Black River Memorial Hospital first opened its doors in Jackson County, Wisconsin in 1917 and has been in its current location since 1968. Since that time, healthcare has gone through many changes, including improved diagnostics, advanced technology, shorter hospital stays, increased outpatient care, increased emergency room visits, and a greater emphasis on community outreach programs.
Even in light of these changes, this small-town hospital — known for offering big-city care — has kept up with the times by adding new services to meet its patients' ever-changing needs. Now this critical access facility is about to face one of the industry's most significant changes — healthcare reform. The good news is that Black River Memorial is more than ready, thanks in part to implementing talent management best practices and an award-winning solution from Halogen Software.
With the deployment of Halogen Software's Halogen TalentSpace, including Halogen Performance™ Healthcare and Halogen 360 Multirater™ modules, Black River Memorial has become a more nimble organization better able to respond to client and patient needs. A few of the benefits the Hospital has realized since implementing the Halogen suite include:
- Dramatic increase in scores for patient perception of care, from the 70th percentile to the 95th percentile
- Transitioning into an organization that is performance- and outcome-focused — and ready for healthcare reform
- 100% performance evaluation completion rates
- Exceeding benchmarks for employee engagement — scoring higher than the industry average
- Time and effort savings while fully complying with Joint Commission requirements
- Significant positive impact to net operating margin from below one percent in 2008 to 9.6% in 2011
As healthcare reform drives a shift from fee-for-service/volume-based payments to value-based payments healthcare facilities must be prepared to adapt their culture to one that rewards positive outcomes and efficiencies. But driving culture change takes time, effort and planning. For healthcare facilities that aren't ready, the prognosis won't be positive. For organizations such as Black River Memorial, the future bodes well; the facility is using talent management best practices to transform culture, and drive higher performance and better patient outcomes.
Even with the changing healthcare environment, Black River Memorial's vision has remained the same, "to be the healthcare provider and employer of choice in our service area". The Hospital has garnered industry awards and accolades to prove it, including being recognized by Modern Healthcare as one of the Best Places to Work in 2011 and 2012 — just one reflection of the Hospital's commitment to best-practices in talent management. In fact, the 2012 results places them # 1 in Wisconsin, and #11 in the country!
Performance management best practices: just what the doctor ordered
As the American Hospital Association noted recently, "A culture of performance improvement, accountability and high performance focus is critical to enhancing the organization's ability to implement strategies successfully. The right culture will enable the transformation to the hospital and care system of the future." (Hospital and Care Systems of the Future, 2011)
Black River Memorial doesn't just understand what it takes to be a care system of the future, it's also well on its way to becoming one. The company has undergone significant changes in its performance management system to support an organizational shift in culture, and one of those changes was to implement Halogen Performance Healthcare.
Since making Halogen Performance part of its performance management process, Black River Memorial has moved from an environment of missed appraisal deadlines and vague goals to a culture focused on performance and success.
Prior to 2008, the Hospital's paper-based employee review process fell short. "We didn't have a formal goal-setting process, we were missing performance appraisal deadlines, and we had no alignment," says Holly Winn, Chief Operating Officer at Black River Memorial. "Our strategic plan didn't feed through from management to staff levels, so participation levels remained flat."
Recognizing that the current system wasn't working, the Hospital leadership team decided it was time to make changes. Before the journey to a more performance-driven culture even began, leaders took the opportunity to define its top three objectives for the first stage, which included implementing a solution that would:
- Streamline processes
- Reduce or eliminate paper
- Support the existing appraisal process
After reaching out for advice from the American Society for Healthcare Human Resources Administration and the Society for Human Resource Management, and researching what other healthcare facilities were using, Black River Memorial narrowed down its selection to three vendors. Halogen Software emerged the winner.
"We were very fortunate to find Halogen; their solution offered everything we wanted," says Winn. "It's an automated, user-friendly system that we knew could support our current performance management practices. Our decision to choose Halogen marked the beginning of a very exciting journey for us."
The important decision made, Black River Memorial implemented a three-step plan to avoid a culture shock and ensure employees embraced the culture shift.
Step 1: automation
Using the Halogen Performance Healthcare and Halogen 360 Multirater solutions, the Hospital was able to automate its existing appraisal process, and begin to implement other talent management best-practices, such as self-appraisals, peer reviews and manager meetings.
