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Patient Experience Case Study - Banner Health
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Case Studies provide real stories of current efforts, including programs being initiated, practices being implemented, and outcomes being targeted and/or achieved. Case studies are presented as both an opportunity for learning from others as well as a spark for further ideas on how we work to improve the patient experience. If you have a case study to share please contact us.

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Related Body of Knowledge courses: Cultural Competence & Diversity.


Best Practices in Leadership Drive an Exceptional Patient Experience


What was the challenge, opportunity or issue we faced?
Understanding how culture and leadership influence patient experience outcomes

With many organizations that have multiple facilities spread across the miles, trying to get a formula for success that can be adopted by all locations and facilities is no easy task. In health care systems that support multiple acute hospitals, one would think it would be easier. In reality, they are no different than other industries when it comes to "being different”. It seems that each location/facility describes their culture as being unique so adapting to a common method of operating is extremely hard, if not impossible. This concept of culture driving success in an organization is nothing new. However, trying to find that secret formula that can work within a large health care system like Banner Health and can work across multiple facilities in multiple states is quite a challenge.

As a result of understanding the uniqueness of each of our facilities, there was a burning question that drove this case study. Why are some facilities more successful than others in spite of being different? To be more specific, why do a few of our facilities consistently exceed our targets for the Patient Experience?

What we did to address it?
Identifying key leadership attributes of patient experience high performers

This case study looked at leadership and the impact it has on the patient experience. If an organization’s culture is a key factor in determining its success and leadership plays a key role in shaping an organizations culture, then it would be safe to say that leadership matters. This is a message you hear quite often at Banner Health This also became the key focus area of this research project. Our research began with identifying a handful of our facilities that were consistently achieving or exceeding our patient experience targets. Four facilities rose to the top, two from our Arizona Region and two from Colorado. These four facilities ranged in size and demographics and also performed well on several other indicators that Banner Health tracks.

With a little help from some work published on characteristics of high performing organizations, a simple leadership survey was created along with an appreciative inquiry interview guide. The survey was sent to every leader at the four facilities with the intent of identifying leadership perception around some key characteristics of high performing organizations. The appreciative inquiry interview guide was used with senior leadership at each facility. In addition to senior leadership at our Colorado facilities, several leaders and employees were interviewed as well. When all the data was collected and analyzed, we identified some common leadership practices and behaviors that clearly established a culture of accountability, development and long-term sustainability. The key theme we discovered at each location was the depth at which these attributes were noted within the levels of leadership. In an attempt to create an easy way to communicate what we discovered, a simple model emerged.


The model represents the four common themes we discovered through our research and how each theme is supportive of the whole picture.

Articulating a Clear Vision
The first theme relates to something that seems to be one of the largest barriers for most organizations - communication. We discovered that leadership at four of our high performing organizations practiced consistent methods for keeping the organization in touch with their vision and that the message was understood down through the ranks. We also discovered that leadership behaviors played a big part in how the organization’s vision was perceived. Leaders at the four facilities made connections with the organization through a high level of emotional intelligence.

Establishing Measurable Accountability
The second theme we discovered through this analysis identified a level of accountability that truly aligned individuals with outcomes. The leaders at the four high performing organizations exhibited a behavior that exemplified true measurable accountability. Each organization used solid metrics as a tool to determine a unit’s success, with the Patient Experience being a key metric for all. Having good metrics is only a part of the equation; it’s what the leaders did with the information that identified this as a best practice in leadership. Each facility, in their own way, used these scorecards as a key tool to hold leadership and employees accountable for results and was not afraid to make some hard decisions based on this. Through our interview process, we heard stories of how senior leadership established the expectation, provided support and guidance to help leaders become successful and when leaders were not capable of achieving the desired results, they made the tough decision to help these individuals move on to something they could be successful at. This level of accountability could not take place if leadership could not articulate a clear vision for the organization.

Developing Leaders for Success
The third theme plays off our second theme and is focused on developing talent within the organization. It uses the approach that in order for employees to be successful, our leaders need to be capable of developing their talents to be successful. The leaders at each of our four high performing organizations put in place an approach for developing leaders for success. Some used a coaching corner concept to develop success-building skills in leaders, while others created an internal program that focused on continuous learning and development. Regardless of the approach, senior leadership practiced what they expected for their leaders and their leaders demonstrated their new skills with their direct reports. This strengthened each of their cultures to embrace learning and development throughout the organization.

