Maintain Your Focus

Maureen Larkin, for HealthLeaders Media, September 11, 2008

When you're in charge of a hospital that is working to improve its quality and patient safety, you need to be focused. At all times, quality care must be an integral part of what's happening at your hospital, and it must be woven into your organization's mission, vision, and values, says Les Donahue, CEO of Saint Thomas Hospital in Nashville. And he ought to know.

Five years ago, Saint Thomas was struggling. Its mortality rates were higher than they should have been. It was treading water financially, and when compared to its peers, it had a higher than expected rate of adverse events. But today, the organization is thriving, and its accomplishments were recently validated by Thomson Reuters, who named Saint Thomas to the 100 Top Hospitals Performance Improvement Leaders list.

Donahue says the award is certainly an honor, but it wasn't a surprise to hospital executives, who have made quality and patient safety a central focus of the organization. I recently talked with him about the award, the turnaround, and maintaining the organization's focus. Here are some highlights from my recent e-mail conversation with him:

ML: In 2002, when this study began, your organization had higher mortality rates and experienced more adverse events than its peer hospitals, but today, that's all changed. Mortality rates are down, the number of adverse events is now lower than expected, and your hospital is financially healthy. What's changed?

LD: Our focus has been, and remains on, the mission, quality, safety, and service. We are not satisfied until we excel in all of these elements. This helps us provide superior care to our patients. In addition, we have an intense focus on priorities for action that have led to improvements across all Ascension hospitals, particularly quality improvement initiatives. We have committed considerable resources to develop a culture of safety, based on the latest techniques for reducing errors, including new behavior based expectations for physicians, and staff that reduces adverse events.

ML: How important is a CEO's involvement in this kind of change? Why must change come from the top?

LD: The hospital's senior leadership team, as well as the medical staff leadership, is passionate about quality, safety, and service. Our culture is committed to performance improvement.

ML: We hear a lot about how patients are coming to the hospital sicker and experiencing more comorbidities than in the past. Still, your hospital was able to reduce the average length of stay by nearly a day. How did you accomplish this?

LD: We believe patient outcomes improve as our efficiency improves. We have instituted "lean methodologies" that assist us in removing waste, which reduces the length of stay, and allows us to provide more focus on patient throughput.

ML: Making any kind of quality improvements takes the involvement of everyone who provides patient care at the hospital, yet sometimes hospital leaders and physicians don't see eye-to-eye when it comes to performance improvement efforts. What was the secret to keeping all of Saint Thomas's physicians—both employed and affiliated physicians—aligned with these efforts?

LD: Saint Thomas is blessed to have physician leaders who are highly engaged and aligned with our mission and organization goals. Our medical staff, as well as staff leaders, shares the same passion for quality, safety, and service, and we work actively to avoid the "we" or "them" mindsets.

ML: Thomson Reuters says many hospitals have been "treading water" over the past five years—meaning that they've been struggling to remain financially healthy and to turn a profit while improving patient outcomes. What has been Saint Thomas' secret?

LD: Our intense focus on the mission, quality, safety, and service has resulted in volume growth. So it's a simple formula, take care of the most important things first, and the financial strength will follow.

ML: Looking back on the last five years at Saint Thomas, what advice would you give to fellow hospital CEOs about their role in improving quality at their hospital?

LD: Their highest priority needs to focus on creating a culture of quality. It starts at the top.

ML: Finally, are the changes at Saint Thomas possible at any hospital?

LD: Yes, all of the ingredients are the same and simple. Have a great staff, focus on quality and follow your mission, vision, and values. The key is the environment. Your associate and physician leaders must be liberated, creative, seek their own answers, the result is excellent care.

Editor's note: Learn more about the leader's role in inspiring quality performance during HealthLeaders Media's annual Top Leadership Teams in Healthcare conference, October 16 and 17, 2008 at the Drake Hotel in Chicago. A panel of representatives from Alegent Health, Christus, and Northwest Community Hospital of Arlington Heights, IL, will be on hand to discuss how their organizations are successfully using transparency to improve the quality of care offered at their facilities. For more information, visit the TLT Web site:

Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at
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