Zen Dens & 'Code Periwinkle': How Beaver Dam Community Hospitals is changing the way it cares for caregivers

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In this special Speaker Series, Becker's Healthcare caught up with Kim Miller, president and CEO of Beaver Dam (Wis.) Community Hospitals.  

Ms. Miller will speak in two sessions at Becker's Hospital Review 7th Annual CEO + CFO Roundtable: "Building a Sustainable Business Model for Community Hospitals," at 1:30 p.m. on Tuesday, Nov. 13, and "Can Your City Make You Healthy?" at 2:55 p.m. on Wednesday, Nov. 14. Learn more about the event and register to attend in Chicago.

Question: What keeps you excited and motivated to come to work each day?

Kim Miller: One of the major drivers for me is to see the impact all our providers and staff have on people's lives. Life is precious, and patients come to us many times in their most vulnerable state. We have a huge responsibility to respect and care for them as we would our own family. The staff work as an exceptional team to assure each and every patient, resident and child are provided an individualized and safe experience with the highest quality of care delivery. Many times, people will take the time to call or write and express their deep appreciation for the care they received. When this is shared with staff and providers, I have seen and felt the impact the thank you has made on them; that's rewarding.

In addition, I thoroughly enjoy mentoring others; it is gratifying to see them grow and expand their leadership impact. Their thirst for knowledge is palpable. I feel CEOs have a responsibility to mentor others to follow in our footsteps to assure the healthcare industry continues to make progressive and innovative advances for those we serve.

Q: What major challenges, financial or otherwise, are affecting hospitals in the markets you serve? How is your hospital responding?

KM: One of the major challenges facing hospitals is adding the fourth component to our quadruple aim: how to care for the caregivers. Beaver Dam Community Hospitals is participating in a national collaborative through Vizient called the "Joy of Work." Caregivers and providers do not leave their feelings at the door when their shift is over and they leave the building. When you are in a high acuity, high-stress environment, it's hard to let go of those feelings.

At BDCH we have an internal interdisciplinary team participating in national webinars learning from others and sharing best practices. We have come up with several ideas, including a Zen Den, which is a quiet space where staff can go if they need to decompress before they go home or after an experience. The team came up with a "Code Periwinkle," which means staff may be in need of support, whether physical or emotional. Coworkers have been trained to provide this care, ranging from a ride home to emotional support following a severe trauma situation. At the end of the day, we have to support team members who provide care to those we serve. Our patients are at the center of every decision we make, but we also have to support the caregivers taking care of the people in communities we serve.

Another major challenge, especially in rural communities, is access to high-quality care close to where people live and work. We need to make it easy to access the care that is needed, offering convenient hours for people who work. When we started urgent care, the hours were 9 a.m. to 9 p.m. We have extended that to make urgent care available 24 hours a day, making sure parents and patients have access to affordable care when they need it. These extended hours mean a sick child gets care immediately and parents can go to work if they desire. We have also looked at extended hours for our clinics, making sure we are meeting patient needs as well as staff needs.

Q: What initially piqued your interest in healthcare?

KM: My mother told me I wanted to be a nurse since I was 5 years old. I never changed my mind regarding healthcare as a career and life calling. As a child, I recall seeing photographs of my mother in the hospital at Christmas when she was 14 years old. She was sick with rheumatic fever, which impacted her heart. In addition to caring for her, the nurses brought her Christmas presents and made sure her holiday was special. It made an impression on me, and I knew then I wanted to be a nurse. I was the first in my family to obtain a college degree and pursue a career in healthcare.

My career in nursing began in pediatrics and while I enjoyed my work, I saw an immediate need for change — I saw that things could be done better. I realized the best way to impact change was to go into administration. The desire to impact change has only gotten stronger over the years. I feel a tremendous responsibility to make things better for our patients, our staff, and our community. Their lives depend upon it.

Q: What is one of the most interesting healthcare industry changes you've observed in recent years?

