Transforming Patient Care at Mt. San Rafael Hospital

Located just 15 miles from the New Mexico state line, Mt. San Rafael Hospital is a 25-bed critical access facility that serves a large catchment area in and around Trinidad, Colorado.

Dr. Kendall Allred

In 2010, Innova took over physician staffing for the emergency department at Mt. San Rafael with a significant goal: increase the quality of emergency care.

The hospital had been struggling with unacceptable patient satisfaction scores, a poor ER reputation, and a high number of patients leaving without being seen – particularly during peak hours.

How Innova Made Changes

In collaboration with the hospital, Innova took a systematic approach to improving the quality of emergency care and the patient experience.

Their approach included:

  • Isolating the reasons for poor satisfaction. The team identified several contributing factors, including low physician empathy from past physician groups, poor communication with patients, and an inefficient patient flow.
  • Assessing the barriers for improvement, ranging from a mentality of "how things have always been done," to a culture of emergency physician entitlement, to silos of care between the physicians and the nursing staff.
  • Evaluating the options for improvement. As part of their process, the team evaluated the emergency department from the perspective of the patient, from the moment someone walked through the door, to the signage and patient check-in process, to the triage and discharge process.
  • Implementing changes to the emergency department’s staffing model, culture and patient experience.

Those changes included:

  1. Investing in board-certified emergency room physicians.
  2. Building provider ownership and accountability (and incenting good behaviors).
  3. Streamlining the entire triage and ordering process.
  4. Putting physician leadership on the ground to provide clinical care.

"We looked at the low hanging fruit first," explains Steve Sherick, MD, founder and CEO of Innova.

"What are the places that take the least amount of money and are the easiest to fix?"

"We were extremely resource and time conscious, and we followed up on every patient complaint."

Best-in-Class Patient Communication

One change that was extremely well received was the implementation of a unique communication process with patients. It's designed to take the mystery out of the ER and include patients in the conversation about their own care.

Today, the hospital's emergency patients know exactly who their physician is, what the emergency team is doing, why they are doing it, and where they are in the process.

At the end of each visit, patients also have an outlet for providing real-time feedback, so the team can immediately improve its processes, as needed. They believe there is always something to learn.

Investing in Board-Certified Emergency Physicians Pays Off

In the past, Mt. San Rafael used family practice physicians in the emergency department. By investing in board-certified and residency-trained emergency physicians (who Innova handpicked for Mt. San Rafael), the hospital saw a huge shift in the staff and patient experience.

Clay Hart, RN − the hospital's director of compliance and risk management and a 22-year veteran at Mt. San Rafael − shares, "With board-certified ER doctors, you can see a difference in their thought process and how they approach a patient. They have a clear and direct path in how they're going to proceed."

"One thing nurses like is a decisive physician. It builds our confidence in them and improves our working relationship.”

To build a strong sense of accountability and professional ownership among its team, Innova reinforces positive behaviors with its physicians through feedback and performance-based compensation. Innova also works diligently to recognize the nursing staff and give them a voice in patient care.

"The Innova doctors are very team oriented," Clay says. "When they started with us, they actually threw our nurses off because they asked for our opinions! We weren’t used to that, and it absolutely helped with team building."


"The Innova providers are engaged with the staff of the entire facility, not just the ER. After hours and on weekends the floor staff will call for assistance when needed or contact the provider if they have questions or concerns. Since we are a critical access hospital and have limited stang, the ER is the only department with a provider available 24/7. I can confidently say the Innova providers are eager to assist when needed and work very well with the floor staff and all ancillary services."

- Deb Moynihan, RN, Director Emergency/Trauma Services

Looking for Ways to Be Better

Steve and the Innova team are always looking for ways to be better.

"We take 50 parts of the patient experience and focus on five elements at a time," Steve explains.

"We are always focused on continuous improvement because every day is different."

Improving Patient Wait Times

One area that Innova physicians keep their eye on is patient wait times. Rather than sitting and waiting for patients, they’re proactively pulling patients in, treating them, and keeping the department moving.

A "Very Different" Experience

Clay Hart observes that partnering with Innova is a "very different" experience than what the hospital has had in the past. Just a few years ago, he says, the ER was for employees. Today, it’s for patients.

"Steve and his group are absolutely wonderful in how they relate to patients. They are so customer-oriented, asking ‘Is there anything else I can do for you today? Thanks for coming in.’"

"They listen to what people have to say, and they’re very responsive to feedback from patients, the staff, the administration, and even our clinic physicians."

"They offer a different point of view. They’re really here to help people."

Request a Complimentary Consultation

For fresh and valuable insight into your emergency department, please request a consultation with Steve Sherick, MD, FACEP.