Through automation, the Hospital saw immediate results, including achieving 100 percent performance evaluation completion rates in the first year of implementation — a trend that has continued. More importantly, it has made the facility's Joint Commission accreditation audits easier. When the Joint Commission team arrived to conduct their audit, managers had every file and document they needed online, at their fingertips (e.g., nursing license and other related documentation). "The Joint Commission auditors were very interested in our process and what we were doing with Halogen Performance. With Halogen in place, we were able speed up the audit process and clearly demonstrate that we had everything under control," says Winn.
Further, automating its performance management process has streamlined how peer reviews are conducted at Black River Memorial. Because the Halogen 360 Multirater solution integrates seamlessly with Halogen Performance Healthcare, the Hospital can incorporate 360-degree feedback assessments into its appraisal process with point-and-click simplicity. The result is a broader more fair view of employee performance. "Halogen has made the peer review process seamless for us," says Winn. "Fostering a work environment that supports continuous learning and development is extremely important to ensuring quality patient care. By automating our peer review process, we can capture peer-to-peer feedback and use it to identify development opportunities in a secure, non-threatening way."
Step 2: goal setting and alignment
Black River Memorial recognizes that one of the most effective ways to communicate a culture shift and a change in priorities is through organizational goals. Prior to using the Halogen suite, the organization did set some goals, but these weren't aligned with organizational strategy. Also, merit-based increases were seen to be more subjective than objective. In 2010, goal setting took on an entirely new life.
"We incorporated goal management as part of our performance management process," says Winn. "In 2010, the Hospital leaders met to set the organization's strategic direction. Next, we formulated the organization's annual goals. Then, as part of our performance appraisal process, managers at every level of the Hospital assigned departmental goals that aligned with organizational ones. Employees were assigned different tactics that would directly support these goals. For example, if an organizational goal is to have Patient Perception of Care in the 95th percentile, an employee tactic could include working on a task force or a team to develop protocols for improved satisfaction."
Halogen Performance Healthcare not only allows Black River Memorial to capture and access these all-important goals and tactics in one centralized place, but also enables the Hospital to track and measure performance. The result is a transparent process that drives greater accountability and engagement. "Every employee is aligned and can see how they individually impact the success of this organization. Employees' focus on their role in helping our facility move forward, and I am very proud to say that it has lead to some phenomenal results for us," says Winn.
Step 3: pay-for-performance
In 2010, Black River Memorial introduced pay-for-performance for all staff. With impending changes to Medicare, the Hospital leadership team saw the importance of recognizing and compensating staff members for the contributions they make to the success of the organization. "We realized that just establishing pay for performance at the manager level was not going to make us successful, that we really needed everybody in the organization to be headed in the same direction," says Winn.
Since the organization must first meet its goals before individual employees qualify for their pay-for-performance payouts, this has become a key motivator for focusing employees on organizational goals and results, and the role they play in achieving them.
Using goal setting and alignment, and pay-for-performance, the hospital has been able to help non-clinical departments — such as IT, the business office, and food services — better understand how they support the outpatient perception of care scores. "For example," says Winn, "If I'm working in technology and I can't register a patient because my computer crashes, that's definitely going to affect the outcome of how the patient perceives me or the organization."
From implementing Halogen Performance Healthcare and Halogen 360 Multirater in 2008 to introducing pay for performance in 2010, Black River Memorial has been steadily developing a more performance-based culture, and it's paying off. "With these changes, we're realizing some excellent results," says Winn. Employee engagement scores rose dramatically, hitting the 90th percentile in 2011 and the 98th percentile in 2012. At 10 percent, the Hospital's turnover rates are also significantly lower than the industry standard of 13–16 percent. But perhaps the most dramatic result has been the impact on the Hospital's bottom line. Net operating margin increased from below one percent in 2008, the year it implemented Halogen solutions, to 9.6 percent in 2011. Winn believes that the Hospital's investment in talent management and pay for performance has played a role in achieving those results.
She adds, "Our staff now understands how what they do contributes to the organization's success, whether their goal is to earn a specific certification or do process improvements. We no longer hear: I don't know why I'm doing this. Now they say: I'm doing this because it makes a difference in areas like patient outcomes, improved service delivery and money saved."
The Hospital's pronounced shift in organizational culture has done more than improve patient outcomes and drive better bottom line results. By transforming itself into a facility that values and rewards performance, positive outcomes and efficiency, Black River Memorial is now confidently poised to face the challenges of healthcare reform.