This article first appeared in the St. Louis Beacon, Sept. 25, 2009 - Work smarter! That's good advice for all employees, especially in health care, where inefficiencies can run up costs and mistakes can cost lives. That's the advice BJC Healthcare, the St. Louis region's predominant hospital group, wants to impress on all of its employees, from its lowest-paid hourly workers to its physicians and top executives.
That's also the rationale for the BJC Learning Institute, formed last spring and now occupying the better part of a new six-floor office building at Hanley and Eager roads, just south of U.S. Highway 40/Interstate 64.
Here, BJC has brought together 250 specialists to work across disciplines toward the twin goals of upgrading the job skills of all 26,000 of the system's employees and improving outcomes for all of its patients.
Like a university, the institute is a place of teaching as well as leading-edge research.
One group of the institute's researchers -- including nurses, pharmacists, physicians, epidemiologists, statisticians, computer programmers and engineers -- monitors adverse medical problems at all 11 BJC hospitals, comparing rates to national ones and working with the hospitals to improve results.
The group goes back about 15 years and claims credit for reducing certain hospital infection rates by 80 percent over the past decade. While continuing to watch infections, the group is currently collecting data on incidents like blood clots, pressure ulcers, patient falls and errors in medicine use.
"We have a lot on our plate," said Dr. W. Claiborne "Clay" Dunagan, the physician who started and still leads the group.
Another of the institute's groups brings together nurses, engineers and MBAs, who use analytical methods borrowed from industry to streamline and standardize procedures like patient admissions and discharge in the BJC's nine community hospitals. (As teaching hospitals, Barnes-Jewish and Children's necessarily use different protocols.)
This group is new, predating the institute itself by a little more than a year, but it can already claim achievements. Shelly DeVore, the nurse who heads it, offers an example: After the group's studies showed nurses and doctors asking newly admitted patients many of the same questions, 30 percent of the questions were eliminated as needless duplications. The group is now studying, among other things, how best to record and execute physicians' orders and to make sure patients get the right medicines at the right time.
The answers will almost certainly entail technology, which DeVore calls key to BJC's goals of eliminating waste, freeing doctors and nurses to spend more time with patients, delivering "efficient, safe, patient-centered care" and lowering costs.
But what technology? For answers, Learning Institute researchers can turn to on-site information technology specialists, who can analyze, for instance, the feasibility of a touch-screen that patients might use to fill prescriptions before they go home. The group is also charged with staying abreast of all emerging hospital-related technologies and how the BJC system might use them.
Lifelong learning keeps turnover rates low
The institute is also home to BJC's Center for LifeLong Learning, which grew out of an initiative several years ago to reduce turnover rates among such entry-level workers as clerks, housekeepers and patient transporters. Administrators learned that the workers often felt stuck in their jobs, lacking the skills or schooling to advance.
JoAnn M. Shaw, then BJC's vice president for human resources, had an idea: Bring some of these employees together once a week for nine months; review basic reading, writing and math with them; encourage them to aspire; and tell them about BJC's tuition reimbursement program, available for the GED or college courses they might need to upgrade their skills and resumes.
Shaw's idea worked spectacularly. The turnover rate among the employees of concern plummeted to 3 percent from 20 percent, saving BJC the cost of training replacements. So the program, called School at Work, stayed -- and continues to this day.
At least 80 percent of those who have been through it have stayed with BJC, and half of them have been promoted at least once to such new jobs as secretary and medical technologist, Shaw says.
Oliver Washington is one of School at Work's standout graduates. A cook and baker when he joined BJC five years ago, he was promoted to lead cook before he even finished the program. And then, newly confident and encouraged, he immediately applied for and got his current job as a patient advocate in the Barnes-Jewish emergency room. He has since taken on additional responsibilities as a cultural and diversity trainer for his department, and he has received raises.
As a home for School at Work and other in-house educational programs Shaw subsequently devised, BJC in 2002 established the Center for LifeLong Learning, put her in charge of it full time and titled her the health system's "chief learning officer."
Today the center proclaims "a program for every employee." Offerings include short, non-credit personal-enrichment or job-related courses in topics like communications, leadership, conflict resolution and computer skills. More than 800 of these are available online. They are so popular that last year 17,000 employees got involved -- for a total of 247,000 separate online enrollments.
The center also delivers education the old-fashioned way -- in an classroom with a live teacher. A day-long course in Microsoft Access, for instance, drew 10 BJC employees. They included a financial analyst, internal auditors and nurses, all having squeezed time from their workdays to learn from Kris Jorstad, one of the center's 13 staffers. He taught them how to use the program to generate and refine reports. Why nurses? Because, as Jorstad explained to a visitor after class, "nurses are expected now to understand how to collect data electronically."
For the credentials-minded, the center even offers a high school diploma, St. Louis University and Washington University bachelor's degrees and Webster University's MBA program -- all taught from start to finish at the institute. More than 300 BJC employees are enrolled in these programs, keeping the institute humming evenings Monday through Thursday. Students include Washington, who started his SLU degree a year ago, taking a class a week.
The center's offerings have been excellent and key to his career, Washington says. "There's no way I could have done it without these opportunities."
Working together, learning together
Its extensive and expanding menu of learning opportunities has earned the center and BJC national recognition. In 2007, the American Society for Training & Development ranked BJC the nation's 19th best workplace education program and No. 1 in health care. Earlier this year the Corporate University Xchange cited the center for excellence in use of learning technology.
The center sets the Learning Institute apart, according to Lee F. Fetter, president of St. Louis Children's Hospital, BJC's group president for learning and innovation and the institute's head. It's not uncommon for health-care organizations to set up groups like DeVore's and Dunagan's, but it's rare to find them side by side with "a curriculum that would apply to every level of employee through the entire company," he said.
In bringing the center and the Learning Institute's other components together physically, BJC was mindful of the visuals, working with architects HOK to create an interior speaking to the institute's purpose.
For one thing, there's a deliberate uniformity about it, with, for instance, identical desks for all employees. This is a way of telling people "there's too much variation in health care," Fetter says. "We're trying to deliver a message on the need for standardization."
He added, "We wanted the space to feel different. We wanted people to feel that they are collaborating with each other. We wanted lots of glass. We wanted flexibility."
And they got it -- an airy, light-filled, inviting place with few walls. Much of the furniture is movable, so that meeting spaces can be quickly created as needs arise. Walkways are laid out with many intersections "so that people literally, physically bump into each other and have a chance to have a conversation with each other" -- the better to share ideas, Fetter said.
Sharing is happening, according to DeVore. "We're all learning from each other. We work very closely with everyone here. It was a great design to put this all together."
Susan C. Thomson is a freelance writer in St. Louis.