Values Drive Everything: Q&A With Bridgeport Hospital CEO William Jennings
Today, Mr. Jennings is leading a campaign to transform Bridgeport's "first impression" with patients and the local community. He's also spending more time talking to lawmakers and helping them understand the fiscal pressure his organization and other Connecticut hospitals face. His style of leadership and management — one grounded in accountability, transparency and a staunch sense of ethics — has earned praise from stakeholders. "His approach is a combination of metaphysics, oral tradition and good old-fashioned values that stress the importance of right over wrong, particularly in an institutional setting," says Meredith Reuben, chair of Bridgeport Hospital's board of directors.
Here, Bridgeport Hospital's president and CEO discusses how he drives accountability, solves ethical dilemmas and is approaching population health management. He also confesses to stealing an idea from an aerospace company — one that has greatly improved operations within the New England hospital.
Question: A few months ago, you delivered a speech called "The Story of the Lost Corpse," detailing the day when two bodies in the morgue of a hospital you previously led were mixed up. One body was to be taken to a mortuary for a traditional funeral, the other to a university as a donation to science. The wrong body went to a university, which corrected the mix-up and returned the body to the hospital unharmed. Although the situation was remedied, you decided to tell the families about the mistake. Can you talk more about that? What are other instances when hospital CEOs might face a similar decision?
William Jennings: What it really boils down to is this: It was the right thing to do. Sometimes, the right thing to do is really hard. I could have easily said, 'No harm, no foul. We got the right corpses to the right families.' But if that had been your dad, or your grandfather, wouldn't you have liked to know? If that were me, I would have thought better of the hospital for coming clean.
That's an ethical dilemma, and they happen every day, from contracts to employee relations to physician discipline and sentinel events in the hospital. I had a hanging occur one time at a different hospital. It was a successful suicide by hanging in a psychiatric unit. It was horrible. One of the things patients in a behavioral health unit need most is our protection, and we failed.
You're required to notify authorities and the Joint Commission and other officials, and as a consequence, inspectors come for days at a time to review the incident and come up with a plan for corrective action. The patient had been known for her long-term experiences with the hospital. She was a heavy IV drug abuser and homeless with no family or friends. A less value-driven organization would have been tempted to not report it, because no one else would have known. But we did report — not only because it was the law, but because it was the right thing to do. Someone had died on our watch.
Values drive everything. I'm sure 100 CEOs have this in common, but I greet every new employee within their first hour of work. I'm the kickoff to new employee orientation, and I spend an hour talking about values and how they're not an option. I even say, 'You have to live the values with every single encounter, every day. If you can't commit, don't come back tomorrow.' And I mean it. We have enough going on here that we don't need to be rehabilitating employees who don't share our values. We don't have time for that. It would be irresponsible of me to let someone start work without knowing what to expect.
Q: Bridgeport Hospital's patient satisfaction rates have excelled in the past two years. How did you help drive that improvement?
WJ: Personal involvement. It's almost a cliché, but what's important to the boss becomes important to everybody else. I stole an idea from my colleague Frank Corvino at Greenwich (Conn.) Hospital, which [is also within Yale-New Haven Health System and] has been at the 99th percentile for patient satisfaction by Press Ganey for years. Every week — at the same time, same day, for an hour and a half — all managers at Bridgeport Hospital come into a room and read aloud every single patient complaint from our satisfaction surveys. There are two ways we receive complaints. The patients either write something on their survey, or we have student nurses who do callbacks. We get mostly positive comments, but if there is a negative comment or if a patient rates us three points or lower, managers read that comment out loud in front of their peers.
Here's the kicker: You have to come to the table with that comment already resolved. The nurse manager doesn't come to the table and say, 'Okay, I'll talk with my team about this next week.' You have to come with it solved — that's become part of the culture. Coming to that meeting unprepared is career-limiting, and people know it, because I'm sitting there. The COO and CNO are also there. We demand performance from our key clinical leaders and not attending the meeting isn't an option. Coming unprepared? You don't do it twice.
That's not the only thing we've changed, but that's a disciplined tactic that is very visible and coincided with significant improvements. We also started hourly rounding and installed new white boards for key information for patients, like their physician's name. There's one more thing I stole shamelessly from Sikorsky Aircraft, a division of United Technologies Corp. [the aerospace company based in Hartford, Conn.]. What I'm about to describe is straight out of the manufacturing world. In every single department, we've put a poster with 8.5 by 11 inch sleeves in it with room for seven graphs.
These posters have two rules: First, those seven measures must be based on the collective wisdom of the staff. They must come up with seven measures that drive success in their department in the categories of finance, patient satisfaction, employee satisfaction and clinical outcomes. Two measures must be based on patient satisfaction and the posters must be posted in public — on a wall where patients, visitors, staff, the news media and Joint Commission surveyors can see them. So, if you're a major surgery nurse manager, you have this poster, and patient satisfaction scores aren't improving — all of a sudden it's not just your boss asking you about it.
This heightens accountability significantly. If I see you haven't updated your poster in six months, it means you don't really care about the poster and I might need a new manager. The COO and I do poster rounds every month, and we walk around for an hour and a half, stopping at various departments and asking employees or managers to walk us through their poster. A couple things happen: The COO and I interact with purpose with the staff, and that's critical to any leadership role. The second thing is we really know what's going on in those units.
