In the center of Emanuel Medical Center’s busy emergency department nurses’ station is a cubicle for Lani Dickinson. The hospital’s interim CEO often uses the space as a way to get a pulse for the medical center’s daily business of providing high-quality care for the community. Dickinson has even been known to put in a few late night/early morning hours in the ER to better connect with all the hospital’s staff and patient needs.
Dickinson’s efforts have not gone unnoticed.
“We’re so happy to have her. I see good things happening,” said Patient Management Specialist Marge Madrid, a nurse with over 16 years’ experience at Emanuel Medical Center.
Although Dickinson has only been the chief executive officer at Turlock’s Emanuel Medical Center for about six weeks, she has made significant changes to the way patients receive care — especially in the hospital’s emergency department.
Dickinson has been serving as the interim CEO at Emanuel since early March, when Tenet Healthcare Corporation, which owns EMC, announced the departure of Sue Micheletti.
The interim CEO said she didn’t have a specific plan for change when she first arrived at Emanuel. Dickinson, who was familiar with Emanuel serving as Tenet’s Western Region Chief Nurse, first asked around about what the hospital does well and what it needs to improve.
“So, we have some community perception problems…I’ve started scheduling every patient complaint to meet with me directly… I’m getting a real feel for what the community feels like we need to improve. My vision is we have to do a much better job at patient experience,” she said.
Dickinson focused on the emergency department because 70 percent of the patients served by Emanuel each year originally come to the hospital through the ER. The changes she implemented aim to smooth the process from being a patient in the ER to one who is admitted to the hospital.
When a physician in the ER decides that a patient needs to be admitted, the nursing director from the inpatient floor now goes down to the emergency department and checks in with the patient and continues to check in every two hours until he or she is given a bed on the inpatient floor.
Dickinson also set up a separate area of the emergency department for patients who a doctor has decided to admit to the hospital. This separate eight-bed unit is staffed with inpatient nurses and a physician who just focuses on the patient’s admission.
“What it does is it pulls admitted patients out of the ER, so then people in the waiting room have a place to go…anytime you have an inpatient sitting in the ER waiting for a bed, there’s somebody in the lobby who is sick and can’t get back there,” she said.
Another change Dickinson made in the ER was a focus on care continuity. This means letting patients know what healthcare resources there are in the community as a way to try and “keep them in their home and independent,” she said.
Along with new procedures in the ER, Dickinson also made changes at the bedside.
“In healthcare in general, a patient comes in and they don’t understand anything that’s going on around them. Nobody’s really talking to them in a way that they understand,” she said.
To address this problem, Dickinson is now having the nurses give their shift reports in front of the patient. Along with going over the status over the past shift, it also allows the nurses to ask the patient how their medicine has been working or if they have any other questions. Emanuel has also implemented hourly rounds, where the nurse checks in with each patient.
Dickinson also had the nurses change the way they give out medicine.
“In healthcare in general, we’re used to talking at the patient and telling them what to do…So we’ve changed the way we do medicine passes, we’re teaching the patients how to ask questions. We’re giving them the power to ask the questions. We’re here to answer your questions so that you can feel safe when you go home,” she said.
Now, the patient is given a card with three questions on it to ask the nurse: What are my medications? What is the purpose of the medications? What are the potential side effects?
According to Dickinson, this activates an active learning process and allows patients to be more informed about their care.
“This is all focused at the bedside to get patients more involved in their care and so they don’t feel we’re just rushing over them, we’re including them,” she said.
Dickinson said that the hospital has already seen a marked improvement in patient satisfaction.
Along with focusing on patient experience, Dickinson has been addressing staffing challenges.
“We are short nurses. Part of that is there’s not enough in the pipeline, so that’s the nursing shortage problem, but part of that is Emanuel is behind on wages. Prior to Tenet taking over, they hadn’t gotten raises in a number of years…they were struggling financially here. Since Tenet took over, they have done what we call a merit increase…and a market adjustment…Our wages are behind the rest of the facilities in the Valley, we know we need to improve that and we’re certainly working on that,” said Dickinson.
The CEO is also working with the nursing program at Stanislaus State to get students doing their clinical studies at Emanuel. Dickinson said this could help get bachelor-prepared students through the hospital and give Emanuel a better chance at recruiting them once they graduate.
“And when they finish school our wages should be caught up, so we wouldn’t have that issue,” she said.
However, Emanuel — and Turlock’s — biggest challenge, according to Dickinson, is the lack of primary care and specialty care physicians.
“People don’t have doctors. That’s part of the reason we have 71,000 ER visits a year,” she said.
While it’s easy for Emanuel to transfer patients to Tenet sister hospital Doctors Medical Center in Modesto for specialty care, from the patient’s perspective that is not ideal, said Dickinson.
“We have a whole team of people at the national level and here locally who are constantly trying to recruit. We have active recruitments where we try to incentivize physicians to come here by helping to relocate them into an existing office so they have partners right away so we can guarantee their income while they get started. We do all kinds of stuff to try and get those doctors here, but it’s incredibly hard to recruit to the Central Valley,” she said.
Despite the challenges, Dickinson — who started her healthcare career as a unit clerk at Doctors Medical Center in Modesto and left as chief nurse and then decided to “bridge the gap” between what happens on the floor and the administrators making policy by going back to school to get a master’s degree in business administration — is excited about being a part of the Emanuel family.
“I was the Western Region Chief Nurse for Tenet Healthcare for a couple of years and during that time I was fairly acquainted with Emanuel, I would come here off and on. So, obviously, I developed a liking or admiration for the staff here,” she said.
“This has a very different feel from many hospitals…I’ve been in probably 50 hospitals and it’s palpable here, there’s a true connection and love of the community. There’s a sense of pride and ownership that I haven’t necessary experienced on that level at other places,” Dickinson continued.