In our third annual Readers' Choice survey, ADVANCE asked nurses to rank hospitals based on their performance in the following areas: quality of care, organizational culture, communication, professional development and retention efforts. Six facilities made the select list of "top hospitals" within the Southeastern States:

• Mary Black Health System, Spartanburg, SC

• Piedmont Hospital, Atlanta

• Randolph Hospital, Asheboro, NC

• University of Alabama Birmingham Health System, Birmingham, AL

• Wake Forest University Baptist Medical Center, Winston-Salem, NC

• WakeMed Health and Hospitals, Raleigh, NC

While calculating how well a healthcare organization or nursing staff cares for a population is hardly an exact science, we at ADVANCE believe our unscientific poll of our readership (i.e., your peers) provides a fair, comprehensive evaluation of the healthcare institutions located in the Southeastern States and the patient care they provide.

"That's such an honor to be recognized by readers for setting a new standard of excellence," said Mary Ann Wilcox, MS, RN,C, CNAA, BC, senior vice president and chief nursing officer at WakeMed Health and Hospitals, Raleigh, NC. "Everything we do from clinical practice and clinical outcomes to customer service to how they take care of each other in the workplace - I think it's a wonderful affirmation."

So, what deciding factors led nurses to give themselves and their administration favorable ratings? The results are below.

Organizational Culture

From what our readers have told us, a facility's culture, or environment, serves as the umbrella that determines how well patients are cared for and how well staff members work together.

And among the nursing executives ADVANCE interviewed for this story, a facility's willingness to establish shared governance was a popular component behind what's pertinent to a positive organizational culture.

"I think a lot of it has to do with the shared decision-making that goes into shared governance," said Maureen Sintich, MSN, MBA, RN, WHNP-BC, NEA-BC, vice president of operations and chief nursing officer at Wake Forest University Baptist Medical Center, Winston-Salem, NC. "Shared governance is really a mechanism to ensure that nurses from the bedside to [administration] participate in the way we provide quality care."

At Wake Forest, which employs a nursing staff of more than 2,000, staff nurses are invited to participate on boards that govern matters related to nursing practice, clinical care, establishment of policies and procedures, professional development, and research initiatives regardless of how long they've been in the field.

"New nurses out of school participate from the very beginning at the unit-based level," Sintich said. "So it's interesting to see the differences among those who've come from other organizations and how much they enjoy the engagement. I think our shared governance structure really gets to the heart of nursing, and nurses participate throughout the organization at all levels."

The staff nursing council at WakeMed Health and Hospitals includes a staff nurse from each unit that meets monthly to discuss various issues that affect the organization as a whole as well as effective practice at the unit level, Wilcox said.

"It's really given staff nurses a voice in managing and running their clinical practice," she told ADVANCE. "It's just an incredibly healthy, caring culture within the organization. It's almost palpable when you walk in. People hold each other accountable for treating each other with respect. We like to call it the 'Wake Way.'"

At Randolph Hospital, Asheboro, NC, council staff members meet formally each month as well as informally, when necessary, to address issues such as ways to improve patient care and outcomes, and means to increase patient and staff satisfaction, said Tremonteo Crawford, MSN, RN, chief nursing officer.

"And when changes occur, staff is very involved in making those changes," she said. "They're taking ownership for the changes made in practice.  [And] ongoing collaboration with their colleagues has yielded greater positive patient outcomes. It is such a rewarding experience for our nurses."

Communication

Directly impacted by a facility's culture is the effectiveness of its communication - not just from nurse to patient but from nurse to colleague, say those interviewed by ADVANCE.

From a patient's perspective, communication in the ED at Piedmont Hospital, Atlanta, is bolstered by newly initiated care maps that guide people through the department and the services they receive, said Connie Whittington, MSN, RN, vice president of patient services and chief nursing officer.

Upon arrival, patients receive a "map" (actually a list of expected treatment protocol) particular to the assessment they're given by the triage nurse.

"If we think they may have pneumonia, the patient will see that they'll get an X-ray, blood drawn, see a doctor and may be admitted to the hospital," Whittington said. "So it's very easy for patients to understand what's going to happen and how quickly it's going to happen. And it gives them a tool to communicate across with their providers."

At Mary Black Health System, Spartanburg, SC, staff communication flows from administration to the floor and between departments through the hospital's "Community Cares" initiative, a program that requires management to conduct routine rounds with staff and calls for senior leadership to highlight important issues during quarterly meetings with staff that mimic town hall gatherings.

Involved in these initiatives is Chanda Flynn, MSN, RN, CEN, CNAA, BC, chief nursing officer, who said she visits each unit frequently to meet with staff.

