Hi everyone – this is Joe McCannon, 5 Million Lives Campaign Manager. This web log (or “blog”) will act as a running journal of all of the fantastic activity that the IHI Campaign team observes in the field. The tone will be informal and we aim to post frequently to keep you apprised of major milestones, relevant news and, above all, the important progress of Campaign hospitals in reducing morbidity and mortality. Please tune in often!
Best regards,
Joe
Thursday, July 31- Friday, August 1, 2008: There is no such thing as a leak on your side of the canoe
With over 400 people gathered in Louisville, the Kentucky MRSA Summit kicked off successfully on Thursday. Node partners, the Kentucky Hospital Association and Health Care Excel of Kentucky, were sponsors of the event along with the state’s Department for Public Health, the University of Kentucky, and the University of Louisville School of Public Health & Information Sciences. This unique conference was designed for hospitals, home health care agencies, long term care facilities, first responders, schools, athletic facilities, correctional facilities, and behavioral health organizations. With such a diverse grouping of professionals in one large ballroom, speakers addressed the issue from a variety of viewpoints.
The morning started with Dr. William Hacker, the state’s Undersecretary for Health. Victoria Nahum, founder of the Safe Care Campaign, gave the first keynote presentation and moved many audience members to tears as she shared her story of three family members contracting MRSA in three different states over the course of only ten months. The last infection resulted in the tragic death of her stepson, Josh. Her family’s story provided inspiration early in the day for everyone in the room. Next, we learned from two experts from the University of Louisville’s Division of Infectious Diseases: Dr. Julio Ramirez, the division’s chief, presented on the evolution of MRSA and Associate Professor of Pediatrics Dr. Kristina Bryant addressed various myths about MRSA.
After a great lunch with lots of cross-setting mingling, we got back into the learning sessions as Dr. Martin Evans of the Lexington Veterans Affairs Medical Center shared work done by the VA at a local and national level. Simple steps such as placing red tape on the floor of an isolated patient that says “wear gloves and gowns when crossing this line” had very successful results. The Lexington VAMC has now spread their practices to their long-term care facility. Christine Nutty, a local provider and president-elect of the Association for Professionals in Infection Control and Epidemiology (APIC), presented on MRSA infection control and prevention in all applicable settings for the audience.
Dr. Kraig Humbaugh, Director of the Division of Epidemiology and Health Planning for the Kentucky Department for Public Health, shared the public health perspective for a MRSA collaborative (with help from some very timely Rex Morgan comic strips (see here for an example). He shared Kentucky-specific data and examples of state collaboratives in Michigan, New Mexico, Maryland, Minnesota, North Carolina, New Hampshire, and Tennessee. He also mentioned how bundle use, positive deviance, the model for improvement, and education of the public contributed to the success of these efforts.
On day two, there were concurrent breakout sessions for each of the various settings. Participants asked great questions, met fellow Kentuckians facing common problems in varied settings, and everyone left with a lot more knowledge, practical tips and solutions, and many new contacts. Kentucky is the only state I know of engaging so many different settings. I very much look forward to learning what they will do next. As one speaker said, “This is a community issue,” and the community was certainly well-represented at this summit.
-- Katie O’Rourke
Wednesday, June 25, 2008: Rural collaboration in Ohio
Last week, I had the privilege of joining Dr. Bob Wilmouth of the Mountain-Pacific Quality Health Foundation and Jeff Spade of the North Carolina Hospital Association on a road trip to scenic Port Clinton where we spoke with members of the Ohio Rural Hospital Flexibility Quality Improvement Work Group. The meeting was co-sponsored by Ohio KePRO, the Ohio Hospital Association and the Ohio Department of Health, and hosted by Magruder Memorial Hospital. The goal of the meeting was three-fold: to provide a Campaign update, to celebrate hospital successes, and to discuss the future of the group.
The Rural Work Group is doing tremendous work: comprising 34 small, rural and Critical Access Hospitals (most of which are voluntarily reporting to CMS), this group has been meeting four times per year for the past four years. Hospitals come from all over the state to share their challenges as well as their strategies for achieving clinical best practices. The majority are enrolled in the Campaign.
Jeff provided a Campaign update, while Bob discussed the importance of engaging hospital boards and senior leaders in quality initiatives such as the Rural Work Group. Representatives from the Node emphasized that with cutbacks anticipated in the new Scope of Work, it would become more important for the member hospitals to “take ownership” of the group. Specifically, they will have to take increasing responsibility for things like sending out meeting invitations and collecting data for improvement from its members; the Node currently provide these services.
Despite such challenges, the group is off to good start: aggregated data shows CMS measure compliance ranging from 75 to nearly 100 percent! The mantra “small is not an excuse” came up repeatedly during the meeting and several hospitals pledged to investigate every incident that “fell out.” Bucyrus Community Hospital, a Cardinal Health grantee, talked about how they had learned to engage physicians by using concurrent review. Specifically, the quality staff employed strategies such as educating the physicians one-on-one regarding the importance of using outcomes data for improvement; approaching physicians with patient’s charts during physician meetings; and posting an internal scorecard in the ED staffroom. By presenting them with charts that were less than 45 days old, Bucyrus has made physicians more responsive to their “outliers” and more conscientious about complying with clinical best practices. Case Management have honed the concurrent review process so it only takes 20 minutes to one hour per day, and the results have been substantial!
Port Clinton – known as the “Vacation Capital of the North Coast” – draws thousands of tourists every summer. Our visit to Magruder allowed my colleagues and I to take in Lake Erie, stay at a charming B&B and also observe some of the most exciting Campaign work we had seen in a while.
-- Jonah Borrelli
Representatives from Ohio KePRO and IHI discussed rural collaboration at a recent meeting (pictured left to right): Donna Moore, Ohio KePRO; Rita Bowling, Ohio KePRO; Patricia Nelson, Ohio KePRO; Dr. Bob Wilmouth, Mountain-Pacific Quality Health Foundation; and IHI's Jonah Borrelli.
Thursday, June 12, 2008 – Lobsters and learning in Maine
The Maine Hospital Association put together a wonderful medication safety program in Augusta this summer. With delicious lobster meals on either side of this meeting, IHI Director Fran Griffin and I learned about the great projects going on in “Vacationland.” After Fran’s presentation on medication reconciliation, we heard about the Critical Access Hospital Patient Safety Collaborative for Maine hospitals inspired by groups in Tennessee and how they plan to use positive deviance in their work.
After lunch, Sherri Turcotte, of Central Maine Medical Center (CMMC), spoke about her hospital’s experience with implementing a system-wide medication reconciliation process. “Focus on developing a solid, natural process rather than requiring extra documentation,” she suggested. By reducing the number of necessary steps, med rec became easier to explain to staff, they got more buy-in and trust in the accuracy of the list, and it became a more reliable process. A multidisciplinary approach was key to their success, involving folks from medication safety; inpatient, outpatient, imaging, IT and quality departments; hospitalists; their CMO; and an outside consultant. They developed ways to address their barriers – time, perceived benefit, trust, and ownership – rather than ignore them. Time spent in person explaining the process and receiving feedback was found to be the most efficient and effective way to get the plan across. At discharge, the providers and the patients are now much happier with the system. Patients receive a print out of their medications from their doctors that spell out clearly “here are the medications I want you to take, here are the ones I stopped, and here are the changes to previous amounts.” While this process is still underway at CMMC, it is obvious their hard work is paying off and they are (and should be) proud of their system.
Kevin Dempsey and David MacMillan of Blue Hill Memorial Hospital (a critical access hospital along the eastern coast of Maine) then presented their work on developing a pharmacy resource page. This page was developed as a communication tool (for MDs, RNs, RPh, etc.), a drug information resource (e.g., “do not crush list,” opioid equivalency table, etc.), a space for updates on the formulary and auto-sub policies, and as a medication reconciliation resource.
The team from Blue Hill also described their medication reconciliation work which started as a pilot project in the SICU. Pharmacy technicians are responsible for getting the medication history, verifying home medications (with the PCP or local pharmacy), completing the med rec form, and other duties. The hospital was able to build the case for hiring a technician for this role based on cost savings on potential medication errors. Not only did the hospital benefit from the pharmacy techs’ medication expertise, but being in this role increased the techs’ job satisfaction.
Blue Hill also engages the local pharmacy (the only one in their small community) in the medication reconciliation process. The hospital provides a medication list to the pharmacy and the PCP at discharge. The pharmacy then automatically discontinues anything not on the list. PCPs love this process as it reduces the number of phone calls necessary after a patient’s discharge.
While their pharmacy resource page is now open to anyone, it will eventually become password-protected and each doctor will have all of their patients listed alphabetically. There will be electronic copies of past medication reconciliation forms sent to the patient, PCP, and pharmacy.
These two presentations showed great resourcefulness in facilities that face many of the same struggles as others across the country. I look forward to hearing many more great stories from the Maine Critical Access Hospital Patient Safety Collaborative in the future.
-- Katie O’Rourke
Thursday, June 5, 2008: Quality improvement in the Mountain State
After some exciting cancelation- and thunderstorm-filled travel, I arrived for my first-ever trip to West Virginia. The West Virginia Medical Institute – the QIO and Campaign Node lead in the Mountain State – hosted their Summit on Health Care Quality in Charleston. Through collaboration with the American Heart Association (AHA) and IHI, the Summit provided presentations from national speakers and breakouts hosted by local facilities. Cardiologist Dr. William Lewis represented Case Western Reserve University, MetroHealth Medical Center in Cleveland, and the national steering committee for the AHA’s Get With The Guidelines program. His presentation on “Turning Guidelines into Lifelines” cited a variety of studies and statistics on coronary artery disease and heart failure. Lillian Burns, Infection Control Coordinator at Greenwich Hospital in Connecticut, then described best practices for reducing MRSA to the audience of hospital and nursing home caregivers.
After a delicious and heart-healthy lunch, the audience joined breakouts to discuss pressure ulcer prevention and changes in case review. I attended the pressure ulcer session and heard some great stories. The first was about how a local family of nursing homes ensures quality care for their residents through morning huddles, daily walkthroughs, and admission and transition communication with the families and staff. Campaign Mentor Hospital Charleston Area Medical Center sent along nurses Connie Lawrence and Sonya Perry, two of the most enthusiastic WOC nurses I’ve ever had the pleasure of meeting. They shared great information on staging, tips for communication with the patient, and methods for ensuring reliable care for all patients. The session finished with a presentation on how local hospitals have partnered with area long-term care facilities to ensure proper hand-offs.
Even with the travel woes, this trip was a great one. I learned so much about how acute care and long- term care facilities in West Virginia are working together. I also saw one of the best thunder and lightning storms of my life. It doesn’t get much better than that!
-- Katie O’Rourke
Thursday, May 22 - Friday, May 23, 2008: La Jolla hosts Town Hall and Hospital Visit
Believing that it should always be sunny in California, I stepped off the plane and had to remind myself that I was in San Diego even though the sun was nowhere to be seen. Arriving at the Town Hall at Scripps Memorial Hospital in La Jolla, I was informed that this weather is so typical of this time of year that the locals have coined it “May Gray.” Despite the gloom outside, the presenters and attendees easily lit up the room with their bright attitudes towards improving quality of care in their hospitals.
Attendees heard about getting Boards on Board from IHI Senior Fellow Blair Sadler and about improving medication safety from Dr. Bruce Spurlock, President and CEO of Convergence Health Consulting.
The following day, Bruce and I – with Node representatives Jenna Fischer and Julia Slininger from Lumetra – visited with staff at Scripps La Jolla. The staff’s commitment to patient safety and quality was apparent and we look forward to learning from their continued work in the 5 Million Lives Campaign and beyond.
-- Jordana Pickman
Scripps Memorial Hospital staff welcome Campaign Node representatives to their hospital in La Jolla.
Thursday, May 15, 2008: Arresting MRSA in Arizona
Greetings from the Southwest! This is IHI Project Assistant Rani Pimentel and I had the incredible opportunity to accompany Western Region Field Coordinator Jordana Pickman and IHI Vice President Joe McCannon to the Arizona’s Preventing MRSA: It’s In Our Hands MRSA prevention campaign kickoff. This new statewide initiative was made possible through the collaboration of several statewide organizations led by the Arizona Hospital and Healthcare Association (AZHHA) and the sponsorship of Blue Cross Blue Shield of Arizona.
We gathered at the Rawhide Wild West Town outside Phoenix. The day began with the “Rawhide” theme playing as attendees sauntered over a covered bridge. We immediately knew this was going to be a fun event!
First up was a performer impersonating “Matt Foley” – Chris Farley’s “Saturday Night Live” motivational speaker character – who had the whole room laughing. Joe McCannon then spoke about the 5 Million Lives Campaign and how Arizona’s efforts to prevent MRSA will contribute to a nationwide network for change and quality improvement.
The end of the day was dedicated to reviewing all of the resources contained in the Implementation Tool Kit provided to each attendee, including useful worksheets and forms and guidance on educating staff and getting “Boards on Board.” It was clear that these comprehensive guides were highly valued by all participants. Another resource the AZHHA unveiled was an web-based interactive MRSA training tool developed and donated by the e-learning company Resolutions.
Although there were humorous moments (including when Joe and other MRSA-murdering “criminals” were “arrested” and made to dance the can-can), the spirit of the conference remained clear: Everyone was serious about taking MRSA prevention “into their own hands.”
-- Rani Pimentel
IHI Vice President Joe McCannon (second from left) and others enjoy a humorous moment at the "kick off" of the Preventing MRSA: It's In Our Hands initiative in Arizona.
Thursday, May 8, 2008: Oregon sets the sights on transformation
Hospitals from across the state gathered in Portland to acknowledge local and national transformations in health care. Multiple speakers addressed the work being done to improve care on a state level with the Healthy Oregon Act and through CareOregon’s innovative work on the Triple Aim. Joe McCannon, IHI Vice President and Campaign Manager, discussed IHI’s national work on the Triple Aim initiative to optimize the experience of the individual, the health of the population, and the per capita cost of care and gave an update on the Campaign.
Most telling of the collaborative environment among hospitals in the state, were the 9 breakout sessions that featured a total of 18 Oregon hospitals, big and small, who shared their work on different Campaign interventions with each other.
A special thanks to Leslie Ray, Field Coordinator of the Oregon Patient Safety Commission, and the Oregon Network for coordinating this energizing and successful event that facilitated powerful learning for all attendees!
-- Jordana Pickman
IHI Vice President and Campaign Manager Joe McCannon with CNO Michele Walsh and CEO Jay Henry of Mountain View Hospital at a recent meeting in Portland, Oregon.
Wednesday, May 7, 2008: Partnering with the National Rural Health Association in New Orleans
Eastern Region Field Coordinator Katie O’Rourke and I are in beautiful, warm and breezy New Orleans at the annual conference of the National Rural Health Association (NRHA). The NRHA continues to be a great 5 Million Lives Campaign partner, and this meeting is proving to be a terrific event with about 1,000 attendees and over 90 speakers! We have had the privilege to meet many, many great folks, including Alan Morgan, CEO of the NRHA, and Paul Moore, the current NRHA President. Both expressed support for the Campaign and described the wonderful work that rural hospitals are doing across the country.
During the opening plenary, Paul shared a moving, personal story involving teamwork, confidence, fear and unintended heroism. He made several memorable points that served as encouragement to all attending: 1) We are all in this together; 2) We can’t control the environment, but we can navigate it; 3) We must implement evidenced-based improvement; 4) A change in perspective is often helpful; 5) Crisis is inevitable; and 6) Sometimes the solutions are “outside the box.”
Another real treat was the plenary address given by Acting Surgeon General Rear Admiral Steven Galson. In his remarks, he provided a national overview of issues related to childhood overweight and obesity. He also reviewed key points of the President’s Executive Order regarding health care: 1) Connect the system; 2) Measure and publish quality; 3) Measure and publish price/cost; and 4) Create positive incentives. A personal thrill was having the opportunity to meet Dr. Galson briefly. He was very kind and graciously commented on his admiration for IHI.
I have to cut this short because Katie and I are going out in search of spicy Cajun food!
-- Kathy Duncan
Tuesday, April 29, 2008: Working together at the Alabama Quality Forum
On my first ever trip to Alabama, I was extremely impressed with the city of Birmingham and all the folks working together on quality improvement. The April Alabama Quality Forum was hosted by the Alabama Quality Assurance Foundation (the Alabama QIO), the Alabama Hospital Association (AlaHA), and Blue Cross Blue Shield of Alabama. With almost 400 hospital leaders, administrators, and infection control practitioners from almost every hospital in the state in the audience, the collaboration of these organizations certainly showed.
After an introduction by Keith Granger (CEO of Flowers Hospital and Chairman of the AlaHA’s Quality Task Force), Charles McCrary (President/CEO of Alabama Power) provided the business community’s perspective on health care. The day continued with a presentation on preventing surgical complications by IHI Director Fran Griffin and moved into discussions of how to promote a culture of safety and hospital benchmarking capabilities within Alabama. Attendees also enjoyed time for discussion and breakout sessions and some very tasty sandwiches and cookies!
The Quality Task Force in the state is a remarkable achievement that I hope many states will emulate as different organizations continue to work together to achieve better health care quality and a better patient experience.
-- Katie O’Rourke
Wednesday, April 16, 2008: Ohio emerges as a laboratory for Rapid Response Team innovations
I was tremendously fortunate to attend the University of Cincinnati’s Annual Symposium on Rapid Response Teams. The purpose of the meeting was to identify the available tools and resources needed for implementation; to examine and extend the operational effectiveness of Rapid Response Teams; and to identify ways to sustain a Rapid Response Team.
Over the past two years, there has been an incredible amount of energy surrounding the Rapid Response implementation in Ohio. This year, staff from 20 hospitals representing three major systems in the Cincinnati area (TriHealth, Health Alliance and Mercy) as well as a few hospitals from Kentucky and Indiana attended this meeting. IHI Rapid Response Team expert Kathy Duncan and I were amazed to see all of the talent consolidated in one room.
Kathy gave a great presentation, with a particular focus on Early Warning Systems. Her talk set the tone for the rest of the day. In between didactic presentations, area hospitals treated the audience to stories of Rapid Response Team calls that saved lives. One of the most inspiring vignettes told of a psychiatric nurse who, before attending last year’s symposium, was not altogether familiar with the Rapid Response Team concept. A week later, he called the team when a patient who had refused to eat or take his medications started showing signs of instability. An early warning system helped this nurse to focus particular attention on this patient before he made the call.
The other stories told throughout the meeting served to remind everyone why this intervention is so important. Participants left feeling energized. I look forward to returning to Ohio next month to work with the University of Cincinnati and the Ohio Node Partners (Ohio KeyPRO and the Ohio Hospital Association) as we continue to harvest best practices from this great state.
-- Jonah Borrelli
Wednesday - Thursday, April 16-17, 2008 – Shared learning at the New England Rural Health RoundTable meeting
What a beautiful time to visit Portsmouth, New Hampshire! After poking around the quintessential New England town, I was able to meet up with folks from the New England Rural Health RoundTable (NERHRT) and various speakers for the follow days’ festivities for a perfect seafood dinner in what used to be the tallest building in the US (about four stories high). I learned a lot about the various state offices of rural health and how the states (Maine, Vermont, New Hampshire, and Massachusetts) have joined together to support their rural and critical access hospitals together.
The following day was a true testament to their work. Dr. Gerald Doekson from the National Center for Rural Health Works in Oklahoma gave a very interesting presentation on the costs associated with different types of physicians and hospital services in rural settings. His economic tools are applicable in many settings and will help communities across the country determine what services they can support. Dr. Doekson was followed by the extremely effervescent and friendly (even if she is a Yankees fan!) Carol Buchdahl of Vermont Technical College who led the group through her leadership development work with small rural hospitals. She showed how we will all be moving into the cyber world by unveiling the NERHRT wiki page. The wiki network will enhance support systems for small and rural hospitals in the area.
Jeff Spade, Rural Affinity Group Node leader and Executive Director of the North Carolina Rural Health Center, spoke about quality improvement in rural settings and how the 5 Million Lives Campaign is applicable to rural and critical access hospitals. Various breakouts in the afternoon highlighted different research; CMS updates; the work of a group of 13 critical access hospitals in New York that have come together in collaboration for the “Never Too Small To Save a Life” project; Martha’s Vineyard Hospital (MA) and their Press Ganey Summit Award for Patient Satisfaction; and Springfield Hospital (VT) and their experience as a CAH partnering with IHI.
Many folks were able to chime in about their experiences and questions throughout the day in this beautiful waterfront setting. The work of this group of rural health organizations is remarkable. I know we will all continue to learn from them as they teach us the benefits of coming together to support one another in our quality improvement efforts, regardless of hospital size or location!