Q: Can you provide an update on the Yale-New Haven Accountable Care Task Force? Is Bridgeport Hospital undertaking any specific accountable care/performance-based initiatives? If so, what are they?
WJ: We haven't signed up to be an ACO. There's too much ambiguity and expense for something that's not proven yet. However, whatever happens in healthcare reform — whether it's ACOs, shared savings contracts, full capitation — there are some key fundamentals to all those changes. We're focusing on those fundamentals and not getting caught up in the independent models. Six fundamentals will have to be in place no matter what: clinical integration, enhancing our primary care strategy, care management, clinical and actuarial forecasting, direct contracting and health information technology integration.
Last week, we flipped the switch at Yale-New Haven Hospital to Epic. Greenwich Hospital went live with Epic last year. Bridgeport Hospital will go live in September. We made a system-wide decision to standardize [EHR] — it's a fundamental. There's not a possible way for us to be prepared for healthcare reform if we're not using the same data. We're focusing an enormous amount of capital and energy to get all hospitals in the system on Epic. We need to have that before we can drive clinical integration, which is about measuring together, defining outcomes together, identifying best practices, reducing variation, providing incentives and driving costs down, while improving quality.
We want to grow our primary care physicians in scale and prepare to be able to focus on a population's health rather than just individual health. We're starting with internal care management processes for employees to begin managing their chronic diseases better. We're doing it on a volunteer basis with employees who are diabetics. We've been on it for a year now and it's been an unqualified success. There have been zero inpatient admissions under that program, which involves care coordinators and standardized diagnostics on a routine and scheduled basis. We're planning to add more conditions to the program, and by virtue of experience, we'll be better prepared to offer population health management to the community.
Q: What are some other developments at Bridgeport that you're most excited about?
WJ: Certainly the most visible developments are some of the physical transformations around the hospital. We've really been paying extra attention to image transformation and first impressions. There's an enormous amount of literature, some from Disney, Toyota and General Electric, suggesting first impressions really matter. They drive pride. Our clinical outcomes are as good, if not better, than any hospital in the country, but the physical image of the hospital has not kept up with that.
We've made investments in our waiting rooms, entrances, main lobbies and cafeterias. A significant one right now is the whole city block that's in front of the hospital — we bought it from the city. The street separating the front of the hospital from the next block south is being transformed to a grand entrance that will be more of a plaza and a park than a through-street. It took about a year for the regulatory and political process [to take possession of that street]. We were very upfront about it. We held neighborhood meetings, introduced concept designs and mentioned how the street closure would alter traffic patterns. As a consequence, we now have a major city street closure that everyone is happy about.
The clinical outcomes are not only outstanding but are improving significantly as well. There's a [business] book by Philip Crosby called "Quality is Free." I read the book 30 years ago and I still believe it. The principle is that when you focus on the customer relentlessly, and every decision is made to improve the customer experience, everything else will follow. We have proof that's working. We're above the national averages for all core measures. We're way above the national average for survival rates and double the national average for survival to discharge for patients who have full codes in the hospital. This is all happening while patient, physician and employee satisfaction rates are each up significantly, and financial performance is up significantly. When you focus relentlessly on the customer and doing the right thing, costs go down. And our costs went down last year. We had one of the best economic years we have ever had.
Third is the continued growth and expansion of services. We're fortunate to be part of Yale New Haven Health System, and the hospital has been making a concerted effort to integrate more with Yale-New Haven Hospital and Greenwich Hospital on key service lines and key services. It's a fabulous brand and outstanding organization. For 100 years, Bridgeport Hospital has had a very good inpatient pediatric division. And Yale-New Haven Children's Hospital is also internationally known for pediatrics. Both are great. Together they're better. Last year, we fully integrated Yale-New Haven Children's Hospital at Bridgeport. Now there is a single standard of care and we're driving variation out of what were formerly separate programs. As a consequence, we've been able to grow and do some recruiting we otherwise would not have been able to do.
Q: What do you find yourself spending the most time on these days? What issue is most top-of-mind for you right now?
WJ: It's quality and patient safety. We have a safety huddle every morning at 8:15. For 15 minutes, every leader meets in the library. The only focus of that conversation is patient safety. The things we ask one another every morning are how long since the last serious safety event, how long since the last employee injury, if there have been any serious safety problems in the prior 24 hours, if there are any safety concerns for the upcoming 24 hours, if there are any equipment issues and, finally, whether there were any great catches so we can celebrate them. We do that every morning, and the night shift does it, too. So it happens twice a day.
We're under increasing fiscal pressure with Medicare and Medicaid. In Connecticut, Medicaid is in real trouble. There are some significant cuts that have already occurred and more are anticipated in the future. My role is for legislators to understand the significance in the decisions they're making, and how they impact patients, the community, access to care for the vulnerable in our state, and jobs. Those are all at risk if they make uneducated decisions. Every CEO is taking that role and it's very time-consuming.
Q: Over the years, what one attitude, belief or notion have you found to be most destructive in the healthcare industry? How would you like to see that change?
WJ: I think it's a lack of shared vision and shared values. I've talked about values, and how important they are to me, and that gets to trust. Our values here, if somebody doesn't subscribe to those, it will be destructive. It means we can't succeed. We all have to be on the same page.
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