by Kay Kendall, BaldrigeCoach CEOWith telemedicine as a focus in this issue of Arkansas Hospitals, I wondered about its possible connection with the Baldrige Excellence Framework. So I reached out to the senior leaders of two of our healthcare clients – Methodist Health System (Methodist) and Kindred Nursing and Rehabilitation Center-Mountain Valley (Mountain Valley) – for inspiration.
At first glance, these two organizations could not appear more dissimilar. Methodist provides quality, integrated health care to individuals and families throughout the large Dallas-Fort Worth metroplex. It includes four large hospitals as well as 27 health care centers as part of the Methodist Medical Group. Its workforce includes 8,000 active employees, 1,200 volunteers and 400 students. On the other hand, Mountain Valley provides five-star long-term care and short-term rehabilitation in the remote community of Kellogg, Idaho, with its population of just over 2,000 people. Its workforce includes 90 employees who provide care in the small, 68-bed facility.
Despite first impressions, however, the two organizations have many things in common. Both have received numerous recognitions for the high-quality care they provide. The senior leaders of both organizations are committed to a journey to performance excellence. And they’re both award winners: Methodist earned the highest-level award from the Texas Award for Performance Excellence program in 2014. Mountain Valley earned the Gold Award from the AHCA/NCAL Quality Award Program (the Baldrige-based program for the long-term care industry) in 2011, and was named a Baldrige Award recipient in 2016 – the first long-term care facility to receive this prestigious national award.
Both organizations have also found that telemedicine offers them ways to provide increased access to care for patients and their families.
Methodist was added to the Mayo Clinic Care Network in September 2014. This relationship has offered an asynchronous form of telemedicine with clinical questions directed to Mayo Clinic specialists. It also has provided Methodist patients with a second opinion on cancer diagnoses. In addition, Methodist contracts with a neurology group as an on-call service to their Emergency Rooms (ERs). Through telemedicine, on-call neurologists confer regarding the diagnosis of a possible stroke. If validated, life-saving drugs can be administered quickly in the ER.
Another innovative use of telemedicine at Methodist is a text-based platform that provides continuity of care for up to seven days after discharge from the ER. Through a secure information exchange, physicians can respond to questions within four minutes and make decisions about whether the patient needs additional care, a return to the hospital or other follow-up. In the event a patient is discharged with an unclear diagnosis, the physician can continue to follow up for several hours after discharge to determine if the patient’s condition requires additional evaluation.
Until recently, Texas law presented multiple barriers to a wide-ranging adoption of telemedicine. Since the recent passing of Texas Senate Bill 1107, Methodist is optimistic that it will be able to adopt a broader approach to telemedicine that is responsive to the increasing expectation in America for real-time access and real-time communication with health care providers.
For Mountain Valley, telemedicine offers access to specialists who are physically located in Coeur D’Alene nearly 40 miles away, or locations even further out. The organization first began using telemedicine to consult with a nurse practitioner certified in wound care. One initial difficulty was overcoming the weakness of Wi-Fi signal strength in the rural valley. Once conquered, this opened the door for the organization’s expansion of services to offer telepsych care through collaboration with physicians practicing in a dedicated behavioral unit 60 miles away. As Mountain Valley added smart TVs to the residents’ rooms, they also gained the ability to virtually include families who are away from the facility in discussions while physicians are making their rounds.
In an innovative collaboration with the Shoshone Medical Center – the small hospital located across the street from Mountain Valley – they explored using a telemedicine program between the two entities to reduce residents’ visits to the ER. Now a resident with an acute condition can be evaluated via telemedicine in the ER to determine if a transfer to the hospital is warranted. In the short time this new program has been in place, Mountain Valley and the Shoshone Medical Center have seen an 11% reduction in hospital readmissions, and Mountain Valley has seen a 22% reduction in ER visits by their residents.
The definition of “innovation” in the Glossary of the Baldrige Excellence Framework includes the concept of creating new value for stakeholders. “Innovation benefits from a supportive environment, a process for identifying strategic opportunities, and a willingness to pursue intelligent risks.” Both of the role model organizations described here demonstrate that innovation is the intersection of telemedicine and a commitment to excellence.