Memorial Hermann Health System’s Innovative Approach To Reimagining a Culture of Excellence

I recently had the privilege of co-presenting a webinar for the American Hospital Association with two colleagues from Memorial Hermann Health System. Memorial Hermann is the largest not-for-profit health system in southeast Texas and spans 17 hospitals and over 260 care delivery sites with 1.7 million patient encounters per year.

Our focus for this webinar was to look at how Memorial Hermann has emerged from the pandemic to reposition itself to successfully move forward in a difficult climate. My co-presenter Bryan Sisk, DNP, MPH, RN, NE BC, CENP, Senior Vice President, Chief Nurse Executive at Memorial Hermann, prefaced, “I think it’s incredibly important that we acknowledge the impact of COVID. Its toll has been incredible. It continues to be a force like nothing we’ve seen before.” We wanted to place our focus on what Memorial Hermann learned from the pandemic and how it has adapted its approaches.

A top performer in quality and safety

As a top performer in quality and safety, Memorial Hermann Health System has seven ANCC Magnet designated facilities and two Pathways designated facilities among its many accomplishments.

An organization committed to high reliability can be agile and optimize resources and expertise when needed. Jody Collins, MSN, RN, NPD BC, System Director, Clinical Education at Memorial Hermann, shared that “optimizing agility to reimagine a culture of nursing excellence and high reliability” became the crux of the organization’s strategic approach when faced with workforce challenges.

Adapting communications to meet urgent needs

Communication is always a key priority in a high reliability-focused organization. Taking a disciplined approach to incorporate interventions aligned to support patient safety as a core value is imperative, especially during a pandemic.  A few key highlights that Memorial Hermann utilized as part of their communication strategy included:

• Ensuring open and transparent communication
• Making modifications in operations and care delivery aligned with a commitment to high quality and safe care
• Establishing methods of immediate messaging (such as email and Zoom) to provide pathways to keep staff informed at all times and to provide a venue to share feedback, information, and insights from the front line about practice changes, issues, stressors, ideas, and solutions
• Establishing town halls with executive leadership to keep employees and physician partners informed

Memorial Hermann found the ability to connect senior executives and clinical experts to be so successful that town halls have become regular events that are recorded and posted on their intranet for employees to access.

A healthcare organization’s journey to excellence can foster innovation and identify new design approaches that support safer patient care. Memorial Hermann has been able to successfully take new learnings from the pandemic and seamlessly integrate them into their structures and processes.

Optimizing resources for rapid deployment

Demonstrating agility and resilience, Memorial Hermann was able to optimize resources for rapid deployment while maintaining their delivery of high-quality care. In fact, numerous Memorial Hermann nurses received awards and recognition during the pandemic despite staffing challenges that required the system to lean on contract labor and large numbers of new grads.

It took an enormous amount of flexibility to maintain high levels of quality while meeting needs at the bedside. Ensuring that competent staff deployed quickly to meet the needs of safe patient care required a team-based approach. Memorial Hermann’s key resources:

• Competency assessments
• Skills assessments and validations
• Shift to team-based nursing
• Multidisciplinary care teams
• Visual monitors to provide virtual nursing support for new grads

Memorial Hermann has created a sense of ownership and commitment to these approaches across the system, enabling them to continue team-based nursing models today. In addition, Memorial Hermann has successfully earned a two-time ANCC-accredited (with distinction) award for its nurse residency program.

Boosting growth through innovation and evolution

During the pandemic, it was important for Memorial Hermann to find a pathway to deliver learning content through virtual simulation. Therefore, they coined and developed “virtual SIM by proxy” or VSP.  Through this innovation, along with collaboration and optimization of resources, Memorial Hermann not only successfully continued its nurse residency program through the pandemic but experienced growth in the program.

Moreover, it has been able to sustain satisfaction and retention among nurse residents onboarded during the pandemic. My colleague Jody Collins noted that Memorial Hermann’s one-year retention among nurse residents during the height of the pandemic from 2019-20 was 80%, just below the Vizient national benchmark of 82%, but the system increased its retention numbers the following year to 82% — well above the national benchmark of 78% — and achieved an impressive 89% in 2021-22.

Memorial Hermann’s human-centered approach

We are all aware of the toll that the pandemic has taken on our healthcare workforce. The continued need for a focus on the emotional health and well-being of our nurses has never been greater. Healthcare organizations across the country are hard-wiring structures and processes to support the emotional well-being of our nurses and providers.

