Studies have shown a direct connection between a hospital’s organizational culture and overall patient satisfaction with their healthcare provider. Nowhere is this more evident than at Crouse Health, where senior leadership maintains a sharp focus on culture and its impact on the patient experience. “We firmly believe that the culture at Crouse Health sets us apart in the marketplace and drives our mission of providing the best in patient care and promoting community health,” says Crouse President and Chief Executive Officer Kimberly Boynton.
A key foundational element of that culture is collaboration, says Seth Kronenberg, MD, Crouse’s Chief Operating Officer and Chief Medical Officer. “When everybody has a voice – and it’s a collaborative discussion – we see that the institution is moving forward.” Boynton echoes the sentiment, adding that she, Kronenberg and the rest of the senior leadership team, operate as a unit.
“We work as a team,” she said. “When staff see that they’ll reach out to their peers and their directors and their managers and start to talk to them differently. Instead of making a decision that is linear, they’ll start to look across the organization and say, ‘Okay, this is going to affect multiple people. We should bring them in from the beginning.’”
Boynton, a Syracuse native, has been at Crouse for 20 years, having started in an entry-level position, working her way up in the Finance Department and taking over as CEO in January of 2014. Kronenberg is an internal medicine specialist from Fayetteville who has been in his leadership role for five years. Both say they never make important decisions about the hospital without the other.
“People know that if you’re talking to one of us, you’re talking to the other,” Kronenberg said. “It’s not important who gets the credit. We all make mistakes. When we make a mistake, it’s not about who to blame. It’s ‘How do we learn from the mistake and go forward?”
A culture of caring
Boynton and Kronenberg both say said they strive to foster a culture where all employees understand the role they play in providing a quality patient experience. “All healthcare institutions are striving for the same thing — high quality care,” Boynton said. “At Crouse, the most important thing is our culture, and making sure that every person who works here understands the value they bring to the patient care experience — whether that’s the bedside nurse or the valet attendant — and that they know the importance of their role.”
Boynton said Crouse encourages an environment in which every employee, regardless of their role or where they work in the organization, should feel comfortable working side by side. “Our culture sets the tone for how patient care is going to be provided,” she said. “So a nurse feels comfortable approaching a doctor and saying, ‘Here’s what I’m seeing, here is what is going on.’ That collaboration is going to lead to better quality. And that is what sets Crouse apart.”
Kronenberg said that while the culture is modeled at the top, it’s not merely a directive that comes from the administration. “The culture is driven by engaged employees and engaged physicians,” he said. “We don’t set the culture at the administrative level. The culture is a function of how engaged employees are.”
That level of engagement starts with the hiring process. When prospective employees apply for a position at Crouse, the hospital’s website clearly conveys the mission, vision and values of the organization (see sidebar). And in addition to more traditional procedures, Crouse also does peer interviewing. “It’s not just about your supervisor, it’s about how you relate to the other individuals in your department,” Boynton said.
Once an employee is hired, they have plenty of opportunities to interface with administration. There’s a two-day orientation for all new employees. Every few weeks, employees get a CEO update via email. There are also quarterly ‘formal update’ meetings, as well as quarterly “Coffee with Kimberly,” informal sessions where employees can meet with Boynton to discuss any Crouse-related topic or issue they may have, including potential improvements in patient care. There is no pre-set agenda for this forum. And after 90 days, new employees are welcomed to a new employee breakfast with Boynton where they can suggest improvements to the orientation process.
All these efforts ensure that Crouse functions seamlessly as an institution. “Everybody feels free to collaborate with each other, with no barriers,” Kronenberg said. “That’s where you get the best quality outcomes. That environment, where everybody functions as a team, is what separates us from other institutions.”
Crouse also prides itself on being a “physician-friendly” organization. “When we’re making decisions about anything — from care plans to budgets to service lines, there’s always a physician piece incorporated into it,” Boynton said.
Kronenberg said the administration is always transparent with the medical staff. “We’re open and honest with all the decisions,” he said. “Every decision made is based on what is best for patient care. So when you have that as the foundation physicians are engaged from the start.”
The best in patient care
Since patient care is at the heart of everything Crouse does, Kronenberg said the hospital has been working with its 3,300-member staff on improving the patient experience. “We’ve done a lot of work speaking with our employees about what the patient experience is,” he said. “It doesn’t mean that everybody is satisfied all the time. It means that we are there to serve the patient. And if there are issues, to correct them as best as we can.” In the last year, all Crouse employees have undergone specific training to learn about Crouse’s strategic initiative to improve the patient experience. The effort is paying off — patient satisfaction and engagement scores are improving, particularly in nursing.
“It raises the bar for all of us,” Kronenberg said. The efforts tie into Crouse’s internal motto of “Every moment matters,” Kronenberg said. “It’s every role, every person, every experience,” he said. “We can take the best care of the patient and can have a great outcome, and if the valet attendant is not attentive, or they have a negative experience with environmental services, we haven’t done our job.”
That motto, says Kronenberg, means every Crouse employee needs to step up and provide help to patients and their families, whenever they see a need. “Again, it doesn’t matter what your role is here,” Boynton said. “When management is doing and working and seeing and talking to patients and families in the same manner that we want our employees to, they know it’s the right thing to do.”
