The Arkansas Heart Hospital (AHH) didn’t start out with the intention of winning national awards. The focus has been on providing an environment for high patient satisfaction, adherence to protocol, value based purchasing and superior treatment outcomes. AHH has done those things so well that it has ranked for two years as the number one hospital in the country by the Centers for Medicaid and Medicare Services (CMS) in the formula used to determine whether hospitals receive a bonus or a penalty for reimbursements.
Patient-focused care is an overused phrase spoken by many facilities and many healthcare workers, and most don’t really know the definition, said Bruce Murphy, MD, PhD, President\CEO, AHH.
“Our definition of it is bringing our resources to the patient so the resources of diagnosis and treatment are available no matter where the patient lives in Arkansas, whether it is in Little Rock or one of our many satellite clinics,” Murphy said. “The other part is to make the patient and the patients’ family feel they are part of your family. That is the real meaning of patient-focused care. We have a culture in our hospital and clinics that embodies that. We are extremely careful we don’t contaminate our culture with people or employees who don’t know what we are about and how we do things.”
The entire 112-bed hospital is an intensive care unit. Every nurse is a critical care nurse. New nurses undergo a three-month proctorship under an experienced nurse, and only work when that nurse is working.
“You find out quickly in that time if their ethics, and work-related culture fits our culture,” Murphy said. “If not, at the end of three months, we tell them they need to try somewhere else. It is about learning our procedures of critical care but, more importantly, it is about learning our culture so we can empower our nurses.”
A top objective is to empower nurses to practice at the highest level of their legal scope of practice. That gives them ownership in the outcome for patients.
“If they are practicing at the highest level and are able to use our protocols to make decisions independently based on how the patient is doing, and have order sets in place to allow that, nurses take ownership of the situation and the outcome,” Murphy said. “She wants to come back for the next shift and work on that same problem. The doctors are with a patient ten to 30 minutes a day. Nurses are with a patient 12 hours a day. Empowering nurses to operate at a high level of practice is a dead ringer for patient satisfaction and superior outcomes.”
Murphy said another vital factor is focused care, which is superior to general care. But that doesn’t mean they only see heart patients at the AHH. Other subspecialties are represented such as general surgery, orthopedics, renal disease, and pulmonology. Often patients will have co-morbidities such as heart disease and diabetes. By having other subspecialties represented, it is less likely patients will have to be transferred to another facility.
“We don’t do neurosurgery, gynecology or deliver babies,” Murphy said. “All other subspecialties are represented. We do have a focus on cardiology and cardiovascular surgery, but have many other product lines.”
They have a full-time diabetes team that does nothing but diabetes. It is likely one of the few hospitals in the country that does a hemoglobin A1C on every patient admitted. Between 25 to 45 percent of patients admitted has diabetes. They make a new diagnosis of diabetes five to ten times a day.
Another unusual thing about the AHH is that it has a cardiologist as CEO. Murphy previously was a “cath lab jock” who spent 28 years in a very intense and stressful environment. Affordable Care Act regulations put in place in 2010 prevent physicians from increasing their ownership role in hospitals where they practice. To bring the hospital under local ownership after it was put up for sale by an out-of-state group, Murphy had to surrender his medical license.
“I couldn’t practice medicine and be seen as a provider of care,” he said. “I had to relinquish my medical license for me to have any part in administration. It was a difficult choice. But I have no regrets. This is one of the best things that ever happened to Bruce Murphy.
“People are asking me continuously if I regret not being able to go down to the cath lab and do procedures. No. Becoming an administrator has been a very good transition for me. The stress is different in the administrative role. It is more self-imposed stress rather than the outcomes of the patient right in front of you.”
Having clinical cardiology experience, he has found, is a very powerful tool to help the other parts of the executive management team with the clinical impacts of various programs, new devices, and even the bulk buying of certain devices needed. It is not always a dollar and cents decision. Having clinical insights brings another level of analysis.
Because most of the population in Arkansas that needs cardiology services is older and rural, the AHH has 30 satellite clinics. Six of those clinics are full-time clinics.
“The demographics are that there is much less heart disease in Little Rock than smaller places like Arkadelphia,” Murphey said. “If you are going to take care of cardiology patients, many of whom are elderly and low-income, they are out in the countryside. They often don’t have transportation to travel to Little Rock. You have to go to small towns to take care of them. In spite of the fact that we are a metro-located hospital, our patients are mostly rural. It is a very interesting dynamic.”
Murphy, who was born in El Dorado, has had influence far beyond Arkansas. Earlier in his career, he published a number of scientific papers in cardiology and peripheral medicine, and spoke at some of the world’s top cardiac conferences. He performed live satellite transmitted cases from AHH to these conferences, as well.
Murphy travels extensively to be sure that the AHH has the best technology available.
Link
Arkansas Heart Hospital http://www.arheart.com/
