Mary Greeley Medical Center

Malcolm Baldrige National Quality Award
2019 Award Recipient, Health Care

Credit: Mary Greeley Medical Center

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Highest-Ranking Official*
Brian R. Dieter 
President and CEO

Public Affairs Contact

*At time of award

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For more information
Steve Sullivan
Director
Marketing and Community Relations
Mary Greeley Medical Center
1111 Duff Avenue
Ames, IA 50010
sullivans [at] mgmc.com (sullivans[at]mgmc[dot]com)
https://www.mgmc.org

Opened in 1916 and now the largest independent medical center in its primary and secondary markets, Mary Greeley Medical Center (MGMC) is a public, nonprofit, 220-bed hospital offering inpatient, outpatient, emergency department, home health care, and hospice services. The hospital, which was gifted to the city of Ames by a Union Army officer in the Civil War in memory of his beloved wife, provides health care to the residents of a 14-county area in central Iowa. Inpatient and outpatient services support a continuum of care for patients, including surgery, cancer care, cardiac care, diabetes and nutrition care, orthopedics, obstetrics and gynecology, gastroenterology, mental health services, palliative care, home health care, hospice care, rehabilitation, and more.

Highlights

• MGMC’s health care results are in the CMS top decile, including 30-day readmissions, 30-day mortality for heart attack patients, incidence of preventable blood clots, compliance with sepsis practices, influenza vaccinations, stroke bundle compliance, and outpatient imaging measures.
• Inpatient satisfaction, as measured by HCAHPS, has been at or above top-decile performance since 2016.
• More than 75% of inpatients and outpatients would recommend MGMC to others, representing top-decile or near-top-decile levels.
• In market share, MGMC has been the dominant leader in its primary market overall and for inpatient (43%) and outpatient (48%) care since 2015, in spite of being one quarter to one third the size of two of its closest competitors.

Health Care Processes with Results

• In many areas, MGMC’s health care results are in the Centers for Medicare and Medicaid Services (CMS) top decile, including 30-day readmissions, 30-day mortality for heart attack patients, incidence of preventable blood clots, compliance with sepsis practices, influenza vaccinations, stroke bundle compliance, and outpatient imaging measures. 
• For many patient care processes related to efficiency and effectiveness, MGMC’s results rank at or near the CMS, “Get with the Guidelines” (an American Hospital Association initiative), and National Database of Nursing Quality Indicators benchmarks. These include results for admission process effectiveness, inpatient rounding, home health timely initiation of care, home health fall risk assessment completed, and hospice diagnosis and treatment process effectiveness.
• By intentional design, those closest to the work are integrally involved in improvement efforts, from daily improvements of individual work to more formal rapid improvement events, and a vast majority of projects are focused on patient care or patient safety. In addition, standard work documents for patient care processes and daily huddles stress operations issues, process improvement, and current performance. Virtually all work process discussions are grounded in understanding and meeting patient expectations. 

Patient Process with Results

• Inpatient satisfaction, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), has been at or above top-decile performance since 2016. These sustained, benchmark levels of patient satisfaction in all domains (communication, responsiveness, environment, discharge information, and transitions of care) show MGMC’s success in sharing and emphasizing its “Big Dot” goal of patient engagement.   
• More than 75% of inpatients and outpatients would recommend MGMC to others, representing top-decile or near-top-decile levels. In addition, MGMC outperforms local competitors in top-of-mind hospital recall, preferred hospital, and brand power index. 
• MGMC outperforms its local competitors and receives scores close to the top decile in inpatient satisfaction, satisfaction with home health care, and satisfaction with hospice care as measured by the National Research Corporation (NRC).
• To serve patients, the entire workforce rallies around the tag line “Doing What’s Right.” For example, following the result of an employee suggestion, MGMC provides patient-centered scheduling: patients are scheduled for needed procedures on an aligned, coordinated schedule, where all necessary procedures and tests are done in a sequence instead of the patient needing to wait for each procedure/test and specialist in turn. This improvement has eliminated a significant amount of delay in patient care and was recognized with an award for patient-centered innovation by the Iowa HealthCare Collaborative.

