Legacy Emanuel: A healthcare organization audit summary

Legacy Emanuel Medical Center, at 2801 North Gantenbein Avenue, Portland, Oregon is

is an IRS 501 (c ) 3 not-for-profit, tax-exempt corporation comprised of five full-service hospitals and a children's hospital. The Center's award-winning facilities offer an integrated network of health care services: acute and critical care, inpatient and outpatient treatment, community health education and a variety of specialty services.

The area's largest locally owned, nonprofit health system, Legacy Health's is a lead healthcare institution in the region, committed to comprehensive service provision to clients through a network of healthcare providers toward a healthier and wellness community. Projected growth for the institution under the direction of the Office of Development advances the mission and vision of Emanuel Medical Center, dedicated to legacy of good health for 'Our people, Our patients, Our communities, Our world' through development of sustainable programs that generate private support and foster charitable giving.

The Hospital organization is comprised of a general medical and surgical hospital, and houses: a variety of specialty services, including the Oregon Burn Center, the Legacy Center for Maternal Fetal Medicine, Legacy Wound Care Center and Legacy Emanuel Children's Hospital. A level I Trauma Center and the base for Life Flight Network, the Medical Center also manages the region's critical care transport service. Legacy Emanuel Children's Garden is a therapeutic retreat for patients, their families and visitors, hospital staff, and the general public. In support of evidence-based practice, the Medical Center is a 'learning institution' for physicians, dedicated to the cultivation of professional knowledge exchange through clinical trial research support, internships, and onsite training workshops.

Summary of Research

The Legacy Emanuel Hospital and Health Center organizational audit was designed as an open ended, semi-structured assessment of an institution well-known for its persistence in service to a community that during the 1960's and 1970's was plagued by a high incidence of violence leading to an exceptionally high rate of admissions per capita in the City of Portland. The field audit offered keen insights into the Medical Center's ongoing support and contribution to North Portland residents, through targeted initiatives such as the outreach healthcare consortium, Project Access, which coordinates the care between uninsured patients and doctors and hospitals who will accept charity care patients.

Data analysis to the organizational audit is conducted by way of Six Sigma qualitative assessment tool, SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis and theory based approach, Porter's Five Forces in review of RN Stakeholder interests. A composite SWOT of the findings from the research is illustrated in Table 1.

Table 1

Strengths

Institutional Legacy

Established stakeholder network

Large municipal context

Multi-scale service provider

Physician & RN staff commitment

Weaknesses

Nursing shortages in sector

Nonprofit finance

Low Income neighborhood means max capacity

Opportunities

Knowledge sharing network

Robust service menu may be enhanced by technology

Advancement of referral partnerships through both

Threats

Decreased contributory finance to 501 ( c) 3 institutions since global economic crisis, 2008

Incapacity to respond adequately through research grants support may mean institutional finance in operational areas may be reduced

Table 1. SWOT of Legacy Emanuel Medical Center

Organizational Structure

An institution of scale, Legacy Emanuel Medical Center is under the direction of President and Chief Executive Officer, George J. Brown, MD. Senior Vice President and Chief Nursing Officer, Carol Bradley, RN provides direction and supervision to the programmatic structure of the institution's RN staff, and adherence to policy and procedures at the Medical Center. Carol Roberts, RNC, CNS, MN, nurse manager of labor and delivery unit provides supervisory oversight to unit operations. Additional direction and management support is in part to the framework of Hospital administration. Vertical leadership in organizational composition is furthered through an extensive horizontal collaboration by professionals at all levels in the practice setting, and partner referral network. Core Staff include six (6) nurses, an OR Technician, OB Hospitalist, OB anesthesiologist, and Resident. At present, Staffing is adequate. Nurses can be transferred temporarily from other units when needed. Methods used to mitigate against staffing shortages and/or difficulties are mandatory standby, resource pool, and on-call staff.

