Adventist Health White Memorial

Malcolm Baldrige National Quality Award
2019 Award Recipient, Health Care

Credit: Adventist Health White Memorial

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Highest-Ranking Official*
John Raffoul
President 

Public Affairs Contact

*At time of award

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For more information
Alicia Gonzalez
AHWM Media Consultant
Adventist Health White Memorial
1720 E Cesar East Chavez Avenue
Los Angeles, CA 90033
GonzalA1 [at] ah.org (GonzalA1[at]ah[dot]org)
https://www.adventisthealth.org/white-memorial

Adventist Health White Memorial (AHWM) is a private, faith-based, nonprofit, teaching hospital that provides a full range of inpatient, ambulatory (outpatient), emergency, and diagnostic services. Six service lines include general medicine, cardiovascular, surgical, orthopedic, women’s services, and emergency services. AHWM, which is deeply committed to its East Los Angeles community, is the only “safety-net” hospital serving more than 2 million people in a densely populated area where most residents live below the Federal poverty level. AHWM’s service area is a federally designated medically underserved area; the payor mix is 97% Medicaid and Medicare.

Highlights

• AHWM has had zero emergency department returns after outpatient surgery since 2014, which places it in the national top decile in 2018.
• AHWM has sustained near or perfect performance since 2013—matching the best performance of the American College of Cardiology—for the delivery of evidence-based care (door-to-balloon times of less than 90 minutes) for heart-attack patients.
• Challenged by high crime rates in the surrounding area, AHWM employs a former gang member as a liaison to create a gang neutral zone. Other hospitals are replicating this unique approach to manage violence.
• AHWM has received a Standard & Poor's AA+ rating for its days-cash-on-hand, with a current performance of 396 days, which is hundreds of days better than its nearest competitors.

Health Care Outcomes

• AHWM has had zero emergency department returns after outpatient surgery since 2014, which places it in the national top decile in 2018.
• Complication rates—including for all causes, general medical, surgical, and orthopedic—have been better than the national top decile from the second quarter in 2015 to 2019. In addition, all causes complication rates are better than a national peer cohort in 2018. Surgical complications have improved from about 17% in 2015 to 13% in 2018, and orthopedic complications have improved from about 16% in 2015 to about 6% in 2018.
• For use of antenatal steroids, an evidence-based practice that reduces complications in newborns, AHWM has been at 100% since 2014, equal to the national top decile and 15% better than a state collaborative.
• AHWM has sustained near or perfect performance since 2013—matching the best performance of the American College of Cardiology—for the delivery of evidence-based care (door-to-balloon times [from the time symptoms start, to the time the patient has engaged medical care] of less than 90 minutes) for heart-attack patients.
• AHWM has achieved significant improvement in Clostridium difficile (C. diff) infections, from about 65 in 2015 to less than 20 in 2018, near the national top quartile.

Citizenship with Results

• AHWM’s Health Careers Pathway Partnerships with local high schools and colleges provide mentorship opportunities through hands-on activities, leadership development programs, and community service projects. Almost half the nursing scholarships that AHWM has awarded since 2018 went to residents in its impoverished service area.
• AHWM is challenged by high crime rates in the surrounding area, with 35 gangs in close proximity to the hospital and one gang covering three quarters of the hospital’s surrounding area. To help improve safety and security within the hospital, AHWM employs a former gang member who serves as a 24/7 liaison to create a gang neutral zone. This unique approach to manage violence is being replicated by other hospitals. AHWM, which provides housing for staff to ensure their safety, is known as a safe zone by local gangs.
• A robust program that diverts 44% of waste (including proper disposal of electronics, batteries, green waste, wood, metal, construction debris, and medical waste) outperforms the national average of waste disposal at 38%. AHWM received third place in the 2017 Sustainability Award for Water Management Greenest Customers through the Los Angeles Department of Water and Power.
• Over nearly two decades, AHWM has worked closely with its partners in the Hispanic-majority community to train more than 224 local residents in nursing. Of these, 100% received registered nurse licensing, 70% pursued advanced degrees and 90% stayed at AHWM after three years. The result is a nursing staff that reflects the demographics of AHWM’s community, providing culturally competent care in the primary language of its patients.
• From 2014 through 2018, AHWM raised more than $27 million through its charitable foundation and nearly $1 million dollars through its annual employee giving campaign to support community health programs. AHWM also offers literal “showers of hope” for homeless community members who need to shower to prepare for school, job interviews, etc.
• The hospital ensures 100% compliance with all ethics processes, including signed annual conflict-of-interest forms, ethics training for the workforce and Board of Directors, monthly workforce supplier screenings, and timely reporting of unusual and adverse events.

