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Committed to culture change:
Transforming a working environment

EXECUTIVE SUMMARY
Leaders at Sutter Solano Medical Center (SSMC) knew they had an excellent care team. But they also observed that the staff as a whole wasn’t living up to its potential. After intensive investigations, leaders determined that a tepid workplace culture was holding SSMC’s staff back. Recognizing this, they wanted to orchestrate a comprehensive cultural overhaul to elevate clinician performance and deliver the exceptional outcomes that SSMC’s patients deserve.

To effect this transformation, SSMC turned to NRC Health. In 21 months, the team achieved remarkable results, including:

  • 11% reduction in nurse turnover
  • 60% decrease in workplace injuries
  • 6.4% increase in patient satisfaction with physician staff
  • 3.6% increase in patient satisfaction with nursing staff

SOLUTIONS UTILIZED
Strategy & Governance | Attract & Acquire | Quality & Outcomes | Loyalty & Retention | Service Culture

11%

REDUCTION IN NURSE TURNOVER

5.6%

INCREASE IN OVERALL SATISFACTION

60%

DECREASE IN WORKPLACE INJURIES

Opportunity

Though a relatively small facility, SSMC faced outsized obstacles in meeting its patients’ needs. Part of the Sutter Health organization, SSMC serves patients in Vallejo, CA, one of the most diverse ZIP codes in America. This high-acuity, low–socioeconomic status population (over 85% of SSMC’s patients are on Medicare/Medicaid) brings unique demands to SSMC’s care staff—demands that three years ago, the staff sometimes struggled to satisfy.

That changed decisively when new leadership joined the facility. The new CEO was determined to root out the cause of SSMC’s patient dissatisfaction. Leadership personally interviewed more than 80 employees, and from these interviews, a consensus emerged. Employees overwhelmingly agreed that a lagging workplace culture was the heart of the problem.

Culture, however, is notoriously difficult to change. Meaningful, sustainable cultural change would require rigor, discipline—and data. For all this and more, SSMC turned to NRC Health.

“Our people are caregivers. They’re showing up every day to do their best and help others. The question is, how do you connect them to that purpose? Culture is the key.”

Abhishek Dosi, CEO, Sutter Solano Medical Center

Solution

With help from NRC Health’s Improvement Advisors, SSMC’s leadership developed an approach for comprehensive cultural reform.

A NEW TRAINING TACTIC
First, NRC and SSMC co-developed a customized training program for every SSMC employee. To underscore the program’s importance, each two-hour session would be personally led by a member of the senior-leadership team.

The session revolved around a concept called PARTnership. The term incorporates an acronym for Professionalism, Accountability, Responsibility, and Teamwork, and it would become a cultural touchstone for SSMC’s operations.

SUSTAINING THE CHANGE
Of course these principles, once taught, would need continuous reinforcement if they were to motivate lasting change within the organization. NRC worked with SSMC leaders to develop sustainability practices that would ensure that the PARTnership would endure.

Along with more conventional tactics—public recognition, rewards, and special merchandise and communications—the most impactful sustainability practice was a new cultural-leadership development program. Promising employees were cultivated through a customized series of training sessions. This helped build a roster of enthusiastic cultural ambassadors for PARTnership, which in turn kept the staff committed to a high standard of performance.

ENFORCING ACCOUNTABILITY
To stay motivated in the midst of cultural change, staff would need assurance that their new approach would bring results. They found these credible results in NRC Health’s Real-time Feedback solution.

Real-time Feedback is a patient-satisfaction survey tool that collects data from 100% of patients immediately after their care episodes. This gives leaders—and frontline clinicians—an immediate view into how patients feel about their care encounters.

Using Real-time, SSMC’s leaders gave staff a totally transparent view into how the new cultural approach affected patient satisfaction—indisputably proving what SSMC’s caregivers were truly capable of.

“With the data we were gathering, we were able to ensure that our tactics were really focused, instead of just throwing things out there and hoping they would stick.”