And employees have risen to the occasion. “Some of the best stories we hear are about experiences that patients have had involving what previously would be considered ancillary support — environmental services, engineering or the barista,” Kronenberg said. “One of the things we do to recognize them is go to their department unannounced — almost like a mini ‘flash mob.’ We’ll read the letter, post it, blast it out on social media. It’s a great way to recognize staff who probably don’t get as much recognition as they deserve.”
It’s not just little things that Crouse is doing to improve patient care; the hospital is undertaking major initiatives to make the experience better, as well. “One of the things we’ve been working on is a ‘quiet initiative’,” Boynton said. Noise on the units presents an opportunity for improvement and Crouse is working on different things to make the patient and family experience better when it comes to maintaining a quiet environment. This includes dimming the lights, providing patients who are watching TV with earbuds and working on the overall quietness of the floor to foster a more calming and healing environment.
Kronenberg reiterates that the patient experience is a major strategic focus for Crouse. “We have developed a five-year strategic plan and have been educating all employees on the patient experience and why it’s important. As part of this, we have put in place action items on specific areas — clean and quiet, nursing communication, physician communication, and all of these have specific action plans that involve staff at all levels, from nurses, physicians and other clinicians, to engineering, food services, volunteer services and housekeeping.” All these efforts — and the fact that everyone within Crouse Health is working together to ensure their success — contribute to a better experience for the patient during their stay, which, Kronenberg noted, is important to the patient’s overall health. “There’s a lot of literature that patient outcomes and patient experiences are linked,” he said. “So the better the patient experience is, the better the patient outcome.”
“In the end, ideally, we want patients to trust us by saying ‘Take me to Crouse,’” Boynton added.
A family of physicians — and more
Crouse is affiliated with some of the most talented and highly regarded physicians in Central New York, which, as Boynton points out, are “of the utmost importance to the success of the organization.”
“Whether it’s OB or robotics or neurosciences or cardiology, the strength of Crouse comes from the strength of the physicians,” Kronenberg said. “We’re here to provide the environment where physicians who choose to practice here can excel.”
Crouse’s providers are on the front lines of providing patient care, as well as helping to set the tone for the culture of the institution. “They drive that culture by how they treat each other and how they treat the nursing staff and how they interact with other support areas,” Kronenberg said. “The physicians who work here really believe in that teamwork.”
Kronenberg said the staff refers to Crouse as having “a family environment.” Boynton said the Crouse community is very supportive of one another. “One of our cardiologists tells a wonderful story about a situation that took place in the catheterization lab. It was a very difficult day for the staff,” she said. “And everyone saw that and knew it. And an environmental services worker approached one of our cardiologists at the end of the day, put her hand on his back and said, ‘Doc, how are you doing?’ It’s that sort of support that takes place here every day.”
Embracing inclusion
Doing the right thing is important to Boynton, and it’s an important part of Crouse’s mission, vision and values. That’s why, when Boynton took over as CEO and several employees approached her with concerns about the institution’s lack of diversity, she jumped into action. “When you looked across the management team, it wasn’t diverse. When you looked across the organization, you could see pockets of diversity, but it wasn’t throughout,” she said. “And we wanted to make a difference there.”
Over the next few years, the hospital launched new initiatives to increase diversity among its staff and to better equip workers to address the needs of a diverse population. Chief among those was the establishment of the Diversity and Inclusion Committee. This group of more than 20 employees has created an annual training that all employees must complete, as well as one that new employees undergo during orientation. The committee also organizes celebrations surrounding events, holidays and historical observations like Black History Month or, more recently, National Coming Out Day, inviting speakers from within the organization as well as the surrounding community to share their experiences with the staff. They’ve also helped to inform Crouse’s marketing and recruitment strategies so that the hospital is attracting more diverse candidates.
Kronenberg said the D&I effort has been successful because it’s become such an integral part of the culture at Crouse. “It’s reflected in human resources when they’re hiring. It’s in new employee orientation. It’s in recruitment and retention. The initiative also represents personal opportunity for every member of the staff, starting with the CEO. “I didn’t grow up in a diverse environment. I grew up in an Irish Catholic family and thought everybody in the world was Irish Catholic until I got to college,” Boynton said. “I had my own learning and growth to do.”
While at first some employees may have viewed the initiative as an additional burden, Boynton said she made it clear she was taking this seriously and expected them to, as well. “We made it clear from the beginning that this wasn’t just a training session, where you could simply check a box,” she said. “It’s not a separate thing that has a beginning and an end. It just becomes part of the organization, part of the culture.”
Both Boynton and Kronenberg said they’re proud to be part of an institution that genuinely encourages and supports such a culture while providing excellent care to thousands of Central New Yorkers every year.
“I’m very proud of the work that we do here,” Boynton said. “We see Crouse as an asset of the community and we’re just entrusted with it for a short period of time to make sure that it’s here for many, many years in the future. We have a rich history, and our job is to carry that history into the next generation.”
From CNY C-Suite V1-N1