An example of the joint provision in oversight within the Hospital organization's practice setting is seen in accountability to the Director of Children's Services in oversight of the Maternal-Child unit by its Unit Manager. The goal of 2W Maternal-Child 12 bed unit is to stabilize patients and keep then safely pregnant for as long as possible. With more than 50% of the patients classified as 'high-risk' pregnancies, the unit...

Nurse productivity is prospective to analysis of the Hospital organization's service systems. Optimizing financial control means that all staff must trained into an integrated system of monitoring patient record and accurate documentation of the managed care component of their patient journey.
Without control over data related to patient admissions and treatment, the managed care criterion may impact certain aspects of the service provision. Fiscal waste ensues where careful attention to managed care records is not kept. Where adequate management of institutional records is not formidable to management procedure, it may even cause patients to endure unwanted duplicate tests and insurance charges. Nurses also cited requests for extra blood testing where not needed. Excess expenses in part of unnecessary procedures add up.

RN Stakeholder Analysis

Responsible for patient care within an assigned department/unit and participates as a member of the health care team in coordination with and under the direction of the clinical manager or designee as defined by the Standards and Scope of Practice for the Registered Nurse {(OAR.851-45-000) Nurse Practice Act (10/97)}, the Critical Care RN assesses analyzes, plans, implements and evaluates patient care following established patient care standards for Legacy Health System including those for patient assessment and transfer. Legacy Emanuel Medical Center's Critical Care RN staff are perhaps the most interesting professionals on the unit floors in the institution(s). With six months nursing experience or completion of Legacy nursing internship program, licensed RN must also exhibit demonstrated ability of positive interpersonal and communication skills with colleagues, patients, families, physicians and the community. Additional clinical experience requirements may vary dependent upon the specific department in which the position is utilized.

For example, Fetal maturation is often a prescribed intervention in the Maternal-Child Unit. For this reason, the Hospital is recognized for treatment of maternal patients as many of the patients have protracted admissions to release periods sometimes extending into weeks prior and post delivery. Average length of stay for unit is typically 1 day for laboring patients and/or 1-3 days for antepartum patients. Variance in patient treatment requirements in the Unit makes oversight and management of nursing shifts particularly important, as consistency in nurse-patient synergy is an objective to the institution's core competencies in comprehensive patient care throughout the practice setting.

Organizational culture at Legacy Emmanuel is predicated upon the aggregate assumption that institutional proficiency is located in the individual professional investment of each employee. Staff reiterated this concept during the audit, stating inspirational comments, like "each person has power;" in a context where managers are referred to as "go-to" or point persons. This extends to the patient synergy relationship, so that decision making is a collaborative method of insuring treatment success. Informal qualities cited in the cultural protocol of the Medical Center's daily routine are mentioned in Table 2.

Table 2

Image: Legacy likes to be perceived as family and patient oriented, not for profit, and for giving back to the community.

Department: All RNs must wear scrubs that cannot be worn in to work. RNs cannot wear false or painted nails.

Status Symbols and Reward Systems: Kudos if the co-workers think other co-workers have done good jobs. The manager will sometimes give coffee cards of something like that. Every 5 years of service workers receive recognition and get to select a prize.

Environment and Ambiance: Unit 2W features 12 Labor and Delivery rooms. Each room has a TV with a DVD player, resting area for the father, table for meals and a refrigerator. The unit is a perfect blend of a five-star hotel and cutting edge medical facility. The unit also includes a nurse's station, pre-natal assessment and observation room, staff locker room, and a conference room. Unit 2W has three operating rooms. All nurses who work on labor and delivery circulate caesarean sections.

Diversity: probably predominantly white. The workforce definitely has Spanish, Mexicans, Russians, and Africans on the unit. The Mission Statement does address diversity.

Teamwork: The maternal-child unit team works very well together. The unit is trending toward people wanting low-intervention, natural births. Legacy certified nurse midwives focus care on the patient and the patient's family. The midwives offer Water Births to people who desire that experience.

Communication: The methods of communication are charting, email, flyers, SBAR, and signs on the bulletin boards. These methods are effective. New policies are communicated via email. If training is required, a notification comes up through E-Plus Training. Nurses get a lot of emails that…