-- Katie O'Rourke
Tuesday, April 15, 2008: Arkansas hospitals celebrate success on the system-, state- and hospital-levels
Today, Kathy Duncan and I joined Node partners the Arkansas Foundation for Medical Care and the Arkansas Hospital Association as well as hospital representatives from all over western Arkansas at St. Edward Mercy Medical Center in Fort Smith. Primarily, we came to learn about the work St. Edward had done to prevent infection in their facility; by the end of the meeting, however, other hospitals were sharing their successful strategies as well. This level of transparency was inspiring, but not altogether surprising: Arkansas recently became one of the few states to achieve 100 percent enrollment in the 5 Million Lives Campaign! The Arkansas Node partners celebrated this feat by distributing special buttons to the participants (see photo below).
At the beginning of the meeting, St. Edward Mercy Health Network President and CEO Jerry Stevenson stated the organization’s goal of no more adverse events. To move towards this goal, St. Edward committed to a) publicly reporting core measures and b) doing executive safety rounding during which leaders and some board members will address 660 different areas for improvement across the organization.
St. Edward’s VAP work was particularly impressive. They actually round every day with every member of the intervention team! It only takes 10 minutes because each member has a distinct role (one person responsible for checking head-of-bed elevation, one responsible for the checklist, etc). Over the course of a year, VAPs fell by 65 percent! The team described two “ah-ha” moments. First, was a nursing education piece: by the second half of 2007, the VAP Team observed during rounds that bedside nurses were demonstrating they understood the evidence supporting the vent bundle (and it was around this time that compliance started going way up.) Second, was when the team realized that the majority of VAPs were happening to patients with contraindications (which showed the bundle worked!)
Kathy and I learned so much about the work happening at St. Edward. By attending this meeting and addressing the Campaign interventions together, the participants showed incredible dedication to providing quality care for all Arkansas patients. We look forward to observing hospitals initiating this type of collaboration in other states as well!
--Jonah Borrelli
The team from St. Edward Mercy Medical Center in Fort Smith, Arkansas greet IHI's Jonah Borrelli and Kathy Duncan during a recent gathering of hospitals in their state.
Thursday, April 3, 2008: Celebration and sharing in West Memphis, Arkansas
What a great trip! After a wonderful dinner with members of the Tennessee and Arkansas Nodes to discuss ways the two states can collaborate on Campaign efforts, IHI faculty member Kathy Duncan and I attended a Town Hall meeting hosted by Crittenden Regional Hospital in West Memphis, Arkansas. Health care providers from Tennessee and Mississippi were invited along to share in the learning and festivities.
Twenty-two other hospitals in the area registered to learn about the keys to Crittenden’s work on VAP and CRBSI (bundle carts and monitoring tools), MRSA (a great song and games based on the germ-phobic TV detective Monk), CHF (work with the community and some great discharge tools), and AMI care (patient education and speedy transfers to a cath lab at another hospital). After Crittenden’s presentations, the floor was opened to all hospitals to talk about the work they are doing, their successes and their tough spots. We learned of a hospital that has gone two years without a VAP; one that was able to reduce surgical site infections from 21 in 2005 to 5 in 2007; and various ways hospitals have improved their hand hygiene compliance.
At lunch, we all celebrated Arkansas hitting 100% hospital enrollment in the Campaign with a delicious cake and cookies. As an Eastern Region Field Coordinator in a Central Region state, I was thoroughly impressed with everything I learned!
-- Katie O’Rourke
Arkansas celebrates 100% enrollment of its hospitals in the 5 Million Lives Campaign.
Thursday, March 27, 2008: South Carolina’s First Annual Patient Safety Symposium - A Patient-Centered Success!
“Every Patient Counts” is a guiding principle in South Carolina, and it is the name of a coalition dedicated to improving patient safety and quality in the state’s hospitals. This week, IHI Executive Director Bob Lloyd and I had the pleasure of attending the state’s First Annual Patient Safety Symposium. The focus on the patient was a clear theme throughout these two days of active learning. Over 240 health care executives, physicians, hospital staff, patient advocates, and experts gathered to share ideas to improve care. Hosted by Health Sciences of South Carolina, PHTS, Every Patient Counts, and the South Carolina Hospital Association, it was hard to believe that this rich and polished conference was just their first!
The symposium opened with a video message from IHI President and CEO Don Berwick, followed by sessions on leadership engagement, the interface between quality improvement and ethics, creating high performance organizations, and patient-centered care through Rapid Response Teams, among others. The most moving and memorable part of the conference was listening to patients and families of patients who had suffered from medical errors, including Linda Kenney, Jan Vick, and Helen Haskell. Ms. Kenney nearly lost her life because of a medical error and her experience inspired her to found the Medically Induced Trauma Support Services. Ms. Vick, now a patient safety advocate, lost her twin sister to a medical error. Ms. Haskell’s son Lewis Blackman died from failure to rescue in a teaching hospital in South Carolina. She was instrumental in helping health care professionals and consumers pass the state’s Lewis Blackman Act, aimed at improving poor communication among hospital caregivers.
The symposium also marked the celebration of the First Annual Lewis Blackman Patient Safety Champion Awards. The awards recognize a caregiver, a health care executive, and a person outside of health care who have advanced patient safety and health care quality in South Carolina. This year’s awardees were greeted by Helen Haskell, and included Greenville Senator Ralph Anderson, Self Regional Healthcare’s President and CEO M. John Heydel, and AnMed Health’s Director of Pharmacy and Centralized Scheduling Patricia White.
For South Carolinians, the importance of patient-centered care has hit home, with an undertaking to move from will to execution. It goes without saying that we can’t wait to come back next year.
-- Jennifer Chi
Helen Haskell and Jan Vick - patient advocates who have lost family members to medical errors - shared their stories at South Carolina's First Annual Patient Safety Symposium.
Thursday, March 13, 2008: A visit to Fresno, California
Today got off to a great start with an early morning visit to St. Agnes Medical Center in Fresno. IHI Director Fran Griffin, California Node representative Mary Lopez of the Hospital Council of Northern and Central California and I were greeted by Director of Quality Julie Cade who introduced us to more of the staff at St. Agnes.
We spent the morning learning about the improvements they have made in ICU Safety and AMI care. Remarkable door-to-balloon times of less than 40 minutes are not uncommon at St. Agnes, with the fastest time yet being 24 minutes! Each month, the cardiologist who has achieved a door-to-balloon time of under 40 minutes joins the "Thirty-Something Club" and their photo is hung on the wall for all to see. It was obvious that St. Agnes had much more to share about their work and they are now serving as an AMI Mentor Hospital.
The remainder of the day was spent at a Town Hall Meeting where over 70 attendees from 21 hospitals heard presentations on MRSA, stroke care, and leadership and shared their own improvement experiences in these areas. Many of the participants I spoke with said they find the opportunities for networking and learning from their peers at these Town Halls so beneficial. It was great to be a part of this forum for connecting and sharing!
-- Jordana Pickman
The AMI Care Team at St. Agnes Medical Center in Fresno, California.
Thursday, March 13, 2008: Puerto Rico – The Campaign’s newest Node is off to a fast start
Hello from the sandy beaches of San Juan, Puerto Rico! It was my great pleasure today to be with the Campaign’s newest Node, led by the Quality Improvement Professional Research Organization (QIPRO), the QIO for Puerto Rico. Campaign activity is off to a fast start on this small island, where partner organizations with QIPRO include the Asociación de Calidad de Puerto Rico, Colegio de Administradores de Servicios de Salud, Asociación de Hospitales, Departmento de Salud SARAF, Colegio de Profesionales de la Enfermería de Puerto Rico, and Tripe-S. Representatives from many of these organizations were present today, which also marked the first island-wide Get With The Guidelines event, co-sponsored by the American Heart Association.
It was clear from the engaged conversation throughout the day: providers across Puerto Rico care very much about giving their patients the best health care possible. Given the eagerness, affable caregiver community, and data-driven attention to quality, it is clear that this territory has great potential to drive this Campaign beyond the US mainland. We look forward to partnering with this group as the newest member of the Campaign’s National Learning Network!
-- Jennifer Chi
Campaign National Field Manager Jennifer Chi joins staff from QIPRO, the American Heart Association, and Aibonito Menonita Hospital, Cayey Menonita Hospital, Ashford Hospital, HIMA Caguas, Arecibo Susoni, and Ponce Damas Hospital at a meeting of the Puerto Rico Node.
Friday, March 7, 2008: North Carolina Road Trip!
IHI Director Frank Frederico and I hit the North Carolinian roads again! After spending time in the western part of the state last October, we headed east into Duke/UNC land this week (just before the big game!). We started our trip with a great Medication Reconciliation Collaborative celebration at the North Carolina Hospital Association. Hearing insightful stories from nine hospitals on their successes and difficulties was wonderful. We learned some best practices from 600+ bed hospitals and a 25-bed Critical Access Hospital with only eight physicians. We hope to get some of the great tools they’ve created to share with others.
After a great southern meal and torrential rain storm, we spent Wednesday at the Friday Center for the Wake and Greensboro Area Health Education Centers 5 Million Lives meeting on MRSA and High-Alert Medications. Frank presented on HAM and facilitated work groups to plan courses of action for what the teams could do “by next Tuesday.”
Our trip ended on Thursday evening after an exciting site visit to Cape Fear Valley Health System in Fayetteville. We heard about their great work in many areas: preventing central line infections and VAP, hip and knee surgeries, Just Culture and peer review process, pharmacists in the emergency department (a project for which they will be published!), and patient flow in the emergency department. It was great to hear from so many different presenters and departments. With 15 patient safety officers in this system, and a motto of “The right thing, the right way, at the right time, every time,” it is obvious that quality improvement is high on their agenda. We hope they will be able to share their stories with more in North Carolina and beyond.
Frank and I headed back to the RDU Airport (along with the masses going on Spring Break!) and had a final pulled pork sandwich before our flight back to Boston. What a great trip!
-- Katie O’Rourke
Thursday, March 6, 2008: Tapping rural hospital talent in Tyler, Texas
Hello from the town of Tyler in East Texas. TMF, a member of the Texas Node, invited IHI VP Joe McCannon and me to meet with members of the Alliance of Rural and Community Hospitals. One of the purposes of the meeting was to encourage more of Texas’s rural hospitals to enroll in the Campaign: these hospitals are delivering such great care for their patients - much of it well-aligned with the Campaign interventions. This is particularly impressive when one considers the many “hats” worn by caregivers in small and rural hospitals. By outlining the benefits of the Campaign, describing the resources the Campaign has developed for small and rural hospitals, and clearing up misperceptions about enrollment requirements, TMF and the IHI delegation hoped to engage these facilities and ultimately spread their knowledge to other rural facilities throughout the country.
The presentations, which were given by Joe and members of the Node, were well-received. We got a lot of questions, and many folks expressed interest in enrolling; furthermore, we were able to distill some of the group’s questions and concerns into a one-page document entitled, “Campaign Enrollment FAQs for Rural and Critical Access Hospitals” (Thanks, Jesse!). The group was very engaged, and many expressed interest in enrolling after the meeting. Not surprisingly, while only 10% of the folks in the room were enrolled in the Campaign, every one of the 30-some odd participants represented Critical Access Hospitals that were voluntarily submitting data to CMS. We also heard examples of individual hospital success: East Texas Medical Center in Athens, TX achieved great results after deploying a Rapid Response Team in their 177-bed facility. They even created a video to distribute to other hospitals! This is just one example of a rural hospital that will have so much to teach hospitals of all types all over the country.
We hope to see more rural hospitals join the Campaign in the near future.
-- Jonah Borrelli
Tuesday, March 4, 2008: Iowa Healthcare Collaborative shines again!
Today, caregivers and administrators from across the state of Iowa convened to discuss their progress and next steps in implementing the 5 Million Lives Campaign. The meeting was held in Ames on the Iowa State campus. The site had been hit by a snowstorm only two days before, but the dedicated members of this group still managed to truck out for a day of educational presentations and rich sharing sessions. After a brief national update, Tom Evans of the Iowa Node gave an update on Iowa hospitals’ progress in implementing the interventions. Tom congratulated Iowa hospitals on having fully deployed Rapid Response Teams in 37% of their facilities; in a state with many rural hospitals, this is impressive indeed!
The focus on “spreading” Rapid Response Teams set the stage for two more excellent presentations: first, IHI’s Kathy Duncan recounted her experiences working with Rapid Response Teams across the country and gave the audience some very practical tips for getting started; second, Michele Kelly of Buena Vista Regional Medical Center in Storm Lake addressed the issue of implementing a Rapid Response Team in a Critical Access Hospital setting. Enthusiasm in the audience was evident from the breakout session I attended that afternoon: in addition to the dedicated improvers who have participated in this breakout group since the IHC began two years ago, at least half of today’s participants represented hospitals that had not yet started a team! The session was rife with questions, and many of the newcomers appeared eager to report what they had learned upon returning to their facilities.
The Iowa Healthcare Collaborative provides a forum where hospitals in various stages of their quality journey can share ideas in hopes of accelerating the pace of improvement; it is truly an “all teach, all learn” environment.
-- Jonah Borrelli
Friday, February 29, 2008: Multiple successes at MultiCare
What a glorious Friday! I was in Seattle for the Safe Table Event on Thursday (see Jordana’s February 27 blog) and Carol Wagner, VP of Patient Safety for the Washington Hospital Association, invited me to visit MultiCare Health System. This morning, Carol drove Yogini Sharma, Sharon Eloranta and I to Tacoma, about an hour south of Seattle. Unfortunately, although we drove past Mount Ranier, it was too foggy to see it. I hoped for a better view in the afternoon.
When we arrived, we were met by about 30 managers and staff from Tacoma General (our hosts for the day), Mary Bridge Children’s, Good Samaritan and Allenmore hospitals. We spent about four hours informally discussing the Campaign’s interventions, staff involvement and opportunities to get past some hurdles. Within the MultiCare system, the four hospitals have had some success in various interventions, including AMI, Rapid Response Teams, and preventing central line infections and VAP. We discussed strategies for spreading their innovations within each building and to their sister hospitals. For example, they have done great work with preventing central line infections in the ICU, but have not yet focused on the ED or Anesthesia. We discussed ways to spread their learnings to any department that inserts central lines.
Although it was still too foggy in the afternoon to see Mount Ranier, it was a great day and I appreciated the opportunity to meet such great people dedicated to preventing harm in the Tacoma area!
-- Kathy Duncan
Wednesday, February 27, 2008: Washington State Safe Table Learning Collaborative
In Seattle today, over 100 Washington state health care professionals gathered to discuss the latest information on Rapid Response Teams and the prevention of pressure ulcers. The event was facilitated by Carol Wagner of the Washington State Hospital Association and IHI faculty member Kathy Duncan. (The “Safe Table Learning Collaboratives” – so named because discussions are designed to be safe for open dialogue – were created by the Hospital Association and Qualis Health.)
The program outlined resources available, an overview of the interventions’ impact statewide, and implementation tips from organizations across the nation. Panel discussions from local hospitals were held for both interventions. I was impressed to learn that there are 65 hospitals with Rapid Response Teams in the state and that 40% of hospitals allow patients and families to activate the team!
With ambitious patient safety goals and a history of statewide achievements, I have no doubt that we will be hearing more impressive results from hospitals in Washington!
-- Jordana Pickman
IHI's Kathy Duncan addresses the crowd at the Washington State Safe Table Learning Collaborative.
Friday, February 1, 2008: Connecticut hospitals gather for MDRO collaborative kick off
On what can only be called an extremely blustery day in Wallingford, teams from almost every hospital in Connecticut gathered to kick off their eight-month multiple drug resistant organism (MDRO) collaborative. Over the course of the day, attendees heard from representatives of local hospitals, Cooley Dickinson Hospital (a Campaign Mentor from Northampton, Massachusetts), and a health care PR expert who shared best media practices in the DC/Maryland area.
Before the collaborative planning began, hospital representatives covered scientific background, literature reviews, effective hospital initiatives and prevention methods, as well as advice on how organizations can better communicate with the public about MDROs. Hospital teams then broke out to write their aim statements and plan their first PDSA cycles. Sherri Barnhill, an enthusiastic Patient Safety Officer from Moses Cone Health System in North Carolina, will coach each team throughout this collaborative. Both the Connecticut Hospital Association and the local QIO, Qualidigm, will support Sherri and each hospital in this endeavor.
I had some pretty high standards after attending the kick off of Connecticut’s great pressure ulcer collaborative last November, but this one was just as great. Congratulations to everyone involved! I can’t wait to hear the results.
-- Katie O'Rourke
Thursday, January 31, 2008: Town Hall targets medication safety, stroke and pressure ulcers in Woodland, CA
Today, seventy-one (71) individuals representing 22 hospitals from a diverse region of northern California converged in Woodland to attend the Town Hall meeting organized by the California Node. Attendees heard from local experts about medication safety, stroke care, and preventing pressure ulcers. Two panels comprising participants from various local hospitals talked about their personal experiences with medication safety and pressure ulcer prevention.
Most notably, Barton Memorial Hospital in South Lake Tahoe shared the “PUP” (Pressure Ulcer Prevention) logos they post on the doors for patients at risk for developing pressure ulcers. Using creativity to raise awareness of their pressure ulcer prevention efforts, the team at Barton sent out an all staff request for photos of people’s dogs to be used in the logo. The response was overwhelming! Staff from all areas of the hospital sent in pictures and – once the logos were posted – staff members were found wandering the halls looking for their mutts’ mugs! (Examples of the PUP logos are posted on the Hospital Council of Northern California’s (HCNC) website.) Throughout the Town Hall, questions from the audience were abundant and reflected the value of an event where hospitals are able to share their experiences and expertise on quality and patient safety issues.
The following day, Vice President of HCNC Mary Lopez and I visited Woodland Healthcare. Teresa Childers, Quality Risk Manager at Woodland, guided us through the emergency department, critical care and medical/surgical units. We spoke with medical staff about their successes and challenges in implementing the 12 Campaign interventions, and learned about fantastic results they have achieved with their Rapid Response Team, and preventing infections and pressure ulcers. After a few hours with the team from Woodland, it was apparent that much of their success came from their ability to work together and set quality and patient safety as top priorities.
-- Jordana Pickman
Panelists at the California Node Town Hall meeting take questions from the audience (pictured left to right): Dierdre Hegarty, Senior Director for Med/Surg Services at O'Connor Hospital; Judy Van Pelt, Chief Nursing Officer for Fremont Rideout Health Group; Karen Wilson, Wound Specialist at Barton Memorial Hospital; and Susan Gonzalez, Director Med/Surg & IV Therapy for Woodland Healthcare.
Thursday, January 17, 2008: New Mexico targets zero pressure ulcers by working across health care settings
Today, over 150 representatives from all over New Mexico gathered in Albuquerque to learn more about pressure ulcer prevention. The event brought together 50 hospitals, nursing homes, and home health agencies.
Upon arriving, each participant was given a name tag with a colored sticker on it. Later, it was revealed that the color of the stickers corresponded to the participant’s region of the state. Based on this information, attendees were instructed to have lunch with their neighbors from different facilities and to talk about how they could join forces to prevent pressure ulcers.
IHI faculty expert Kathy Duncan shared pressure ulcer prevention strategies along with “tips and tricks” she has picked up from visiting hospitals throughout the US. Karen Clay, president of Kare N' Consulting, declared that she and Kathy must have been twins separated at birth (because they echoed so many of each other’s comments) and also spoke on pressure ulcer prevention and wound care.
The event was sponsored by the New Mexico Medical Review Association (NMMRA), which serves as the QIO for New Mexico. NMMRA and the New Mexico Hospital Association comprise the state’s Node. The New Mexico Health Care Association has also committed to a joint effort to reduce the incidence of pressure ulcers statewide.
The commitment among hospitals, nursing homes, and home health agencies to work across health care settings was truly inspiring!
-- Jordana Pickman
Western Region Field Coordinator Jordana Pickman provides a 5 Million Lives Campaign update to the audience at a New Mexico Node gathering.
Tuesday, January 8 - Wednesday, January 9, 2008: Georgia hospitals gather for two-day quality summit
IHI faculty member Kathy Duncan and I had a wonderful visit to Reynolds Plantation, GA for the Georgia Annual Patient Safety Summit (hosted by the Georgia Hospital Association). We enjoyed a beautiful setting (not entirely lost on us even though we aren’t golfers), amazing presenters, and wonderful hospital improvement stories. Twenty-one (21) hospitals won awards and many presented on their successes.
