Senior Executives Who Get It

Carrie Vaughan, for HealthLeaders Media, December 12, 2008

Given the perpetual flow of news about what's wrong with healthcare, it was refreshing to hear at this week's Institute for Healthcare Improvement conference in Nashville, TN, about how some hospitals and health systems are actually improving the care that they deliver to patients.

There certainly doesn't seem to be a shortage of process improvement strategies to improve patient care—developing those ideas seems to be the easy part. The challenge for senior leaders is implementing those strategies systemwide and sustaining them. Here's a quick snapshot of how some hospitals are driving and sustaining that change.

Bellin Health in Green Bay, WI, uses a 120-day review process to analyze how its processes are working and examine the organization's priorities. "It creates a rhythm of discipline and flow," says Pete Knox, Bellin's executive vice president. As part of that review process, Bellin brings together all of its managers—roughly 200 people. Senior executives explain the areas of focus and why they are emphasized. Teams are also created to manage those process improvements; those teams are composed of a project manager, senior executive, physician champion, and a representative from every department that is impacted—no exceptions. Knox says that the system uses a simple energy grid with a scale of hi, medium, and low to evaluate the resources required of each team member to meet its objectives. That grid can also help identify potential bottlenecks. For example, Bellin recently hired eight new full-time IT staff members because of bottlenecks identified in the IT department.

It took 10 years to get San Francisco General Hospital's Acute Care for Elders Unit (ACE) under way, says Susan A. Currin, director of patient care services and chief nursing officer. "The process was not easy," she says, adding that it takes various strategies to sell the program to the administration, nurses, and physicians. One strategy will not work for everyone. For example, making the business case may help sell it to administrators, but that is not what sold it to the nurses, she says. Other strategies that can be used are highlighting the evidence-based protocols or results data. Currin, herself, was also a strong advocate and champion of the effort. She says telling the story of sentinel events and soliciting feedback from employees on what they should do different was an extremely effective way to garner support.

Similarly, Sentara Health in Norfolk, VA, shared its five worst safety events with employees and looked for common causes. Gary Yates, MD, senior vice president and chief medical officer, said their results weren't unique. For example, common threads were a lack of attention to detail and critical thinking. But simply telling employees to be careful and vigilant is not enough, he says. No one sets out to harm a patient, but there are a lot of repetitive processes in healthcare that can lead to these unfortunate events. So Sentara borrowed some safety tools from the nuclear power industry. For example, the STAR program teaches employees to stop, think, activate, and review when they are doing repetitive tasks. Yates says giving employees a tool that they can use is one way to help establish habits, which in the long run can prevent some of these events from occurring.

Cincinnati Children's Hospital Medical Center uses its intranet to keep its patient-safety initiatives front and center. For example, the opening page of the intranet has a bullet with the number of days that have gone by without a serious safety event, says Stephen E. Muething, MD, Children's assistant vice president of patient safety. If an event does occur, employees can click on the link and get a brief description of what happened. Cincinnati also makes the same measures and data that the board and senior executives track available to employees. Cincinnati Children's records its serious safety events on a rolling 12-month scale, as well. It's helpful for leadership to view a 12-month graph, so they don't see improvement in one month and get complacent, he says.

"Education not enough," says Bill Corley, president of Community Health Network in Indianapolis, IN. Organizations need to identify people who support the organization's quality and patient safety efforts. Corley actually keeps a list of people who "get it" in his organization. These are staff members who not only follow best practices, but they help spread them throughout the organization. Community Health also uses a daily check-in that gathers all of the department directors for a 15-minute phone call to discuss potential patient safety events. It used to occur only Monday through Friday. But a staff member asked if that meant patient safety wasn't as important on the weekends, so now the check-in is done every day, says Corley. "Patient safety isn't just a priority during the week."

Carrie Vaughan is leadership editor with HealthLeaders magazine. She can be reached at
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