"We built Walnut Hill to be a place to go to remember why you went into healthcare." - Ricardo Guerra, Jr., M.D., Interventional Cardiologist and Executive Board member
Located in Dallas, Walnut Hill Medical Center is a rare breed of hospital – designed primarily by physicians and purposely built to optimize the care experience for patients, families and care providers. The 100-bed acute care hospital, which was a decade in the planning, opened in April 2014. The unique focus of the organization is evident in its vision statement: “To improve health and enrich lives through partnership, compassion and innovation, every person, every time.” The vision statement grew from an original concept of “creating a place where a community of talented, compassionate caregivers could care for patients and each other.”
The creation of the hospital was a response by physicians to take back control of the care of their patients and address the forces pulling them away from direct patient care, such as financial concerns, regulations and onerous documentation. “We saw that hospitals were positioned to withstand those forces but physician practices alone were not. As a hospital, we could adapt to or better position ourselves to respond to changes in the system and thus avoid becoming mere cogs in a healthcare delivery machine.”
Federal regulations prohibit physicians from owning hospitals; instead a development partner is owner and physicians manage and govern the organization. A majority of the board members are physicians. Their decisions are driven by a mandate to concentrate attention on patients. The leadership believes that by focusing on and optimizing the patent and family experience, the organization will see both positive patient outcomes and balanced books.
Guerra sees huge advantages in creating the hospital from scratch, in creating both a physical plant and an organizational culture that align with the organization’s mission. “We put the patient at the center – partnered with caregivers. We thought about the patient as our primary customer and re-imagined what care might look like. Everything is done from the perspective of the patient, considering how to bring value to their life.” The physical design is patient-centered, with convenient access and flow, large windows with views of greenery that allow in an abundance of natural light and a calming earth-toned décor.
For inspiration on building a right organizational culture, leaders looked outside of healthcare, taking tips from companies, like Apple and Ritz-Carlton, that were known for exceptional customer service. The focus on creating relationships through customer service became a singular vision around which they built corporate practices, which in turn shaped the organizational culture. “We adopted the belief that happy employees lead to happy customers. If we take care of our staff, they will take care of our patients,” says Guerra.
The organization also adopted the practice of hiring employees for an aptitude for service and training every employee to deliver the essential steps of service with every customer interaction. Potential employees must take a personality survey. Only individuals with high scores on service-related components, like teamwork and caring, are considered. Guerra estimates that the hospital has received about 7500 applications and hired just 240 employees, an acceptance rate of just 3.2 percent. According to Guerra, “You can’t teach people to care, but you can teach them everything else.”
Guerra speaks personally to all employees at orientations held twice a month. He tells the story of the organization’s founding and defines the vision statements for them. He leaves them with the message, “You’re here because we believe you can help us with our vision. You were chose because you are special.”
Guerra notes that both leaders and frontline employees are inspired by this vision. “We are all working hard to create something. Our goal as leaders is to inspire employees to keep the momentum going. This entails giving employees the resources they need to take care of patients and do what they came to do at Walnut Hill: make a difference in people’s lives. What I’ve found is that if you give people meaning in their work, they will do incredible things.” Guerra notes that they consider all employees throughout the enterprise to be caregivers, no matter their role. “The valet, food services worker and administrator in the business office are considered to be caregivers every bit as much as the physician, nurse and allied health professional.”
Guerra states that the goal is for all employees to create relationships that cultivate a caring feel at Walnut Hill. To that end, all employees are trained to provide the six WE CARE steps for communication and interactions with patients:
• Warm welcome and personalized greeting
• Communicate and connect
• Address the patient’s concerns, questions and needs, both expressed and unexpressed
• Resolve and reassure
• End with a fond farewell
Guerra has personally found the WE CARE steps of service to be rewarding. “It’s about human beings taking care of other human beings.” He has also received spontaneous positive feedback from patients and families who recognize him in the hallways of the hospital. “They tell me they are surprised by the feeling at Walnut Hill. They say, ‘The medical care here is great, but it’s the people that are different. They really care. I’ve never been treated with such kindness. I felt special.’” Guerra believes this environment is created by selecting employees carefully, motivating them and managing how they work with people.
Guerra lists a number of benefits to supporting and motivating employees. “If given the resources and the expectation of compassion and kindness, caring for patients is more rewarding for physicians.” In addition, Guerra believes that better employee satisfaction will lead to less turnover. For example, the hospital tries to maintain a 1:4 nurse-to-patient ratio, which is more costly than other staffing models but may prove less expensive over time. “Especially with the nursing shortage, nurses will move on if they become burned out, and as any HR director will tell you, replacing them is not cheap. If nurses are well-trained and happy, they will stay and it will be cheaper in the long run.” The same goes for physicians, according to Guerra, who, if poorly treated, will admit their patients elsewhere.
According to Guerra, the key to an excellent patient experience begins with employees, including physicians. “We all want to be in a place where we are treated with dignity and respect, where our goal is their goal too. Doctors want to be where their work is meaningful, where they get to do what’s best for their patients. We built Walnut Hill to be a place to go to remember why you went
- Courtesy of Beryl Institute. “An Invisible Barrier to Compassionate Care: The Implications of Physician Burnout on Patient & Family Experience.” Diane W. Shannon, MD, MPH. https://theberylinstitute.site-ym.com/store/ViewProduct.aspx?id=3601656
Learn more about The Beryl Institute here: https://theberylinstitute.site-ym.com/