A few hundred attendees gathered over these two days to hear from a variety of experts from different fields. The presentations included: changes in quality improvement since the IOM’s report “To Err Is Human” with IHI senior faculty Dr. Robert Wachter; how to handle “crucial conversations” with David Maxfield; best practices from PHA (Partnership for Health & Accountability) Quality and Safety Award Winners; how to admit medical errors with Jack Schroder, Esq.; pressure ulcers and Rapid Response Teams with Kathy Duncan; and updates on core measures and SCIP with Dr. Dale Bratzler.
The overarching message was that Georgia hospitals are advancing to new levels of quality improvement in many aspects of patient care. By devoting themselves to learn the many topics presented, these hospitals are making a very strong statement to those in their care.
-- Katie O’Rourke
IHI faculty member Kathy Duncan presents at the Georgia Hospital Association's Patient Safety Summit.
Thursday, November 15, 2007: Colorado Kicks off the 5 Million Lives Campaign
In Denver today, more than 120 representatives from 45 hospitals across Colorado met to formally launch the 5 Million Lives Campaign in their state. The audience of board members, CEOs, nursing staff, physicians, and quality leaders spent the day learning about the new Campaign and the resources available to them. Everyone who attended the kickoff was sent home with a massive three-ring binder filled with helpful tools and resources for implementing Campaign interventions. IHI faculty member Kathy Duncan shared some tips and tricks for implementing the MRSA and pressure ulcer prevention planks, while IHI senior faculty member Michael Pugh talked about the importance of getting boards on board.
A portion of the day was dedicated to familiarizing hospitals with the different organizations involved with the Campaign. The Colorado Trust; Colorado Foundation for Medical Care; the Work Education and Lifelong Learning Simulation (WELLS) Center (a statewide initiative funded by the Colorado Department of Labor & Employment and the Colorado Workforce Development Council); Colorado Hospital Association; Colorado Rural Health Centers; and SE2 Communications, all explained how they would be providing support for individual hospitals.
We are looking forward to hearing about the great work that is bound to be done in Colorado!
-- Jordana Pickman
Posters presented at the November 15 Colorado Campaign kick off: "Good call. Trust your instincts. Call the Rapid Response Team immediately whenever something about a patient doesn't look or feel right to you" and "Timing is everything. Always deliver antibiotics within one hour of surgical incisions."
Wednesday, November 7, 2007: The Fall Harvest visits end, but the learning continues
Can it really be over? After traveling to nearly all 50 states and the District of Columbia (only the threat of Hurricane Noel kept us from visiting Florida), it’s hard to believe that the 5 Million Lives Campaign’s Fall Harvest visits have come to a close. Over 80 IHI staff and faculty members logged almost 275,000 miles and met literally hundreds of people who demonstrated enormous passion, caring, and commitment. The pride they expressed in the improvements they are making individually and collectively was nothing short of inspiring.
We’ve learned so much in such a short time and we feel privileged to have interacted with so many wonderful, welcoming organizations. We are deeply grateful for their generosity and I would be remiss if I did not also offer special thanks to the Campaign team and IHI staff and faculty who flawlessly planned these visits and tirelessly traveled the nation.
We set off on the Harvest two weeks ago with a guiding question: “What is the formula for success in those hospitals that are most successful at improving quality and safety?” We had some theories in mind about what makes high-achieving organizations tick (see the IHI white paper, Execution of Strategic Improvement Initiatives to Produce System-Level Results), but we wanted to test and confirm them. What is the answer to our question? While there are certainly no silver bullets, here are some of the things that seem to be happening in these hospitals (and many others like them):
· Leaders set ambitious, system-level aims for improvement and closely track progress against these aims. In the facilities we visited, boards, executives and clinician leaders set goals for total facility or system transformation (e.g., reducing all-cause harm or risk-adjusted mortality, enhancing patient and staff satisfaction) and study their progress every month, noting opportunities for improvement, removing barriers to progress and liberally celebrating success. Giving the chief medical officer responsibility for quality seems especially effective in creating clinician ownership of improvement.
· The organization gives itself “permission to prioritize.” Where resources are finite organizations must make decisions about which improvement projects to select; by doing so on a quarterly or annual basis, using their system-level goals as a compass, they are observing more success, feeling more confidence and building more capacity to take on additional change.
· The organization regularly and transparently reviews its performance data. Honest, frequent assessment of data by everyone in the organization, including front-line staff, allows high-achieving facilities to stay agile, focusing energies on their most acute problems and building joint accountability for progress.
· The organization’s care is focused on the patient (inside and outside of the hospital). Hospitals that view themselves as part of a larger system, consisting of other hospitals, outpatient settings and the patient’s home, provide coordinated, integrated care that comforts the patient and their family and significantly improves outcomes.
Taken together, these characteristics – and many others – create organizations where quality is not a department, but a shared responsibility; where excellence is not defined as adherence to external guidelines, but as care for the patient that approaches perfection. Describing exactly how these organizations achieve such complete transformation is the Campaign team’s next task, and I encourage you to tune in closely as we explore this – in calls, materials and countless other learning opportunities – in the months to come.
Can it really be over? The real answer, of course, is “no.” As always in our continuous effort to improve hospital care in this country, we must continue, relentlessly, to learn from one another and to study how your organizations are seeing their way through the hard work of making change. We are humbled to see that not only are organizations working hard on the Campaign, many are also building on these experiences and expanding their improvement efforts to areas outside the 12 interventions. This is confirmation that we are building a renewal resource for continuous improvement within organizations.
We will distill and re-broadcast what we have learned in the last two weeks, but we will also push out into the field to see what’s happening at the front lines of this crucial movement in service of patients and families. Amazingly, we feel more energy now than we did two weeks ago, and we look forward with pleasure to being on your doorstep sometime very soon!
-- Joe McCannon
At the end of the Fall Harvest, Thomas Van Der Laan and Katie O'Rourke pause for a well-earned rest.
Wednesday, November 7, 2007: Top-down and bottom-up improvement at Pitt County in North Carolina
My final stop for the Fall Harvest took me once again to the south (Greenville, North Carolina, this time) for a dual event. The morning brought me to the first meeting of a new collaborative on reducing MRSA launched by the North Carolina Hospital Association. MRSA is certainly a hot topic and this collaborative is a great first step because it will really take community efforts and the hospitals working together to tackle this bug.
North Carolina is no stranger to regional efforts to improve care for their patients as I later learned when visiting Pitt County Memorial Hospital. One of the dramatic improvements at Pitt has been a very significant reduction in door-to-PCI time which has led to an approximately 50 percent reduction in AMI inpatient mortality. This was achieved as Pitt has been participating in RACE (Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments), a regional effort in eastern NC to improve AMI care for all.
I could have spent an entire day at Pitt hearing about their work. A few other highlights included their efforts to reduce VAP through a modified ventilator bundle (they have added two elements to the original IHI bundle) and how they have patient safety champions from almost every department in the hospital who educate, spread information and design safety strategies for their areas. A great example was the "Room in Ruins" presented by the respiratory department (near and dear to my heart and past life!): a room set up with safety issues and staff compete to see who could identify and fix the most. Very clever!
The most impressive aspect of my visit to Pitt was hearing about how their board is involved in promoting quality and safety. Three (yes, three!) board members joined me for lunch to talk about this and it quickly became obvious that this board was well ahead of the Boards on Board intervention and could easily be a role model for others. One of their former board members owned an industrial plant and shared how the "10 worst machines" in the plant were always known by the front line. The board at Pitt has applied this to health care and wants to know what the "10 worst machines" (translated to processes) are in the hospital so they can focus on these for improvement. One board member even attended (on her own initiative) a conference on high-performing organizations, which included businesses like Continental Airlines (one organization that I am personally thankful is on this list). The enthusiasm at Pitt clearly is top-down and bottom-up! What a wonderful way to wrap up my Fall Harvest travels!
-- Fran Griffin
Wednesday, November 7, 2007: Garden State collaboration deserves congratulations
While it was still dark, IHI Fellow Susan Went, Eastern Field Coordinator Katie O’Rourke, and I made our way to Boston’s South Station and boarded a train for Newark. The day grew brighter, warmer and more colorful as we arrived in the Garden State.
Joe, Atlantic Health’s driver and all-around-good-guy drove us to Morristown Memorial Hospital. We joined the Overlook and Morristown teams (which included board member David Powell) and New Jersey Node representatives Aline Holmes of the New Jersey Hospital Association and Maureen McKee of the New Jersey Council of Teaching Hospitals for a delicious lunch served on a rose petal-strewn table. While we enjoyed some fantastic desserts and caffeinated drinks, we were doubly pleased by the 20 storyboards showing significant progress on the 5 Million Lives Campaign interventions and much more.
We then attended presentations given by the North Central New Jersey Health Association Partnership for the Reduction of Pressure Ulcers (or the NCNJHAPRPU, if you’re fond of acronyms). Collaborative participants we heard from included Morristown Memorial, Overlook Hospital, Atlantic Rehabilitation Institute, Runnells Specialized Hospital of Union County and CareOne at Madison Avenue. Highlights from this initiative included collaboration between acute care hospitals and rehab and long term care facilities, multidisciplinary teams and an internal shared website. Each team described how they achieved the bold aims they set for 2006-07 and the new aims they’ve set for 2007-08. Excited Morristown frontline nurses then showed us the great training they do for staff at time of hire and annually thereafter.
On the train home, we spoke of how impressed we were by the way Atlantic Health collaboratively communicates and pursues improvement. Then we took advantage of the opportunity to sleep.
Congratulations Atlantic Health on your great work and thank you for your hospitality!
-- Thomas Van Der Laan
IHI's Katie O’Rourke, Thomas Van Der Laan, and Susan Went join participants in the New Jersey Health Association Partnership for the Reduction of Pressure Ulcers and representatives from the New Jersey Hospital Association and the New Jersey Council of Teaching Hospitals during the state's Fall Harvest event.
Wednesday, November 7, 2007: Making improvement personal at Mountain View Hospital, Oregon
Maybe it’s the clear mountain air in Madras, Oregon, that makes the team at Mountain View Hospital know how to have so much fun. Suzi Bean, Director of Quality Improvement, made improvement fun from the beginning with ideas ranging from her alter ego as Clarabelle in an advice column to staff on quality improvement, to Rapid Response Team guidelines built to the acronym CANDYBAR. Jay Henry (CEO) and Michele Walsh (CNO) stressed that their work is fun, especially as a smaller hospital with agility to change. Mountain View Hospital serves a population of 25,000 with 25 beds as a rural critical access hospital.
The Mountain View team is also achieving remarkable results, with a 50 percent drop in the overall hospital mortality rate in the last year. The team attributes much of this drop to the Rapid Response Teams, but other work includes surgical site infection prevention, a hand hygiene campaign, medication reconciliation initiatives, perinatal care bundles, practice changes in AMI care, and so much more that it is impossible to list it all! A wide audience included St. Charles Medical Center in Bend, St. Charles Medical Center in Redmond, and Pioneer Memorial Hospital in Prineville, partnering hospitals who make up the Cascade Healthcare Community; Oregon Node representatives Leslie Ray (Oregon Patient Safety Commission), Kathy Phipps (Acumentra Health), and Linda Lang (Oregon Association of Hospitals and Health Systems); and the visiting IHI team of Jordana Pickman, Jennifer Chi, Jane Roessner, and me. All of us applauded Mountain View Hospital for their remarkable accomplishments!
A message that resonated throughout the day is that in this small community, anyone who walks through the door of your hospital could easily be your neighbor, mother, or child. Each of the team members shared how their personal experiences as consumers of the health system drive their desire to improve the care that they deliver as providers. As Suzi Bean concluded at the end of the day, “We make it personal, we make it fun, and that’s why our work gets done.”
-- Karen Zeribi
Wednesday, November 7, 2007: Baylor Regional – A star in the Lone Star State
Jonah Borrelli and I visited the team at Baylor Regional Medical Center in Plano, Texas to hear about their surgical care improvement work. Our visit was beautifully choreographed, and we came to appreciate a corresponding level of choreography that goes into their care of surgical patients. As these patients move through the system, from the surgery check-in center, to the OR, to the post-anesthesia care unit, to the medical/surgical unit, there is a strong web of interacting roles and processes that is focused on avoiding surgical complications. Every day, the team leader generates a list of scheduled surgeries, identifies the patients that fall under the SCIP guidelines, summarizes the type of surgery each patient is receiving, and lists the antibiotics that are recommended for that type of surgery. The list is distributed by email every morning to every department that will end up caring for the patient, including anesthesia and pharmacy. It also goes to the Chief Executive Officer of the hospital. Each component of the team swings into action, making sure that all of the appropriate steps – from antibiotic use, to DVT prophylaxis, beta-blockade, and temperature management – occur perfectly.
We were especially impressed with the handoffs from department to department, and the degree to which nurses and pharmacists are empowered to question and engage in problem-solving with physicians. The best examples occurred between departments responsible for the appropriate administration and discontinuation of antibiotics. At the end of every day, the pharmacy department reviews each case for appropriate use of antibiotics, and notifies everyone on the distribution list of the outcome. It could be a day where every patient received appropriate antibiotics, or a day where there were exceptions to learn from.
The team has developed a great facility for doing small tests of change. When they needed a better way to identify SCIP patients on the chart, one of the nurses developed a sticker, printed up a batch, and tried them out on the chart the same day. The sense of daily innovation, and fast PDSA cycles was pervasive in our conversations. It was also apparent that the teams derived a great deal of pride and satisfaction from their results as well as from their ability to improve quickly.
Contributing to the “one-team” feeling at Baylor is the alignment across all levels of the organization – from the board to the front lines of care – around “big dot” goals and how everyone’s work is related to the big dot. They have put a great emphasis on mortality reduction, and have achieved an estimated 37 percent reduction in mortality. As they become more experienced with the Global Trigger Tool, Baylor foresees shifting their organizational big dot to harm reduction.
In short, we left the Lone Star state convinced that there are actually many “stars” in Texas and we felt privileged to to have spent the day with a number of them at Baylor.
-- Carol Beasley
A sample of the data posted prominently at Baylor Regional Medical Center showing their compliance with efforts to prevent surgical infections.
Tuesday, November 6, 2007: Hot Springs County Memorial Hospital, Wyoming – A small hospital getting big results
Our Fall Harvest team (Angela Zambeaux, executive assistant to IHI Senior VP Jim Conway; Dr. Bob Wilmouth, Mountain-Pacific Quality Health Foundation Node representative; and Christina Gunther-Murphy, project manager for the 5 Million Lives Campaign) was greeted in Thermopolis, Wyoming — population 3,172 — by a variety of wildlife including falcons, antelope, deer, and rabbits. The next day, we made our way past the sulfuric hot springs to Hot Springs County Memorial Hospital, a 25-bed critical access hospital with an average daily census of six patients.
From the moment we walked through the doors, we could feel the energy and passion evident throughout the organization. During a brief hospital tour led by Chief Executive Officer Trudy Chittick, it became evident that – from the top down and in all departments, clinical and otherwise – there is a deep commitment to providing each patient with the best and safest care. Presentations by the surgical, nursing, technology, and laboratory services teams, and the board of directors confirmed this dedication. Chief Operating Officer Belenda Wilson summed it up best when she succinctly stated, “Culture eats strategy for lunch.”
The most impressive work was presented by Belenda, board member Dr. Howard Wilson, and Board Chair Ron Jurovich. Their board has not only made a pledge towards safety and quality, they have executed. The board decided that zero falls was the only acceptable benchmark for their organization, and they targeted this aim with resources. As a result, Hot Springs has gone two months without a single fall.
Hot Springs has also gone beyond bringing patients and families who have suffered medical errors at their hospital to board meetings to tell their story. They asked their senior staff to apologize to these patients and relay how their experience is going to change hospital operations. Hot Springs County Memorial Hospital publicly reports their data, demonstrating an impressive level of transparency and accountability to the community. The board of Hot Springs reiterated what was clear from their presentation: their duty is to provide impeccable care for the community and to keep the doors of the hospital open.
The board of directors’ review of data and commitment to improvement was mirrored in Hot Springs’ work on the surgical care measures. We heard from Robin Griffin, who talked about how she worked tirelessly to bring their compliance with surgical measures to 100 percent. Robin and her team collected data on patients for three months after their surgery as the proof needed to convince others that there was no correlation between discontinuing antibiotics and higher infection rates. Throughout the organization, staff members studied and used data to continue to improve and found every opportunity to “make it easy to do the right thing.”
Hot Springs County Memorial Hospital may be small, but they are getting big results!
-- Angela Zambeaux and Christina Gunther-Murphy
IHI's Angela Zambeaux and the team from Hot Springs County Memorial Hospital pause for a photo during the Fall Harvest.
Tuesday, November 6, 2007: Making higher standards the standard at Self Regional Hospital, South Carolina
From the moment we arrived at Self Regional Hospital in Greenwood, South Carolina, Joe McCannon and I knew something special was happening. “Manicured” understates the beauty of the grounds. “Immaculate” comes closer. The grass was emerald green, edged, and almost appeared to have been vacuumed. The attention to detail outside followed us inside where we were graciously welcomed by Mary Margaret Jackson, director of performance outcome services, and members of her staff.
For the next two hours, we were awed by the discussion of the journey Self Regional had taken to achieve ISO certification. Beginning with the pharmacy, Self Regional has now certified a total of four departments including the ED, laboratory, and radiology. But they aren’t done. Next on the agenda is environmental services.
Self Regional President and CEO M. John Heydel has clearly provided the requisite leadership initiative to get this ball rolling. He clearly sees ISO certification as central to Self’s business strategy. He proudly described the bridges ISO has built with members of the Greenwood business community.
I would be remiss if I failed to thank Sonya Dawkins from PHT Services for her support. Dr. Rick Foster and Thornton Kirby from the South Carolina Hospital Association provided us with the broader perspective of the quality movement across the state. Being a native South Carolinian, I have to admit being more than a little proud of what I saw and learned in Greenwood!
-- Pinckney McIlwain
Tuesday, November 6, 2007: The Show Me State shows IHI how their perinatal improvement is done
The team from St. John’s Hospital in Springfield lived up to the reputation of Missouri as the Show Me State by showing us how Campaign hospitals are taking on improvements beyond the Campaign interventions. In this case, it was reducing harm by improving perinatal care. We could tell right away we were at a hospital that had all the ingredients for success: every key member of the team met with us, including the medical director of OB, senior administrators, nursing leadership, performance improvement representatives, and the director and staff members from the OB department.
During the presentation and discussion, our hosts described the importance of having an open dialog with physicians. The medical director explained how she was able to present strong clinical evidence for the changes to the physicians while at the same time listening and involving them in how the changes would be tested and implemented. They stressed the importance of setting a pace and consistency in the work through regular weekly meetings of the entire team. We also heard about their efforts to spread the changes at St. John’s to other hospitals in their system through tours, site visits and webcasts. While on a tour of the OB department, we met two of their star “patients”: the simulation “mother” and “newborn” they use as part of their staff education program.
Thanks to the St. John’s team for a great visit and for all your hard work with improvement!
-- Marie Schall
IHI's Jonah Borrelli and Marie Schall take a tour with the OB team from St. John’s Hospital in Missouri.
Tuesday, November 6, 2007: Improvement never ends at Mercy Medical Center in Iowa
After a 4:00 AM wake-up call, I met my bleary-eyed travel companions – IHI Director of Marketing Katy Dowd, Senior Engineer Andy Hackbarth, and Executive Vice President and Chief Operating Officer Maureen Bisognano – at Logan Airport. Off to Iowa we went, where amidst the ubiquity of tall corn and “field(s) of dreams,” we found Mercy Medical Center in Des Moines, a dream unto itself.
We knew that Mercy had attained tremendous success before arriving, but once we got there, we saw just how far they had come. They are achieving greater than 95 percent Perfect Care for AMI, haven’t had a single case of VAP in their cardiac ICU within the last 27 months, and have reached door-to-balloon times of under 60 minutes for cases in a 60-mile radius. Mercy runs the largest emergency department in Iowa and just reached the greatest number of births in a month this past October (450) in Mercy’s history. Their clinical success, however, was only the beginning of the story.
Greeted by VP for Performance Improvement Dan Varnum and Tom Evans of the Iowa Healthcare Collaborative, we heard more about Mercy’s story of improvement. Dan identified Mercy’s greatest transformation as their development of a culture of safety. By changing the attitudes of leaders and team members, they found they were able to work cooperatively to achieve sustainable results. To help to align their work and maintain a uniform focus, they now perform multidisciplinary rounds, arrange doctors and nurses into pods in the emergency department to facilitate improved communication flow, and practice daily goal setting in the ICU. From board reports to quality measurements and statistics, Mercy is also working to make their practice increasingly transparent.
