The news was a surprise to everyone at St. Bernard Hospital and Health Care Center.
It was April 2021, and the Englewood hospital had just learned that it had earned an F grade for safety from the Leapfrog Group, an organization that releases widely watched grades twice a year.
It was the only hospital in the state to earn the dreaded distinction that spring.
“We are really proud to be here and be part of this community,” said ER attending physician Dr. Ashley Magda, remembering the day staff learned about the F grade. “To have kind of what we feel pride in, all of a sudden being told we’re not doing the appropriate things was definitely disheartening.”
Often, when hospitals earn low marks from Leapfrog and other groups, their leaders say the grade is wrong, the methodology was flawed or the grade doesn’t matter to them.
But St. Bernard leaders didn’t do those things. Instead, they released a statement, at the time, saying that South Side residents deserve to go to hospitals that “can afford to invest in all the measures that the Leapfrog Group assesses, just as residents of Streeterville and Lincoln Park do.”
Then the hospital got to work, making change after change.
Now, less than two years later, the hospital is celebrating the results. Its safety grade shot up from an F to a B despite challenges that may have made other hospitals balk. Those challenges include financial struggles, patients who have trouble accessing regular medical care or don’t always have the resources to recover at home, and an aging facility. The 118-year-old hospital is also a rarity in Chicago — an independent community hospital — meaning it doesn’t have the same resources as hospitals that are part of larger systems.
“To take this hospital from where we were to where we are took perseverance, hard work and dedication,” said Joy Greer, a nurse and unit manager of the ER. Greer grew up on the South Side. “It’s been a very important thing to me to be able to give back to the community I was raised in.”
St. Bernard is a safety net hospital licensed for 174 beds. The main hospital building sits tucked in an Englewood neighborhood just a few blocks off the expressway, next to an elevated train track. It’s less than 2.5 miles from the University of Chicago Medical Center, one of the city’s largest and most prestigious hospitals, and some patients from the neighborhood choose to go to the bigger hospital.
About 94% of St. Bernard’s patients were Black in 2020, and a majority of its patients were on Medicaid, a state and federally funded health insurance program for people who have low incomes. Medicaid generally reimburses hospitals less for services than private insurance, which can leave hospitals such as St. Bernard struggling to pay their bills.
Like many community hospitals, St. Bernard closed its obstetrics and pediatrics units in recent years, because of low numbers of patients, and the expense of running them.
“We are not in great shape,” said Michael Richardson, the hospital’s chief clinical quality and patient safety officer, of the hospital’s finances. “We have definitely drained all of our reserves, if we had any.”
The hospital is now running in the red by about $1 million a month, he said.
Despite those challenges, one of hospital leaders’ first moves after the F grade was hiring Richardson, a licensed registered nurse who had been leading patient safety efforts in hospitals in Florida before coming to St. Bernard.
His strategy, once he started in September 2021, was to tackle the lowest hanging fruit first, in hopes of quick, but meaningful improvements.
First, he and others looked at the hospital’s system for making sure medication is administered correctly, to the right patients. Hospitals generally scan a bar code on a patient’s wristband and a bar code on medication before administering the medication in order to avoid mistakes. Leapfrog asks hospitals to report on how well they’re doing that.
St. Bernard leaders found that those scans weren’t always being done consistently because of faulty equipment or a weak internet connection. It was an easy, immediate fix, Richardson said.
The hospital also installed technology to remind staff to sanitize their hands when entering and exiting patient rooms, and to track how often they did so. Staff now wear small electronic devices, often attached to their shirts, that beep when they enter and exit rooms to remind them to sanitize their hands.
The staff at St. Bernard is now about 90% compliant with hand hygiene requirements, Richardson said.
The hospital also reshaped its culture of dealing with mistakes. Leaders introduced a “just culture” model, which aims to create fairness for employees, and a culture that encourages workers to report mistakes. With “just culture,” hospital leaders look at systemic issues that lead to mistakes rather than immediately blaming the worker.
All St. Bernard directors, managers and senior leaders are now trained in “just culture.”
“We had two choices,” Richardson said of the F grade. “We could ignore it and move on, or we could look at what the (Leapfrog) survey required.”
That’s not to say, however, that the hospital doesn’t continue to face obstacles.
Though its Leapfrog grade has improved dramatically, it still has just one star, out of five, for quality from the federal government, which rates hospitals using different methodology than Leapfrog.
One reason for the single star is because St. Bernard’s percentages of patients who are hospitalized for mental illness and then receive outpatient follow-up care after leaving the hospital is lower than state and national averages. Also, its percentage of patients who leave the ER before being seen, and the number of minutes patients spend in the ER, are significantly higher than state and national averages. Richardson is optimistic the hospital’s star rating, like its Leapfrog grade, will improve.
Like most hospitals in the Chicago area, St. Bernard’s ER has been slammed in recent months. Hospitals are facing a barrage of people with respiratory illnesses, the flu and mental health conditions. They’re often having trouble discharging hospital patients to skilled nursing facilities, which lack open beds, creating backups in hospitals, and emergency departments.
