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Yale New Haven Health System Honored for Quality Improvement

Analysis  |  By Christopher Cheney  
   July 30, 2021

The American Hospital Association award recognizes healthcare leadership and innovation in improving quality and advancing health in communities.

Yale New Haven Health System (YNHHS) has been named the 2021 recipient of the American Hospital Association Quest for Quality Prize.

The Quest for Quality Prize recognizes healthcare leadership and innovation in improving quality and advancing health in communities. The first Quest for Quality Prize was awarded in 2002, and the honor is sponsored by RLDatix.

YNHHS earned the Quest for Quality Prize based on three factors: addressing social determinants of health, using data to drive quality improvements, and engaging staff in quality improvement work.

1. Addressing social determinants of health

Steven Choi, MD, chief quality officer of New Haven, Connecticut-based YNHHS and Yale School of Medicine, says the health system has been working to address social determinants of health for several years. "We have supported efforts such as food pantries, Habitat for Humanity, college scholarships for those people who live in underserved areas and those people who are members of underrepresented minorities in the healthcare industry, job training programs, and transportation."

Part of the effort has been screening patients for social determinants of health, he says. "We screen patients in our emergency departments, primary care practices, and medical group practices for social determinants of health. We have been conducting this screening in an organized and structured way for about five years. We screen about 450 patients a month for social determinants of health. The screening involves assessing their ability to maintain financial means, food security, housing, utilities, and transportation needs to access healthcare."

YNHHS also partners with community-based organizations so the health system can refer patients for resources within their local communities, Choi says.

2. Using data to drive quality improvements

In the effort to harness data to drive quality improvements, YNHHS made a pivotal change about three years ago, he says. "We had plenty of outcome data to understand and monitor our patients' physical outcomes such as mortality, complications, readmissions, and medical errors. But we had very little data on the key drivers of outcomes."

YNHHS developed a "key driver" dashboard to help the health system determine the fundamental behaviors and processes that staff were executing to get patients their best outcomes, Choi says.

"For example, we are trying to prevent infections and we want to know that we are doing the right things. Now, we can monitor our quality improvement by measuring all of the key drivers for preventing infections, including glucose control for individual patients, monitoring patient temperature to make sure they do not get too hot or too cold, making sure patients get the right antibiotics at the right time, and making sure our providers are using checklists for patients with central lines," he says.

The key driver dashboard has been a powerful tool for frontline care teams because YNHHS leaders can avoid making blanket pronouncements to staff about quality improvements such as limiting infections and reducing readmissions, Choi says. "Instead, we ask them to focus more on making follow-up appointments with patients when they get discharged, we ask them to focus on antibiotic compliance for patients coming out of the operating room, or we ask them to focus on scrubbing the hub of a central line to avoid potentially life-threatening bloodstream infections."

3. Engaging staff in quality improvement work

To engage staff in quality improvement work, YNHHS has a dedicated quality improvement team at each of the health system's hospitals, he says. "We do the fundamental basics of staff engagement in making sure that we have a multidisciplinary team that represents critical service areas such as nursing, pharmacy, medical staff, housekeeping, information technology, food services, and transportation. All of these services are represented on the performance improvement teams."

The health system also uses rounding to engage staff in quality improvement work, he says.

"A fundamental change that we made is that we now round every week on medical units and other sites where care is delivered to talk about our quality improvement work to make sure that the staff is aware of the key drivers that help build success. We want staff members to understand how the things they do contribute to success. This is a process called Rounding to Influence, which is a model that many high-reliability organizations have adopted. We go around and ask specific questions about the key efforts we are striving for. We also ask the staff to give us feedback about what is prohibiting them from executing best practices."

Related: Acclaimed Clinical Leader Offers 4 Steps to Quality Improvement

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Yale New Haven Health System's social determinants of health work includes working with community-based organizations to connect patients with resources in their local communities.

The health system's efforts to use data to drive quality improvement include focusing on the fundamental behaviors and processes that staff execute to get patients their best outcomes.

The health system's efforts to engage staff in quality improvement include having multidisciplinary performance improvement teams at each of the organization's hospitals.


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