While they have found success in engaging teams of providers, what was also astonishing about Mercy was their focus on the patient and family. In a newly renovated facility, Mercy has designed their patient rooms to accommodate family members by including couches, desks, and internet connectivity. After observing an eye-opening catheterization procedure, the patient’s family was brought in immediately. Mercy doesn’t believe in restricted patient visiting hours and it’s this commitment to the patient that really impressed us.
What surprised me most, though, happened on our ride back to the airport. Clinical Safety Coordinator Monica Gordon described how she felt that Mercy still had so far to go. This hospital – which had achieved so many great clinical outcomes and created a community where their employees received everything from Turkeys at Thanksgiving to flu shots in the fall (we got one too!) – seemed to be at the top. However, this desire to constantly strive for better was a display of the true engagement of Mercy’s staff in the improvement process. Campaign or no Campaign, they intend to continue their work in quality improvement. There’s no better campaign statement than that.
-- Meredith Kimball
The staff of Mercy Medical Center in Des Moines welcome IHI Director of Marketing Katy Dowd, Project Assistant Meredith Kimball, Executive Vice President and Chief Operating Officer Maureen Bisognano and Senior Engineer Andy Hackbarth during the Iowa Fall Harvest visit.
Tuesday, November 6, 2007: The “status quo” is not good enough at West River Regional in North Dakota
Greetings from IHI Director Diane Jacobsen! I had the pleasure of traveling west-southwest from Bismarck to West River Regional Medical Center in Hettinger, North Dakota. Our colleagues from the North Dakota Node met me at the airport and – after stopping for lunch to sustain us – we embarked on a beautiful three-hour drive. It was a sunny autumn day and pheasants were everywhere. (Unfortunately for these beautiful birds, the state was in the midst of pheasant hunting season!)
When we arrived, West River Regional’s CEO Jim Long, CNO Barb Stadheim, and QI Manager Dana Andress provided a tour of their critical access hospital. They were excited to show us the plans for the renovation/expansion currently underway at the hospital. The expansion will provide updated and additional surgical services space that will enhance care and separate the inpatient and outpatient surgical streams.
After completing a full day at the hospital, West River Regional’s CEO, CNO, medical staff, board members, quality and hospital staff were kind enough to describe their quality journey at a dinner meeting. “Quality was important to us before it was fashionable,” they stated. They emphasized that the “status quo is not good enough.” Throughout the visit, the level of commitment and focus on quality was clear with a strong focus on care for persons with diabetes, reducing the risk of surgical complications and strong teamwork and communication to respond to patients needs quickly.
They described their ongoing efforts to engage their board and community in building partnerships. Their dedication to providing top-quality health care to their rural population is amazing: the medical staff travels 50-100 miles daily to round at outlying satellite clinics and provide secondary care at the hospital. “[The Campaign has] your 5 Million lives,” they said. “We have our 25,000 lives.”
We have a great deal to learn from the ongoing work at West River Regional Medical Center in their steadfast commitment to providing quality care to rural North Dakota.
-- Diane Jacobsen
IHI's Diane Jacobsen, the West River Regional Medical Center team, and representatives from the North Dakota Node pause before a dinner discussion.
Tuesday, November 6, 2007: St. Clair Hospital, Pittsburgh, PA – A large hospital with a community feel
We set out for St. Clair Hospital in Pittsburgh on a bitingly frigid, blustery morning, but the welcoming reception we received upon our arrival warmed us up in no time. We were introduced to a large group of excited people from all sectors of the hospital and began learning about some amazing improvement work in medication reconciliation, fall prevention, and MRSA reduction.
The team that led the medication reconciliation initiative developed a nifty tree diagram visualizing the reconciliation process. In addition to consulting with clinical staff, the team interviewed key stakeholders including patients and families, skilled nursing facilities, and other care providers in preparation for a new system. Using an electronic medication reconciliation form developed by St. Clair’s IS department, there has not been a medication error in over one year and patient handoffs have simplified tremendously. With the electronic form, completing the previously lengthy discharge process now only takes three clicks! St. Clair has also created an easy way for a patient to track their current medications using a convenient fold-out wallet card. The hospital has put considerable effort into encouraging adoption of the card in the community.
St. Clair has also made great strides in preventing patient falls by standardizing equipment, processes and communication. One of the precautions developed by the team is giving red slippers to patients especially at risk for falling so they can be easily identified and assisted by anyone who sees them, including environmental staff and other non-clinical hospital workers.
Safety is a priority in the minds of St. Clair's entire staff, not just doctors and nurses. They have achieved 100 percent compliance with hand hygiene and other MRSA reduction measures in twelve of their departments and the others are not far behind! To top it off, St. Clair has seen only one VAP and one BSI in the last 16 months. What was also impressive was the outstanding communication among staff for such a large hospital.
St. Clair services over 300,000 residents in 20 communities in Pittsburgh, but they manage to maintain a community feel. It was truly an enriching and incredible learning experience and the hospital staff’s dedication to patient safety was truly touching.
-- Julie Buchik and Nathalie Desrosiers
Tuesday, November 6, 2007: Success Takes a Strong Team with Even Stronger Leadership
On a cold and rainy New England day, five members of the IHI family (Don Berwick, Kate Bones, Samantha Henderson, Jesse McCall and I) braved the elements like a group of mail carriers working overtime to reach our destination of the UMass Memorial Medical Center in Worcester. Our visit began with an invitation to sit in on the hospital’s Clinical Performance Council where we were introduced to System President and CEO John O’Brien, UMass Memorial President Walter Ettinger, MD, several clinical department chairs, and members of the senior management team. During this meeting, leadership talked about the hospital’s dramatic changes in their approach to quality improvement. After determining that their cardiac surgery mortality rate was unacceptably high, they worked to completely revamp their quality and safety department, cardiac surgery department, and intensive care units. In addition, board engagement with issues of quality and safety are now a primary focus of the system’s CEO.
Our next stop was the cath lab, where we met the multi-disciplinary team working to improve door-to-balloon times including staff from pharmacy, the ED, cardiology, and the lab. The path to the cath lab was easy to find as the hospital has created a visual cue (a thick red line painted on the wall leading from the ED entrance to the lab) for EMTs to easily and efficiently reach their destination. The level of teamwork was evident. What was equally as impressive was the amount of community education being done on recognizing STEMI patients through the training of the police and fire departments and all first responders. The primary goal of this effort is to speed the activation of the cath lab upon arrival of each patient. These concerted efforts have greatly reduced the hospital’s door-to-balloon time. (We heard UMass Memorial’s shortest door-to-balloon time to date was 12 minutes!)
We also visited the recently constructed Lakeside 3 ICU where we learned about the use of EICU remote video support. This new technology provides 24-hour video monitoring of patients and support to bedside caregivers, and allows continuous opportunities for review and improvement.
As we departed, Don asked ICU Director Dr. Richard Irwin to share his thoughts on what factors contributed to the strides being made at the hospital. He responded with three things: the strong leadership of their CEO John O’Brien, teamwork, and holding people accountable.
Needless to say, there truly is no ‘I’ in teamwork, or in UMASS Memorial Medical Center, except for the two in "memorial" and "medical" but you get my point!
-- Betty Amoah
Monday, November 5, 2007: Team Empowerment is Key to Successes in Maryland and Washington, DC
Greetings from IHI Systems Analyst Virginia Vance, and R&D Research Assistant Nichole Willy! After a crab cake dinner overlooking Baltimore Harbor and a good night’s sleep in a quirky art deco hotel, we set off through the heart of Baltimore with IHI Director Frank Federico and National Campaign Field Manager Jennifer Chi for Mercy Medical Center. When we arrived, we were greeted by IHI Board Member Ruby Hearn; our colleagues from Delmarva, NQF, and CareFirst BlueCross BlueShield; a warm plate of biscuits; and room full of smiling faces.
At Mercy, we heard about their improvement processes addressing infection prevention (including MRSA, VAP and BSI), medication reconciliation, and – most notably – about how staff in the ICU flock to the 15-minute weekly “Discovery & Action” huddles. These facilitated creative discussions keep everyone, from the head of the ICU to the housekeeping staff, excited about improvement!
From Baltimore, we drove to DC, miraculously managing to avoid traffic! We arrived at the bustling campus of Washington Hospital Center (WHC), a large hospital in the MedStar Health System. At WHC, multidisciplinary teams are key to achieving their goals around Rapid Response Teams, achieving excellence in cardiac care, and preventing central line infections. Additionally, the Performance Improvement Committee structure systematically involves senior leadership in their quality initiatives. We were also greatly impressed with their dexterity at using data to identify their most and least effective changes, and to drive improvement. Consequently, the average response time for a Rapid Response Team is 3 minutes and 58.9 percent of patients stay in a room after the Rapid Response Team is activated! Central line infections at WHC have also decreased significantly in the ICU, through the use of PDSA cycles to create an “opt-out” CLI check-list that enforces compliance with Core Measures. Next, the CLI team is expanding their project to include non-ICU units. Downstairs, the Simulation Center was alive with activity. The Center is busy teaching all their physicians the standard protocol for putting in central lines, so – by this time next year – everyone at WHC will be very well acquainted with Mr. SimMan!
The overarching themes of the day were empowerment of all team members and leveling the playing field. Both sites have made huge strides in involving the whole hospital community in improvement, from the CMOs to the receptionists and transport staff. At Washington, nurses are the champions of the Rapid Response Team, and at Mercy, the RNs keep everyone on task with their central line insertion checklist.
We can’t wait to hear more from these great sites as they continue to learn and spread their great work!
-- Nichole Willy and Virginia Vance
Monday, November 5, 2007: Maine Medical Center - Another New England champion
This is IHI Event Coordinator Ilenna Elman reporting from Maine. It was a perfect New England autumn day with crisp air, a bright blue sky, and beautiful foliage as Eastern Field Coordinator Katie O’Rourke, IHI Fellow Karen Metzguer, and I drove to Portland. While our lunch of delicious clam “chowdah” certainly lived up to our expectations, our Fall Harvest visit to Maine Medical Center (MMC) exceeded them.
New Campaign field team member Dr. Eric Dickson, from Iowa, joined us at MMC where we were welcomed by about 25 people. In the room were physicians, nurses, and pharmacists in various positions from management to department chiefs to staff clinicians. In addition, several representatives from other Maine hospitals – including competitors – were present to hear about MMC’s great work.
Dr. Chris Wellins began our meeting by announcing MMC’s goal to be “as successful as the New England sports teams.” (Go Sox, Pats, Celtics and Bruins, in case the reference wasn’t clear!) He went on to outline the background and results of their medication reconciliation work. MMC started this initiative in 2005, when a dedicated team looked at the Joint Commission’s National Patient Safety Goals for 2006. In MMC’s design, physicians are held accountable for completing the reconciliation. Some of the challenges they have faced in this work included engaging a large staff (many of whom are not hospital employees) and a lag in technology with electronic solutions still on the horizon. Nonetheless, MMC has increased their compliance over the past two years from 43 percent to 78 percent by emailing weekly reports and scorecards directly to clinicians, getting the department chiefs actively involved, and sharing stories of providers catching instances where reconciliation did not happen. MMC’s increasing engagement can be attributed to their emphasis that the goal is not to merely reconcile medication for the sake of doing so, but to prevent errors and protect patients.
Following Dr. Wellin’s presentation, the group had an informal conversation, including descriptions of MMC’s other successes, including a Rapid Response Team that lowered the number of non-ICU codes from 17 per month to three or four a month; a below average door-to-balloon time they attribute to allowing Emergency Medical Services to activate the lab; surveillance and in-room cleaning services that have helped reduce drug-resistant organisms from seven infections per month to one since August 2007; and a dedication to the Boards on Board Campaign plank by starting every board meeting with a 30-minute curriculum sharing harm stories. These improvements have come with challenges, but the culture at MMC is supportive: leadership is continuously striving to better assist the frontline workers, and there is a unique level of trust amongst doctors and nurses.
Throughout our visit, it became evident how committed everyone at MMC is to making quality improvements and providing the best possible care. While there may not be a World Series to win, Maine Medical Center is certainly championing safer health care.
-- Ilenna Elman
Monday, November 5, 2007: Giving families a voice at Children's Hospitals and Clinics of Minnesota
Fall Harvest is winding down, and just in time as Minnesota’s infamous winter approaches. IHI Director Diane Jacobsen, Central Region Field Coordinator Jonah Borelli and I were warmly welcomed at Children's Hospitals and Clinics of Minnesota, as we arrived amidst swirling snow flurries. We spent the afternoon hearing from a number of people including staff, the Minnesota Hospital Association, and Stratus Health. Topics of discussion included cystic fibrosis outcomes, pediatric pain and palliative care programs, Rapid Response Teams, getting Boards on Board and engaging patients and families.
After learning about these quality improvement efforts, we toured the facility. We started off on the seventh floor to get a sense of how the hospital was originally designed. The majority of the rooms had two or four beds and the nursing station spanned the middle of the hospital floor. Our next stop was the third floor to get a glimpse of how the impending hospital redesign would look and feel. The hospital’s Family Advisory Council has been very involved in planning the hospital expansion and Tessa Billman – the Council’s chair and passionate mother of two – explained how each room will be converted to singles, and outside of each room will be a nursing station allowing more convenient access to nursing staff.
Personally, the most powerful part of this visit was witnessing the strong partnership that exists between the Children’s staff and the patients and their families. It was incredible to hear the voice that families have and how medical staff truly listen and respond to the feedback parents offer. Tessa Billman told us the compelling story of the first time she got up in front of a board meeting three years ago and described experiences she’d had with her disabled daughter. The president and CEO of Children’s pulled her aside afterward and asked for the text of the story she shared so he could send it as a memo to all Children’s staff, and ask them to come up with solutions to the issues Tessa’s family experienced.
Children’s works hard to engage their board of directors in quality improvement. When members join Children’s board, they are required to be on the quality and safety committee their first year. Also, the board chair also serves as the chair of the quality and safety committee.
We have a lot we can learn from the work happening at Children’s and are grateful for the time they took to share it with us!
-- Greta Retterath
Friday, November 2, 2007: From Caterpillar to Healthcare
The day began early, so early that the night shift was still on duty at the hotel, coffee wasn’t yet available and there was some confusion over whether we were checking in or checking out. For an 8:00 AM meeting a three-hour drive away, you need strong coffee and a fairy godmother a/k/a Pat Merryweather, VP of the Illinois Hospital Association, a partner in the Illinois Node. Pat arrived with a large smile and a large car to whisk IHI’s Manager of New Product Development Janice Gagnon, Central Region Field Coordinator Jonah Borrelli and I from Chicago to central Illinois.
By the time we reached Decatur Memorial Hospital (DMH), the sun had come up and we could see the heavy frost on the cars. No matter. Our welcome from the DMH executive team (including CEO Ken Smithmier, COO Tim Stone, Vice President Quality Management Dr. Michael Zia, Vice President and Chief Nurse Executive Linda Fahey, and CFO Gary Peacock) was very warm.
The executive team spoke, with pride and honesty, of the journey to change the culture of their organization, from “push from the top” to “pull from the bottom.” The initial learning came from Caterpillar – the manufacturing company and largest local employer – that had achieved impressive results after changing its corporate culture. The DMH team wanted to transform their hospital in the same way, so Ken asked the Caterpillar plant manager to talk to the hospital board. They then brought consultants from the Pacific Institute on site to instruct 30 trainers and provide four days of training for all 2,000 physicians and members of the staff and board.
Their aim was to be an organization which excelled because of the values which shaped the hospital. They wanted to employ people with the right strengths, then encourage and support those staff to make decisions, implement changes and not to settle for the minimum standard. Tim and Linda spoke of the strengths and behaviors which the organization values. Ken spoke of defining “the what not the how,” and Mike talked about not limiting the aspirations of the staff and enabling them “to be a better version of what they already are.”
Where are they now? DMH was the first hospital to publish a report card, they have no outside temporary staffing and do well on Medicare core measures. The Model for Improvement is part of core hospital business, the strengths valued by the organization are built into pre-hire processes, managerial assessment, practice development and leadership development. DMH has developed their own two-day curriculum which they use internally and are hoping to share with other hospitals.
What were our impressions? There is real ongoing commitment here, difficult decisions have been made, some staff have moved on, others have changed roles. This is not seen as an improvement project; it is a way of working which in turn encourages and enables staff to deliver better care. It is certainly a team with a great story to tell and IHI can help them tell it.
-- Susan Went
The staff from Decatur Memorial Hospital hosted a team from IHI during the Illinois Fall Harvest visit.
Friday, November 2, 2007: Patient-centered culture at the Phoenix Indian Medical Center
Another first-time visit to a major US city for your faithful narrator, and my last Fall Harvest hospital stop this week. For today’s trip to Phoenix Indian Medical Center (PIMC) in Arizona, a 127-bed hospital serving the regional Native American communities, I was joined by IHI’s Siobhan Moran and Anna Roth. Luckily for me, both of my fellow Harvesters have some relevant background: Siobhan is the IHI liaison with the Indian Health Service (IHS) with which PIMC is affiliated and – in addition to being a Merck Fellow at IHI – Anna works at Contra Costa Regional Medical Center, a hospital in northern California that is similar to PIMC in size and setting, and – as we found out – faces many of the same resource challenges.
To begin the day, Dr. Charlton Wilson, COO of PIMC, welcomed us and introduced us to CEO Dr. Vince Berkeley and Area Director Don Davis, who provided some background about PIMC, the IHS, and the local history, including some of the difficulties facing the Native American communities in the area. Drawing from a wide geographic area, PIMC serves a huge portion – one third – of all IHS patients; their outpatient services saw 260,000 patients last year. One point that stuck out – and was indicative of the overall patient-centered culture there – was that because their patients often do not have any other options for health care, PIMC staff feel an acute responsibility to provide them with the best possible care. In other places, lack of competition might be an excuse for relaxing quality standards, but here it has the opposite effect.
Next, hospital staffers walked us through a few of their notable programs. First, we saw how PIMC is using an intranet to track and present performance measurement data – including run charts with statistical process control data – making their results easily accessible to front-line staff involved in the improvement work.
We then heard about PIMC’s amazing medication reconciliation work. PIMC has achieved almost 100 percent reliable medication reconciliation throughout the inpatient stay, and because of a shared IT infrastructure, has connected this process with outpatient and primary care settings as well. Anna, knowing the challenges of implementing med rec in a similar setting, was particularly impressed with the fact that staffed pharmacy space exists on each inpatient floor, which allows pharmacists to be available for real-time corrections or changes needed when updating the Medication Administration Record (MAR), ultimately allowing the MAR to be used reliably as a medication care plan rather than just a documentation tool. The pharmacist we met later on the floor tour confirmed that the pharmacists see med rec as a core responsibility, which is one of the key reasons for the program’s success.
We also heard about PIMC’s infection control (IC) work. My favorite bit in this area was the IC department’s approach to maintaining proper hand hygiene through a clandestine network of “spies” that keep track of missed hand-washing opportunities within departments. The great innovation is that, through a system of constant rotation, everyone eventually becomes a “spy,” and so – along with the light atmosphere cultivated around this process by the IC leaders – the program has never veered toward the sinister or paranoid and simply serves as a constant reminder for vigilant hand hygiene practices.
We heard about several other programs as well – improved pressure ulcer care, work to reduce ventilator-associated pneumonia and central line infections, and MRSA screening and isolation – and we toured the inpatient and primary care facilities that share space on site. To top it all off, we headed down the road to a local (South Asian) Indian restaurant for the standard all-you-can-eat lunch buffet.
Improvement has never been so delicious.
-- Andy Hackbarth
Friday, November 2, 2007: Improving by leaps and bounds at Alleghany Regional Hospital, Virginia
This is Northeastern University co-op student Chris Cassorio. Katie O’Rourke and I had a scenic drive through the mountains and valleys of rural Virginia en route to Alleghany Regional Hospital (ARH), a 190-bed facility in Low Moor. Our hosts greeted us at the door with excitement.
During a brief lunch, we attended a presentation on core measures by Dr. Sallie Cook from the Virginia Health Quality Center. We met a number of people from ARH, including their nurse managers, quality team members, and the CNO, CEO, and CFO.
ARH has developed an effective Rapid Response Team, provides top-notch AMI care, added to the ventilator bundle, does great work in identifying and isolating MRSA and C. diff, and is implementing a strong hand hygiene campaign. The ARH staff eagerly presented us with a binder of information detailing their strategies and results for the 12 Campaign interventions and expressed their willingness to share their successes with the whole health care community.
The goal of CEO Tim Tobin – and the entire team at Alleghany – was to initiate a culture change to transform quality quickly and effectively. All the hard work has paid off for ARH as they have improved their core measure scores from the 50th to the 95th percentile in the past 24 months.
