The Exec: Newark Beth Israel's CMO Focuses on High Reliability

The new CMO of Newark Beth Israel Medical Center plans to continue pursuit of high reliability that he helped lead at a Boston-based hospital.

Supporting the quest for high reliability in healthcare should be a top priority for CMOs, the new CMO of Newark Beth Israel Medical Center says.

Scott Schissel, MD, PhD, became CMO of the 665-bed academic medical center, which is operated by RWJBarnabas Health, this month. He had been CMO and vice president of medical affairs at Brigham and Women's Faulkner Hospital in Boston, where he also served as associate CMO and chief of medicine.

Pursuing high reliability is one of Schissels' primary strategies, which he honed in Boston.

"We had a system of just culture, where patient care was examined from the perspective of systems improvement and accountability that goes beyond individual human error," he says.

Staff from all disciplines at the Boston-based hospital shared a vision of high reliability and worked collaboratively on care and quality goals, Schissel says.

"In addition, every decision we made in healthcare leadership placed the patient's best interest and safety at the center," he says. "Creating and maintaining this kind of culture is hard work, and it is a continuous process."

The first principle of high reliability is transparency around safety and quality for the organization, so that everybody from frontline staff to the most senior leadership are willing to engage and talk about safety events and quality metrics, Schissel says.

"The dialogue that ensues is one of constructive building as opposed to a punitive or disciplinary environment," he says. "It's more about engaging in a culture of continuous process improvement."

A good example is process improvement in patient safety, Schissel says.

"At Newark Beth Israel Medical Center, there is an excellent electronic safety reporting platform, which is accessible for all employees," he says. "It is also important to have a culture where employees want to report safety events, and they are encouraged to report their observations. It should be celebrated when someone raises a safety concern."

The medical center has a Good Catch Award, where employees are recognized for reporting safety concerns, Schissel says.

"This kind of culture has led to a reduction in our serious safety events by about 80%," he says.

There are core elements to promote a culture of patient safety reporting, Schissel says.

"One is education of staff," he says. "Even at the point of onboarding, we train employees about our culture of safety, demonstrating that new employees know how to use the performance improvement tools and the safety reporting tool."

Maintaining that culture is also important, Schissel says.

"That has many avenues, from leadership rounding on the units to encourage and engage staff in reporting safety events to safety huddles on the units to a hospital leadership safety huddle," he says. "We are educating and reinforcing patient safety reporting on a daily basis."

Scott Schissel, MD, PhD, is CMO of Newark Beth Israel Medical Center. Photo courtesy of RWJBarnabas Health.

Promoting patient safety

The safety reporting system and safety culture at Newark Beth Israel Medical Center are foundational, Schissel says.

"Those are the most fundamental pieces of patient safety, so we can act on trends and individual safety events to make corrective action plans and process improvement," he says.

Promoting patient safety involves extending the work that has been done around safety reporting, Schissel says.

"When we receive a safety report, we are going to look hard at our response, which is through root cause analysis or interdisciplinary case review," he says. "We want to drill into how we methodically look at case events, so that when we make corrective actions, we are addressing the underlying root causes to minimize the recurrence of events."

The medical center's quality and safety teams look at all safety event reports daily, with supervision from Schissel and nursing leaders.

"We immediately engage the frontline unit where the event occurred, including their directors and staff, to obtain information," he says. "We review every safety event and plan different levels of root cause analyses, so that we address the underlying drivers of an event."

Best practices for promoting quality

Efforts to promote quality should be data-driven, Schissel says.

"The most important start to a quality program is to be sure you are dealing with the highest and best quality data of your clinical outcomes," he says.

Newark Beth Israel Medical Center has quality dashboards available to the staff that capture key metrics, such as hospital-acquired conditions and mortality, which are benchmarked against national standards, Schissel says.

"We are holding ourselves accountable to performance at a national level, not just our own year-to-year quality changes," he says. "We set clear goals to improve our quality metrics. Even if we are within the national benchmark, we always want to do better."

The medical center looks for opportunities for improvement in quality metrics no matter how well the hospital is performing, Schissel says.

"We have robust data around where our quality is doing well, on target, or falling short," he says. "We have a broad corrective action plan to address our performance."

"We look at core quality metrics every month," he adds. "We reassess where our interventions are working or not working like we want them to work. When needed, we institute new care protocols and care bundles. Like many hospitals, we can address conditions such as sepsis and heart failure by implementing care bundles or packages to enhance quality of care."