Continuous Improvement

 Read this case study about the continuous improvement and innovation at a rural hospital. The case study discusses “spa-like amenities to increase market share.” Is it possible for every hospital to achieve this? What would be the challenges from the perspective of the administration, doctors, patients, and staff? Discuss with reasoning.

Making the Case for Quality

Rural Hospital Thrives With

Continuous Improvement
and Innovation

• Not long ago, poor
internal communication,
low morale, and high staff
turnover were the norm at
Wright Medical Center.

• A new CEO ushered in
a culture change with
the hospital focusing on
open communication
and accountability. Soon
publicly sharing all patient
comments—both positive
and negative—became
standard practice.

• After implementing a
pillar system with six key
areas for performance
improvement, Wright
Medical Center is now
a destination of choice
for healthcare in north
central Iowa with patient
satisfaction scores among
the highest in the nation.

• During its decade-long
quality journey, the hospital
captured several state
and national awards,
including two Press Ganey
Summit Awards and
silver and bronze awards
in the Iowa Recognition
for Performance
Excellence program.

At a Glance . . .
When Steve Simonin began his duties as CEO of Wright Medical Center (WMC) in late 1996, he took
the helm of a small, rural hospital known for poor communication and a negative work environment.
Word on the street was that the hospital’s nursing staff “ate their own,” and employees wouldn’t rec-
ommend the medical center to family or friends. It wasn’t uncommon to find local residents driving
50 to 75 miles to seek medical care elsewhere. Fast forward to the present and the transformation is
astounding: WMC flourishes as a regional healthcare destination and continues to capture state and
national quality accolades.

About Wright Medical Center

WMC, built in 1951, is located in the small town of Clarion and serves a rural, agricultural area in
north central Iowa. This 25-bed facility is a critical access hospital, a designation that provides the
opportunity for Medicare reimbursement, allowing many of the state’s rural hospitals to keep their
doors open. Owned by the town of Clarion, the hospital employs more than 300 people and offers a
variety of services, including acute and surgical care, emergency services, family practice and obstet-
rics, orthopedics, many specialty clinics, and therapy options, as well as hospital and retail pharmacies.

Gaining a Fresh Perspective on Quality in Healthcar

e

Soon after arriving in Clarion, Simonin gathered a group of trusted leaders and they immediately
focused on improving staff communication and creating a more positive work environment. Some
success followed, but it wasn’t until a family member in another part of the state became seriously ill

that he began leading WMC’s real quality journey. “When I was on the other side of the hospital bed I
began to appreciate healthcare from a different perspective,” explains Simonin.

At the same time, Simonin and his leadership team learned of the Studer Group, a consulting firm that
helps healthcare providers focus on compassion and caring with the belief that positive financials will
follow. The team appreciated the balanced approach that Studer advocated and soon WMC adopted the
pillar system, which provides a foundation for setting goals and evaluating progress toward those goals.
As illustrated in Table 1, the pillar system incorporates five focus areas for performance improvement at
WMC: quality, service, finance, growth, and people (a sixth category, community, was added later). The
hospital began “hard-wiring” the improvement processes into daily activities at WMC to ensure these
processes turned into habits.

Simonin explains that the pillar approach helps the hospital to engage employees in forming, execut-
ing, and evaluating goals on three levels: personal, departmental, and organizational. The pillar system
provides the infrastructure to ensure that the hospital’s overall action plan measurement system covers
all key departments and stakeholders.

by Janet Jacobsen

April 2009

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Creating an Environment of Communication and
Accountability

To increase market share, leaders at WMC began looking at
the reasons why people were leaving the community for their
primary healthcare needs rather than utilizing the services of
the local hospital. The leadership team carefully studied patient
and employee surveys and ultimately decided to introduce a no-

secrets environment
where everything
from patient satisfac-
tion survey comments
to strategic planning
and financial reports
would be posted for
all to read. Simonin
recalls that some
employees were
resistant at first to
posting customer
comments, but for the
most part, the major-
ity of staff responded
positively.