It was great to see how excited Alleghany was to embrace the Campaign interventions. Their willingness to collaborate with IHI and other hospitals to change and move forward is amazing. This hospital has clearly worked hard to improve its operations and – more importantly – maintain its excellent reputation within the community.
-- Chris Cassorio
The team from Alleghany Regional (including CEO Tim Tobin, center) take representatives from IHI and the Virginia Health Quality Center on a tour of their facility.
Friday, November 2, 2007: Quality is what happens at the bedside
“Quality is what happens at the bedside” is the pervasive cultural attitude that Fall Harvesters Jim Conway and I found at St. Rose Dominican Hospital in Henderson, Nevada. We were impressed the moment we entered the Siena campus – surrounded by faith-based healing messages and greeted by friendly, welcoming faces. The commitment to quality was ever-present. Seemingly everywhere we walked, there were posters recognizing providers for their quality contributions, quality data transparently presented, and opportunities and encouragement to disinfect hands. This is an organization deeply committed to doing what is best for its patients, to measuring its progress, and to celebrating its successes.
We were warmly greeted by Deb Winiewicz, Director of Quality Management System, and joined by Jackie Buttaccio and Debra Huber from HealthInsight (the Nevada Node). Dr. Stephen Jones, CMO, and about a dozen other frontline staff members joined us in the boardroom for a rich discussion about the hospital system and its quality journey.
We focused primarily on two topics: initiatives to prevent sepsis and increase patient satisfaction. But our discussion covered lots of ground, including core values, board involvement, physician engagement, activating nurses, project prioritization, efficacy of measurement, and preventing pressure ulcers. This group takes great pride in their work and accomplishments, but also recognizes there is still much to do.
St. Rose Dominican is also an organization with a deep commitment to measurement and the sharing of data and dashboards across the organization and with all staff. Our only grievance was that there was so much measurement that the binder of data we were given was difficult to carry home in our little suitcases!
Most powerful concepts: Nursing “bundle” (hourly rounds, individualized care planning, bedside reporting and handoffs, discharge planning calls) and the "Get Well Network" (a set of tools for achieving patient satisfaction and service recovery, including extensive bedside education resources clinicians can "order" for patients and real-time patient satisfaction review).
Thanks for a great visit...wish we had a better experience in the casinos!
-- Jonathan Small
St. Rose Dominican Hospital hosted IHI's Jim Conway and Jonathan Small during the Fall Harvest.
Friday, November 2, 2007: Teamwork, Collaboration, Will
Blount Memorial Hospital in Maryville, Tennessee has a team that isn’t afraid of tackling the Campaign’s ambitious interventions. IHI Director Marie Schall and I were greeted by two excited members of the Tennessee Node who joined us for this visit and were eager to share what Blount (pronounced blŭnt) Memorial has accomplished.
Upon our arrival, we entered a crowded conference room where they had prepared storyboards of their PDSAs on central line infections and MRSA. Their storyboard on SBAR has to be the most creative use of a NASCAR driver to prove a point! Kyle Petty’s quote, “My team makes a difference in a safe trip around the track,” demonstrated Blount’s ability to relate the community’s love of race car driving to a vital message on safety. It is this simple, yet effective method of communication that has helped this hospital in their efforts to reduce MRSA and prevent central line infections. Communicating with staff and families about infections could have been a difficult feat, but simple and concise pamphlets have proven to be quite successful.
The visibility of Blount’s leadership was clear as two board members joined us as well as Dr. Dick Evans, the hospital’s medical director. It speaks volumes that these individuals were able to attest to the great work and dedication of their staff. We’re all familiar with stories about the challenge of engaging hospital boards and leaders, so it was truly amazing to see with my own eyes how special Blount’s leadership makes them. Marie posed questions about keeping staff motivated and the difficulties the hospital has faced. Dr. Evans and his colleagues were honest and shared how their work is ever evolving, but so rewarding.
This group is also working with eight other hospitals in Blount County to provide better care for the community and it was heartwarming to hear the genuine sincerity in their stories of working to prevent harm to patients. I’m not sure if it’s the beautiful scenery or the fresh air in eastern Tennessee, but I only wish all hospitals could be as devoted and enthusiastic as Blount!! We’ll keep our fingers crossed for you to become a Campaign Mentor Hospital!
-- Afiesha Balgobin
Friday, November 2, 2007: Turning crisis into opportunity at Clarian Healthcare, Indiana
This is IHI Fellow Pinckney McIlwain writing from Indianapolis where Joe McCannon and I visited Clarian Healthcare. From our initial reception by Betsy Lee, Director of the Indiana Patient Safety Center (and old IHI’er), and Cathie Pritchard, Health Care Excel (the Indiana QIO), to the new ideas, success stories, and even failures we learned about, the hours seemed like minutes.
I was particularly moved by the open and honest discussion surrounding the heparin incident slightly more than a year ago. This organization has taken a heart-wrenching event and made it into a vehicle that has accelerated intent and motivation for change. To a person, all present spoke to the power and presence of their CEO, Mr. Dan Evans, and Methodist Hospital President, Mr. Sam Odle, during this crisis exemplifying the importance of leadership in the quality and safety journey.
As you might imagine, high-alert medications provide rich opportunities for improvement at Clarian. Quite unique and very exciting is the development of insulin and heparin dosing tools. These tools are available to staff via their computer system and have markedly reduced errors in dose calculation, timing of administration, and – with insulin – has enhanced tight glycemic control with significant reductions in episodes of hypoglycemia.
Another notable achievement was the development of a community-wide MRSA database identifying individuals known to be positive and making that information available across health systems, even among competitors. Consider the possibilities this kind of collaboration could achieve for other thorny problems involving information exchange like medication reconciliation!
Quality of care as an organizational “Big Dot” was clear. Dr. Sam Flanders, Senior VP, Medical Quality, shared the Clarian Quality Matrix including many of the measures Clarian uses to achieve transformational performance. Clear focus on execution was apparent. Transparency was a means to achieve desirable outcomes.
I was also impressed with the commitment to staff training and development. Dr. Flanders shared the Clarian Preeminence Seminar, based on the IHI Model for Improvement. This is required training for all managers. The organizational goal is for 25 percent of front line staff to attend. In this way, Clarian achieves concept spread throughout a large organization with a central quality staff of only seven people. Amazing! I plan to “steal shamelessly.”
My take away from this meeting is that leadership supporting the development of a strong foundation associated with dedication and commitment from staff sets the stage for becoming a high performing health system. My hat is off to Clarian!
-- Pinckney McIlwain
Friday, November 2, 2007: Pediatric Pressure Ulcer Prevention Pervades in the Peach State
An early November day in Atlanta felt like a bit of late summer to those of us from the Northeast! We had the pleasure of visiting the Scottish Rite campus of Children's Healthcare of Atlanta (CHOA), where a large group welcomed us to tell their story of pressure ulcer reduction. This was a unique learning opportunity for us as our content is based on the adult population and it is a common misconception that children are not at risk for pressure ulcers, even among those who care for children, as we learned.
With little in the way of literature and guidelines for this in pediatrics, CHOA ventured down the path of innovation, using two years of their own data that clearly indicated a need. The passion was apparent, as Marie Sosebee (their Wound Nurse) and Carrie Silver (Senior PI Consultant) described their work; it was further evident that the enthusiasm was shared as nearly everyone jumped in to share some aspect of their excitement about what had been achieved. CHOA had a baseline of 7.5 percent pressure ulcer incidence back in October 2005; their improvements have led to an average of 3.4 percent sustained for one year - quite impressive! Taking the IHI How-to Guide for Pressure Ulcers, and at the request of our "sister organization," the National Initiative for Children's Healthcare Quality, CHOA developed a pediatric version which is publicly available on the NICHQ website. This superb document summarizes all of the lessons CHOA learned in developing standard risk assessment scales, educating staff and parents, and building the process changes into their daily routine. They have great examples of reliability concepts: standardization of scales to prevent staff confusion, standardization of products to ensure consistency, and computer calculation of risk score with prompts on recommended treatments.
We toured the hopsital and saw the improvements in action out on the front lines. It was a great visit and we were thrillled to learn so much about this really innovative work to improve care for some of the smallest patients.
-- Fran Griffin
Thursday, November 1, 2007: Riding the Improvement Wave at Queen’s Medical Center, Hawaii
Aloha from beautiful Honolulu, Hawaii! Ninety-degree weather, ocean breezes and soft rains welcomed me to Queen's Medical Center. Immediately after their Medical Executive Committee meeting, physicians and staff stayed to present some of their great work. The staff from the Emergency Department, cath lab and critical care, along with key physician champions, told me of their work in two areas: reducing door-to-balloon times and VAP prevention.
The development of the "Code STEMI" team at Queen’s was a great model for process improvement. Great tests of change and the standardization of processes amazed me! Upon review of the timeline for getting a patient to the cath lab, several hindrances were noted and processes put in place to shave off valuable minutes, including
- A “STEMI alert box” that saves staff from spending valuable time gathering equipment to start IVs, write orders, etc. This small red tackle box from Sears (see Picture) contains orders and a flow chart along with the supplies. This shaved 8 minutes off their door-to-balloon time, and the staff loves it!
- The meds on the orders are packaged together as STEMI drug kits in the med distribution system, so the staff can enter a possible STEMI patient into the system and grab all the meds in one trip.
- Their clipboards have a stop watch (counting down from 90 minutes) to allow the use of the same clock for documentation of all interventions and to keep staff aware of how much time has ticked away since the patient arrived. (picture)
- To facilitate smooth transfer to the cath lab, they crosstrain their ED staff and cath lab ancillary staff.
- Segregation of possible MI patients in a special area of the ED close to triage.
Also, Queen’s has been focusing on VAP prevention for about five years. The critical care staff and the respiratory therapy department have worked together to standardize processes and supplies. The result is a more than a 75 percent decrease in VAP rates.
I was also invited to observe a debriefing event in the OB department. It was a great learning exercise. Staff involved in the case – both nursing and physicians – were present. Hawaii Node leader and Queen’s anesthesiologist Dr. Della Lin facilitated the discussion and great opportunities for testing new processes were identified. I was so impressed with the transparency, the encouragement and the desire to improve the process for all patients.
-- Kathy Duncan
Queen's Medical Center's 90-minute countdown stopwatch on their STEMI alert clipboards.
Thursday, November 1, 2007: Notable
numbers in Nampa, Idaho
In Nampa, 20 miles west of Boise and the second largest city in Idaho, Mercy Medical Center (MMC) demonstrates its commitment to quality care and patient safety every day. Campaign Project Coordinator Christina Gunther-Murphy and I – along with Idaho Node partners Jane Burgman from Qualis Health, Nanette Hiller from the Idaho Hospital Association, and Blue Cross of Idaho representatives Andrew Baron, Brenda Vanden Beld, and Zelda Geyer-Sylvia – were welcomed by Mercy staff with smiling faces and alcohol gel dispensers at every turn!
Ryan Lund, Director of PI and Case Management at MMC, introduced us to about 30 folks from Mercy including physicians, nurses, quality managers, board members and CEO Joe Messmer. They shared very impressive results including 100% compliance with all the CHF measures for 20 months! Staff attributes part of this success to the implementation of concurrent coding, a process by which Case Managers receive a work list detailing patients admitted to the hospital with CHF. All patients are coded within two days of admission which allows the Case Managers to make sure patients receive all CHF care measures before being discharged.
If you ever happen to visit Mercy Medical Center, you might hear a “Code 90” page over the intercom. Ask anyone what that means and – because of hospital-wide education – any staff member will be able to tell you that a “Code 90” is a page that mobilizes a designated team to transfer a patient experiencing an ST-elevated MI to the cath lab. At Mercy, staff reviews every AMI case and work as a team to make every step from the ER to the cath lab as efficient as possible. This may be why they had the best door-to-balloon time in Idaho in 2006!
Seen on promotional posters in the hallways:
When there’s something strange and it don’t look good
Who you gonna call? Rapid Response Team!
If your patient’s not responding like you think she should
Who you gonna call? Rapid Response Team!
The Rapid Response Team at MMC has been very successful. MMC had 49 Rapid Response Team Calls in 06-07, at a rate of 6.31 calls/1000 discharges. The Team can be activated by anyone from housekeepers to family of the patient, and thrives through creating an atmosphere of teamwork and trust.
Thanks to Mercy Medical Center for an impressive Fall Harvest visit!
-- Jordana Pickman
Thursday, November 1, 2007: Making the business case for quality in New York
Overlooking kayaks and foliage at the New York Athletic Club in Pelham, IHI’s Executive Director of Performance Improvement Bob Lloyd and I had a great Fall Harvest visit in New York. We were graciously invited to attend New York-Presbyterian’s 8th Annual Quality Symposium. With 312 attendees from over 100 hospitals in the NYC region discussing the business case for quality, we harvested quite a bit. Bob had the privilege to be one of the storyboard judges for the event. With 64 submissions (including a New York-Presbyterian storyboard accepted for the IHI National Forum in December), he had quite a task to sort through all the great presentations.
While at the event, we were both able to meet with the folks behind the storyboards as well as key members of the Healthcare Association of New York State. We heard some wonderful presentations that ranged from the “quality-conscious consumer” to sports analogies of transparency and statistics in health care. The two winning posterboards were submitted by Stamford Hospital (“Improving Patient Safety through Better Environmental Cleaning: An Opportunity to Reduce the Rick of Hospital-Acquired Infections”) and Vassar Brothers Medical Center [“Capturing Opportunities Required for Excellence (CORE)”].
This was a great chance for us to learn about the stellar quality culture in the NYC area. Seeing the New York Halloween Parade the night before put the whole trip over the top!
-- Katie O’Rourke
Thursday, November 1, 2007: Sooners follow surgical best practices to a "T"
IHI Director Fran Griffin, Staff Accountant Jillian Atkinson and I accompanied members of the Oklahoma Foundation For Medical Quality on a visit to OU Medical Center (OUMC) in Oklahoma City, the state capitol. Together, we witnessed the pride shown by this esteemed academic hospital when it comes to improving their surgical processes. As the only Level-One Trauma Center and Joint Commission-certified Stroke Center in the state, OU Medical Center handles a huge volume of surgical patients. The hospital works hard to comply with each of the measures in SCIP.
For example, in addition to giving anesthesiology responsibility for administering the antibiotic within an hour of incision—a strategy we have seen in many successful hospitals—OUMC has also done a thorough job of educating their medical students on the importance of the measure; furthermore, the hospital uses standard order forms for the antibiotic, has pharmacy send the first preoperative dose immediately (regardless of surgery type), and uses blinded physician data in order to foster healthy competition between departments. As a result, OUMC has seen their compliance on timely administration of the preoperative antibiotic fall within the top 10th percentile for US hospitals in 2007!
OUMC attributes their success this year to five components: systems improvements, accountability, feedback, physician leadership, and interdisciplinary collaboration. These leaders will have loads of tips and tricks to pass on to other surgical centers, large and small, in the coming months.
-- Jonah Borrelli
Thursday, November 1, 2007: Loving, Relentless Health Care and Business Practice in Tupelo
How can health care be both loving and relentless? We found out at North Mississippi Medical Center (NMMC) in Tupelo when Dr. Ken Davis, their chief medical officer, told us. First, he explained, in order for his hospital to run as harmoniously as possible, he needed to get everyone on the same page. He accomplished this by partnering with his accounting department to understand how spending money to save medical errors was very cost-effective. Their idea of centralizing the budget to cater to care and safety first (known as Care-Based Cost Management) made it possible to get everyone on board to make safety the top priority in every department. The key strategy for NMMC is workforce excellence, with a structure and culture that supports good outcomes, efficiency, and patient and staff satisfaction. They are rewarded with a tremendous retention rate: 92 percent for physicians and 95 percent for pharmacists.
The structure and culture of NMMC can be traced back to their open communication system. Because safety is the top priority in every department, open communication is a must. Traditional health care silos are broken down and are organized into specialty sections that optimize multidisciplinary teamwork. Data is readily available to almost anyone who requests it, which results in constant checks to make their practice error-free. They have an integrated electronic medical record across hospitals, clinics, and the community. They even have a TV studio inside the hospital that broadcasts health tips or reminders for the employees of the hospital.
So, how exactly are they “relentless”? NMMC is relentless in that they are always looking for new ways to improve. Each year, NMMC sets priorities; this year the top priority is hand hygiene. Joe McCannon, Cory Sevin, and I were able to watch employees participate in a hand sanitation lab for the employees. Upon completion, the employees got to choose a prize.
Staff members also carry cards that describe their individual performance goals in relation to their department goals and to the organization’s strategic plan. Each person has the opportunity to understand their impact on and role in the big picture, which contributes to the self-described family atmosphere in the hospital.
NMMC has also gotten involved in the community. Joe, Cory, and I attended a Health Fair, with a very large turnout, including eye exams, flu shots, Tai Chi videos, a moon-bounce, and balloon animals. The dedication to make the health fair a good place to take the family on an afternoon was tremendous, and really embodies what health care across America could be one day.
I would like to personally thank Dr. Davis, Joellen Murphee, and everyone we met at on behalf of all of us here at IHI. Their willingness to share, along with their hospitality, friendliness, and overall attitude, made a great learning experience a great personal experience as well. This hospital shows that actions speak louder than words, and their actions have paid off.
-- Alex Greenland
Alex Greenland and the team from the North Mississippi Medical Center pose for a shot in front of a storyboard collection.
Thursday, November 1, 2007: New London Hospital, New Hampshire - Big things can happen in small places
In case you didn’t know, big things are happening at the New London Hospital (NLH) in New London, New Hampshire (and I don’t mean the construction!). Earlier today, Jo Ann Endo, Mike Sweeney and I had a chance to tour the hospital’s halls and hear about the success they’re having with Boards on Board, SCIP and pneumonia.
If you’re unfamiliar with hospitals in New Hampshire, you might find it interesting to note that they have 26 acute care hospitals; 13 of them are designated as critical access facilities. NLH is one of these 13 and their work is among the best out there!
Dedication to quality improvement was clear from all the leaders around the table. In addition to NLH President and CEO, Bruce King – who is championing the Boards on Board movement both at NLH and across the state – the chair-elect of the board, the chair of the board quality steering committee, the president-elect of the medical staff, the chief clinical officer and the CFO were all in attendance.
An invitation to apply to become a Boards on Board mentor is on its way because of their impressive governance focus on quality: every board meeting starts with the presentation of a story detailing an adverse event and what's been done to prevent it from happening again; composite quality measures are included on the board's balanced scorecard; and executive compensation is tied to meeting quality improvement goals.
NLH credits their notable (and sustained) improvements in their SCIP and pneumonia composite scores to their use of multidisciplinary teams, role clarification, use of order sets and other standardized processes. Restless and eager for greater success, they are continually reviewing current processes and testing new changes.
The entire NLH team deserves a round of praise for their work, especially Director of Quality Improvement Leigh Roche and Rachael Rowe who proudly collaborates with NLH as the vice president at the Foundation for Health Communities.
What a wonderful visit and inspiration to all!
-- Nicholas Leydon
Wednesday, October 31, 2007: Griffin Hospital, CT - “A small community hospital can do wonders”
Hello from the great Nutmeg State of Connecticut! After a two-year reprieve from Campaign duty, I had the privilege of hopping back on the Campaign trail for the Fall Harvest at Derby, CT’s Griffin Hospital. I joined IHIers Jonathan Small, Peter Cerbone, Angela DiGioia, and Jesse McCall. Julie Petrellis of the Connecticut Hospital Association, the state Node, also attended.
It may have been Halloween, but Griffin Hospital was anything but spooky, despite all the scary creatures lurking the halls – a “cereal” killer, Batman, and the Addams family among them. As we walked through the front door to the sweet musical stylings of the lobby piano player, it was clear that Griffin is not your average hospital; instead it felt warm and welcoming. Walking to our meeting room, I felt as if I was in a first-rate hotel. The “ambassador” at the front desk pointed me in the right direction, and at every step along the way, any time it appeared I might be lost, a friendly member of the Griffin staff always popped out of his or her chair to get me back on track.
Griffin is all about creating a great experience for its patients, their families, and the hospital staff. Where else would you find an “exercise stairwell” that blasts hot gym tunes to encourage everyone to take the stairs instead of the elevator? And where else would every member of the staff introduce themselves by proudly stating that they’ve been at Griffin for 15, 20, 30+ years?
