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Malcolm Baldrige National Quality Award
David P. Tilton
AtlantiCare, a nonprofit health system in southeastern New Jersey, delivers acute and chronic care, preventive and at-risk services, and health information services. The system employs about 5,100 people, making AtlantiCare the largest health care provider in the region. AtlantiCare has achieved market advantage with a diverse array of services delivered through a comprehensive distribution network and continues to grow in both system revenues and patient volume. From 2000 to 2008, system revenues grew from $280 million to $651 million, refl ecting an 11 percent compound annual growth rate, compared to a state average of 5.6 percent. During this time period, AtlantiCare’s medical center volume increased from about 34,000 to over 56,000 discharges—also more than twice the state average.
AtlantiCare applies the concept of an “epidemic of health” to its community health care efforts, understanding that the organization’s mission to “deliver health and healing to all people through trusting relationships” and its vision of “building healthy communities” can only be realized by involving everyone—staff, patients, and members of the community—in health improvement. The effort focuses on three services designed to promote health and well-being at every stage of an individual’s life. AtlantiCare’s core competency is the integration of these services: (1) health care delivery, (2) health engagement, and (3) health information.
Health Care Delivery: AtlantiCare’s primary service offering focuses on the physical health care of the community. AtlantiCare Regional Medical Center (ARMC), a 589-bed teaching hospital, provides a full range of inpatient and outpatient services, and centers of excellence, including the Heart Institute, Level II Trauma Center, Center for Childbirth, Neonatal Intensive Care Unit, Joint Institute, Cancer Care Institute, and Neuroscience Services.
AtlantiCare Behavioral Health offers mental and behavioral health services, such as adult and child counseling services; substance abuse treatment; addiction recovery services; and education, preventive, support, information, and referral services. It operates outpatient programs and the inpatient psychiatric unit.
AtlantiCare Health Services provides a wide variety of health care and wellness services outside the hospital, such as the AtlantiCare Surgery Center, clinical labs, urgent care centers, the hospice program, home care, family medicine, occupational medicine, retail health, child care and early learning centers, and nonhospital charity care for the homeless.
Health Engagement: AtlantiCare’s health engagement focuses on the prevention of injury and illness, the management of health risks and chronic illnesses, and health care utilization in the community. The LifeCenter is a medically supervised health and fitness center for employee and community use. The Center for Community Health partners with schools, businesses, and other stakeholders to improve the overall well-being of the community. For example, a program was established to promote nutrition, fitness, and well-being in children.
The Special Care Center in Atlantic City is designed to lower costs and improve quality for patients with complex chronic conditions. This innovative method of primary-care delivery provides services in three “fl oors” of care. The “First Floor Team” performs relationship-based care management focused on intensive upstream cost and risk reduction. The “Second Floor Team” consists of doctors and nurses who deliver primary care on an as-needed basis. The “Third Floor Team” is the referral stream to specialists and acutecare settings. These specialty services are provided on-site when possible and selected on a quality and cost effi ciency performance basis.
Health Information: AtlantiCare captures and shares health information electronically to improve patient safety and quality of care. Through its technology company, InfoShare, AtlantiCare uses the electronic medical record and the Connected Community Health Information Exchange to record patient clinical data and to share health information electronically among all participating health care and health management stakeholders.
AtlantiCare has a decentralized leadership approach for achieving organization-wide goals (referred to as our “Tight- Loose-Tight” system). Senior leaders set clear objectives and targets through a planning process and a performance excellence framework known as the “5Bs”: Best Growth, Best People and Workplace, Best Customer Service, Best Quality, and Best Financial Performance. They also co-chair system-level, multidisciplinary teams organized around the fi ve performance excellence commitments. These system-level “B teams” research best practices, identify resource needs, and provide internal support to business unit “B teams” who are responsible for implementing these approaches throughout their units.
Recently, AtlantiCare implemented the use of a “personal strategy map” for deploying 5B action plans to the individual level. Folding into the size of a credit card, the map may be stored in an employee’s ID badge carrier. On the map, the employee records how he/she plans to contribute to the accomplishment of the 5B goals. Additionally, AtlantiCare leaders have implemented the Share the Success program throughout the organization; the program aligns bonuses with achievement of performance-excellence goals and supports employee engagement.
During strategic planning, AtlantiCare uses a voice of the customer (VOC) inquiry process to understand patient and stakeholder requirements and identify opportunities to develop innovative health care service features. Key stakeholders, including community and voluntary advisory groups, physicians, and partners, are involved in planning new initiatives. In one example of community advisory group participation, the new Patient Tower on the Atlantic City campus relied on VOC input to develop a customer and community-focused project.
By integrating key services and providing value to the community through its performance excellence focus, AtlantiCare is achieving its mission and vision, maximizing both employee and patient engagement/satisfaction, and maintaining a sustainable competitive advantage. Recent accomplishments and milestones include the following:
ARMC achieved Centers for Medicare and Medicaid Services national top-10 percent performance in 2008 for patient care measures related to congestive heart failure, acute myocardial infarction, and pneumonia.
AtlantiCare’s current employee-loyalty index score from an Allegiance Technologies survey indicate that it is the health care leader in this measure while results from the 2009 HR Solutions survey of key drivers of workforce engagement are equal to or approaching 90th percentile national performance levels. The annual turnover rate for nurses declined from 7.75 percent in 2006 to 6.02 percent in 2008, significantly outperforming the New Jersey Hospital Association average of 12.43 percent.
AtlantiCare was recognized in 2008 by the American Nurses’ Credentialing Center as a Magnet nursing organization, receiving the nursing profession’s highest honor for the second time.
From 2007 to 2009, survey responses for multiple service lines, including those for the Surgery Center, the Spine Institute, urgent care, and clinical labs, show customer satisfaction above the Professional Research Consultants (PRC) 90th percentile national benchmarks. In customer preference, AtlantiCare was the 2008 market leader over competitors for the overall system.
AtlantiCare’s new Cancer Care Institute qualified for a Leadership in Energy and Environmental Design Gold Certification in 2009, a first for health care facilities in the region.
For the past four years, AtlantiCare Home Health has been awarded HomeCare Elite™ status by OCS (formerly Outcome Concept Services), based on quality outcomes, quality improvement, and financial performance. This designation places AtlantiCare Home Health in the top 100 nationally out of 8,222 Medicare-certified home-health-care agencies.
Community outreach is a key component of AtlantiCare’s vision to build healthy communities; attendance at community outreach events increased from 6,000 in 2005 to 18,486 in 2008.
As one of two Safety Net Hospitals, ARMC provided 90 percent of the free medical care to people in need in Atlantic County, New Jersey, in 2008.
Results for nonhospital charity care provided through three Mission Healthcare facilities show increasing utilization from 2004 to 2008, with growth in patient visits from 8,277 to 26,032.
For more information:
Joan Brennan, DNP
Vice President, Quality and Performance Excellence
2500 English Creek Ave., Building 500
Egg Harbor Township, NJ 08234
Telephone: (609) 272-6349
Web site: AtlantiCare/ Malcolm Baldrige National Quality Award
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