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Heer reflects on busy first year at helm of NMHS

Tupelo — When John Heer arrived last summer to take the top job at North Mississippi Health Services, some openly wondered why he would ever leave his previous assignment.

Prior to his NMHS appointment, Heer (pronounced “Her”) had steadily worked his way up through the healthcare ranks at large and small facilities throughout the South during the past 20 year. But during his leadership as president of Baptist Hospital Inc. in Pensacola, Fla., the organization was named a 2003 recipient of the prestigious Baldridge National Quality Award, achieved five years ranking in the top 1% of hospitals in the Press Ganey survey database and was selected to the list of “100 Best Companies to Work for in America” by Fortune magazine.

In contrast, as the new CEO of NMHS, Heer would inherit a hornet’s nest of community relations problems that swarmed around the institution for much of 2004. While quality of medical care was viewed positively, critics charged that the not-for-profit hospital system had veered from its purpose of serving the community and was more driven by building projects and organizational charts than it was by patients. A contractual stalemate with Blue Cross Blue Shield continued as a source of irritation and confusion among patients, as did billing and collections procedures.

Hitting the ground…

Once on board, Heer hit the ground running, initiating changes in community outreach, communication, patient satisfaction assessment and in organizational structure. At press time — and to the relief of several Mississippi, Alabama and regional patients — North Mississippi Medical Center announced that it had reached an agreement in contract talks with Blue Cross & Blue Shield of Mississippi when the North Mississippi Health Services board of directors approved a new contract.

Beyond Blue Cross Blue Shield, much of Heer’s attention has been directed throughout the past year in transitioning the organization from what many deemed as a “financially-focused” institution to a “patient-centered” institution.

“When the (NMHS) board hired me, they said that they were looking for a more balanced approach regarding the leadership of the organization,” Heer said in an interview at his modestly-furnished office. “The reason that we’re here is to take care of patients in the best manner possible — that’s our priority and our focus. As organizations like ours strive to move from good to great to world class, changes in structure are oftentimes needed. We are at that point as we make the transition to a service line organization structure.”

In simplest terms, the service line concept is designed to bring more people who directly care for patients, such as physicians and front-line managers/employees, into the planning process. A host of changes have been implemented to reflect that philosophy, most recently, at the senior management level at North Mississippi Medical Center.
Earlier this summer, Mississippi native Chuck Stokes was hired as the new president of NMMC-Tupelo from Huntsville Hospital in Alabama where he had served as chief operations officer for several years.

Heer described Stokes as a team player with a servant leadership style who brings a strong clinical background to the task and a history of engaging physicians, staff members and broader community members with a hospital system.

Interestingly, Stokes’ résumé also includes training and experience as a registered nurse, which would underscore the patient-driven emphasis at the administrative level.

Streamlining management

Additionally this summer, three vice president-level positions were eliminated in an effort to reduce layers of management while increasing decision-making authority of those closest to patients. At that time, it was also announced that long-time NMHS executive Gerald Wages would serve as executive vice president for external affairs.

At the time of the announcement, Heer said that Wages’ new role would take advantage of Wages’ credibility and strong contacts in the community. Additionally, Heer said that the organization is working with medical staff leaders and seeking their input into the service line team development process and in the selection of service line administrators.

“We think that this structure creates a more agile organization that empowers employees and more actively involves medical staff in decision making,” Heer noted.

Another goal has been improvement in wait time at the emergency room at NMMC, and Heer acknowledged that in any environment, an emergency room is “one of the most difficult places to have great patient satisfaction.”

“We have additional nurses and increased physician coverage and our new leadership team is monitoring work-flow processes to ensure that patient service is continually improving,” Heer stressed. “Looking at the experience from the patient’s perspective is what’s driving the changes we’re making.”

Patient satisfaction throughout the entire system has been another key area for Heer since his arrival. While overall quality of care has been described as good, Heer said that there are several components that impact patient satisfaction scores beyond quality of care. While the medical center had worked with one particular company for more than 12 years to conduct patient satisfaction surveys, officials believed that more specifics were needed to obtain a better assessment of patient satisfaction. A new vendor’s written, expanded format provided more detailed information regarding the patient’s experience with the admitting and discharge processes, the room, meals, nursing responsiveness, physician interaction, satisfaction with radiology and the lab and so forth.

“As we looked at this process, we asked ourselves whether we were measuring patient satisfaction as fully as we should to identify and improve individual service shortcomings,” Heer said. “Now we can pinpoint the specifics that are driving patient satisfaction scores.”

Heer said that coaching is another important tool in working with staff to enhance patient satisfaction. He added that employee satisfaction levels have continued to improve throughout the past year and he said that he believes that employees are committed to organizational goals and improvements.

From a community relations standpoint, Heer moved quickly upon his arrival in hiring a community relations facilitator to establish a framework in “reconnecting with the community.” The facilitator continues to meet with business and civic leaders in the region, while the entire NMHS leadership team supports the facilitator via speaking engagements, small-group presentations and other opportunities as they arise. Additionally, Heer said that NMMC’s community hotline and expanded Web site continue to provide community feedback.

Because billing was an area of consternation for patients, Heer stated that NMMC initiated new, easier-to-read statements with more specific contact information and payment options. He added that NMMC will continue to find ways to improve the billing process in both clarity and convenience.

Looking back on organizational strategies of the past year, Heer said that he is proud of accomplishments such as the recent American Hospital Association McKesson Quest for Quality Prize, which Heer said underscores NMMC’s tradition of clinical quality.

While not-for-profit hospital systems have generated increased scrutiny throughout the past year, Heer said that he believes that NMHS is focused on serving patients and the community.

“I’m really excited about everything that we’re doing here,” Heer concluded. “If the clinical quality is there, you can address the other issues we’ve talked about. We have a supportive board and motivated professionals on staff and we’re making progress where we should be.”

Contact MBJ contributing writer Karen Kahler Holliday at mbj@msbusiness.com.


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