With the motto that
“a complaint is a
gift,” WMC places
great importance on
customer feedback.
WMC uses a variety
of methods to collect
voice of the customer
data. Patient welcome
packets contain a
letter from Simonin,
which includes his
work, home, and cell
phone numbers so

that patients may contact him with comments at any time. The
hospital encourages its senior leaders to play active roles in
community organizations such as the chamber of commerce and
churches. “People are very comfortable coming up to us in the
grocery store and talking about their ideas for quality and ser-
vices,” reports Simonin.

Following the PDCA Model

Utilizing survey data and customer comment information, lead-
ers conduct root cause analysis and apply the plan, do, check,
act (PDCA) model to guide performance improvement initia-
tives. For example, when patients gave low scores and negative
feedback about the lack of privacy in the outpatient surgery and
emergency room areas, members of the service pillar team took
action. They contacted the patients who had expressed concerns,
and after gathering and analyzing feedback, the team helped
develop new, private waiting rooms.

Another example of responding to patient feedback involves the
creation of a “pain team.” Charlie Hammel, quality coordinator
and co-leader of the quality pillar, recalls that WMC’s patient
satisfaction scores relating to pain management fell sharply from
the 90-percent range to between 40 and 50 percent after the
hospital expanded its orthopedics services and began performing
several joint replacement surgeries each week. “We studied the
data and formed a multi-disciplinary team and eventually devel-
oped pain protocols, brochures, and recommendations on how to
manage a patient’s pain,” Hammel explains. The hospital’s pain
management scores improved dramatically and are now typically
at 99 percent for orthopedics.

The PDCA model is such an integral tool that WMC uses it prior
to launching all new services and work processes. “It’s become
so engrained into the culture that most employees don’t even
realize they are using it,” Hammel says.

Increasing Satisfaction Scores and Market Share

By focusing on open communication and accountability as well
as offering additional services such as orthopedic surgery, the
hospital improved patient satisfaction scores substantially while
also growing its market share. Figure 1 illustrates noteworthy
gains in patient satisfaction scores, which are consistently above
95 percent, and Figure 2 depicts a steady rise in the number of
residents from the county who select WMC for outpatient ser-
vices. The hospital’s market growth in recent years is 13 percent
for inpatient and 8 percent for outpatient visits. With the help of

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Since beginning its quality journey and
adopting the pillar strategy for performance
improvement, Wright Medical Center
(WMC) has garnered a variety of national
and state awards:

• WMC received Summit Awards from
Press Ganey in 2006 and 2007 for
inpatient satisfaction scores that reached
the 99th percentile nationally.

• In 2007, WMC earned a bronze award
in the Iowa Recognition for Performance
Excellence (IRPE) program, which is
based on the Malcolm Baldrige Criteria
for Performance Excellence. A year later
the hospital captured a silver IRPE award.

• Also in 2007, HealthLeaders media
named WMC to the Top Leadership Team
in Healthcare for small hospitals.

• The Studer Group honored WMC with
its Fire Starter Award in February
2005 to recognize the hospital’s
performance improvement results and
in June 2005 with the “What’s Right in
Healthcare” recognition.

• CEO Steve Simonin was named to the
Studer Group’s 2008 Fire Starter Hall
of Fame for his commitment to clinical,
service, and operational excellence.

Capturing National and State Awards

Table 1— Wright Medical Center Pillar Approach
for Performance Improvement

Pillar Overall Goal

Quality
To monitor and ensure that the best quality of
care is delivered by WMC’s work force.

Service To implement services and activities consistent with world-class service.
Finance To improve WMC’s cash flow.
Growth To identify market opportunities.
People To be the employer of choice in WMC’s service area.
Community To identify community needs.

Figure 1— Patient Satisfaction Scores at Wright
Medical Center

Pe
rc

en
til

e

100
90
80
70

60

50

40

30

20

10

0

Jun. ‘05 Dec. ‘05 Jun. ‘06 Dec. ‘06
Date

Inpatient Outpatient Family Practice Emergency Dept. Surgery

Jun. ‘07 Dec. ‘07 Jun. ‘08 Dec. ‘08

http://www.asq.org

quality tools such as the PDCA model, the hospital has improved
processes for pain management as reflected by improved patient
satisfaction scores shown in Figure 3.

