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100 Top Hospitals supplement: Saving lives and money

Ohio hospital focuses on quality efforts by paying attention to its nursing staff


By Elizabeth Gardner
Posted: May 7, 2007 - 1:40 pm ET
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What does a hospital do when the average age of its nurses is in the upper 40s? In the case of EMH Regional Medical Center, Elyria, Ohio, it does everything it can to keep them from throwing their backs out.

Its new family birthing center has laundry chutes at floor level, so that heavy laundry bags can be scooted across the floor rather than hoisted to a wall chute. A new universal-care unit has patient lifts in each room. Two scooters are available for nurses who’ve had joint replacement surgery, broken bones or other mobility impairments but are eager to return to work and can handle aspects of the job that don’t involve standing.

“We try to build in ways for our clinicians to stay and use what we’ve hired them for—their brains,” says Debi Jones, vice president of patient care and chief nursing officer.

The 264-bed hospital has 2,000 employees, 600 of them nurses. It has been named a Solucient 100 Top Hospitals winner a record 10 times for its size category, including the past seven years in a row. Having enough nurses is an ongoing challenge, as it is for most hospitals, and EMH has devised a number of ingenious ways to make sure its needs are covered.

When Jones arrived in 1999, one of the first things she did was write to all of EMH’s registered nurses who had retired, inviting them to come in to work for a few hours every now and then, to take admissions data from patients and add it to the hospital database. Some of the retirees are in their upper 70s, and a number have had to reactivate their licenses, but they’ve got the necessary know-how, and they free up younger staff members for more physically rigorous tasks. “They do a wonderful job of making families feel comfortable,” Jones says.

EMH pays nurses the top rate in its market, according to salary surveys, and may pay above market for experienced RNs with hard-to-find skills, Jones says. In addition, each department sets goals annually for nursing cost and quality, and if a nursing unit beats its goals, the nurses share in the savings. The unit can get back 40% to 70% of what it saved, depending on its specific achievements in areas such as length of stay, emergency department turnaround time and patient satisfaction.

The average savings range from $5,000 to $38,000, though one department racked up $70,000 one year, Jones says. But because quality and patient satisfaction are factored into the equation, units don’t seem tempted to understaff to save money.

EMH uses very little contract labor because it frequently acts as its own nursing agency. A pool of medical-surgical and critical-care nurses is available to meet shortages as they occur, and they’re paid a hefty premium per hour to keep up the multiple competencies that ensure their versatility. When the hospital opened a new emergency department recently, it had to ramp up quickly, so it offered short-term contracts to a combination of existing staffers and outside hires—at a higher hourly rate than an agency would pay—while it looked for permanent staff.

EMH’s vacancy rate is low and its turnover rate is in single digits. Jones is also relieved to note that the employees who leave voluntarily are likely to have been performing below the median anyway. “We’re happy that the people who are doing well want to stay with us.”

Jones has this advice for other hospitals: “Find your top performers, don’t be afraid to pay them, and give them the autonomy to make decisions in their workplace.”

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