Nebo Valley Healthcare

SOCIAL RESPONSIBILITY REPORT: NEBO VALLEY HEALTHCARE 1

Nebo Valley Healthcare

Social Responsibility Report

Mike Daley

SOCIAL RESPONSIBILITY REPORT 2

Traditional business practices have long been based on customer

service and creating an ever increasing bottom line. In the past,

making a profit has been the sole purpose of any business. Making

money is the key to surviving in the business world and having a

viable business for a long period of time. This is still true today,

if the business does not make money, it will not survive. In the

business world today, a company has some even bigger responsibilities

than just the creating a bottom line. The company has the

responsibility to create a bottom line that includes more than just

making a profit. It is vital that companies know and understand their

social responsibilities to the world. This social responsibility

includes a bottom line that is successful in profits, people and the

planet. In addition to making a profit, the company must do what is

right for the people and for the environment in which they live.

Corporate social responsibility is defined as "the way a company

acts that enhances society and its inhabitants and is held accountable

for its actions that affect people, their communities and their

environment." (Lawrence & Weber, 2011) Many companies now track their

social responsibility score through the use of rating organizations

and customer surveys, and publish the results in their annual reports.


They recognize their investors and customers want to understand how

companies are taking environmentally responsible actions. At Nebo

Valley Healthcare it is no different. They must create a new way of

looking at the bottom line that includes the people that work for them

and the environment in which they do business. (Lawrence & Weber,

2011)

Nebo Valley healthcare is a not-for-profit healthcare

organization that operates both hospitals and clinics. It has been in

business since 1978 and has worked hard to meet the medical and health

demands of the communities in which they serve. It is well known for

its amazing clinical outcomes and has been recognized for its work in

controlling costs and keeping the cost of healthcare down. Healthcare

costs are a very hot topic, both politically and in the communities

that are served by Nebo Valley. They have done an amazing job in

keeping costs low and creating the best care for their patients. The

following is a report that focuses on what they can do as an

organization in developing and growing their social responsibility.

This report will focus on four aspects of their responsibilities and

make recommendations for improvements in each of the four areas. This

report will look at their footprint in the environment, the ethics of

how they conduct business, organizational viability and any legal and


regulatory considerations. By looking at all of these areas closely,

and making recommendations, we will work together to have a strong

plan for being socially responsible to those served by Nebo Valley

Healthcare.

Environmental Considerations and Recommendations:

Nebo Valley Healthcare has an obligation to the community to do

what is right for the environment and the communities in which they

serve. They currently are doing some really good things for the

environment such as controlling waste, water conservations and energy

conservation. They have done some amazing things in these areas which

have allowed them to lower costs, but more importantly increase their

contribution to the environment in which they do business. In this

report, we recognize the work that has already been done and will make

some additional recommendations to lower the carbon footprint of Nebo

Valley and increase their commitment to bettering the environment

around them. Nebo Valley Healthcare is committed to fulfilling their

community stewardship, as part of the dimensions of care for the

organization. Part of what they have committed to do, as a healthcare

organization, is to give back to the communities that they serve. This

would include creating a stronger emphasis on reducing their carbon

footprint to the environment. The following are recommendations of


how they can increase their efforts in a commitment to the

environment.

The first recommendation is the enhancement of the recycling

program of Nebo Valley. Currently they are doing a small recycling

program that includes mostly the recycling of paper. They have in

place a document shredding program to shred all the documents with

personal protective information on it. This, of course, is a federal

requirement, but included in this plan is the recycling of that

shredded paper. The recommendation is to move to a more advanced and

facility wide recycling plan that would allow them to capture things

such as paper, aluminum cans, plastic, and other recyclable items.

Currently, these items are all being placed in the municipal waste and

being taken to the landfill. This practice is not in compliance with

being socially responsible and doing the right things for the

environment. The recommendation is to create a single stream

recycling program in both the hospitals and the clinics to capture all

the waste that can be recycled, instead of sending this waste to the

landfill. This will be developed and implemented with the help of

their current waste stream provider and set up with specific goals to

achieve. There are many advantages to creating this program, they are

as follows:


It is the right thing to do for the environment and the

communities in which we live. They have the ability to redirect

nearly 4 million pounds of waste a year from the landfill to be

recycled.