Being fun and creative and bucking trends is what Griffin is all about. And that’s most clear in the hospital’s successful efforts to make care patient-centered. Bill Powanda, the hospital’s VP, explained that Griffin went from the brink of closure 20 years ago to being a nationally-recognized center for patient-centered care. They started by surveying their community to find out how to improve the patient experience, and they responded to the input quickly. One particularly successful endeavor was their childbirth center, which now has a dedicated entrance from the street, bassinets in patient rooms, double beds so partners can stay with new moms, and Jacuzzis (!) to help women in long labor, relax. Even more importantly, Griffin joined the Planetree initiative, which has transformed the institution. Carrie Brady from Planetree explained how Griffin and Planetree have worked closely together to implement the initiative’s highly effective patient-centered principles. Kathleen Martin and Todd Liu told us about Griffin’s open medical record and how they encourage patients to get involved in their own care through “patient care conferences” that bring the entire care team to the bedside to discuss goals and plans with patients and their families, so everyone feels they’re on the same page.
Griffin CEO Pat Charmel took us on a tour and showed us the new wing they built around patients’ needs (complete with separate family hallways and clinical corridors), the Planetree lending library they built to educate their patients and the community about health issues, the gorgeous (and sweet smelling) dining room they built for families and staff, and the music performance spaces they created to keep patients entertained. He even introduced us to Jax, one of the terrific “pet therapy” dogs that provide the best medicine – unconditional love.
In the last few years, Griffin has turned its focus to ensuring that reliable, high-quality care for its patients is a vital component of Griffin’s patient-centeredness campaign. And the team is bringing the same ingenuity and hard work to quality improvement and patient safety that it has brought to patient-centeredness for last two decades.
What keeps Griffin on the trail to improvement? How do they stay motivated enough to meet the higher energy level that their brand of care demands? VP of Patient Services Barb Stumpo may have summed it up best: “We are very good at keeping ourselves uncomfortable.” The status quo at Griffin is in many ways leaps and bounds ahead of other institutions, but it’s not good enough for the Griffin team. And that’s the true hallmark of a leading improver!
-- Alexi Nazem
Jax, Griffin Hospital's littlest quality improver (and pet therapy dog).
Wednesday, October 31, 2007: St. John Macomb-Oakland Hospital’s never-ending cycle of improvement
After traveling to my home state of Michigan with Jonah Borelli and Joe McCannon, I had the extraordinary opportunity to attend the Fall Harvest visit at the St. John Macomb-Oakland Hospital. The leaders of this organization welcomed us into an intense learning session in which they shared the many changes implemented and tools they have used to significantly reduce harm over the last couple of years. St. John has a strong foundation in Six-Sigma, a set of practices designed to systematically improve processes by eliminating defects. The Six-Sigma “black-belts” have shepherded many of the changes in the hospital.
During our meeting, each team presented an array of ideas designed to improve care. In particular, St. John’s innovative “Seven Strategies to Hardwire Change” and use of Rapid Improvement Events were fascinating and showed the organization’s goal of instilling in their employees the never-ending cycle of improvement. For an organization that is already a center of excellence, their critical evaluation of sub-optimal systems in their hospital seems to really indicate their level of commitment to being a leader of change in the near and distant future.
I hope that as I return to Michigan next year to enter medical school I can again visit this hospital to learn more about integration of improvement into the professional growth of their employees.
-- Andrew Billi
Wednesday, October 31, 2007: The Billings Clinic “pit crew” wins the door-to-balloon race against time
If the AMI team at Billings Clinic in Montana were a NASCAR pit crew – their analogy, not mine – they would win the Nextel Cup! And yet, this team knows there is more at stake: saving the heart muscle. Having attended my first NASCAR race this summer, I’ve learned there are many similarities between successful pit crews and improvement teams. Pit crews review their actions after each pit stop, spend hours analyzing opportunities for improvement, work effectively as a team, and approach their job creatively and passionately. Billings Clinic – including their AMI team – is no different.
Their physician champion, Dr. Scott Sample, showed us their impressive data distilling the critical success factors in short door-to-balloon times. They have a clear process with owners for each step and the team works together to continuously improve the procedures. The team welcomes ideas from all staff members and is committed to caring for each heart attack patient as they would their own family member. As a result, Billings Clinic has gone months without a door-to-balloon time over 90 minutes. Yet, they are still hard at work, trying new ideas and reviewing each patient case to determine how they can continue to improve. Their leadership continually reinforces and celebrates the team’s work.
We discovered that Billings Clinic has many incredible individuals committed to creating a strong culture of safety. They have created a “cultural bundle” that Infection Control Practitioner Nancy Iverson asserted is just as important – if not more important – than the clinical intervention bundles. In their winning fight against MRSA and other hospital-acquired infections, they are creating a safe and supportive environment where peers reinforce hand hygiene, use of contact precautions, and other good MRSA reduction practices. As a result, they have seen 50 percent to 70 percent decreases in transmission of MRSA and other infections.
The Billings Clinic has created a culture without blame where individuals take personal responsibility for their work. Western Region Field Coordinator Jordana Pickman, Node representatives Dr. Bob Wilmouth and Kim Kurokawa, and I all walked away with new ideas and a renewed spirit. We know this is just the beginning of more great things to come at Billings!
-- Christina Gunther-Murphy
Wednesday, October 31, 2007: Outstanding Results at Exempla St. Joseph's in Colorado
The Mile High City. Unfazed by the altitude, but a little jet-lagged, I, along with IHI Co-Harvesters Anna Kawar and David Gozzard, saddled up with a group of Colorado node honchos for a visit with the good folks at Exempla Healthcare at their St. Joseph facility downtown.
The meeting, which was attended by about 60 people and featured the most enormous cheese platter I had ever seen (photo imminent), began with a frank and inspiring introduction from system CEO Jeffrey Selberg. He described a sentinel event and the subsequent internal analysis that led to a leadership-driven change in culture to focus on quality and safety, eventually culminating in Exempla’s 5-year plan to become the “Best in the Nation.” (Jeff’s enthusiasm for the improvement work was obvious throughout the presentation, but I already knew to expect this: several months ago, we had spoken on the phone at length about using mortality as a scorecard indicator. Any time a system CEO cares enough about measurement to spend that much geek time hashing through the pros and cons and statistical esoterica of calculating lives saved, you’ve got someone special on your hands.)
The Exempla system comprises three hospitals—St. Joseph, Good Samaritan, and Lutheran—and teams from all three were on-site to present on their work. The first presentation described an incredible medication reconciliation program, featuring integrated electronic communications between inpatient, outpatient, and primary care settings. David Gozzard, no stranger to the difficulties presented by med rec as a leader of a large hospital trust in Wales, remarked that he’d never seen anything like it before. I will be contacting these guys shortly to make sure they submit an entry for the med rec Innovation Challenge.
The next presentation described Exempla’s work on the SCIP measures, which has resulted in a composite measure score in the high 90s through remarkable efforts from the perioperative services team. (“I live at Lutheran” was offered as explanation for presenter Janie Griffin’s facility with the myriad measures and processes involved.) An emotional description of a MRSA scare in the NICU, and the subsequent all-hands-on-deck response from the NICU and infection control staff rounded out the day, highlighting the genuine responsibility that these folks feel for the safety and well-being of the patients who trust them with their care.
The IHI team was grateful to be at the meeting where the outstanding results of so much hard work were presented, but my final word of thanks must go to the day’s master of ceremonies, Dr. Dave Munch, Lutheran's Chief Clinical and Quality Officer, who not only gave me a lift back to my hotel but called in and picked up for me an order of his favorite Mexican delicacy. Dave—thanks again; it was, as promised, delicious.
Tomorrow: Phoenix.
-- Andy Hackbarth
Andy Hackbarth and his beloved cheese platter (left) and the group from Denver posing after their Fall Harvest discussion (right).
Tuesday, October 30, 2007: Cincinnati Children’s is changing the outcomes
What can you say when you walk away from a site visit in complete awe? That is exactly how NICHQ VP for Programs Doris Hanna and I felt when we left Cincinnati Children's Hospital Medical Center!
We spent five hours with a number of key staff – Patty Bondurant, RN, MSN, Senior Clinical Director for the Regional Center for Newborn Intensive Care; Debbie Hershberger, MN, RN, Outcomes Manager; Frederick Ryckman, MD, Director of the Liver Transplant Program; Stephen Muething, MD, Assistant VP for Patient Safety; Richard Brilli, MD, Associate Chief of Staff; and William Kent, MD, Senior VP of Clinical Care – who provided us with the amazing stories that are a part of this organization’s improvement journey. Beginning a few years ago with Dr. Uma Kotagal’s careful and insightful selection of key providers to champion improvement efforts, Cincinnati Children’s has raised the bar for all health care organizations with their outcomes.
A focus on high reliability, transparency, immediacy of event review and real-time data availability has resulted in significant reductions in ventilator-associated pneumonia, bloodstream infections and codes. Even more impressive is the transformation of the hospital’s culture to embrace patient safety and continuous quality improvement as part of everyone’s daily responsibilities. Hospital staff is empowered by the knowledge that they can change the outcome and are supported with resources and tools to do exactly that. It is no surprise that Cincinnati Children’s Hospital is consistently ranked among the top 10 pediatric hospitals in the nation! Doris and I are honored to have had the opportunity to spend time with such exceptional people and see the transformation they are continuing to create.
-- Tracy Jacobs
Tuesday, October 30, 2007: Rapid Response Team meets with swift success at Kent Hospital, Rhode Island
This is IHI Chief Financial Officer Amy Hosford-Swan writing from Warwick, Rhode Island. During our visit to Kent Hospital, Madge Kaplan, Katie O’Rourke, and I met a group of committed professionals who described how their Rapid Response Team is making everyone in the hospital – patients and staff – “feel safer.”
Following the best improvement advice to start small, Kent piloted their Rapid Response Team on an oncology/medical/surgery unit in August 2005. The introduction was so successful that nurses on other floors quickly started to request the team’s assistance. That led Kent to go hospital-wide with the program fairly quickly.
They described how their rapid response system has made an impact on their effectiveness, empowered staff, and reduced their costs. Once the team is activated, patients’ needs are quickly evaluated and addressed, often heading off needless, costly transfers to the ICU. (Kent has even developed a method for calculating how much $ their Rapid Response Team saves.)
A unique feature of their team is the inclusion of Physician Assistants. Kent PAs receive airway management training enabling them to do rapid assessments and immediate intubations, if needed. They believe their Rapid Response Team has helped bring down their number of codes and contributed to their drop in hospital-wide mortality and cardiac arrests.
Kent’s leaders stressed the importance of educating staff on what should trigger a Rapid Response call and making people feel empowered to activate the team without fear of criticism or undue scrutiny. One enthusiastic staff person stated, “You don’t just wait for the code blue to happen. You want staff awareness. That is how things get better.”
-- Amy Hosford-Swan
Tuesday, October 30, 2007: Setting a Standard of Excellence for Academic Hospitals at the University of Kansas Medical Center
Campaign faculty expert Kathy Duncan and I had the pleasure of visiting the beautiful University of Kansas Medical Center (KU) on a brilliant afternoon in Kansas City. The stunning interior of the hospital at once made us feel welcome and eager to begin our visit. Every detail of the hospital was geared towards affability. I was particularly impressed by the hospital cafeteria, where nutritional statistics for every item offered were listed on menus throughout the dining area. The hospital environment directly reflected KU’s number one priority: the patient.
Terry Rusconi, Senior Director of Organizational Improvement at KU, and Tina Lodgson, from Child Healthcare Corporation of America, greeted Kathy and me at the visitor’s desk with enthusiasm. As Terry led us to the meeting space, the jovial employee dynamic was immediately apparent as he greeted everyone he passed with smiles and humor. Among the key hospital staff joining us were Vice President & Chief Medical Officer Dr. Lee Norman, President and Chief Executive Officer Bob Page, and Executive Vice President, Chief Operating Officer & Chief Nursing Officer Tammy Peterman. Over thirty members of the hospital staff and several people from the Kansas Foundation for Medical Care joined us to hear about the fantastic improvement work that KU has aggressively implemented.
The cardiac care team highlighted their fantastic door-to-balloon times and Hospital to Home Guide for heart failure patients. The sepsis team is deeply involved with the national Surviving Sepsis Campaign. In less than five years, mortality rates have decreased over 25 percent and are still falling.
In February 2005, KU began implementing Rapid Response Teams. As early adopters of the concept, they shared with us extraordinary stories of Rapid Response calls happening all over the hospital including the elevator and bus stop.
KU was recently recognized by the University Health System Consortium as the #5 best teaching hospital in the country for patient safety and quality. Their willingness to not only use new improvement methods but share them was inspiring. KU started the Kansas Critical Care Collaborative focusing on sharing improvement and getting executives committed to quality care. Most notably, the AMI team has reached out to referring hospitals to work on decreasing transfer times and the sepsis team is working with hospitals statewide in a collaborative to decrease sepsis mortality. They have also implemented a quarterly meeting with EMS and are holding an ECG interpretation class at the end of the month.
Two hours passed before we knew it! I left KU inspired by the people that I met. Steve Simpson of the sepsis team said it best: “KU is keeping score because not keeping score is just practice.”
-- Courtney Kaczmarsky
Representatives from the University of Kansas Medical Center welcome IHI's Kathy Duncan and Courtney Kaczmarsky during the Fall Harvest.
Tuesday, October 30, 2007: Getting the Board on Board in Southwestern Vermont
Becky Grossman and I visited Southwestern Vermont Health Care (SVHC) in the beautiful town of Bennington, VT. Over lunch, a group of quality improvement leaders and members of the SVHC Board shared with us some of the things they are doing to get their “board on board.” One impressive aspect of their work is how actively members of the board participate on the Patient Safety and Quality Committee. Three members of the board joined us for lunch, and it was apparent they bring a great deal of energy, skill, and knowledge to their role.
SVHC has restructured their board meetings, making Quality agenda item number one. They open every board meeting with a real patient story involving harm that occurred in the hospital. Their CMO, Mark Novotny, presents these stories, and they have served to catalyze the board’s commitment.
SVHC has also developed a concise summary of sentinel events that is shared at every board meeting. It provides a structured description for each case, including what happened, a root cause analysis, action plans, and status. The Patient Safety and Quality Committee members described how challenging it was to share this information with the board in an open way, but how helpful it was to develop processes that would hold them to account for fixing safety and quality problems. They are willing to share their tool with others.
In addition, they have really stepped up their involvement of patients and families in making the care better. They recently ran a focus group of patients and families who had been harmed at SVHC or elsewhere to better understand their experiences and what they need. A couple of the important findings were that families want to hear from the hospital sooner rather than later when something goes wrong, and that often the concerns about care start long before a catastrophe happens—when patients and families experience a lack of connection and relationship with the health care team. They now have a process for contacting patients and families right away when something goes wrong, and to partner the physician or other care team member with a trained staff member for support in communicating openly and effectively.
We met a new board member, Kevin, whose brother died after a routine procedure that went very wrong at SVHC. He described waiting for six weeks to have a chance to talk with the hospital about what happened. His commitment to making the care at SVHC more patient- and family-centered as a member of the board was palpable. He brings a professional background in human resources management and knows what it takes for complex organizations to make fundamental changes. SVHC has developed guidelines for bringing patients and family members onto the board, and has generously offered to share this document with other hospitals.
We discussed the “Will, Ideas, and Execution” framework, and it is clear that SVHC has an abundance of Will at the board level, the senior administration, medical executive, and front lines. They also feel that there are abundant Ideas for how to fix quality issues. Where they feel challenged is in the realm of Execution. Sometimes they feel that their very ambition leaves them feeling swamped with problems and a “to-do” list that gets longer all the time. I recommended they read the new IHI White Paper on Execution [http://www.ihi.org/IHI/Results/WhitePapers/ExecutionofStrategicImprovementInitiativesWhitePaper.htm]. We talked about Don Berwick’s injunction to “waste no will” and how the execution framework could help harness will effectively.
We thank the Campaign team for this opportunity to visit an exemplary 5 Million Lives Campaign hospital, and for the chance to enjoy the lovely fall scenery along the way!
-- Carol Beasley
Fall is in the air at Southwestern Vermont Health Care.
Tuesday, October 30, 2007: MRT's and Show No MRSA in "Mwaukee"
My first Fall Harvest trip took me to a state known for its uncommon affinity for cheese, to a city that is the home of the Miller Brewing Company, to a place where "Hackbarth" is actually a common surname. A new Eden, you say? "It's pronounced 'Mwaukee,'" my fellow Harvester and "Mwaukee" ex-pat Jeff Spade informed me.
After a quick lunch and a whirlwind tour of the local sights, Jeff piloted us (in his sweet, cherry-red Monte Carlo rental) to Wheaton Franciscan Healthcare – St. Joseph, where we met Barbara Rogness, Director of Quality, who introduced us to her merry band of die-hard improvers. (It was encouraging to see among this group two senior physicians and the hospital CEO.) St. Joseph is pursuing all 12 Campaign interventions, and teams gave detailed presentations on two of these, Rapid Response Teams (called Medical Response Teams, or "MRTs", at St. Joseph) and MRSA. We also heard a presentation on glycemic control work that started back in 2002 with cardiac surgical cases only, and has since been rolled out for all med/surg patients.
The quality of the work was really outstanding. After a difficult start in which uncertain nurses and medical staff supported the concept only because of prior successes with other IHI-related improvement projects—a testament to the trust among quality staff, leaders, doctors, and nurses—MRTs took off. The team publishes a monthly newsletter detailing the drop in codes outside the ICU and describing an “MRT Call of the Month,” every code is checked to see if it could have been prevented by early detection, and a sophisticated “Early Warning System” (EWS) based on a composite of patient vitals adds to the vigilance of front-line staff in detecting deteriorating patients.
The glycemic control and MRSA presentations were equally encouraging. St. Joseph has experienced a precipitous drop in their risk-adjusted mortality rate (measured with the HSMR), and the team believes that a strong contributor to this has been their house-wide glycemic control work. The project trajectory they described was textbook rapid-cycle improvement and adaptation to navigate some very technically challenging improvements. The MRSA presentation (“Show No MRSA”) showcased the great, fun atmosphere that pervades the organization’s improvement work.
Jeff and I had a great time, and there was a lot of good discussion throughout the day, resulting, as usual, in some measurement homework for yours truly. That will have to wait until later, however; now, I’m off to Denver. I hope they won’t be too sore about that whole World Series sweep thing…
-- Andy Hackbarth
IHI's Andy Hackbarth, Jeff Spade of the North Carolina Rural Health Center, and the "merry band of die-hard improvers" at Wheaton Franciscan Healthcare - St. Joseph in Wisconsin.
Tuesday, October 30, 2007: Data-driven improvement, strong physician engagement, and active leadership involvement thriving at UHC in Clarksburg, West Virginia
Joe McCannon and I were joined by node leaders Patty Ruddick from the West Virginia Medical Institute and Cassie Jo Watson from West Virginia Hospital Association for a visit to United Hospital Center (UHC) in the picturesque, rolling mountains and vibrant, rich fall colors of Clarksburg, West Virginia. From the moment we made our entrance into this vibrant community hospital, the organization’s focus on quality and safety was apparent. Bruce Carter, UHC President, and Mark Povroznik, Director of Quality Initiatives, welcomed us into a warm room of nearly 40 people, including board members, physicians, management, clinicians, and other front-line staff, all dedicated to continuous improvement in their facility.
Through presentations from Bruce, Mark, and many others, we learned that from the top down UHC has established a culture of shared accountability and collaboration in pursuit of better outcomes. The team shared its tremendous success in driving ventilator-associated pneumonia rates down to zero and establishing a model of performance on the AMI intervention that is exceptional. In particular, the facility has consistently seen door-to-balloon times in the range of 60 minutes, despite the challenges posed by its rural location, matching some of the best performers we have seen around the country. They are also working rigorously, with teamwork and innovation, to prevent pressure ulcers, dropping rates drastically and now observing in-hospital incidence of pressure ulcers well beneath the national average.
An appreciation for data-driven improvement, the presence of strong physician engagement, and leadership insistence on enhanced care for patients emerged repeatedly as themes in our conversation. With board acknowledgement, an active quality team, and a new facility in sight for 2010, United Hospital Center is positioned for ongoing success. The trip was a great Fall Harvest highlight.
-- Marie Defer
Tuesday, October 30, 2007: Rallying for safety and quality at KP South San Francisco
Today, for my first Fall Harvest visit, we headed to the Kaiser Permanente South San Francisco Medical Center. As we sat in a conference room framed by beautiful hills, clinicians from all different specialties and backgrounds poured into the room—physicians, nurses, administrators, quality improvement folks—with an excitement and energy that was palpable. I was struck by how proud they all were of the difference they were making in their lives and those of their patients.
A physician from the emergency department told their story, which actually began in 2005. They shared the pain of the past, when the medical center had been close to closing its doors. This caused them all to come together and decide they needed to work as a team. Shortly after this, they attended a 100,000 Lives Campaign meeting at which Maureen Bisognano challenged attendees to “have a rally” and change the way they provide care. These words changed their lives—and those of their patients—forever.