Memorial Hermann leaders noted that the pandemic heightened awareness of how they cared for their employees. They took the approach that the many changes occurring were part of their evolution to a human-centered approach. Jody Collins further acknowledged that they are in the “business of people.”

Being well-connected with their staff during unprecedented times, they could see the impact of their evolving efforts to support them through system-wide programs to promote resiliency and wellness. Key themes focused on being well together, strengthening organizational culture, and prioritizing a supportive and positive work environment. Memorial Hermann identified the key components that supported their human-centric approach.

Highlights

• Prioritizing staff resiliency and wellness through activities such as meditation and wellness coaching
• New and expanded child and eldercare benefits
• Wellness Wednesdays featuring activities such as “Laugh Yoga”
• An 8-hour mental health day
• Innovative models to support preceptor programs
• Expanding efforts to care for staff as people, including growing diversity, equity, and inclusion (DEI) initiatives
• Developing employee resource groups (ERGs)
• Increasing access to chaplains and counselors across its campuses
• Establishing a Code Lilac emotional response team, a volunteer interdisciplinary peer support system that provides immediate support for staff experiencing a stressful, emotionally, or spiritually challenging crisis
• Enhancing educational reimbursement
• Providing loan forgiveness benefits for staff

Creating a culture of excellence while promoting staff well-being supports an organization’s ability to build teams, connect to mission, vision, and values, and ultimately impact organizational outcomes. Memorial Hermann recognized that taking a human-centric approach creates a safe, caring, personalized, and connected workforce that maintains alignment with its core values and service standards.

Key strategic partner for quality education

Memorial Hermann’s partnership with Relias as its education solution provider has been essential in helping it sustain best practices. Relias provides a foundation for Memorial Hermann’s process for assessing nurses and allied health staff to maintain a high level of practice excellence and safe patient care delivery. My colleague Jody Collins noted, “Both the pre- and post-hire assessment support an individualistic approach to employee orientation and overall experience. The pre-hire assessment also serves as a valuable resource in the interview process itself, as it provides appropriate interview questions based on the candidate’s responses.”

Relias’ assessments provide insight into candidates’ overall behaviors, attitudes, and engagement in a “match day” report that identifies the top three areas of clinical specialty interest and best fit. Post-hire assessments provide specific insight into clinical strengths and identify understanding, opportunities, and knowledge gaps in clinical specialties and skills. Professional development specialists can design individual orientations and development plans for employees’ unique needs.

Integrating performance excellence through research

With all the great work coming out of Memorial Hermann, it was also important for the organization to build in agility to support future innovation that will enable it to continue improving performance. A joint research endeavor with Relias was part of this effort.

When we began our partnership more than six years ago, I could see that Memorial Hermann had taken an outcome-based approach to incorporating its best practices and identifying key critical success factors that were essential to achieve those outcomes. We knew about anecdotal successes with the structures and processes that were in place, but we wanted to explore all the relevant key variables and analyze the findings and correlations in a more formal way.

For the study, we obtained data and insights from Relias Assessments about Memorial Hermann’s hiring and onboarding processes. We performed an in-depth analysis to ensure that there was statistical rigor to support the findings. From five years’ worth of data with a sample size of more than 1,700 newly-licensed nurses across 13 hospitals, these were the key findings:

• There was statistically significant reduction in onboarding time by 6.5 days for each new hire.
• Using a personalized, data-driven approach helped enhance the new hire experience and improved engagement while ensuring efficient and effective onboarding.
• Multiplying these factors over 1,700 newly-licensed nurses created significant cost savings while improving confidence to practice, boosting morale, reducing the burden on preceptors and clinical coaches, and improving productivity.

Broader clinical implications of research findings

From the research, we know that ensuring a strong match between a preceptor and a newly-licensed nurse can promote a positive onboarding experience, which is vital to first-year retention and beyond. Developing a strong relationship during clinical orientation can also assist in the areas of patient safety, clinical competence, efficient time optimization, and better financial stewardship.

Published in the Journal of Nursing Professional Development (JNPD) in an article titled “Determining the Impact of Best Fit for Newly Licensed Nurses” (May/June, 2022), the study exemplifies Memorial Hermann’s willingness to look deeply at what is working and what is not working in its environment — methods, processes, and offerings — and how they contribute to delivering excellence at the bedside.

To summarize my colleague Bryan Sisk, the journey to nursing excellence, the ability to foster a spirit of inquiry, and a willingness to pivot are critical to cultivate skills and talent, to excel in execution, and to reimagine the delivery of care, culture, and well-being for success in the years to come.