In 2008, when Sandra L. Coletta, MBA, accepted the position of president and CEO of Kent Hospital, Providence, Rhode Island, she knew that she would be facing significant challenges when implementing organizational changes at the institution. At the time, Kent Hospital ranked in New England’s lowest percentile in overall client satisfaction. Its emergency department earned customer complaints of poor quality patient service and medical care. To add another mark against its already marred reputation, the hospital was in the middle of a high-profile lawsuit, filed by actor James Woods, who blamed the facility for the wrongful death of his brother, Michael J. Woods. Given these circumstances, Coletta was struck by the urgency with which changes would have to be implemented, but she had a steadfast belief in her abilities to accomplish the task. With a positive attitude, the desire to effect change, and the will to make it happen, she hit the ground running. At the 2011 meeting of the American Health Care Congress, in Anaheim, California, Coletta spoke on “Accelerating and Achieving Organizational Change,” sharing the philosophy that guided her dynamic approach to making sweeping changes at Kent Hospital. Initially, she examined all of the dimensions of Kent Hospital personnel and operations—from the physician staff, to the nursing staff, to the actual design of the workspace. It wasn’t long before major personnel changes began, with many employees leaving within the first 60 days of Coletta’s arrival. She dismissed the notion that her decisions might be interpreted as harsh, and that she didn’t give the departing employees a chance to prove themselves. “When you’re as bad a team [as they were], there’s no time to look around [for the good team members],” she notes. Ramp Up the Clock Speed The second step in the reorganization process was to ramp up the clock speed, in Coletta’s words. “When you go into a situation, and you really want to get things moving . . . MOVE,” she advises. “You give up deadlines, make it now. Make a decision . . . just fix it.” “You know what?” she adds. “If you move, and you’re wrong, you can change.” She informed the Kent Hospital community that her crew would be moving quickly and making significant changes to their day-to-day routines. “We were going to be doing things that were dramatically different,” she says. “We had to look at the process, the people, the schedules, and the physical environment, all at the same time.” Coletta cut two layers of management, because they “got in the way of moving,” she explains. More changes were made, but she saved the “worst” for last. Finally, she began her move on the most problematic of all challenges, the hospital’s emergency department, which had been the target of customer complaints. Her team interviewed each of the nursing staff individually to evaluate their competency. Then, in the company of a proctor, each nurse was asked to demonstrate an element of their job to determine how well they could execute the task (such as running and reading an ECG or performing a tracheotomy). Those who could not accomplish the task to satisfaction were either moved to another department, or dismissed. Long-term employees who consider themselves above change also were weeded out. “You know what I do with sacred cows?” Coletta asks. “I kill them . . . after [they were] given a reasonable chance.” Then, changes were made to the actual workspace, to eliminate patient stress and maximize staff efficiency, by a human factors engineering team. After making these changes to the emergency department, Coletta says that wait time to see a physician dropped from two hours to 30 minutes. The average turnaround time for treatment has gone from six hours to four hours overnight. Mounting the Burning Platform Coletta admitted that—faced with implementing such sweeping operational changes at Kent Hospital—she received unexpected support in breaking through organizational resistance from what she called “a burning platform” (business lexicon for a situation that demands immediate and radical change, due to its dire circumstances). Ironically, the burning platform turned out to be the ongoing lawsuit involving James Woods, who had filed a malpractice suit against the hospital, claiming that the 2006 death of his brother was a direct result of the incompetency of the emergency department staff. The lawsuit had attracted coverage in both the national news and entertainment media, and brought notoriety to the hospital. Coletta was able to impress on the financial committee of the hospital that this grave situation, along with its negative press coverage, precipitated the need to make radical changes in the day-to-day operations of the facility. Without this leverage, she knew that she would not have the support to make the needed changes. “James Woods was extremely angry with us,” Coletta says. “His brother had passed away at our institution. Our errors had killed his brother.” She offered her sympathies to the Woods family for their loss, and apologized for any involvement Kent Hospital had in the incident. The Woods family, which had received no direct communication from the hospital following Michael’s death, was moved by Coletta’s apology, as well as her acknowledgement of possible hospital blame. Within 24 hours, the actor and his family offered to settle the case, with one stipulation—that the hospital and the Woods family would collaborate on methods to improve the quality of care patients receive at Kent Hospital. “I was not going to let that case go—I was going to use it,” she emphasizes. “I needed to take advantage of this really bad situation, and find a way for us to get better through it.” Her efforts paid off. The hospital is now rated in the 62nd approval percentile (a vast improvement from a one-percentile rating). Coletta sees it as an indication that the hospital is moving in the right direction. She offers a last bit of advice: “Human behavior is really what drives most of what we’re doing. Take time to learn about that, because it helps you make change happen.”

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Rogena Schuyler Silverman is a contributing writer for Health CXO.