"It's important that the staff sees me, know that I care about what they do and have what they need to do their jobs," she said.

Furthermore, at Mary Black staff can volunteer for 2-year stints on its nursing leadership group, which meets monthly in an open forum to give insight on what nurses consider important concerns at the facility.

Retention Efforts

Both communication and organizational culture are said to go a long way in retaining staff, ADVANCE has learned.

At Randolph Hospital, retention is actually considered before the hiring process and benefits existing staff members, who assist the facility's recruiter in scouting and interviewing potential new staff, as Crawford explains.

"The staff accompanies the nurse recruiter at job fairs and area college special events," she said.  "Job shadowing is [also] highly encouraged [and] provides an opportunity to 'get up close and personal' with our staff."

Additionally, Crawford said staff is very active in the interview process for new hires. 

"It is our belief that a strong recruitment process and effective hiring process yields a good fit for the new hiree and a good fit for the facility," she continued. "Attention to these processes will result in retention of engaged staff."

At WakeMed, where Wilcox says the vacancy rate is only about 3 percent, all staff goes through 6-8 weeks of assisted training but the orientation program especially benefits new graduates, she noted.

"It's really a time when we're helping them get their clinical skills nailed down and setting them up with strong coaching and mentoring to the culture of being a nurse in addition to the actual hands-on skills of taking care of patients," she said. "But I think what really keeps nurses here is their commitment to caring for our large [population of] indigent patients. Especially now, when times are really tough, there are a lot of places you could go and life would be easier. But they choose to stay here."

Part of the facility's retention success is also due to administration's willingness to keep existing incentives like flexible hours in place despite a down economy.

"A lot of hospitals, when times got tough, got rid of their weekend programs," Wilcox added. "We still have ours, and most of my staff nurses who work during the week do not work weekends. And if they do, they work very few because we really believe it's important to have a work/life balance."

Each administrator interviewed by ADVANCE also cited tuition reimbursement as a major incentive in keeping staff motivated to work through sluggish economic times.

Professional Development

Also common among the survey's top-rated facilities, but unique in their own right, is the existence of internal performance-improvement and recognition programs.

At Wake Forest, a clinical advancement program allows nurses to participate in and develop evidence-based projects that include monetary bonuses and recognition among fellow staff.

"We recognize that we don't do these things by ourselves; it really does take a team to make a difference," Sintich said.

Still, the facility participates in the DAISY Foundation's awards program, a monthly initiative run by the nonprofit organization that recognizes nurses chosen by their administrators, peers, physicians, patients and families.

"It's quite meaningful when your colleague recommends you for an excellence award," Sintich said.

Mary Black's GEM (Going the Extra Mile) program is a volunteer-based effort that offers nurses the chance to apply for evaluation twice annually. To be considered, nurses must be involved in such activities as community education and training of co-workers. Benefits include paid time off to attend continuing education sessions and stipends dependent upon achievements.

"It's been a positive way of rewarding people for work they've been doing anyway," said Flynn, who helped implement the program.

The ACE (Advanced Career Enhancement) program at Randolph Hospital also extends a voluntary opportunity for nurses to apply and be rewarded financially, as well as with a formal dinner, as a group each year.

To participate, staff members must fulfill criteria like reading research journal articles, assisting in educational programs for staff, serving as preceptors, obtaining national certification and participating in poster presentations at national conferences, Crawford said.

"Our nurses are involved in so many things that we want to highlight their many accomplishments," she continued. "We are extremely proud of our nurses, and we want to say 'thank you.'"

The program has also contributed to the facility's nearly reaching 35 percent of its nurses holding a BSN degree, a number Crawford said is impressive for a rural hospital.

Quality of Care

Of course, everything adds up to delivering care that results in satisfied patients and documented positive outcomes.

Administrators said that's tough to define, but when you have it, you know it.

"Our nurses are the most committed, compassionate and passionate that I've seen," Sintich said. "The fact that they strive for excellence in everything they do and how they care for patients on an everyday basis is exciting. When I talk to our patients and families, you can see the difference that our nurses make. It truly does remind me everyday of why I became a nurse."

Methodology

ADVANCE provided a list of 445 hospitals in the Southeastern States and invited readers to rank their facilities by responding (on a 1-5 scale) to 10 statements regarding five different categories.

From this list, participants voted on 52 different hospitals. A minimum number of three participants had to vote on a hospital in order for it to be part of the calculations.

We then took the total score for each question and determined the average score per hospital, per category. The highest possible score was 5. A total of six hospitals in the Readers' Choice list earned an overall average score close to or more than 4. Four of those facilities scored above 4.

Joe Darrah is senior associate editor at ADVANCE.