The team took Maureen’s words to heart. Within a month, they identified key stakeholders in different areas of the hospital and asked them to lead a team. They had a meeting in the cafeteria to celebrate the difference they were going to make and identified these key leaders—who had no idea what they were going to be doing! These teams were then empowered to take the tools put out by the Campaign and change the way they cared for patients. They worked together in ways they had not done before; the excitement and the challenge drove these teams, and the original task force had trouble keeping up with them! Senior leadership from KP Northern California came to the facility and spent a day listening to these frontline teams and the work they were accomplishing. A transformation had occurred that made safety personal to all staff and clinicians; it became unacceptable for any employee to accept unsafe conditions, and together they all worked to own and share the safety journey.
We toured the hospital and saw this work in action: nurses wearing fluorescent green vests while they were dispensing medications. It was very clear that interruptions and distractions while administering medications are no longer acceptable. This team had moved beyond the “quiet zone” by using their data: using the vests resulted in a 40 percent decrease in administration errors. Involving multidisciplinary teams in this work and communicating the why’s and how’s to everyone was necessary. Team members are now also identifying additional areas where interruptions contribute to unsafe conditions—such as when physicians are writing orders—and trying to identify how they can build safety practices into these high-risk conditions as well. Every day the nurse managers hold a High-Alert Medication noon huddle to discuss patients on high-alert medications. Any near misses are identified and sent to Quality. Clinicians are told how their identification of these near misses results in a review, and all staff are informed of any changes so they can share in how this work leads to a safer environment.
The hospital has also taken the Rapid Response Team concept to a new level. The ICU nurse assigned to the team for her shift makes rounds several times a day to all of the inpatient units, troubleshooting the care of patients with the frontline nurses and identifying concerns before it is necessary to call the Rapid Response Team. They are committed to doing this even though they are a small community hospital. The team tested not doing these rounds and saw the codes on the units go up and calls to the Rapid Response Team go down—after which the rounds were immediately re-instated. They have now also built the Rapid Response Team work into simulations for current and new staff, focusing on what needs to happen in the time between when the Rapid Response is called and when the team arrives. This week the team launched their “Condition H” response—allowing patients or families to call the Rapid Response Team —by testing it on one unit.
The surgical team described their improvements and the resulting collaboration among all providers. Physicians talked about how other physicians on the teams have been present in the OR to support their peers in making some of the improvements. Physician engagement is clear at this facility.
The clinicians also communicated that, in all of their work, “SIMPLE” has become a motto. They have refined and tested everything they do to make it as uncomplicated as possible. SBAR is now the standard communication tool, whether it is giving report to a physician or identifying a near miss. The organization has adopted James Reason’s “Just Culture” algorithm and uses it to understand all events that occur in the medical center.
This Fall Harvest Team was energized by the commitment KP South San Francisco has made to themselves and to their patients. It was amazing to witness the energy that was unleashed by Maureen’s challenge two years ago. The rally has not finished and, from what we witnessed, will be going on for a very long time!
-- Sue Gullo
Christina Gunther-Murphy, Anna Roth, Sue Gullo and the Kaiser Permanente South San Francisco Medical Center Team posing on the roof.
Monday, October 29, 2007: Holy Cross Community Hospital - A Home Away from Home
At 8:30 in the morning, sitting in the lobby of my hotel waiting for Jordana and Joanne, I pondered just what this day would bring. I had never been to New Mexico, never been on a site visit, and never met the two members of the QIO, New Mexico Medical Review Association (NMMRA), with whom we were about to spend the day. After a hearty breakfast and some ribbing at my expense due to fact that my newly acquired belt didn’t fit exactly as it should, I still blame the belt. With a quick stop at the hotel store, Joanne had her much-needed hair spray and we were ready to begin this adventure. Even after I had pleaded with Jordana that it would make us look good if we showed up in a red convertible, we got a grey Dodge minivan. She handled like a dream—a dream you’re stuck in a soccer mom’s body. Nevertheless, I was enthused that our state-of-the-art van was equipped with satellite radio; I thought, well, at least we can rock out like we have a convertible! But all I got from the back seat was “easy listening only, Jake.” Dang. I thought, well, at least I’ll be able to tear up the roads; then Jordana jumped into the driver’s seat. Trumped again!
We were on our way, off to pick up our friends at NMMRA. We marveled at the grid-like system and road signs aplenty, yet being in a new city proved too much for the navigator (me) and with a left, left, left, right…. wait for it left, we were there. Once we were all in the van, we hopped on Route 25 and, with Anne Timmins and Jennifer Trotter as our guides, we saw the beauty that was New Mexico. It was two and a half hours to Taos, the site of Holy Cross Hospital, and with a stop-over in Santa Fe we were able to truly get a sense of the local culture. We ate lunch at a wonderful little local spot our New Mexican hosts picked out. We passed though many art shops and a small market, where it was apparent how big a part art and artistic expression played in their culture. None of us bought anything, but I was able to pick up a huge souvenir in Santa Fe for free! It was a gift from a rather large bird that passed by; I guess he thought my brand new shirt just looked too good. Thanks hawk, you’re the best. With my attire tarnished, but not my mood, we headed out again.
The drive to Taos was amazing; colors and rock formations such as Camel’s Rock kept me glued to the window. We pulled into Holy Cross Hospital right on schedule, hopped out of the van, and after a quick stretch of the legs we entered what truly felt like a home away from home. We were met by two members of Holy Cross who were all smiles; in fact, that’s all we got during our site visit there, smiles. They were glowing with pride, and rightfully so. During our tour through the facility, we marveled at the art that was hung on every square inch—all of it donated from the community to the hospital, the facility not more than 12 years old. In total, an estimated half a million dollars’ worth of art blanketed the facility. It was apparent from the start that this hospital was deeply a part of the community, and community was a part of it. The facility itself was beautiful, with natural light pouring in through skylights and a cafeteria that had one of the most amazing views you could find anywhere. It was a wonder how in a setting such as this anyone could get sick. The maternity rooms looked more like what you might find in your own home, with hardwood floors and wooden rocking chairs, and newborns sleeping in the same room as their mother.
After our tour, we were brought to a large conference room and in front of us was another row of smiles. We were greeted warmly and took our seats intent on listening to all the great work that had been taking place. I was amazed to hear that the staff, after some frustration with the system as it was, went to the management and the board with a case for change. And boy, did the board and management react. They went out and found the 100,000 Lives Campaign and Life Wings. Life Wings is a quality system that was developed from the field of aviation, much like the lean work we have learned from the Toyota model. Borrowing tools from aviation safety standards and techniques, Life Wings coupled with the Campaign has really transformed the way care is given at Holy Cross. The management and board mandated that everyone in the hospital comply and observe the new processes and interventions, along with a mandatory training even for the board!
We heard accounts of how communication and innovation were the cornerstone of their improvement efforts. They took SBAR and tweaked it to fit their own organization better. They had a system in place that empowered everyone so that no problem, small or large, would go unchecked. “See it, say it, fix it” has become their motto and it is working. Everyone now has a stake in the improvement of their community’s hospital. They live there, too; Holy Cross is the only hospital within 60 miles; they see themselves as a family and it shows in their work. Briefings before each day and debriefs after each surgery have led to daily problem solving, and fast spread of information and safety techniques. The team had also collected a lot of data to determine just how they were doing in certain efforts. For example, they went from marking the surgical site 30 percent of the time to 100 percent of the time by empowering nurses to help their doctors remember. They created procedure cards that have helped every level of care and are now at 99 percent utilization. They have been without a pressure ulcer for six months!! They created a system for tool stations (using trays) that drastically improves making sure that each tool is in its place when needed.
After leaving the hospital and all the warm faces, we had another trek through the wonderful scenery that was New Mexico. Surely if anything can be said about our trip, it’s clear that you are apt to get warm, safe, patient-centered care at Holy Cross.
-- Jake Auger
Members of the Campaign team, IHI staff, and the NMMRA get down to business during the New Mexico Fall Harvest visit.
Monday, October 29, 2007: Volume Follows Quality in Kentucky
The first day of the first full week of Fall Harvest found CSI Coordinator Caitlyn Carlson and me in beautiful Northern Kentucky. Members of Health Care Excel joined us for a visit to St. Elizabeth Grant County Hospital, a 25-bed critical access hospital in Williamstown, located 40 miles outside Cincinnati. Grant County was one of the first Critical Access Hospitals to achieve Magnet status. They owe this achievement to a commitment to providing the best care possible for their rural population and to a belief that "volume follows quality."
The staff shared with us their great success in improving care for heart attack patients. In 1991, when Grant County joined St. Elizabeth's Health System, the board staffed the hospital's ER exclusively with board-certified ED physicians. While initially this was financially challenging, it was more important that St. Elizabeth maintained its reputation for providing high-quality care; furthermore, leadership had faith that improved outcomes would draw more customers from this fast-growing region.
Many years later, when the American College of Cardiologists suggested that hospitals set a goal of 90 minutes for door-to-balloon time, Grant County began extensively educating their staff on the importance of reperfusion. Their attitude was that rural heart attack patients needed (and deserved) treatment that was just as timely as that received by patients entering the ER at a receiving hospital. Through a series of innovative process changes—including enabling the ED physician to contact a cardiologist and activate the cath lab with a single call—Grant County has worked with its receiving hospital to get more than 85% of its AMI patients from door to balloon in under 90 minutes!
St. Elizabeth shared with us the many awards they had won as a result of their improvements in cardiac care; furthermore, since 2003, visits to the ED have more than tripled! This is in part due to the growth of the region; however, it is also due to the facility's reputation for providing top-notch care!
-- Jonah Borrelli
Campaign Fall Harvesters and the team from St. Elizabeth's in Kentucky pause for a photo-op outside.
Monday, October 29, 2007: Post-Katrina success story - Meeting the “cream” of Slidell Memorial Hospital
Greetings from Louisiana! This is Samantha Henderson, Special Assistant to Dr. Don Berwick. Sunny skies and balmy weather welcomed Campaign Manager Joe McCannon, Eastern Region Field Coordinator Katie O’Rourke, and me to New Orleans. After admiring the beautiful balconies of the French Quarter, sampling the delicious seafood dishes, and even finding a handful of Red Sox fans to cheer the Sox on to victory, we piled into our rental car early Monday morning and drove across Lake Pontchartrain to Slidell Memorial Hospital (SMH).
At SMH, we received a warm welcome from Chief Nursing Officer Mark Stockstill and several key players in SMH’s quality improvement work. They told us about their Rapid Response Teams, known at SMH as Critical Assessment Teams (CATs). This acronym lent itself to clever marketing strategies to raise awareness and promote the CAT: the CAT tiger logo is posted prominently around the hospital, stuffed animal tigers are given to staff members who activate the CAT, and Kit Kat candy bars distributed at traveling road shows spread the CAT concept outside of SMH. The staff also raises morale with a Save of the Month trophy that rotates among teams that had the most successful or inspirational patient “save.”
Widespread educational programs, hand-picked CAT members, and strong support from the SMH Board contribute to the hospital’s great success in reducing codes outside of the ICU. Two years ago, over 40 percent of the hospital’s codes occurred outside of the ICU; this month, the rate is down to 12.5 percent. The SMH staff accomplished this in the face of Hurricane Katrina and its aftermath, during which the hospital lost almost half of its nursing staff and took in displaced nurses from nearby flooded and abandoned hospitals. Despite the massive staff turnover, the SMH leadership did not flag in its quality improvement work and instead used the setback as an opportunity to re-launch and reinforce the CAT initiative. The staff of Slidell Memorial Hospital developed successful and resourceful methods to reduce codes outside of the ICU in spite of formidable challenges, proving one of CNO Mark Stockstill’s favorite quotes: “Shake it up and the cream comes to the top.”
-- Samantha Henderson
Slidell Memorial Hospital welcomes the team from IHI during their Fall Harvest visit.
Monday, October 29, 2007: Big strides in sepsis care at St. Bernards in Jonesboro, AR
It was a crisp, clear, southern morning as Campaign faculty member Kathy Duncan picked me up from a hotel on Memphis’s famous Beale Street. We set out across the Mississippi river to the vast cotton and soy bean fields of Arkansas towards St. Bernards Medical Center in Jonesboro. Pam Brown of the Arkansas Foundation for Medical Care joined us for a site visit packed with learning and Fall Harvest fun.
The team we met with is really living by the hospital’s mission to provide healing to the community through education, treatment, and health services. After analyzing their hospital-wide mortality rates, they realized that sepsis was an area of care that needed improvement. They then drilled down to find the area of sepsis prevention and care that needed to be improved: early identification. They addressed this issue by creating a sepsis identification card that all doctors and nurses carry with them during their shifts to ensure sepsis is at the top of their mind. They also engaged their Rapid Response Team to help when needed in the immediate care of a septic patient and – starting in December – families will be able to call the Rapid Response Team as well.
Once they set protocols for the identification of sepsis, engaging their staff was paramount in ensuring they were followed. Hospital administration sent out letters to the staff addressing the prevalence and severity of sepsis at St. Bernards as well as inviting them to a dinner with an accomplished speaker in the area of sepsis care and identification, Dr. Art Wheeler from the Vanderbilt University Medical Center.
Their methods are consistent with an organization focused on quality care led by leadership and adopted by a staff truly concerned with quality and the safety of their patients. They are also doing excellent work in the areas of reducing MRSA and preventing both central line-associated bloodstream infections and ventilator associated pneumonia. After excellent presentations, Kathy and I were treated to a true southern lunch of pulled pork BBQ and sweet tea. Even though I was out of town during the Red Sox World Series victory, I felt right at home in Jonesboro!
-- Jesse McCall
Team members from St. Bernards Medical Center in Jonesboro, Arkansas celebrate the Campaign Fall Harvest with IHI's Jesse McCall.
Friday, October 26, 2007: Who says small can’t think big?
Campaign Central Region Field Coordinator Jonah Borrelli and I had the pleasure of visiting a small hospital located in the wide open spaces of rural Nebraska. Nemaha County Hospital is a 20-bed facility that exemplifies what is possible with a steadfast commitment to providing care that is patient-centered, high quality and, above all, safe. Supported by a board of directors that has patient safety as the first agenda item at their monthly meetings, Nemaha has implemented impressive IT tools to support and sustain their improvements in patient safety and quality.
Our visit began with a warm welcome and introductions to key hospital staff including CEO Marty Fattig and CNO Kermit Moore. Representatives from the Nebraska Node, Monica Seeland of the Nebraska Hospital Association and Janet Dooley of the Nebraska QIO, were present as well. We spent the first hour learning about their vision, their accomplishments and the outstanding caliber of the staff. During the hospital tour, we saw firsthand the benefits of their IT investment during a demonstration of the safety features built into their daily medication administration routines. We were then delighted by a presentation about their Personalized Patient Centered Care program, Partners for Life, which embodies the core values of the organization: Integrity, Compassion, Accountability, Respect and Excellence (I CARE).
The message we heard from both administrative and frontline staff was clear: transparency and a blame-free environment are key to consistent improvement. Addressing all twelve Campaign interventions, Nemaha County Hospital is a model of the level of excellence that can be achieved in rural hospitals. To quote CEO Marty Fattig, “You may be small, but that doesn’t mean you can’t think big!”
-- Tracy Jacobs
The team from Nemaha County Hospital welcomes IHI Director Tracy Jacobs and Central Region Field Coordinator Jonah Borrelli for the Campaign's Fall Harvest visit to Nebraska.
Friday, October 26, 2007: Inspiring dedication to quality at MemorialCare in California
This is Dan Souw, Project Coordinator for IHI Strategic Partners, writing from Newport Beach. As the sun was rising through the smoky skies of southern California, IHI Senior Fellow Blair Sadler, Western Region Campaign Field Coordinator Jordana Pickman, and I met with several system and hospital board members and frontline staff from MemorialCare.
Helen Macfie, Vice President, Performance Improvement, gave a wonderful overview of the system’s accomplishments and described how MemorialCare’s system- and hospital-level boards are highly engaged in the organization’s quality agenda. They use IHI’s Seven Leadership Leverage Points as a focus to start their meetings, include storytelling, and do not forget to celebrate their successes – and there are many. Their use of Process Improvement Dashboards (spider diagrams) presents simple and clear breakdowns of organizational aims with the status of each based on four target levels. As finance departments would initiate a quarterly “close,” MemorialCare conducts a “quality close” to review system-wide data.
Results from the individual hospitals were also very impressive. To name a few, Orange Coast Memorial Medical Center has had no VAPs since November 2005 and their use of Rapid Response Teams has reduced code blues outside critical care by 48 percent over two years! Anaheim Memorial Medical Center has 97 percent reliability in their AMI Perfect Care delivery and has reduced their central line infection rates by 50 percent.
MemorialCare’s spirit and ambition to provide quality care is truly inspiring, and I am very appreciative for the time they gave to sharing their great work with us.
-- Dan Souw
The Fall Harvest discussion group pauses for a snap shot at Memorial Care in Southern California.
Friday, October 26, 2007: Commitment to the community at Alaska Regional Hospital
This is IHI Fellow Anna Roth and Campaign Project Manager Christina Gunther-Murphy sending word from Anchorage. We arrived on a beautiful Alaskan fall day: 30 degrees and two inches of snow! Despite the cold weather, we were greeted warmly by the team at Alaska Regional Hospital (including staff, executives, and the board chair).
Their clinical results are impressive, but it is their approach to patient care that touched us the most. The staff members at Alaska Regional are committed to providing every Alaskan in their hospital, and in all hospitals in the state, with superior care. This commitment has led to collaborative efforts statewide and the formation of the Alaskan Patient Safety Collaborative. The Chief Medical Officer, Dr. Norm Wilder, reiterated that this collaboration is critical to providing the safest care possible to the community: “We don’t compete on quality. We collaborate and share in every way throughout the region.”
Alaska Regional has seen measurable progress in a number of areas. They have gone from 44 percent to 90 percent compliance on SCIP measures, partially as a result of their “Decorate Your Socks” contest aimed at raising awareness about preventing deep vein thrombosis. (We were lucky enough to see pictures of the creative designs, including entries from the CEO, COO, CNO, and CMO.) Additionally, they are the only hospital in Alaska to receive Joint Commission accreditation for stroke care. This is a critical stride in meeting the needs of the community; stroke is the fourth leading cause of death in Alaska. The design of the stroke program has been an organization-wide effort, resulting in a redesign of the emergency department and community outreach. Alaska Regional has provided public service advertisements on the city bus and television to educate the community about signs and symptoms of strokes and the importance of seeking care. Robin, an ER nurse, shared a story from a grateful patient whose mother was having a stroke.
We could have spent all day learning from this great team. They are also working on MRSA, Rapid Response Teams, and many other initiatives. We were grateful for their informative sharing.
--Anna Roth and Christina Gunther-Murphy
IHI Fellow Anna Roth and Campaign Project Manager Christina Gunther-Murphy receive a warm welcome from Alaska Regional Hospital.
Friday, October 26, 2007: Collaborating on quality in Washington State
Crisp fall weather and peak foliage greeted me this morning in Spokane, Washington, for what was a tremendously exhilarating visit to Sacred Heart Medical Center, an enormous 600-bed teaching hospital that is the nation’s largest between Seattle and Minneapolis. All hands – from Sacred Heart’s President Mike Wilson and the board to frontline care providers – were present to describe in detail the organization’s strategy for addressing all of the 5 Million Lives Campaign interventions. Closely mirroring my recent experience at Jackson Hospital in Alabama, I observed a deep leadership commitment to improvement, a safe environment for sharing and learning from performance data, and the devotion of dedicated resources to quality activities. I was also particularly struck by the structures in place – including standardized quality data bulletin boards, visible to patients and families, in every unit - to ensure regular review of progress and identification of opportunities for improvement. Clinically, Sacred Heart is doing outstanding work by improving early detection with its highly-active Rapid Response Team, by joining a city-wide initiative for standardizing and tracking patient medication lists and by driving VAP rates down to zero in its ICUs. It has also introduced a remarkable regional model for getting heart attack patients from surrounding rural facilities into its catheterization lab in 90 minutes or less, an approach we learned about in even greater detail during the day’s second visit.
Thirty-five miles away in rural Davenport, we met CEO Tom Martin and the hard-driving team from Lincoln Hospital, who described the symbiotic relationship between their critical access facility and a referral center like Sacred Heart, telling us in detail the story of the first heart attack patient assessed in their facility and immediately helicoptered to Sacred Heart for a door-to-balloon time of just over 90 minutes. Tom, the board, quality managers and medical staff aspire to an ambitious and innovative vision of Lincoln as a world-class hospital that distinguishes itself by doing more than simply providing excellent care within its own walls; instead they seek to provide a “coordinated care experience” that utilizes all technology and all available resources (in referral centers, at other sites and in the community) to provide comprehensive care for local patients. As leading members of the area’s Rural Healthcare Quality Network, Lincoln shares its vision with other facilities and encourages leaders and clinicians in the area to adopt a similar, data-driven ethic of improvement.
