’s the framework we’ve focused on. It’s really about how to become a more efficient organization. We want to align our culture and for all of our associates to move in the direction of exceptional safe care. This is the number one priority. And, it’s a journey that you never really finish – you always push harder to continually improve. It’s really a cultural change, and if you ask me in five years where we are – I will say that we are still on that journey. Because, there is no finish line when it comes to safety. It’s all about continually excelling and aligning the culture of your workforce. YS: Can you tell our readers how NRMC is succeeding in creating a zero harm culture? KS: That is what I call a top-down philosophy. It starts with our board and it starts with myself as the CEO, setting the expectation towards zero patient harm in everything that we do. And, to the point where we drive those metrics, when we do check-ins with our quarterly round tables with our associates, we identify, and we show them, here’s where we’re performing on an inpatient and an outpatient perspective in relation to zero harm. I'm very proud of the work we’ve done here. Like for instance, early elective deliveries, we’re now almost five years without an early elective delivery before 39 weeks. We empowered our caregivers, our nurses in labor and delivery, to do a hard stop. If the delivery was elective or was not for a medical necessity reason, you stop it. And so we’ve empowered our teams to do that, and it’s really about educating them on the significance of what we do and everything when it comes to quality. Our CAUTI and our CLABSI rates and our abdominal surgery [infections] rates are nearly zero. For CAUTI’S – We’ve gone three years and had one CAUTI on a patient – so we learned from that and improved processes. We have our whole team involved when we round every day with our safety huddle. We meet every single morning at 8:15, all leadership. And we say, “Okay, how many ventilators do we have, patients on a ventilator? How many indwelling catheters do we have? What’s our post op surgical [infection] rate? What’s our falls rate? Do we have any falls and how many days have we gone without an injury?” This is driven into the culture on everything that we do.
YS: That’s so nice to hear. Please explain what is positive, proactive, and accountable for everyone. KS: What I consider positive is using data to educate every single associate and physician, as well as our patients and families of what we’re planning to do, why we’re doing what we’re doing, and what to look for. For us being positive is really being on the front end to educate so we stay proactive. We also do a culture of safety survey every year, and it’s really important for us anytime we determine a variance in performance that we don’t make that a punitive situation. We address it whether it’s an associate or a physician or whoever it in a proactive manner. And everybody is accountable for the success and safety and care of our patients. We push that all the way down to the bedside, and it doesn’t matter if you’re some non-licensed personnel or you are our chief medical officer. Everybody is accountable, and we share those metrics. We share our performance, and if there’s ever a variance, we do a hard stop right then. We immediately address that. About four years ago, we put in place just-in-time huddles which we use for any type of patient outcome issue, or experience issue with a patient or a family member. It is a five-minute standup meeting, and the whole purpose is to address the issue and resolve it within one business day. It’s been extremely effective. About two years ago, we had a disconnect with our medical staff. When I say disconnect, we weren’t always closing the loop with our physicians when they would bring an issue or concern to us. So now we bring that to our patient concern committee, and we change it from patient to customer. We have seen an incredible alignment with our medical staff by bringing their issues in a formalized method of resolving the issues and following back up. It’s no longer verbal instead it is a hardwired process where our physicians know that if they bring a concern to us, we will follow back up with them in writing, so that we’ve closed the loop. YS: Is this how NRMC creates a positive patient experience? KS: Correct, and we do that through a number of ways. We do daily walking rounds. Part of our expectations include doing hourly rounding with 100% of our patients. We call patients post-visit in all of our clinics; in the hospital we call within 24 hours to follow up with patients after they go home. If any issue or concern is raised during rounding or on a post follow-up call, we immediately bring that to patient concern and we address that on the spot. The idea is to ensure that our patients and family members know that we care about their perceptional care and what we can do differently. It’s vitally important. YS: How does your hospital get information up and down the organization, to the right people at the right time? KS: We have communication boards in each one of our departments, and we standardized what’s on that board. One of them is all about quality metrics for the organization as well as the departments’ quality metrics. We then talk about changes within the organization communication focused on the patient. Third, is about education and learning. We publish those weekly and more frequently when needed. That’s really our method of making sure we communicate up and down the organization. We also have monthly staff meetings, daily safety huddles, walking rounds, and handoffs in all of our patients’ areas. Those are hardwired now. They’re walking handoffs, and we do those at the bedside with the patient and family members included in these conversations. It’s amazing. As we’re doing handoffs, we’re also educating the patients and family members. It’s been incredibly effective -- very, very effective.
