Q&A: Mary Bishop, Jupiter Medical Center
Mary Bishop, RN, CNAA, is the chief nursing officer at Jupiter Medical Center in Jupiter, Fla. Like most hospitals, Jupiter Medical Center must work hard to balance quality and costs. However, unlike most hospitals, Jupiter also must contend with a distinct busy season. Located in a resort area in Florida, the area’s population—and therefore the medical center’s patient population—dramatically increases during the winter months as "snowbirds" from the north settle into their winter homes. As a result, the hospital increases its staff from 1,200 during the summer to 1,400 during the winter.
In this Web-exclusive interview, Bishop explains how Jupiter Medical Center manages that employee population shift while keeping costs low and quality high. In addition, she shares some of the initiatives and programs Jupiter uses to meets health care’s most common challenges.
What are some of the best methods you’ve used to increase quality while keeping costs down?
MB: Talking from the recruitment standpoint, a method we’ve used is having a major focus on recruitment and retention of our own staff and not using an agency or travelers. That improves quality because we can ensure the education of the staff—we know who the staff is and we have the consistency of the staff. Whereas when you have outside contract labor, which is very expensive, you have variations in the quality and the knowledge of the staff in the organization.
We’ve also instituted and recruited for a program we call “seasonal contract,” so we’ve come up with our own seasonal rates for the winter because we’re very busy here in the winter. So we have our own internal pool of staff for the winter. We actually have some employees who go up north for the summer and come down here in the winter, and they work with us in the winter months. They’ve been through orientation, and we know them, and they’re part of the Jupiter Medical Center family. We pay them more than we pay our per diems, but a lot less than we would pay an agency.
We’ve been able to find nurses who would like to be seasonal. They sign on from Dec. 1 through May 1 and they work full time or part time, and they get a premium pay and they’re part of Jupiter Medical Center. So then in the summer, we can keep our own staff working. Our census will drop in the summer because of vacations and the snowbirds are gone. So that is one way that we really work to save expenses and reduce salary expenses, which is the biggest expense here, and improve the quality.
We also use Pinstripe, which is a recruitment company. It is time and cost-effective for us to do that. They prescreen all our candidates for us, and they set up all the interviews and appointments. They get profiles on the employees and do a lot of the legwork that our nurse manager did before. That’s been very helpful for us because that allows our nurse manager to be out on the units being with the staff and working with the staff rather than having to spend so much time on the recruitment aspect. Our own staff still interviews candidates, but all the legwork is done by Pinstripe, so that’s very helpful.
What are some of the challenges to the typical quality-cost ratio in hospitals?
MB: I think the challenge is improving the quality while keeping the costs down despite the declining reimbursement. The expectations for quality are increasing, and it’s hard to balance the amount of staff with the reimbursements that we’re getting for some procedures. The outside quality requirements from agencies such as CMS (Centers for Medicare and Medicaid Services) increase our attention to detail with our patients, which is important and something we need to do. But a lot of that is coming by a lot of paperwork, and it becomes hard for the nursing staff directly to be able to manage that and provide direct bedside care for the patients.
How have you worked to overcome some of these challenges?
MB: We’ve done some things to incorporate staff in that we’ve assumed some of the responsibilities with charge nurses. We have a daily huddle to review quality of the patients every morning. In every unit we have a case manager, and with the charge nurse and the unit nurse manager, they get together to discuss quality initiatives for the patients: Are they being protected from falls? Who’s on restraints? Who is on core measures? So in our daily huddle we meet and say: Are these needs being met for our patients? What can we do for them today? How can we help our nursing staff achieve that? And that’s been very effective for us to increase our quality.
We also have an active timeout at discharge. The charge nurse has a timeout with the primary care nurse, and she has a list of items to go through: Has the patient’s medications been explained? Has the patient been given instructions for home? Has the patient been give a pneumonia or flu vaccine, if appropriate? We go down a whole list to ensure that the quality at the time of discharge is as high as the quality that we expect during their whole hospital admission.
When implementing these initiatives, which department or party holds the responsibility?
It’s interdisciplinary. It’s nursing but it also involves respiratory therapy and the lab. We’ve done it on both ends. We have what we call “Unit Champions for Quality.” We have at the staff level, staff members in the nursing areas on our nursing floors, who meet with us once a month to discuss quality initiatives and how we can improve the quality for our patients. They have some great suggestions, and they have probably the best ideas because they’re at the bedside.