This program will give a better perception to the community, the

patients and customers as they see their efforts to recycle,

where ever possible.

This recommendation will also lead to an eventual cost savings

for the company. There will be some initial costs for containers

and equipment, but this will lead to a cost savings in the

overall costs of the waste stream. By redirecting at least 23%

of the waste to recycling, they will save money. Most recycling

plants will pay for the waste they receive, but all of them do

not charge for the handling of this waste. That means that Nebo

Valley can take nearly 4 million pounds of waste, which we would

be a cost at the landfill, out of the waste stream costs for the

company. This is an estimated savings of $70,000 a year in waste

stream costs.

In relation to the environment, this would be 4 million pounds of

waste that is reused and repurposed and not places into the


landfill. This alone is would be a major step forward in being

more socially responsible.

The next recommendation has to do with water conservation at both

the central laundry and also at two of their older facilities. Water

conservation is an area that has not been looked at very aggressively

in the past. It is any area that needs to be looked at closely to see

where they can make some changes. Most of their facilities are

situated in a desert climate and water is getting scarcer each year.

Nebo needs to do their part in conserving as much water as they can.

Currently the central laundry uses .92 gallons of water per

pound of laundry. Even though this is below the national average,

they can still make some adjustments to what they do to lower this

even more. With the use of some new technology that is available,

they could lower their numbers to .52 gallons of water per pound of

laundry. There are places in the country and that hitting these lower

numbers with the use of this new technology. In talking with the

teams at the central laundry, it is possible for them to implement

this new technology and reduce their gallons per pound of laundry to

reach their goal of .52 gallons, over the next two years. The cost of

the new technology is programmed to pay for itself, in costs savings,


in less than 3 years and will bring additional costs savings in future

years, adding to the benefits and advantages of making this move.

The other water conservation recommendation is also to adapt a

new water treatment system in two of the older facilities that

scheduled for an upgrade. By including this new alternative water

treatment system in the upgrade of the facility, they could save an

estimated 105,625 pounds of water a year, at each of the two

facilities. This is a fairly easy fix since it will be completed with

the scheduled upgrade of the facilities boiler rooms. Instead of

keeping the water treatment system they currently use, they can put in

this new alternative water treatment system and conserve a total of

211,250 pounds per year with this switch. By being aware of new

technology and taking advantage of it, they can not only conserve

water but enjoy savings as well. The recommendations made here, for

water conservations, will allow Nebo Valley Healthcare to add to their

commitment of community stewardship in the areas that they serve.

The final recommendation for the environment is for them to

continue their efforts to reduce the carbon footprint through the

fleet vehicles. Nebo Valley has a large number of fleet vehicles,

most of them are smaller box trucks that deliver supplies out of the

supply chain center. In the past several years they have converted 23


of their fleet vehicles to natural gas and have reduced their carbon

foot print by 20%. The recommendation is to continue that effort and

replace even more of their existing vehicles to natural gas. Nebo

Valley is scheduled to replace 25 more vehicles over the next two

years. These vehicles have already been scheduled to be taken out of

the fleet and replaced with new vehicles. The recommendation is to

replace them, wherever possible, with vehicles that run on natural

gas. In looking at these 25 vehicles, it is believed that they could

replace 21 of them with vehicles running on natural gas. This would

give is a total of 48 vehicles that run on natural gas and expand

their reduction of carbon footprint of their vehicles to close to 40%.

These recommendations will demonstrate Nebo Valley's commitment to

fulfilling their community stewardship mission, save costs, and help

the environment.

Ethical Leadership Recommendations:

Nebo Valley Healthcare has in place some very strict and straight

forward ethical requirements for its leaders. There are many things that

Nebo Valley does in order to ensure that their leaders and employees are

ethical all that they do. Every day, patients and their families come to

them in times of need, trusting that they will give them their very best

medical care and service. Nebo Valley is committed to honoring their


trust by providing excellent clinical care and superior service with the

highest standards of integrity. This commitment applies to every aspect

of their work, and is fundamental to their mission, vision, and values.