Senior Leadership

• As part of the organization’s culture, leaders continually reinforce MGMC’s tag line, “Doing What’s Right.” Reinforcement takes place through the Patient and Family Advisory Council, where patients and families share their views of “what’s right” and learn about and contribute to important changes; in leaders’ visits to patients on care units and to employees in their work environments; through leaders’ participation in improvement events; via the Employee Advisory Committee; and through CEO breakfasts with employees and regular employee updates. 
• MGMC’s leaders set the vision (“to be the best”) and values (PRIDE: “People, Respectful, Innovative, Dedicated, Effective”) and ensure that they reflect the requirements of patients and their families. Leaders personally and regularly share the vision and values with the workforce, medical staff, and key suppliers and partners.

Financial Results

• In market share, MGMC has been the dominant leader in its primary market overall and for inpatient (43%) and outpatient (48%) care since 2015, in spite of being one quarter to one third the size of two of its closest competitors. 
• MGMC’s days-cash-on-hand, at more than 650, is three times the Moody’s A2 peer-group level and has increased over five years. MGMC's debt-to-capitalization ratio stands at 0.250, and its operating margin of 4% exceeds the Moody’s A2 peer-group level. 
• MGMC has sustained Medicare spending per beneficiary at or close to the CMS top decile for four years; cost per adjusted admission has improved over three years and is consistently below budget. Salary and benefit expenses as a percent of net revenue have remained stable over six years in spite of a tight labor market. 

People Process with Results

• Close to the NRC top decile, 75% of employees agree that they “talk up” the organization as a great place to work, with similar results for patient care and support services staff. Physician engagement ranks in the 86th percentile. 
• In a tight labor market, MGMC’s average tenure of staff—at approximately 10 years—ranks in the American Society for Healthcare Human Resources Administration’s top decile, as does the average time to fill vacancies. 
• MGMC fosters a just culture with a focus on open communication, high performance, and patient safety; these are emphasized in the onboarding process, rounding, shared decision making, daily huddles, and participation in rapid improvement events.
• About 75% of employees agree that their managers create opportunities for growth, and the number of employees participating in the Rewards for Employee Achievement Program quadrupled over eight years. In addition, 60% of employees report having participated in an improvement project. 

Strategic Planning

• The organization’s mission, vision, and values are the foundation of MGMC’s strategic planning process. The process drives MGMC’s strategic objectives, establishing long- and short-term performance goals and systematically cascading goals throughout the organization through four goals (around serious safety events, employee engagement, patient engagement, and net operating margin). 
• Strategic goals are highlighted in each department and unit on huddle boards, and each member of the workforce carries a card outlining aligned personal goals. Employees can routinely speak to their own contributions to one or more of these goals and the associated measures. 
• MGMC’s measurement system is fully aligned with its strategic planning. Key performance measures relate to Big Dot goals and their action plans, indicators of excellence, and strategic objectives. Progress is reported to the Board of Trustees each month, and leaders are able to track progress to plan down to the individual employee. 

Citizenship with Results

• MGMC ranks in the top decile on the Iowa Hospital Association’s Board Assessment Survey, and the organization scored 100% on the key governance measures of board certification, fiscal accountability, conflict-of-interest disclosures, accreditation, and compliance with ethical behavior standards. MGMC ensures responsible governance through a highly trained, publicly elected board of trustees. 
• As a public organization in a small community, MGMC considers that community its primary stakeholder, anticipating public concerns and mitigating them when necessary. MGMC includes the community in its strategic planning, improvement events, forums, and neighborhood meetings. 
• MGMC meets community needs determined through the Community Needs Assessment Survey by underwriting the addition of behavioral health beds and providers; collaborating with key community members to apply successfully for a grant to open a Federally Qualified Healthcare Center; and collaborating with the City of Ames to provide public health services. 
• Community financial support through the Mary Greeley Foundation stands at nearly $1.5 million in 2019, an increase of one third since 2014. In addition, MGMC’s scores on the local consumer perception survey of hospital preference are more than quadruple those of its competitors over five years.

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