Patient and Other Customer Process with Results

• Since 2014, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) results for “would recommend” the hospital have improved almost 10%, with a level in 2018 better than the National Research Council (NRC) top quartile, competing hospitals, and a peer cohort.
• AHWM’s net promoter score results of about 50 in 2018 for the NRC consumer awareness survey show a significant increase from 2015, with levels in 2018 almost 25% higher than competing hospitals.
• HCAHPS survey rankings for timeliness/responsiveness and communication with nurses outperform the NRC top-quartile rankings by 5% and 9%, respectively. Other HCAHPS rankings of medication explanation and communication with doctors have improved since 2015; such rankings impact value-based reimbursement from the Centers for Medicare and Medicaid Services.
• AHWM continuously studies the changing market to determine what patients and other customers need today and to anticipate what they will need in the future. To identify the types of services that provide value and differentiate the organization from competitors, AHWM determines potential service offerings using surveys, focus groups of key stakeholders, and information gathered through a variety of voice-of-the-customer mechanisms.

Senior Leadership

• AHWM pursues its mission of “living God’s love by inspiring health, wholeness, and hope” through its senior leaders who create an environment of servant leadership. Senior leaders role model the mission-driven partnership with the East Los Angeles community by caring for the underserved through their personal actions, including participating in mission work, donating time cooking and serving food, taking bus trips to homeless shelters to pass out clothing and toys for children, and attending health fairs.
• Guiding Principles are set during the strategic planning process and cascaded to physicians, associates, and volunteers. Guiding Principles include senior leaders and employees taking responsibility to ensure the safety of patients, coworkers, and others; reaching for the highest standards of work and being honest in all things; using all resources responsibly and efficiently; and treating others with the same compassion and respect that they would want for their families. 
• AHWM’s senior leaders encourage frank, two-way communication with and engagement of the workforce, key partners, and patients through rounding, support of local charities, involvement in community events, and participation in mission trips. The council structure empowers associates and medical staff to participate in shared governance, with transparency and accountability for all decisions made. Regular review of results at all levels of the organization through the organizational rhythm also contributes to a culture of accountability. 

Financial Results

• Despite an impoverished service area and dependency on government reimbursement, AHWM has received a Standard & Poor's AA+ rating for its days-cash-on-hand, with a current performance of 396 days, which is hundreds of days better than its nearest competitors.
• Since 2013, AHWM has sustained a dominant leadership position across Los Angeles and in its primary market area of East Los Angeles, with an overall market share of 10% (its closest competitor has approximately 4.9% of the market). This sustained leadership performance is supported by AHWM’s cardiovascular services market share that has exceeded its closest competitors by almost 2% since 2014 and its women’s services market share that has exceeded its closest competitors by three to four times.

People Process with Results

• Workers’ compensation costs have decreased each year since 2015, with marked improvement from more than $1,250,000 in 2015 to about $175,000 in 2018. This is compared to a California hospitals’ workforce compensation benchmarking report that shows an increase of 2.9% annually in claims from 2007 through 2016.
• AHWM’s medical resident retention rate has increased consistently at levels better than competing, regional hospitals since 2014, from 6% in 2014 to 41% in 2019 year to date. The number of medical practioners with admitting privileges to the hospital has increased from 328 in 2014 to 539 in 2018; the number of new practioners has increased from 34 in 2014 to 74 in 2018.
• Based on survey results, volunteer satisfaction for positive experience and the proper amount of training is at 100% from 2013 through 2018; volunteers account for about 15% of AHWM’s workforce. Results for key volunteer engagement factors show similar performance.
• Performance is at or very near the top quartile nationally for physician engagement factors, including for highly satisfied patients, according to a third-party physician engagement survey. Other factors for which AHWM physicians scored in near the top quartile are hospital provides high-quality care, departments work well together, and confidence in future organizational success. 
• As an indicator of physician development, 100% of family medicine residents have passed the American Board of Family Medicine certification exam on the first try since 2014, surpassing the national comparison.

Process Efficiency/Effectiveness with Results

• Use of barcode medication administration to match patients with their prescribed medications has improved from less than 60% in 2015 to almost 100% in 2018. According to a national hospital study, barcode medication administration has resulted nationally in a 41.1% relative reduction in nontiming errors in medication administration and a relative reduction of 80.7% in emergency departments.
• AHWM established a cleft palate clinic in 2016 to meet community needs. Since inception, the clinic has achieved 100% compliance with required documentation and medication reconciliation. 
• AHWM has reduced its emergency department length of stay from more than 250 minutes in 2015 to about 150 minutes in 2018, a level very close to the national top-quartile. AHWM uses a real-time electronic dashboard to monitor each phase of a patient’s stay in the emergency department, which supports caregivers in delivering timely, patient-centered care.

Strategic Planning

• A fully integrated strategy development process includes detailed market analysis, input from the community, health care experts, current organizational performance, and an aligned communication system. 
• AHWM’s Strategy Day brings together individuals key to developing strategic challenges and advantages from across the health system, as well as key partners, suppliers, community members, and health care experts.
• AHWM uses a robust approach for prioritizing and selecting strategic initiatives through its governance structure, with a flow of information from the workforce to senior leaders through its alignment of the Governing Board, Executive Committee, Organizational Performance Council, and subcouncils. Strategic areas of focus are shared through an integrated communication plan including digital, media, print, face-to-face, and events. All of which make a significant impact on the hospital's vision and mission in the community.

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