Leslie Cerpa, Patient Experience Program Manager, Sutter Solano Medical Center

Results

Within just a year of mobilizing this cultural-transformation program, SSMC’s staff saw remarkable results.

IMPROVED EMPLOYEE RETENTION
Clinician burnout is an intractable problem for many health systems. In its cultural transformation program, SSMC has found a significant lever for change.

In the months since the deployment of PARTnership, nursing-staff turnover has declined more than 11%—from 18% to less than 7% year-over-year.

“Fundamental to all this is having the vision—believing that better is possible. If you use data to back that vision up, that’s what gets people believing they can do better.”

Abhishek Dosi, CEO, Sutter Solano Medical Center

A SAFER WORKPLACE
The “T” in PARTnership stands for Teamwork—the idea that clinical care will always be a team pursuit fundamentally. But the concept also signifies employees’ commitment to each other—especially in the prevention of workplace injuries.

In just one year, PARTnership training, combined with a revised approach to safety training, reduced workplace injuries at SSMC by 60%.

64%

increase in patient satisfaction with physicians in just one year

IMPROVED CLINICIAN SATISFACTION
Coaching physicians to conduct more meaningful clinical encounters was an integral part of PARTnership training. Patients, evidently, took notice.

In just one year, patient satisfaction with physicians improved by 6.4%. Likewise, satisfaction with nursing staff improved by 3.6%.

IMPROVED OVERALL SATISFACTION
Nor are these clinician-specific rankings the only improvements that the program brought about. Patients’ understanding of discharge instructions also improved, as did their ratings of communications about medication and post-care transitions.

Little surprise, then, that in just 12 months SSMC’s overall satisfaction rating increased by 5.6%.

“When you’re consistent with the process, you get to the point where it isn’t management enforcing these things. It’s the staff holding each other accountable. Everyone is coaching everyone, we’re all holding each other up.”

Leslie Cerpa, Patient Experience Program Manager, Sutter Solano Medical Center

Forward

Continuity is one of the PARTnership approach’s chief benefits. Once begun, there’s no need for the work of culture improvement to stop. SSMC can keep pursuing a workplace culture that inspires and invigorates its staff.

Now SSMC’s leadership’s eyes are on the future. With a sustainable strategy for cultural transformation firmly in place, they’re ready to evangelize their approach across the Sutter organization. They’re currently working with one of NRC Health’s Improvement Advisors to develop a cultural toolkit, with the hopes of replicating their success at other Sutter facilities.

“Accountability is the most important part of the daily rigor behind creating change. People need to see that your efforts are actually meaningful, and leveraging Real-time data is how we reinforce that.”

Leslie Cerpa, Patient Experience Program Manager, Sutter Solano Medical Center

KEY TAKEAWAYS
For organizations seeking results like SSMC’s, Sutter’s leaders offer some advice.

1. ACCOUNTABILITY IS KEY
SSMC’s leadership found that without an element of discipline, efforts at culture change will likely flounder. Staff members need to see a visible commitment from
leadership at every stage. That will help them internalize the change that leadership is driving for.

2. DO NOT DELEGATE
In the same vein, leaders at SSMC emphasized the personal stake they took in their organization’s culture. They personally walked the floors, conducted trainings, and coached

floor staff through the change they wanted to see. Tactical and technical execution follow a firm commitment from leaders, which SSMC’s leadership made a central part of their work in the organization.

3. CELEBRATE STRIDES
Leaders at SSMC have one more reminder for hospital executives: cultural change is a long and difficult process. While that’s no deterrent for committed caregivers, anyone facing such a challenge deserves encouragement.

“When you start progressing, you have to start celebrating. Recognize people for the little things, and the big things will come.”

Abhishek Dosi, CEO, Sutter Solano Medical Center


LEARN MORE
For more on employee engagement solutions from NRC Health,
call 800.388.4264 or visit nrchealth.com/demo.