Five-Part Leadership Blog Series
In this five-part blog series on the 2017 Baldrige Award recipients’ leadership presentations at the 30th Anniversary Quest for Excellence® Conference (April 8–11, 2018), senior leaders of the five new national role models share best practices and stories of how they achieved excellence.

As a faith-based organization, Adventist Health Castle embraces its spiritually based mission of “Living God’s love by inspiring health, wholeness, and hope” (in Hawaiian language: E ola mau ke Aloha o ke Akua i ke olakino, i ka pono iho, a me ka mana’olana), according to the president and CEO Kathy Raethel.

In describing her community health system’s history, Raethel said it was established in the wake of two tragedies, becoming the only hospital to serve the community on the windward side of the Hawaiian island of O’ahu. In the late 1950s, a local government agency did not want a hospital built in the area, she explained. But community perceptions that accidental deaths could have been prevented with closer access to an emergency room created momentum for the board of health to approve a plan to construct a local hospital. Castle Medical Center was established in 1963, named after the man who donated land for the hospital.

Employing 1,046 people today, Adventist Health Castle (AHC) offers 24-hour emergency care, inpatient acute care, a birth center, a joint care center, inpatient behavioral health services, multi-specialty surgical services, cardiovascular services, neurological services, a center for metabolic and bariatric surgery, outpatient services, a chemotherapy clinic, imaging services, and a wellness center.

Leadership System and the Baldrige Framework
Raethel stressed that AHC’s mission, vision (“We will transform the health experience of our community by improving health, enhancing interactions and making care more accessible”), and values (integrity, compassion, respect, and excellence) drive her organization’s leadership system. This system incorporates concepts from the Baldrige Excellence Framework, she said, noting,

“Everything has [become more] effective since we’ve defined Baldrige as the way we work.”

The AHC Leadership System (depicted above) depends on an integrated strategy and leadership structure. The leadership structure consists of five key teams—the Patient Experience Team, the Playbook Team, the People Team, the Operations Council, and the Improvement Council—all of which report to the President’s Council and, in turn, share information with and from the organization’s quality resources, clinical information systems, and information technology function. The seven categories of the Baldrige framework and Health Care Criteria for Performance Excellence are represented in this structure, from the President’s Council representing the Leadership category; the five teams accounting for Customers, Strategy, Workforce, Operations, and Results categories, respectively; to AHC’s information resources aligning with the Measurement, Information, and Knowledge Management category.

Love Matters
In order to “transform the culture and deliver results,” AHC defines its core competencies as (1) “Love Matters,” (2) “Tenacity for Excellence/We Chase Zero Harm,” and (3) “Execute Strategy.” As conveyed in Raethel’s presentation, following are key practices through which the organization demonstrates that “love matters”:

We bring our compassionate, healing ministry to the forefront in all that we do.
We provide care with the same Aloha spirit that makes our island home so unique, creating a palpable environment frequently articulated by patients, associates, and community partners.
Always Behaviors support our values and help our associates know exactly what behaviors are expected.
The “In Their Shoes” empathy workshop is required in first 90 days of employment.
Related results presented by Raethel showed that AHC has achieved physician engagement results in the 99th percentile of national hospital survey data maintained by the Centers for Medicare and Medicaid Services (CMS). Therefore, “Our physicians are amongst the most engaged in the nation!” Raethel shared. She also highlighted AHC’s exemplary workforce and patient engagement results. For example, data show that AHC is in the top decile of CMS results for inpatient overall satisfaction as well as inpatient engagement/loyalty.

Tenacity and Chasing Zero Harm
In relation to AHC’s second core competency, Raethel provided this statement, “We are tenacious about quality improvement, especially in regard to chasing zero harm to our patients. We have honed our approach to performance improvement over decades into a rigorous, transparent, and well deployed approach. However, the strength of this capacity is in our tenacity to never accept anything less than excellence.”

Making clear that AHC is delivering on its aim of causing zero harm to patients, Raethel highlighted several of the organization’s excellent safety results. For example, for patient falls, data presented from recent years show that AHC has been outperforming a national benchmark and is still improving. In addition, data presented show that AHC’s birth center has met its high target of zero early elective deliveries from 2013 through 2017, thus performing in the top decile of national comparisons collected by The Joint Commission (TJC). And for two common hospital-acquired infections (catheter-associated urinary tract infections and central-line-associated blood stream infections), AHC has outperformed national comparisons by achieving an infection rate of zero and nearly zero, respectively, for at least four of the last five years, according to results presented by Raethel.

Also demonstrating its core competency of tenacity for excellence, AHC has been a TJC Annual Top Performer Award Recipient for four years in a row for its results for treatment of acute myocardial infarction, community-acquired pneumonia, and heart failure, as well as for measures of surgical and perinatal care.

Strategic Alignment and Accountability
photo depicts beautiful ocean scene on the cover of the 2016-2020 strategic playbook of the organization
Credit: AHC; used with permission
As presented by Raethel, AHC’s processes for strategy are aligned and focused on taking action on what matters most. For example, AHC’s Strategic Planning Playbook is aligned with that of its parent organization Adventist Health.
The organization’s strategy cascades to all AHC leaders through measurable goals to which they are held accountable through use of an evaluation management tool. The strategy also cascades to staff members, through practices such as regular leadership rounding and “Top 5 Boards” that are displayed in staff-only areas to highlight the latest goals as daily reminders.

Transforming Health Care
With its aim of “transforming the health experience,” AHC has been making progress in meeting the need for population health care. As shared in Raethel’s presentation, AHC has achieved performance in the top decile or higher on 14 out of 17 key indicators (e.g., mammography, cervical and colorectal cancer screenings, and diabetic eye exams), making it the leading health care organization in the state of Hawaii for population health. For these results, AHC has improved from the bottom quartile to the top decile of comparison data over the past five years.

Financial Strength
Raethel also highlighted financial practices of AHC that have delivered excellent results. These practices include a focus on proactive, vigilant management of budgets and expenses; a focus on achieving 100 percent productivity; a focus on maximizing quality incentives (e.g., Value-Based Purchasing by CMS, for which AHC is achieving at the level of the top 3 percent of U.S. health care organizations); and a focus on exercising good financial stewardship. She connected such practices with strong financial performance and growth of AHC’s physicians network and future expansion.

Sharing Lessons
Raethel concluded her presentation with these lessons from AHC’s journey to excellence:

Create a culture where love matters and permeates all relationships and everything you do.
Because love matters, seek excellence and chase zero harm—any patient harm is unacceptable.
Deploy integrated strategy and performance management to create a “remarkable ability to execute.”
She encouraged other organizations to learn more about by attending AHC’s Sharing Day at its Hawaii site on September 4, 2018.