These impressive results have no doubt contributed to WMC
receiving several high-profile awards, as detailed in the sidebar
Capturing National and State Awards. Aside from this recogni-
tion, Simonin says he’s proudest of bringing quality care to this
rural setting. See the sidebar Offering Spa-Like Amenities to
Increase Market Share for more information about the hospital’s
innovative offerings. “A lot of us in rural areas haven’t always
had access to the best quality products and services. Through
this journey we’ve been able to provide the highest quality
healthcare to our citizens and we’re starting to see others from
larger communities coming here for their healthcare as well,”
remarks Simonin.

Hardwiring Processes for Continued Success

One of the keys to WMC’s remarkable success is the hospi-
tal’s decision to connect process improvement goals directly
to employees’ performance evaluations and merit raises.
Employees can track progress toward goals through dashboards
called monthly report cards. Hardwiring patient satisfaction data
into the appraisal system helped secure staff buy-in and a con-
tinuing commitment to quality.

Simonin believes the biggest challenges in the process improve-
ment journey are consistency of leadership and communication.
He says that it all comes down to working with people and lis-
tening to them, but at the same time holding them accountable
for their performance. He says that other executives who are
looking to change the culture of their organizations through pro-
cess improvement should realize that it’s not something that will
happen overnight: “This type of journey is the hardest thing you
are ever going to do, but it’s so worth it.”

For More Information:

• To learn more about Wright Medical Center, visit the
hospital’s Web site at www.wrightmed.com.

• Wright Medical Center’s CEO, Steve Simonin, recommends
the following books, all available at leading bookstores:
Leading Change by John Kotter, Good to Great: Why Some
Companies Make the Leap and Others Don’t by Jim Collins,
and Hardwiring Excellence: Purpose, Worthwhile Work,
Making a Difference by Quint Studer.

• Visit the Iowa Quality Center’s Web site at www.iowaqc.org
for further information about the Iowa Recognition for
Performance Excellence awards.

• For more resources on quality approaches in healthcare, visit
www.asq.org/healthcare-use/why-quality/overview.html.

About the Author

Janet Jacobsen is a freelance writer specializing in quality and
compliance topics. A graduate of Drake University, she resides
in Cedar Rapids, IA.

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Figure 2— Residents of Wright County
Choosing Wright Medical Center
for Outpatient Care

Pe
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en
ta

ge
o

f O
ut

pa
tie

nt
s

60
50
40
30
20
10

0
Belmond
Medical
Center

Wright
Medical
Center

Trinity
Regional
Hospital

Healthcare Facility
2004 2005 2006 2007

Mary
Greeley
Medical
Center

Mercy
Medical
Center –
North IA

Hamilton
Hospital

Other

Figure 3— Patient Satisfaction Scores for Pain
Management

Pe
rc
en
til
e

98 98

46

64

91
98

87 88
97

93%
Goal

Apr.
‘06

Aug.
‘06

Nov.
‘06

Feb.
‘07

Apr.
‘07

Aug.
‘07

Nov.
‘07

Feb.
‘08

Jun.
‘08

Quarter End Date

100
90
80
70
60
50
40
30
20
10
0

Patterned after the luxurious Ritz-Carlton hotel chain, Wright Medical
Center (WMC) offers spa-like amenities delivered with small-town,
friendly care to help increase market share. Orthopedic patients at WMC
can relax during their choice of a free massage, hairstyling session,
or facial before checking out of the hospital. All patients can enjoy the
following amenities designed to offer a more comfortable, resort-style
experience:

• Wireless Internet access

• Softer lighting

• Complimentary long-distance phone cards

• In-room video/DVD machines

• Warm, spa-like robes

• Five-star food on demand ordered from an in-room menu

• Free meal passes for family members

• Warm cookies served daily

• Softer sheets and blankets

• Carpeted hallways

Offering Spa-Like Amenities to Increase Market Share

http://www.wrightmed.com

http://www.iowaqc.org

http://www.asq.org/healthcare-use/why-quality/overview.html

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