Nebo Valley's expectation is that every employee, clinician, trustee,

vendor, contractor, and volunteer, who is a part of their organization,

to understand and follow the rules and requirements that apply to their

work. Even though they are doing a great job in the area of ethics, there

are still things that they can do add to the great work that is already

being done. The following are some recommendations that can lead to

helping them become more ethical in all that they do.

The first recommendation comes in the way of the training of their

leaders. Currently, new managers go through an ethics class when they

are first hired. This class covers the code of ethics and their

responsibility in keeping this code. This is a great class for new

leaders and gives them the opportunity to learn how they should conduct

their work ethically. After this class, there is really not much

training given to existing leaders, as a reminder of what they need to be

doing. The recommendation being made is to have each leader be assigned

to attend this ethics class every two years, as a reminder of their

ethical responsibilities. In the world of healthcare there are so many

regulations that must be met, each and every day, when it comes to


patients, their information, and what they do day in and day out. With

so much on the plates of their leaders, it is imperative that they

retrain to their code of ethics every two years as a reminder of all that

we need to be doing, as leaders, in order to be as ethical as possible.

Creating an ethical environment is more involved than creating a

policy and directing employees to be “ethical.” An ethical work

environment is one where it is easier to discern and do the right thing,

than it is to do the wrong thing. This type of culture is not created

overnight, nor is it created by posting a list of the company values on

the wall. It is created by a constant reminder of those values and what

the responsibilities are, of each employee, to perform their work in an

ethical manner. In order to accomplish this, the recommendation is that

every employee has the opportunity to be trained on each of the values of

Nebo Valley Healthcare each year. As part of the online learning plan,

which is sent out each quarter, a new learning module will be developed

for each of the four values of Nebo Valley. By learning the values of

integrity, accountability, trust and mutual respect, they will be taught

how they can use these values to accomplish their work ethically. The

more they are able to learn, and have these values in front of them, the

more likely they will be to follow them. Part of this training will be

to show them the benefits of following the values and the consequences if


they chose not to. This recommendation will allow Nebo Valley the

opportunity to create a culture of ethics throughout the organization.

Unfortunately, no matter what is done to create a culture of

compliance and ethics, there will be those who chose not to follow what

is required. One of the issues that Nebo faces is the reporting of such

violations of noncompliance. They train to it, and will train even more

from the recommendations above, but what happens when someone violates

the policy or is unethical in what they do? How does that get reported?

The last recommendation is the creation of what will be known as the

"compliance hotline" This will be a hotline that anyone can call to

report any violation of patient safety or any problem they feel is in

violation of policies of Nebo Valley. This hotline will be open 24 hours

a day, 7 days a week and will allow for an easy way to report violations.

This will be an anonymous hotline, making it easier for staff or patients

to call and report, without the fear of retaliation. This number will be

posted in all areas of the hospital and in the welcome packets for the

patients. Once a problem is reported it will be directed to the

department manager, where the problem occurred, and also to the HR

consultant for investigation. The department manager would then be

accountable to investigate the complaint to see what happened and take

any action if it is needed. The actions will include fixing the


situation, holding employees accountable and ensuring that ethical

behavior takes place. This is not a complaint hotline, but a way for the

employees to have the opportunity to share ethical and compliance

violations. This allows them a safe environment to help ensure that when

unethical acts occur, they can be reported and corrected. This hotline

will be staffed by the compliance department and all violations will be

funneled down to the compliance officer at each facility. The compliance

officer is then accountable to follow up and ensure that it has been

properly investigated and there is a resolution when the occurrence is in

violation of any compliance issues.

Organizational Viability:

As a not-for-profit organization, it is often thought of that they are

not in the business to make money. They have to make money, just like

every other business, to stay alive and functioning. Revenue that is

generated must be higher than the expenses incurred. If they did not

make a profit, they would not be able to continue serving the communities

as they currently do. Not-for-profit organizations are formed to operate

for the benefit of the communities they serve. Surplus funds are used to

cover operating expenses and are typically reinvested to further their


charitable purposes. So that said, they need to look at ways that they

can be more viable as a company. The recommendations below are made to

help the organization remain viable and continue into the future.