YS: How does NRMC measure and manage metrics to attain industry standards and excel benchmarks? KS: We’re using the Baldridge framework to really move our organization to a different level. It’s broken down into seven elements, leadership, strategy, customers, measurement analysis, workforce design, how we operate and at the end of day results. And, how we bring all that together. We’ve benchmarked using both state and national benchmarks. You look at early elected deliveries, CAUTIs, CLABSIs, abdominal surgery infections, and our Medicare spending per beneficiary. Our goal is to be in the top docile in performance in all that we do. We consider ourselves innovators. We’ve moved not only to match but to exceed national benchmarks, and we ask ourselves what can we do differently for this community? One of the things we’ve put in place is a project we’ve been working on for two years, and we go live in that in the coming weeks. It’s a project with the state and federal government. We’ll be the first hospital in the US to develop a strategy to go at-risk with Medicaid, and with the state, to move beneficiaries out of the emergency department into primary care. So, we’re bullish on that we’re going at-risk. So, in other words, we’re going to guarantee to the state that we will reduce Medicaid beneficiary spending and Medicaid business in our ER by moving them to a primary care clinic open seven days a week, 12 hours a day. We believe by doing so we can improve the quality of health of the Medicaid beneficiaries and also reduce the cost at both the state and federal level. This is a national demonstration project we’re working on with the Louisiana Department of Health. Secretary Dr. Gee, and I started this project almost two years ago. Again, its involved legislators, and it’s involved our entire medical staff. As innovators, we want to improve the health and quality of the community we serve. YS: How do you help the hospital’s medical staff stay in step with quality metrics? KS: We’ve got our very engaged executive committee. What we’ve done is try to be as transparent as we can. The expression “transparency” may sound cliché, but that expression is accurate. We share results. We literally do rounds on our physicians, and we see 100% of our medical staff at least on a monthly basis. And, what that means is we do a check in with them, and we tell them where we’re going as an organization, and how they can help us along the way. We bring to them industry standards and updates. An example of the information we share is the work we did with early elected deliveries. Also, the work we’re doing right now with Sepsis. We focus on how to save lives through early detection of Sepsis in the emergency department. We’ve brought information to the physicians and showed them where we’ve had variances and where we need their help. As a result, they have helped us develop strategies. Physicians are statisticians, and they want to respond with timely data. So, it’s important we bring them reliable data as quickly as possible for them to make decisions, and then we work together. You know, doctors don’t like surprises, and they want to make sure that we provide a level of care that is exceptional, and they know if there’s a concern we’ll bring that to them. To me that’s the biggest thing we’ve done…is share data. YS: One of the things that you know we’re a technology company and we make software that helps hospitals with Joint Commission’s OPPE. Does the hospital utilize software technology to reduce unnecessary health care utilization, such as double procedures etc.? KS: The quicker we can get data to our caregivers and users, the quicker we can decrease variation in performance. For instance, you mentioned double procedures. To give an example, we have changed protocols to where we don’t use contrast at all on a CT scan, unless if they fall on a certain algorithm. So that they have to have a certain condition, the patient does, in order to have a scan with contrast. Another one is if the patient is admitted to the hospital and has been in our clinic and had a CT scan within 14 days. We have a hard stop before we order another procedure. We raise questions: So, in other words we’re ordering it again? What are you doing? Is that because you had a change of condition or what’s the reason? The practitioner may say I didn’t realize that CT had been performed or there’s a variance or there’s a change in position that warrants us performing that procedure. That’s really what we call hard stop in those areas where there are points of vulnerabilities for the patients. YS: As you know we’re up to value care now, it’s no more volume. What steps is NRMC taking for patients to get more value for the money that’s spent at the hospital? KS: When we talk about value, it’s not only knowing about the quality metrics, but the perception of care from the consumer. One of the things that we see, is the patient today is the consumer. They want to be seen the same