KM: Healthcare systems have always been seen as places to go when you have an illness or you need a procedure. It has been someplace to go when you have a problem. Healthcare systems need to be looked at more holistically as a source of prevention and education. With the epidemics of diseases such as obesity, diabetes and Alzheimer's, I think it is imperative for healthcare organizations to take a different approach and teach patients how to prevent these diseases. We want to help people understand every decision they make can impact their overall health, from what foods they eat to how often they exercise and where they park their car. This awareness can lead to better choices which will lead to a higher quality of life for the individuals and lower overall healthcare costs with the intended goal of ultimately preventing the diseases. That's one of the reasons I have lead the initiative and focus on the Blue Zones Project, with the goal of making our county a healthier, happier place to live, work and play.

Q: How can hospital executives and physicians ensure they're aligned around the same strategic goals?

KM: Healthcare is a team sport; it always has been, but it is even more critical today. You must have input in developing strategic goals and then transparently communicate those goals, cascading it through every level of the organization. Once the board approves our goals, the goals get cascaded to senior level executives, medical staff, then directors and managers, then employees. At BDCH we have employee forums at least two times a year and share this information at the medical staff meetings. We look at our strategic goals and metrics as well as our performance over time, looking back four or five years to see where we have gotten better and where we still need to focus. We compare ourselves to national benchmarks. It helps everybody understand why we're doing what we're doing. If everyone understands the goals, they can see what role they play in helping to achieve those goals. Each caregiver understands the part they play to ensure the delivery of care is where it needs to be for each individual patient, resident and child.

Q: Describe the most challenging decision you had to make as a healthcare executive. Why was it so challenging?

KM: Because healthcare has continued to evolve, there is less need for inpatient care and more need to access care on an outpatient basis, in the patient's home or from a mobile device. As change has occurred, staffing levels have to be adjusted so you have caregivers where the care is needed. In a past situation in a different organization, when staff needed to be reduced, through analysis we were able to determine we needed to adjust and reorganize staff while keeping their well-being in mind. We looked at the organization's turnover rate and determined that over a period of six months, we could achieve reduced staffing levels without layoffs. By reflecting on the turnover rate and asking people to work in different areas, we were able to completely avoid layoffs. The most difficult part was getting the opportunity to prove this was the best course of action, even if it did take time to achieve and then gaining the trust of our staff during the process.

I feel a tremendous responsibility to the caregivers who work for BDCH and are providing care. Their livelihood is their work, not just personally for them and their families, but also professionally. I accept this responsibility with the utmost respect for each and every provider and care team member while honoring those we serve and their needs.

Q: What do you see as the most vulnerable part of a hospital's business?

KM: Healthcare as an industry needs to change at a much more rapid pace than in the past. Others are looking at our industry and identifying very innovative ways to trim costs while delivering quality services. If the individual business lines begin to erode, then the ability of the smaller organizations to remain viable for their communities will also erode. This is very concerning. Healthcare organizations must exist to be available for communities when they need us and the expertise that we provide. We must continue to work on constantly improving quality and access to care while reducing the cost of care. We must respond to the needs of those we serve. If we do not, others will, and this will severely threaten the healthcare systems communities need.

Q: What's one conviction in healthcare that needs to be challenged?

KM: People come to healthcare providers because they need their help as experts, but patients know their bodies best and we must listen even more attentively to patients. After the provider gives a thorough education of options, patients must be empowered to make decisions for themselves and partner with the healthcare team to determine the 'right' next step for the patient. This is another demonstrated example of healthcare being a 'team sport,' with the patient central to this planning. Patients may need an advocate to help them understand and walk through the complex and complicated healthcare system that has developed nationally. In addition, the healthcare model has previously been the patient coming to the provider for care; the new model evolving is the provider going to the patient and through innovative technology this transition is occurring faster. Access to many varieties and points of care, paired with advanced electronic capabilities without the inconvenience of a drive to the office, sitting in the office and waiting to be seen will revolutionize our delivery and the care over time.


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