In the business of healthcare, the best and most important resource is

the staff. They bring with them the knowledge, experience and ability to

take the best care of their patients. Without the staff, they could not

operate their business. The first recommendation on the viability of

their company is to continue and expand the live well program that has

been put into place. This program is designed to help their staff live a

healthy and well balanced life. Currently, this program has been

optional for employees to participate in and take advantage of the

education and experience of health care workers. The recommendation is

to make this program mandatory for all staff members and continue to

expand the program in bigger and better ways. This does not mean forcing

the staff to exercise, but encouraging them to live the healthiest lives

possible. This will be done through training, classes, and the

opportunity for staff to have access to this information. The live well

learning modules, that are a part of the quarterly required training, are

currently optional for staff. Last quarter only 28% of the employees

took advantage of these live well learning modules. These modules of

healthy living need to be made mandatory in order to help promote


wellness. Once the staff have the information, they are more likely to

make changes in their lives and in the lives of their families. Helping

them to live the healthiest lives possible will cut down on sick calls

due to illness or injury and allow the staff to be at work. It will also

help them to feel better overall, leading to a more engaged staff. In a

business where the staff are your greatest resource, doing things to

promote their wellness will help lead to the overall viability of the

business in the future.

In the ever changing world of healthcare, finding ways to do more with

less is a vital part of doing business. With the onset of the Affordable

Care Act, Obama Care, and Value Based Purchasing, healthcare organization

must be very vigilant in what they do and how they spend their money.

The biggest expense, in the operational budget, is staffing. If an

organization is able to help control the staffing levels, it can lead to

some major cost savings. The recommendations for Nebo Valley is to

develop a staffing best practice protocol, that will allow for each

department to staff at the right levels to meet the needs of the

patients. This protocol will make it possible for the company to staff

appropriately and still meet all the criteria for patient care and

patient safety. These standards will work to get rid of the fluff in the

schedules and staff at the most appropriate levels. As we have seen,


there are departments that currently do this very well and are staffing

at appropriate levels. This process would allow for Nebo Valley to set

clear guidelines for staffing, with the use of benchmarking each of the

department against the departments that do it well. Setting a benchmark

for staffing and working to meet that benchmark will allow for Nebo to

save money and be more efficient in what they do. In order to meet the

demands of a reduced revenue cycle through provisional changes to

Medicare and Medicaid reimbursements, staffing at the most efficient

levels will become necessary. Setting these standards and working to

meet them through benchmarking will allow for these changes to take

place.

Looking closely at the Value Based Purchasing requirements through the

Center for Medicare and Medicaid (CMS), it is clear that changes in the

customer service approach for Nebo Valley is needed. These

reimbursements will be based on the hospitals ability to meet the

customer service expectations of CMS, in order to get the maximum

reimbursements allowed for them. If Nebo is not able to meet these

customer service expectations, they stand to lose millions of dollars

each year in reimbursements. Nebo Valley has historically done well on

their patient scores, but as it stands right now they would lose money on

reimbursements. They need to work to improve their interactions with


patients, thus increasing their scores. By so doing they will be

eligible for the full reimbursements from CMS. The recommendation is

that Nebo Valley partner with an outside company that teaches staff

members how to interact with patients and works to improve their scores.

There are several options out there but the recommendation is to use the

Studer Group as their partner to help increase patient satisfaction

scores. The Studer Group has a proven record of raising and maintaining

the some of the highest scores in healthcare. This recommendation would

also include the creation of a new department that's sole purpose is

patient satisfaction. This would be both at the corporate level and at

each facility. This new department would work closely with their

partners to improve the patients experience by working with the staff

members. This is not a quick fix by any means, but overtime the scores

will rise and the overall viability of the company will be increased. In

order for the company to stay viable they need the reimbursements from

Medicare and Medicaid and in order to make that happen these measures are

a must. There are healthcare organizations closing up shop all over the

country due to the new provisions in place. Nebo must stay ahead of the

game and this recommendation will allow for that to happen.