Create Sustainability
The last theme we discovered relates to change capability that creates sustainability. In today’s ever-changing world, if an organization is not capable of change, it cannot sustain its success. The leadership at the four high performing organizations we focused on for this analysis all had a highly tuned change-ready posture. Rapid and constant change is not unfamiliar to the employees and leadership at these organizations. We discovered that these organizations are capable of adapting to constant change at a high rate of speed and exhibit excitement, enthusiasm and energy when faced with a challenge. These four organizations are usually called upon to pilot new things, and at times are the ones discovering new opportunities that improve the way we work.

All four of these themes support each other in several ways. By articulating a clear vision throughout the organization, every employee understands what is important and why changes are important. Leadership behaviors demonstrate their commitment to the vision, which is passed down through the leadership ranks to the front line employee. Understanding the vision also adds meaning to what metrics determine success. This clarity in direction provides a foundation for holding individuals accountable for results. Articulating clear expectations and a willingness to make the hard decisions are core behaviors that set good leaders from exceptional ones. The foundation to holding individuals accountable is ensuring they have the tools and equipment to be successful. Leadership skills that deliver results is not something individuals are born with, it’s a learned behavior. With learned behaviors, observation and practice are key. When an organization is focused on developing leaders for success, they demonstrate and teach the core behaviors that drive success. With these learned behaviors for success also comes the ability to adapt to change rapidly. When the organization understands the vision and direction, they also understand a driving need to adapt and change. Sustainable success is the result of a resilient, change-ready organization that develops its talent and is driven by results. The four organizations we explored all exhibit a set of core behaviors that support our model for leadership best practices.

What outcomes are we achieving?
Recognized performance and score improvements

Over the past 3 years, banner health has improved their patient experience scores as measured through HCAPPS and the CMS database, exceeding internal targets for the past 2 years with the potential of achieving our stretch targets for 2010. The four facilities included in this case study are at or above the 80th%tile ranking for "Rate this Hospital” based on the CMS data posted in September of this year. These high performing facilities continually set the bar for our system by exceeding our stretch targets for the patient experience. They continually excel in all areas Banner Health measures, including our core clinical measures.

About Banner Health

Nonprofit Banner Health is deeply committed to its mission. We exist to make a difference in people's lives through excellent patient care. Headquartered in Phoenix, Ariz. with locations in seven states, Banner Health operates 23 hospitals and other facilities.We provide services in hospital care (inpatient and outpatient), home care, hospice care, nursing registries, surgery centers, laboratories, rehabilitation centers, and residential care. Our major programs are Cancer, Critical care, Emergency/Trauma, Heart care, Medical imaging, Neurosciences, Obstetrics, Orthopedics, Pediatrics, Rehabilitation, Surgery, and Stroke. We also specialize in Alzheimer's disease treatment/research, Behavioral health, Burn care, High-risk obstetrics, Level 1 trauma, Organ and bone marrow transplants, and Toxicology.

Banner health is rapidly emerging as a leading health system in the nation.
  • Top 10 Health System, Thomson Reuters
  • Top 10 Integrated Health Network, SID
  • Collaborating with M.D. Anderson Cancer Center to build the Banner M.D. Anderson Cancer Center on the Banner Gateway campus, opening in 2011
  • Banner Alzheimer 's Institute nationally/ internationally recognized for its
  • Alzheimer's Prevention Initiative, brain imaging research, clinical care
  • Will complete implementation of an enhanced suite of electronic medical records in all 23 hospitals by end of 2011
  • Utilize a 55-bed simulation medical center to enhance training of medical staff

The communities we serve benefit from:

  • Charity care (at cost) - $80.2 million
  • Unpaid cost of public programs, Medicaid and other indigent care programs - $79.3 million
  • Health professional education (includes training 260 physicians year) - $19.4 million
  • Community health services - $10.8 million
  • Research activities - $7.2 million
  • Total cost of the community benefit (includes additional areas) - $207,796
  • Additionally, the Banner Good Samaritan Poison and Drug Information Center hotline saves the community $33 million annually in emergency center costs
  • Banner Olive Branch Senior Center provides meals to more than 12,000 seniors, children and homeless families per year

Banner Health is a leading employer

  • Banner Health's Journey commitment to employees: We'll make a difference in your life so that you can make a difference in the lives of others
  • More than 35,000 employees
  • Second largest private employer in Arizona and northern Colorado
  • Rated as "Best Places to Work”

A leader in medical education and research

  • Train 260 physicians annually at Banner Good Samaritan and North Colorado Medical Center
  • Residencies include Family Practice, Internal Medicine, Internal Medicine/Pediatrics, Obstetrics and Gynecology, Podiatry, Psychiatry and Surgery
  • Banner Research Institute programs are focused on Alzheimer's, Parkinson's, cardiovascular disease, arthritis, fibromyalgia and orthopedics, offering scores of research studies and clinical trials.

Related Body of Knowledge courses: Cultural Competence & Diversity.

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