St. Bernard also grapples with treating patients who sometimes come to the hospital extremely ill because they didn’t get care earlier.
On a recent Tuesday morning, nearly every bed in the St. Bernard ER was full, with one patient being treated on a stretcher in the ER hallway.
That morning, a patient on Medicaid, who was wearing an ankle monitor, came to the ER because he was having trouble walking. It turned out he likely had osteosarcoma, a type of bone cancer. He said the issue had been bothering him for almost a year, but no one had looked at it closely until that day.
Dr. Magda and her team spent hours that morning making calls, trying to transfer him to bigger hospitals that could treat his cancer, but none had room. They then tried to at least get him an appointment to see a specialist, but were told by multiple providers’ offices that they didn’t have appointments available for six months. Finally, Magda reached a specialist on his cellphone and was able to get the patient an appointment the next day.
“Even with all the knowledge we have, it’s very difficult to do,” she said of trying to find him appropriate care. “This is how people end up returning in a year with a metastatic cancer,” meaning a cancer that has spread to other parts of the body.
People who live on the South Side are more likely to be diagnosed with cancer than those who live in other parts of the city, and cancer death rates on the South Side are about twice the national average.
Like hospitals throughout the city, St. Bernard has also struggled to handle patients with mental health challenges, particularly finding beds for them at mental health facilities.
Recently, a 12-year-old patient was brought to the hospital after the patient tried to jump out a window. That child spent seven days in St. Bernard’s ER before another facility that treats children with behavioral health problems had an open bed for the patient, Richardson said. During those seven days, the already-stretched ER had to dedicate a certified nursing assistant just to the child, 24 hours a day, because of the seriousness of the child’s condition.
Still, the situation in St. Bernard’s ER is better than it was just a couple of years ago, during the early days of the pandemic when the hospital, at one point, ran out of stretchers.
Since then, the hospital has turned most of its ER rooms into negative pressure rooms, meaning air from those rooms is sent outside instead of recirculating throughout the hospital, to help prevent the spread of illness. It’s a technology used by many hospitals, including Rush University Medical Center which was widely praised for being particularly well-equipped to handle COVID-19.
“We learned our lesson,” said Yolanda Penny, director of nursing services. “We needed more negative pressure rooms to handle pandemics coming our way.”
The hospital is now wrapping up a $2 million ER renovation. Patient rooms and triage areas in the ER are now more private, and light floods into the once dark ER waiting room through large windows. A security guard still sits at a reception desk in the lobby, but is no longer the first thing patients see when they arrive.
Some patients say they notice the difference, while others say they’ve always thought highly of the hospital.
Loretta Bush, 51 of Auburn Gresham, said she prefers to go to hospitals with higher grades, but she has no complaints about St. Bernard. When she visited the St. Bernard ER with a blocked artery “they saved my life.”
“They took me in there and took care of it right quick,” Bush said.
Rick Batts, 61 of Englewood, said he’s been seeing St. Bernard doctors for about half a dozen years, and didn’t pay any attention to reports about its grade. “The doctors are great here,” he said.
Workers at St. Bernard agree, saying the F grade never felt right to them.
When St. Bernard first got the F in spring 2021, leaders hadn’t expected to be graded. St. Bernard hadn’t filled out an optional survey that Leapfrog uses, along with federal data, to help it determine a grade. Sometimes, filling out the surveys can help hospitals’ grades if they show data demonstrating safety. For the more recent grades, St. Bernard has been filling out the survey.
“I felt like that’s not who we are,” said Joanne Igney, a nurse and clinical documentation specialist, who has worked at St. Bernard for 12 years, of the F grade. “I think everybody that works here just works with heart.”
Dr. Daria Terrell, president of the medical staff at the hospital and an orthopedic surgeon, said, to her, the F meant there was room for improvement. “This transition from an F to a B has meant a lot,” she said.
When St. Bernard earned that B in November, hospital leaders threw a celebration for staff. They decorated the cafeteria with balloons and handed out cupcakes to employees.
They hung a sign in a busy hallway outside the cafeteria explaining why St. Bernard earned the B: for decreasing patient infections; because of its hand hygiene monitoring system; and because it had no central line or catheter-associated infections, among other reasons.
The bottom of the sign read: “‘B’ PROUD.’”
But the grade wasn’t just important to workers. It was important for the community, Richardson said.
When the city’s largest hospitals — institutions such as the nearby University of Chicago Medical Center, Rush University Medical Center and Northwestern Memorial Hospital — earn top marks, they advertise them on giant billboards, in newspaper ads and in TV commercials.
Meanwhile, other hospitals, typically those that earn poor or middling grades, say the importance of grades is overblown, and they don’t paint a full picture of a hospital’s quality or safety.
But St. Bernard wants its community to know how far it’s come.
“We wanted to change that perception that St. Bernard may not be the best place to go,” Richardson said. St. Bernard, he said, “is definitely needed by the community.”