Improving Care Through Accountability and Loyal Relationships
In 2004, Advocate Good Samaritan Hospital in Downers Grove, IL, determined it wouldn’t thrive in the future if it kept to the status quo, says David S. Fox, president. So he launched an initiative called Moving from Good to Great. “The strategic intention was to become the best place for physicians to practice, associates to work, and patients to receive care,” says Fox.
At the time, Fox, who comes from family of physicians and grew up working in hospital settings during his summer vacations in Chicago, had no idea that the initiative would help Good Samaritan earn the 2010 Malcolm Baldrige National Quality Award.
The organization established 27 standards of behavior that staff must adhere to. A group of employees and managers created these standards, which are representative of a high-performing and compassionate organization. “We said to the whole organization that we are going to live these behaviors, and anyone—myself included—who doesn’t live these behaviors will be asked to remediate,” Fox says.
The results have been outstanding. Not only has Good Samaritan achieved higher physician, patient, and employee satisfaction rates, which are all in the 90th percentile, but it has improved clinical quality as well. For example, in 2004, Good Samaritan’s outpatient satisfaction score was in the seventh percentile, Fox says. “No change happens without leadership saying, ‘We can do better,’ so we said outpatient satisfaction is going to be important.”
Eliminating Pressure Ulcers
Diane Whitworth, RN, CWOCN
Diane Whitworth, RN, CWOCN, has been a wound ostomy and continence nurse for some 22 years. During the past six years, she has become a champion in the nationwide effort to prevent hospital-acquired pressure ulcers.
St. Mary’s Hospital in Richmond, VA, part of the Bon Secours Health System, always looked at its HAPU statistics on a yearly basis, says Whitworth, who is the manager of the wound care team at St. Mary’s. “But it wasn’t a concentrated focus,” she says. Then in 2006, some areas of the hospital were showing HAPU rates at 20%. The national average at the time was roughly 5%–6%, says Whitworth. “We said, ‘This is totally unacceptable.’ We set up a goal and started our journey to zero. It was a pretty lofty standard, but that was the vision.”
To ensure St. Mary’s was doing everything it could to prevent HAPUs, it created an interdisciplinary team, including nurses, physicians, dietary, physical and occupational therapy, and quality staff, to review processes and guidelines. St. Mary’s also brought in subject matter experts and conducted research reviews.
“It was a matter of realizing we did have an opportunity here, and it was an issue across the country—and that we need to have the focus on what we can do here to make a difference,” says Whitworth.
The hospital’s HAPU rates dropped from 20% in 2006 to 2% in 2007, and is now around 0.5%. “We started out on a six-lane highway. We had so much out there to improve—we got the low-hanging fruit and improved dramatically in a short amount of time,” says Whitworth.
Dealing With Epidemics, Again
Jim Geary has been challenging the healthcare system to be better for 30 years.
Geary moved to San Francisco in 1974, and he worked for three years as an attendant on an oncology unit. Later, he found solace as a volunteer for the Shanti Project, a support group for people with life-threatening illnesses. In 1982, while serving as executive director, Geary spearheaded a change in mission, turning Shanti into what’s considered the first support agency for the disease that came to be known as AIDS. His efforts played a key role in educating the public and healthcare professionals. Healthcare organizations could do a better job of supporting patients in concrete ways, as well.
“Support groups are as needed today as they were 25 years ago,” Geary says. “There’s an array of issues that medical personnel cannot really address or don’t have the time to address. The patient is not necessarily in need of physiological or therapeutic counseling, but they really want to meet someone who has gone through or is going through a similar experience.”
Hospitals should play an active role in forming support groups to lessen the alienation that people newly diagnosed with a disease or condition feel and increase their sense
of empowerment, Geary says.
“You treat someone at the hospital and then you send them home, and oftentimes you send them to a home where they don’t have that type of emotional support available. They don’t know other people with the illness,” Geary says. The support group, he adds, “would also have the benefit of empowering patients to be able to articulate more clearly what they need from their doctor-patient relationship.”
Investing in Innovation, from the Outside
Some argue that the healthcare industry is innovation-proof. It is risk averse. It is too slow—even unwilling—to change.
It doesn’t have to be that way, says Rebecca Lynn, a partner at Morgenthaler Ventures, a venture capital and private equity firm with offices in Menlo Park, CA. But the healthcare industry isn’t going to save itself, she adds. Change will come from outsider entrepreneurs unfettered by the status quo—who can tame the healthcare data beast and who are willing to try new ideas, such as outsourcing some care to patients themselves.
Lynn, who has a background in consumer and finance products and services, has turned her attention to investing in companies that are “reinventing healthcare [and] bringing healthcare closer to the patients, that are making doctors more efficient and better able to do their jobs,” she says.
Patients have proven they are capable of tending to their own health issues: Diabetics manage to measure their insulin levels and women take pregnancy tests at home all the time.
So why should it fall to outsiders to reinvent healthcare? Because they “don’t know where the walls are,” she says. They have a clearer vision of what works in other industries and tend to be more consumer-focused than providers, she adds.
“They don’t have an entrenched interest,” she says. “There’s been a ton of resistance from the industry because they want to preserve the status quo. And that’s typical of any industry that’s about ready to be changed and reinvented.”
Working Hard for a Good Day
A “good day” for family caregiver Min-Shih Chen is often measured by what doesn’t happen for his wife Gloria, 71, who is battling Parkinson’s disease.
“A good day for her is there are no incidents. She is cared for. She is content. There are no expected illnesses or difficulties,” says Chen, 68, of his wife of 42 years. “It’s a good day when I can take sufficient care of her. If my wife has a good day, then that makes me happy.”
Chen is one of 65 million Americans—roughly 29% of the population—who provide a total of $375 billion in uncompensated healthcare each year for a family member.
Gloria Chen was diagnosed with Parkinson’s in 2004, and since then it’s been a tactical retreat against the relentless degenerative disease. When Gloria, a retired music therapist, was still able to walk, Chen took her to a physical therapist and watched the treatments, using what he learned to help his wife. He devised a set of portable parallel bars in their Ann Arbor, MI, home to help her exercise.
The Chens’ life now revolves around four daily “cycles” starting around 8 a.m. and ending around 8 p.m. Each cycle lasts about three hours and involves bathing, feeding, administering medications, rest, and moving Gloria—who has been rendered nearly speechless as the disease progressed—from her bed to her wheelchair, from her wheelchair to her recliner, and back again.
When time allows, he is also a frequent contributor to a website established by the National Family Caregivers Association. “It is my social outlet, my outside contact. Sometimes we have new people join and the first thing they realize is ‘Oh, I am not alone.’”
This article appears in the December 2011 issue of HealthLeaders magazine.