day in the clinics. So, what we’ve done, is we’ve made sure that we establish points of entry for the patient and family members so that we get to move them into a primary care mode as quickly as possible. That’s why we opened up our ambulatory clinic. We opened up our clinic hospital almost four years ago. The purpose of that clinic was to be a bridge as we partnered with industry in the community to setup access points to where a patient could come into our facility, our ambulatory clinic. If their employer or their spouse’s employer is a member of our network, they can be seen with no co-payer deductible, no paper work. What that means is, we move people as quickly as possible, getting them, either back to work or getting them home. This approach helps us with managing population risk. That’s what we call the first component of our population health management. We guarantee to the industry segment here that we can provide care, and we can help you reduce your medical spend by getting people into what we call our access network quickly with no co-payer deductible. You eliminate the barriers of cost. Because right now, when you look at some of these industries where people make under 12 or 14 dollars an hour and may be living check to check, some may not go to a primary care clinic, because they don’t have that 20-dollar co-pay. We eliminate that barrier. So, we zero that out to where the consumer or the industries pay us per-member per-month fee and that’s whether their client comes in once a day, once a week, once a month or once a year. We’ve eliminated that barrier of cost, and allowed them access seven days a week, 12 hours a day into our clinic network. It has been phenomenal. Every industry segment we work with has told us we’ve reduced their medical spend because now people are moving into our primary care model verses episodic care. So to us that’s value. The second value is we’ve automated our scheduling process to where we send emails, text messaging, or voice calls depending on what our client wants. We communicate to get them into a clinic visit to decrease what we call our no-show rates. We’ve seen in the first year a reduction in our no-show rate by 20%, just by reminder notices. It’s about aligning the level of care to the consumer needs as quickly as possible. That’s what we consider value to be. It’s not about volume as you mentioned earlier. It’s about value and what we do to reduce the spend, the cost of care delivery to the consumer, and the people we serve. YS: Let’s shift gears a little bit. What keeps you up at night as a CEO? KS: What keeps me up at night, is figuring out what can we do as an organization to make sure that we are prepared to deliver care to the patients we serve. It’s really about aligning with our providers. The main reason I say that is that as we move from volume to value, we’ve got to improve access to care, and we’ve got to provide access for our providers to be able to take care of the patients in a timely manner. It’s always about cost and about funding. I believe if we take care of the patients everything else fall into place. The money will be there, but we’ve got to be able to make sure we match utilization with resources. YS: Where is NRMC on the road to perfect care? KS: As I mentioned earlier, we are running a marathon, not a sprint. We just had our first Baldridge visit this past fall. We really did well, and we’re on the second application as we talk. As long as we deal with human beings, I don’t know if we can ever reach perfection, even though we strive for it. Our goal is to decrease variation and make sure we educate our teams and our physicians about providing the safest, highest quality care we can. And the Baldridge framework is allowing us to really know this and determine where we have gaps in performance and where our opportunities are to become and remain as a truly learning evolving organization. YS: What is one issue that you believe will influence your hospital/health system in 2018? KS: I think at the end of the day it’s aligning our provider perception to the community patients’ needs. That is still as the biggest gap I see that we as a healthcare system can work towards. We see it even in our community. We still have providers working in silos, and it’s really about focusing on what are the needs of the consumer and the trends moving forward. That’s really where I believe is our biggest opportunity is and we’re going to do that by making sure that we stay in front. We work with our providers, and we assess and determine what our consumers are telling us we need. That’s one reason we did our community health assessment this past summer. We want to make sure that our strategy is headed in the right direction. The community health needs assessment allowed us to be able to confirm that what we are doing as a strategy aligns with our community’s needs. YS: Thank you Kirk for inspiring excellence every day.
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