Legal and Regulatory Considerations:


Nebo Valley Healthcare, as all healthcare companies, are highly

regulated and controlled through many different agencies. They are

regulated by several government agencies and laws that contribute to what

they do and how they do it. Nebo Valley is known for their compliance to

these laws and regulations and does a great job in protecting the health

and personal information of their patients. In looking the regulations

and laws that govern this work, there are several recommendations that

can be made to help them be even more compliant.

The joint commission is one of the biggest regulatory bodies that

control what happens in the hospital. They are one of the bodies that

help with the accreditation of the hospital and allow it to operate and

do business, as required by the government. The regulations put in place

by the joint commission are for the overall safety of the patients. The

joint commission comes every three years unannounced to the hospital.

Often hospitals and caught off guard and not as prepared as they should

be for this visit. The first recommendation for the regulatory

compliance is to create an internal team to work with all of the

facilities to ensure that they are joint commission compliant all the

time. The team would be made up of professionals that work in the quality

department and are very familiar with the regulations and can make sound

judgment when things are not followed. This internal team would travel


from on facility to the next to do some "mock" joint commission surveys,

to help ready each facility for their real survey. They will work

closely with the leaders in each department to help them be joint

commission ready every single day. This has worked well in other

organizations and will allow for Nebo Healthcare to be more complaint to

the regulations set forth by the joint commission. This team will be

made up of nurses and environmental personnel to ensure that all aspects

of the joint commission are reviewed with each facility.

In the review of the waste stream, for the recycling purposes, it was

clearly seen that there are some regulatory issues found in the waste

stream. The waste stream is highly regulated by the government and the

joint commission. Only certain things can go into the medical waste it

has to be handled in a very specific way. It was clear that some of the

facilities struggle in meeting these expectations. It is the

recommendation that Nebo Healthcare partner with a company to help handle

their waste stream. The company can help with the education of staff on

the regulations, the packing of the waste and the control of how it is

collected. There are many waste stream companies that handle medical

waste and an RFP could be created to see what company would be best.

Through our reviews it was clear that non medical waste was being placed

into the medical waste and this is due to poor education of staff


members. Carelessly placing gloves, paper towels and other items into

the regulated medical waste is a very expensive way to dispose of waste

that can be places in regular trash. With this partnership they will be

able to meet the regulations of the waste stream and more effectively

manage their waste to save money. It is vital that Nebo does something to

help control their waste stream. If issues continue there could be fines

placed on them and their local landfills could refuse to even accept

their waste, if it is not controlled. This partnership can be just a

onetime survey of the waste streams or can go as far as a full partner to

handle all of the waste in the hospital. There are many advantages that

come with this partnership including cost savings, but most importantly

they will help them to be compliant with all the regulations for packing,

storing and shipping of their medical waste.

The last recommendation made for the regulatory considerations is a

creation of a safety committee at each facility. There are countless

safety regulations in the hospital and it is difficult to stay on top of

all of them. This recommendation is a simple fix that will give the

company some lasting results. Under the direction of the safety officer,

a safety committee will be created in each facility to oversee the safety

regulations of the hospital. Each department will have a representative

on the committee and will bring back the needed information to the


department. This committee will discuss the many regulations of safety

such as fire codes, egress routes, doors, locks, pull boxes, fire

extinguishers and any other safety regulation. The committee members will

be the "safety champion" for each department and would do any training

that would be required. The representative will conduct a monthly safety

inspection in their department to ensure that the regulations are being

met. They would share any needed changes with the department manager and

report their findings to the safety officer. This is a very cost

effective way to ensure that all departments are complaint with all of

the safety regulations. The safety officer will still need to do surveys

and tours as the expert, but the smaller stuff can be found by each

department's safety champion. This recommendation allows for staff

members to better understand the regulations and for each department to

be ready, at a moment's notice, for an inspection by the fire marshal or

the joint commission.

The recommendations in this report will all work to better the

company's social responsibility and decrease the carbon footprint of the

company. In today's world of business, these are just as important and

any bottom line. By following these recommendations you can increase

your effect on the environment, the people and the profits of the

business.


Reference Page

Lawrence, A. and Weber, J. (2011). Business and Society: Stakeholders,

Ethics, Public Policy. New York, NY: McGraw-Hill.

Nebo Valley Healthcare

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