By Jim Hill with Stephanie Meade

For practitioners of performance and quality, it is beneficial for us to hear from client executives, particularly those that think more about practical outcomes than they do about the science behind the solutions. What follows is a discussion with a notable executive using questions crowdsourced from various interest groups. Stephanie Meade is the vice president and chief nurse at Mercy Health–West Hospital in Cincinnati, Ohio.

JH: Tell me a little bit about the culture of your organization and the biggest priority you have for the year.

SM: In health care, we have many changes that are occurring–especially with reimbursement. Many of our reimbursements are based on quality outcomes and patient experience. So we continue to look for ways to improve performance to maximize our reimbursements. Also, we recently moved into a new facility. This is giving us a chance to review our growth opportunities while continuing to assess the appropriate size of our organization based on what we’re seeing in the new market we’re a part of.

JH: You engage in a lot of new performance initiatives. How do you screen those and what are your decision criteria when you are constantly being approached with new ideas?

SM: Our organization is part of a larger corporation. So, before we take on something new, we will reach out to our sister hospitals to find out whether we already have this type of technology or is there something similar that we can adopt to get to the desired end result. Ultimately, we want to look at a return on investment, a consideration of growth potential, or an improvement in quality in some way that will help differentiate us from others in the market. Our objective is to provide a value-based product to the community we serve.

JH: How do you balance return on investment and competitiveness in the local market with being a not-for-profit?

SM: We have to remember that patients have choices. So regardless of where their doctor tells them to go or where their doctor typically provides care, they have many other avenues to learn what other patients say about your services. For example, there are many websites with this type of information. That provides consumers many more choices in health care, and they will vote with their feet. If your reputation is not good or you’re not providing a high-quality product, there is enough competition to ensure that what you are providing is a value-based service. And it is getting to the point where people expect their hospitals to provide almost hotel-like service. This plays into their decisions about where to get their care.

JH: Many leaders I have spoken with bring up the topic of emotion from either a customer or employee perspective. How does it apply to your organization?

SM: In health care, many failures occur because the front line is not engaged. As you add more and more technology to the work, management knows less and less about how people do their jobs. The staff can tell you all kinds of things that aren’t working right and where there are opportunities for improvement. So to strengthen the organization, it is important to provide a venue for staff members to provide feedback and suggestions. What you’re doing is creating an environment of share leadership.

As one example from our hospital, we recently merged two smaller hospitals into one much larger, state-of-the-art operation. At the same time, we were also starting many new programs–cardiac, maternity, robotics–and merging two different cultures of people who hadn’t worked with each other before. One of the many projects we worked on was related to how we would deliver care at the bedside.

Our new facility was designed so that there would be supply carts in each room. However, I had a group of nurse managers that were suggesting that we not use that approach. The managers were looking at it, appropriately, from a compliance perspective: Will the nurses lock the carts? Will they put their dirty hands in the cart? How will we manage the carts?

I had actually taken the carts out of the budget. But I paused and decided to go to the floors where the nurses were working. When I looked at their cultural environment, they had had their supplies by the bedside for years. They explained to me how much easier it was to do their jobs–even in an environment with a higher patient-to-nurse ratio. And, although the managers were telling me that no one ever locked the carts, I found that they were locked about 75% of the time. That’s not “never.”

By taking the extra time to talk to the staff about how they did their work, we were able to determine the best way to support them, which was to keep the carts in the rooms. That eliminated a number of issues we would have likely faced in the future.

StephanieMeadeStephanie Meade is the vice president and chief nursing officer at Mercy Health-West Hospital. In addition to serving on the team for the integration of Mercy Health–Mt. Airy and Western Hills Hospitals into the new Mercy Health–West Hospital (opened in November 2013), she maintains executive responsibility for strategic and operational nursing services in the new 250-bed acute care facility, which includes two emergency departments, nearly 500 nurses, and approximately 150 staffed beds. After just four months of operation, the hospital is exceeding targets set for its cardiac open heart, obstetrics, and robotic programs. Stephanie facilitated and led implementation of an electronic rounding tool to assist with evaluating real-time patient experience, new culture, and service recovery. Early results show improvement in the overall patient experience. Prior to her role with Mercy Health, she served as the executive director of Patient Care Services at the Christ Hospital, Cincinnati, Ohio.

Stephanie has earned an MBA from Northern Kentucky University; a Master of Science in Nursing from University of Cincinnati, College of Nursing and Health; and a post-graduate certificate in health informatics from Northern Kentucky University. She is a graduate student preceptor for nursing administration students for both Northern Kentucky University and the University of Cincinnati. She serves as a board member of the Greater Cincinnati Nurse Executives and is a member of the Ohio Organization for Nurse Executives and the American Organization of Nurse Executives.