Cary Medical Center has earned ‘Tier One' status as a preferred hospital in terms of established measures of quality care and patient safety.  Cary, along with a number of other hospitals in the state was recognized by the Maine State Employees Insurance Program.  The recognition was based on the results of a survey conducted by the Maine Health Management Coalition.  Cary is one of a handful of hospitals in the State that has been on the list since the inception of the ‘Tier One' designation which began in 2006.  According to Frank Johnson, Executive Director of the Maine State Employees Health Insurance Program, the hospital rating system provides a benefit to members.  

      ‘The benefit design provides that if a member receives care from a preferred hospital, any services billed by that hospital are not subject to the annual deductible. Once the annual deductible is satisfied, there is no financial incentive. We remind members that the modest financial incentive was not designed to save the members or the plan money but to give them pause to consider patient safety and clinical quality issues when choosing a hospital. The tiered hospital is a tool to help them make informed decisions."

     The survey was designed by the Maine Health Management Coalition measures issues such as patient satisfaction, patient safety, and clinical quality.  Johnson said that response to the hospital comparative data has been generally positive.

     "We introduced this rating system to engage our members in assessing the variation in patient safety and quality measures among health care providers in our state.  We also believe this reporting system encourages the provider community to enhance transparency and public reporting.  We began this process in 2006 and we update the ratings every six months.  We believe the system has met our expectations.  While we may not have had a mass migration of patients moving to specific hospitals I can certainly say that we have had movement and that the reports generate great interest among employees and retirees.  Each time we update the report we communicate the revisions to all of our members including retirees.  We get a number of inquiries as to how the system is designed and why certain hospitals did not make the list.  We also monitor the Maine Health Management Coalition web site to review the feedback.  We plan to continue the effort.  The feedback we are getting from the Maine hospitals has generally been favorable and we hope to expand our reporting measures and to consider additional measures relating to tertiary care hospitals".  The Maine State Employees Insurance Program comprises some 34,000 members State wide.  

     To meet the ‘Tier One' or preferred status, hospitals must reach certain goals.  Kris Doody, RN and Chief Executive Officer at Cary Medical Center said that she was very pleased Cary made the preferred list again and she sees an increasing demand for public accountability.

     "We are very proud that Cary has made this list of preferred hospitals for the third time in a row.  We work very hard on all of the issues of clinical quality, patient safety and patient satisfaction.  Organizations like the Maine Health Management Coalition and others are revising and expanding their survey tools.  I believe hospitals will continue to be under the microscope of public accountability.  That is why Cary presents our quality ratings through our web site.  Patients and families have a right to this information and should use it to make more informed decisions." 

     Doody went on to say that the success of the hospitals quality program has been remarkable in terms of changing procedures and historical practice.

     "There are a number of measures in this survey that are challenging.  Members of our medical staff have been wonderful in how they have responded to the demands for change.  The quality measures are based on evidence based medicine and best practice from the physician's own professional organizations.  Without the support of the medical staff and their willingness to adapt to this new and changing science it would not be possible for us to meet these quality improvement goals."

     Patient Safety has also been a key area of improvement at Cary and is measured by the survey.  Cary Medical Center has advanced its performance in this area as well.  The hospital has introduced a fully automated medication dispensing program including computerized physician orders and bar coding of medications.  The use of computers for physicians when ordering medications reduces the risk of medication error caused by poor handwriting.  Bar coding of medication is done both on the medication and on the patient's wristband prior to the dispensing of the medicine.  The bar coding notes that it is the right medication for the right patient at the right time.  David Silsbee, Chief Information Officer at Cary said that the hospital is among a small list or rural hospitals across the nation to have a fully automated medication dispensing program.

     "We have really made great strides in recent years towards automation and the electronic

Medical record", said Silsbee who is a member of the hospital's senior management team.  "We are far ahead of most rural hospitals in the country and we are continuing to showcase new technology."

     Carl Flynn, M.D., Chief of the Medical Staff at Cary said that the move to computerized physician orders and other technology has been a challenge for clinical staff but the effort is paying off and is inevitable.

     "This is just the right thing to do for our patients and it is dramatically improving patient safety", said Flynn, who is a Family Practice Physician with Pines Health Services.  "Not only do these advances improve patient safety, they also streamline processes and help us to better manage costs by practicing smarter medicine.  New physicians, those coming out of medical school, are now quite familiar with the technology but it has been an adjustment for those of us who have been in the field for some time.  The entire health care industry is moving towards the fully electronic medical record and it is nice to know that Cary Medical Center is on the leading edge of this reality."

     The hospital has also implemented a number of patient safety programs related to patient falls.  A new ‘Ruby Slipper' program initiated in 2006 has had a remarkable impact.  The program identifies patients at high risk of falling and initiates prevention measures immediately upon the patient's admission.  Thanks to this and other efforts Cary has experienced the fewest patient falls in more than 12 years.

     In regard to patient satisfaction Cary is just now completing a three year organizational wide initiative to improve customer service.  The ‘Service Excellence' program is designed to engage front line employees in the process of educating all staff about ways to improve patient satisfaction.  Shawn Anderson, Chief Operating Officer at Cary said that the effort has generated a new level of energy around customer service and has identified some outstanding front line employees.    

     "Cary has a culture that revolves around quality and a personal approach to patient care", said Anderson who joined the senior management team at the hospital in 2004.  "We appreciate the efforts of all our staff in fostering and maintaining this culture and now we want to raise the bar.  Our employees who have led this training have been outstanding and they add a real credibility to the process.  We now have more than 100 employees who have been involved in teaching the program and they have created a powerful mentoring workforce committed to a new standard of customer service.  We have established a goal of creating the ‘5 Star Patient Experience'.  Our employees are coming up with new ways to better serve patients and families and it is showing in our patient satisfaction scores."  Cary Medical Center, like many hospitals in Maine utilizes the services of AVATAR, an international survey company to assess its level of patient satisfaction.  The company randomly surveys patients who have experienced care at the hospital.  Results of the surveys are analyzed and reports are routinely sent to the hospital.