Special thanks to Carol Wagner of the Washington State Hospital Association and Sharon Eloranta of Qualis, Washington’s QIO, who joined me for both visits and who have both played key roles in the remarkable improvement activity in the state. Though tired at the end of a full day, we finished full of ideas and energy for the work ahead!
-- Joe McCannon
Thursday, October 25, 2007: Pressure ulcer prevalence down to 1.5 percent at Yuma Regional Medical Center
What a beautiful day in Yuma, Arizona! The beautiful sunshine and the 90-degree temperatures made the visit to Yuma Regional Medical Center a great day! Eighteen leaders of Yuma Regional greeted Barb Averyt (of the Arizona Hospital Association) and me. They spent the morning describing their tremendous work in several areas: Infection Control, Pressure Ulcer Prevention, Glycemic Control, and Advanced Clinical System Project. After five years of focus on pressure ulcer prevention, their pressure ulcer prevalence is down to 1.5 percent! Several leaders proudly described their work in these key strategies. The passion for the patient at YRMC was evident with every presentation! They have created a tool to assist them in staying on the right track as they journey through a long IT process: It’s called “The Story of Jane” — a story from a patient’s point of view that gives a glimpse of the future of health care delivery at Yuma Regional Medical Center. It brought tears to my eyes! Barb and I were privileged to meet and learn from these talented folks!
-- Kathy Duncan
IHI's Kathy Duncan joins the team from Yuma Regional Medical Center in Arizona.
Thursday, October 25, 2007: Christiana Care – The crown jewel of the Diamond State!
Believe it or not, it was a dark and stormy night as Eastern Field Coordinator Katie O’Rourke, Don Berwick’s Executive Assistant Markus Josephson, IHI Director Cindy Hupke, and I made our way to Philadelphia on Wednesday. After white-knuckle turbulence and multiple flight delays, I was glad we decided to fly in the night before our first Fall Harvest visit (although it meant missing most of the Red Sox rout of the Colorado Rockies in Game 1 of the World Series!).
Within minutes of our arrival on Thursday, it was clear that – if Christiana Hospital is anything to go by – Thomas Jefferson had it right when he deemed Delaware a jewel among states! Everything – from the opening remarks by Christiana’s CEO Dr. Robert Laskowski, to our tours of the ED and their simulation lab, to the very last presentation on their medical residency program – demonstrated how thoroughly they have embedded their devotion to excellence into practically everything they do. I was prepared to hear about their first-rate AMI work and their exceptional work on reducing sepsis (Christiana Care Health System estimates their Sepsis Alert Program reduced mortality by 46%), but until today I had no idea that they also considered employee satisfaction to be an integral part of their mission. Most impressively, it’s not just that the many people we met seemed excited about working at a high-performing institution; to a person, they also seemed driven to continually provide better care for their patients and eager to share what they’ve learned with other hospitals.
I learned so much and felt so inspired by this visit. I can hardly wait to see what else we reap from the Fall Harvest!
-- Jo Ann Endo
Thursday, October 25, 2007: Codes and falls drop at St. Mary's in South Dakota
Greetings from Pierre, South Dakota! IHI Fellow Karen Metzguer and I just visited St. Mary's Healthcare Center where we met with their Rapid Response and Falls Prevention Teams. St. Mary's is a 60-bed facility and the only acute care hospital in the state capitol. Karen and I were amazed by their highly engaged staff and by the incredible amount of support shown by St. Mary's leadership.
During the 100,000 Lives Campaign, St. Mary's did a "gap analysis" and determined – of all the interventions – Rapid Response Teams would have the biggest positive impact on their mortality rates; furthermore, the hospital is located 170 miles from the nearest cardiologist, so caregivers need robust systems for recognizing when a patient's condition is declining before s/he has a heart attack. Since implementing a Rapid Response Team, St. Mary's has seen codes drop by 50 percent and plans are in place to allow family members to activate the team in 2008.
Since 2000, the leadership at St. Mary's has fully supported the implementation of several best practices for preventing falls. To get this buy-in, the Falls Prevention Team cited data from other hospitals across their system, Catholic Health Initiatives. Best practices included developing an assessment tool for evaluating patients' needs, integrating their Fall Prevention Plan into MediTech, and investing in exercise equipment for elderly patients. St. Mary's has seen the number of falls decline by 73% since 2000! The Campaign Team looks forward to spreading the strategies we learned on this visit to hospitals across the country.
On a personal note, for reasons of geography, the other members of the Campaign Field Team and I seldom get to visit successful smaller-sized hospitals like St. Mary's. We are grateful the Fall Harvest has offered us the opportunity to "discover" these gems.
-- Jonah Borrelli
St.
Mary's Healthcare Center's Flame of Life: The names of people who survived cardiac arrest in or while being transported to their Special Care Unit.
Wednesday, October 24, 2007: LDS Hospital uses teamwork to improve safety
October 24th was a glorious day in Salt Lake City! As the sun shone and the mountains in the distance displayed their snow-capped peaks, IHI Fall Harvesters arrived at LDS Hospital. Campaign faculty member Kathy Duncan and I were accompanied by Utah Node members Jackie Buttaccio and Linda Johnson of Health Insight. Fifteen folks, including administrators, quality directors, nurse managers, and a physical therapist, welcomed us upon our arrival. Brent James, executive director for Intermountain Health Care, introduced the group to some of the research done at LDS that was used in developing IHI's Global Trigger Tool. We then learned three different ways in which LDS was improving safety throughout their hospital and how teamwork played an integral role in achieving quality care.
LDS has created safer ICUs by creating an ICU Safety Team that meets monthly with Safety Champions from each of the seven ICUs who together recommend and implement changes in the ICU systems that impact patient safety. The group mentality of watching out for each other and involving everyone from clerks, to physicians, nurses, and housekeeping has made the project very successful. One specific change they implemented was requiring that the name of a drug be circled with red pen before being hung.
LDS has also worked to improve their medication event verification. They have developed their own software that requires a pharmacist to examine all drug-related events. One pharmacist is assigned to a specific nursing unit and examines 1-3 events a day to determine if the error was a result of a system problem.
We also learned about how LDS has improved their pressure ulcer prevention program through nurse education, the use of electronic charting tools, product standardization, development of a SWAT (Skin and Wound Assessment Team), and communication tools.
We thank the folks from LDS for sharing their work to improve quality and patient safety in their hospital!
-- Jordana Pickman
Wednesday, October 24, 2007: Jackson Hospital's strong leadership culture prioritizes improvement
It was raining in Montgomery, Alabama on the morning of the Fall Harvest’s first visit to lovely Jackson Hospital but I consoled myself by noting that some rain is necessary for any good harvest (and by learning just how badly local crops are in need of some water)...I was welcomed by a team of more than twenty hospital executives, Board members, physician leaders and quality practitioners, and they proceeded to impress me enormously with their commitment (active teams on all twelve Campaign interventions), their success (tremendous outcomes on reduction of infection and surgical process improvement) and their insights on what makes an organization like theirs so successful at pursuing system-level change. Their recipe for success? “Brutal honesty” (sober, regular assessment of data and progress), physician engagement – from the front lines to the Board - and a “no fault” environment that encourages candid sharing of successes and shortcomings. Their pride and energy was infectious and my compliment to them is one of the highest I can think of giving: if I were a health care professional, this is the type of organization where I’d like to work.
This terrific visit happened, incidentally, on the heels of an exhilarating day with all of Alabama’s hospitals at Tuesday’s Alabama Quality Forum, co-hosted by AQAF (the state’s QIO), the Alabama Hospital Association and Blue Cross Blue Shield of Alabama. Keith Granger, Chairman of the hospital association’s Quality Task Force, opened the day with a transparent review of hospitals’ performance and set a tone of great ambition by asking if the state could move into the top 10 performers in the country on measures of quality and safety. To judge by the presence of committed and engaged leadership, the heated and practical discussion on keys to success at introducing best practices, and the unprecedented willingness to share learning between hospitals, this seems entirely possible!
-- Joe McCannon
Joe McCannon makes his first Fall Harvest visit at Jackson Hospital in Alabama.
Thursday, October 18, 2007:
Don Berwick describes making the Fall Harvest connection
The trees are glorious, the air is crisp, and the World Series and the NFL compete for attention. It must be fall. Thanksgiving impends… then Christmas, and, incredibly, then we will be one full year into IHI’s 5 Million Lives Campaign – the largest single improvement effort we have ever tried – you have ever tried.
We’ve been watching closely as over 3,600 hospitals have signed onto reducing patient injuries even faster than they were already trying. We’ve populated the IHI website with hundreds of pages of supportive materials, and we have joined with dozens of partner organizations and Node leaders to share and extend knowledge as fast and as far as the computer age and airplanes will let us.
Now, with the 5 Million Lives Campaign “Fall Harvest,” we will connect at a level we never have before. Part of the reason, frankly, is that, without something like this, we can’t keep up with the creativity we are seeing everywhere. When we started this Campaign, we did offer an even dozen “planks” designating specific kinds of harm to reduce, and how. But we said and knew from the start that safe patient care requires a far bigger portfolio than that – not dozens, but hundreds of targeted types of injury – and that hospitals and clinics throughout the country would be adding their extra sauce to our recipe. I saw this after the Campaign had barely opened, when a CMO from a small, rural hospital in Eastern Washington came up to me after my talk and asked if it would be “OK” if they tried to improve outcomes for sepsis – not one of our original twelve planks. “OK”??? OK!!! Exactly!!! The shared explorations of hundreds of places and thousands of people, with a good dose of science, evidence, and caution, can amount for our country and the Campaign to a treasury of ideas and possibilities for all.
But, of course, that knowledge lies fallow unless it can spread. Transparency is leverage. That’s a key purpose of the Fall Harvest – get out, get about, and find out whatever we can about the innovations and surprises surfacing in the field. Think about it. If we do it right, all staffs in all hospitals are your staff, too. Leverage.
There is one other, more selfish, reason for IHI to lead the Fall Harvest: building our own joy in our own work. The core of IHI’s staff is remarkably small – barely 100 people in our office in Cambridge, Massachusetts, and maybe 20 others around the US. Most of them connect with the field of improvement partially and remotely. They take your phone calls, coach you on the web, and make it possible for you to learn from each other and our faculty at meetings. They celebrate the work in the field, but they don’t get to see it, first hand, as most wish they could.
The Fall Harvest will include the biggest outreach in person – as opposed to electronically – by IHI staff to the field in our history. Over 80 IHI personnel will board planes, trains, and cars during the Fall Harvest to visit real sites and real teams everywhere in the nation. I think it’s possible that this experience will transform IHI as our entire staff gets a new infusion of both excitement and reality from their dialogues with many of you.
The aim, of course, is improvement – safer care for patients. Our premise is simple: we’ll make gains faster together than separately, and the Fall Harvest will connect us all in new and energizing ways.
-- Don Berwick
The excitement builds as the IHI staff and faculty attend a Fall Harvest briefing.
Wednesday, September 12, 2007: Results and Innovation in the Heartland
Today, IHI Director Diane Jacobsen; Campaign Project Manager Christina Gunther-Murphy; Western Region Field Coordinator Jordana Pickman; and I spent the morning visiting two outstanding hospitals in Omaha. Our visit to Nebraska Methodist gave us a window into the workings of an incredibly innovative hospital. You could hear the joy in staff members’ voices as they described the creative processes they had developed to ensure that the right care was delivered reliably to every patient. In a hospital where many of the nurses are right out of school, it is great to know that new staff are continuously exposed to other (and are educated to become) clinicians with a strong commitment to evidence-based care.
Down the road, the Nebraska Medical Center – a Campaign Mentor Hospital – is doing an amazing job of “raising the bar” on a number of performance measures and has achieved some great outcomes. In their efforts to prevent pressure ulcers, for instance, the SWAT (Skin And Wound Advisory Team) created their own data submission tool, mandated education among nurses, and implemented electronic reporting. From 2005-2007, they report that 329 patients did not develop pressure ulcers and they saved $3.6 million!
The Campaign participants we met in Nebraska are truly committed to delivering the right care to every patient, 100% of the time!
-- Jonah Borrelli
Friday, August 24, 2007: “Talking story” and taking action in Hawaii
Aloha from Hawaii! This is IHI Communications Specialist Jo Ann Endo, writing from the island of Oahu in the wake of a very successful first Town Hall meeting hosted by the Hawaii Node at the Queen’s Medical Center in Honolulu. Western Region Field Coordinator Jordana Pickman, and I had the honor of attending a series of terrific meetings this week and – as a result – we’re very excited about what’s in the works in Hawaii.
First, we attended a morning meeting at the Kaiser Permanente Moanalua Hospital on Wednesday. With Quality Manager, Darlene Sawamura, and her team, we shared some pastries from the popular local eatery, Zippy’s, and we settled into a wide-ranging discussion about everything from local culture to the complexity of medication reconciliation. Their dedication to continuous improvement (including monthly PCI drills to maintain their impressive door-to-balloon times) was inspiring and their praise of one another when individuals were reluctant to take credit for their accomplishments was heartening. We look forward to hearing more about their new hand hygiene initiative (dubbed “WHALL” for “Wash Hands And Live Long”) and efforts to encourage open communication with patients and their families.
On Thursday, Jordana and I headed to Kapiolani Medical Center at Pali Momi where Director of Quality and Risk Management, Kellé Payne, greeted us with fragrant plumeria leis. We met with an enthusiastic group that included their quality and physician leaders, infection control specialist, data analyst and executives from their parent system, Hawaii Pacific Health. Pali Momi currently serves as an AMI Campaign Mentor Hospital, but from what the team described, we’ll be inviting them to consider applying to mentor for Rapid Response Teams and Boards on Board as well.
Throughout our discussion, it became clear that Pali Momi exemplifies much of what we’ve seen across the country among high-performing Campaign participants: energetic people constantly looking for ways to improve patient care, strong leadership support, transparency, effective use of their own data, and celebration of their successes. In addition, Pali Momi has capitalized on the strengths of local culture and engaged non-clinical staff in their quality work. Guided by the principle of Alapono – a Hawaiian word meaning “the path to well-being through better health” – Pali Momi adapted what started out as executive walk-arounds into “Talk Story Alapono,” a monthly opportunity for everyone who has patient contact (from nurses to security guards to housekeeping staff) to voice their opinions on “What can we do today to improve things for our patients?” (In Hawaii, to “talk story” loosely means to chat informally.)
On Friday, over 200 people representing nearly all of the acute care hospitals in the islands attended a Town Hall meeting moderated by the energetic Dr. Bruce Spurlock of the Bay Area Patient Safety Collaborative. Organized by the determined quality leaders at Mountain-Pacific Quality Health, Queen's Medical Center, and Hawaii Pacific Health with support from HMSA (a/k/a Blue Cross Blue Shield of Hawaii), the gathering spotlighted some of the amazing work being done on the Campaign in Hawaii. Presenters from Pali Momi described how they achieved 22 consecutive months of 100% reliability for all AMI measures. The Queen’s “D2B” team recounted how changes they made – including the use digital stop-watches on clipboards set to count down from 90 minutes – helped them shave an astounding 62 minutes off their average door-to-balloon time.
Following an engaging presentation on implementation of the SCIP recommendations at Queen’s and Straub Clinic and Hospital and a sobering discussion of the need to reduce MRSA in Hawaii, a number of attendees stood to publicly declare the improvement aims they’re pledging to tackle in the coming months. Despite – or perhaps because of – the sometimes daunting challenges they face, participants described their determination to work together to improve their patients’ care. With the impressive progress the organizations in Hawaii have made so far, I’ve no doubt their efforts to work more collaboratively will bear fruit from which the whole country can learn.
-- Jo Ann Endo
Friday, August 24, 2007: Improving cardiac care in the Sunshine State
IHI Director Diane Jacobsen and I attended a great event in Florida today. Miami-area hospitals came together on a beautiful summer Friday (shocking, we know) to discuss the American Heart Association’s “Get With the Guidelines” program, the 5 Million Lives Campaign interventions on CHF and AMI, the economic and legal incentives to participate in these programs, and presentations from different local hospitals on the success of their cardiac work. This event was particularly interesting as it showed alignment with different QI projects in the country.
-- Katie O'Rourke
August 22 - 23, 2007: South Carolina Campaign Caravan!
Hello from Jesse McCall, 5 Million Lives Campaign Project Coordinator. This past week I had the privilege of attending the South Carolina Node Campaign Educational Forum and visiting three hospitals in SC. The South Carolina Hospital Association and PHTS continue to be a robust Node by providing guidance and resources to hospitals across the state. They were also very hospitable and gave us a taste of southern charm all week long.
The Educational Forum kicked off on Wednesday with an energetic presentation on physician engagement by Dr. Eric Dickson, Head of the Department of Emergency Medicine at the University of Iowa. Next, Dr. Cassandra Salgado of the Medical University of South Carolina spoke on reducing MRSA. After the key note speeches, we formed break out groups and drilled down deeper into infection control and physician engagement topics. I left the meeting with a big picture of the Campaign in SC and I was ready to see improvement work at the front lines.
On Thursday, our first stop was Aiken Regional Medical Center (ARMC). We heard from their Wound Care Team that has virtually eliminated pressure ulcers, but still strives to improve with the mantra that "One is too many." We also heard from their team working to prevent ventilator-associated pneumonia and learned they established protocols to dramatically reduce their rate and have gone months without a VAP. They have also done excellent work in reducing codes on the floor through the implementation of Rapid Response Teams. ARMC 's organizational transformation and culture of safety can be directly attributed to the involvement of their senior staff and board of directors. Everyone at ARMC is rightfully proud of their accomplishments and is excited at the potential to further reduce harm.
Our second stop was Colleton Medical Center in rural SC. At Colleton, they have fully embraced the recommendations of the SCIP project and the VAP bundle. They were also in the midst of a hand hygiene initiative to reduce MRSA infection hospital-wide. Once again, senior level leadership was leading the improvement charge and their results show it! Implementing some of the interventions in a rural setting can be difficult, but the teams at Colleton have done an amazing job reducing harm at their organization.
Finally, we pulled into Charleston, SC at Roper St. Francis Hospital. We toured the facility, which was designed with patients and families heavily in mind, to see quality their improvement work in action. They are working to reduce patient falls and have seen a 50% reduction in fall rates over the past year. They are also implementing the central line bundle and have seen a 40% reduction in central line bacteremia. Their VAP rate has been reduced by 71% over the past year in their ICU and they are currently working on an oral care study for patients on a ventilator. And once again, leadership and the dedication of physicians and front line staff were the keys to success in their improvement work.
I was impressed at the dedication and forward thinking of all the teams we met with and the strong leadership displayed throughout South Carolina. Keep up the great work Palmetto State!
-- Jesse McCall
Thursday, August 16, 2007: The Campaign Heats Up in Houston
I recently returned from a trip to Houston with National Field Manager, Jennifer Chi, and Dr. Eric Dickson from the University of Iowa. We had the opportunity to present to Christus Health at their “Lifelines to Patient Safety” conference. Christus as a system includes more than 40 hospitals and facilities in six states. Jen and Eric did an excellent job providing an overview of the Campaign, and showing how it aligned with many of their strategic priorities. Christus has an extremely engaged board and leadership. Their CMO championed a patient-centered approach to hospital care and advocated using small tests of change for the Campaign interventions.
That afternoon, we headed to St. Luke’s Episcopal Hospital, where we heard about how their AMI team had succeeded in lowering door-to-balloon times. The staff commute, as well as the distance between the hospital and its Minor Emergency Center, once made it difficult for them to keep their times below 90 minutes. (Locals say that “any two places in Houston are 45 minutes away from one another.") Through a series of process changes – including allowing the STEMI nurse to activate the cath lab – St. Luke’s has achieved an average time of 46 minutes in the month of July!
Finally, we visited Memorial Hermann Hospital SW, where the staff had prepared for our visit with snacks, posters and balloons! System hospitals had much progress to report since our last visit in Feb. 07: Rapid Response Teams in every hospital – some of them family-activated – and numerous hospitals having gone over a year without a VAP. What was most exciting for us, however, was the goal they set for the 5 Million Lives Campaign: Memorial Hermann plans to track their harm data across the system, and periodically project the number out to fit the entire Campaign population. Their plan is to exceed their share of Campaign harms avoided by December 2008.
We hope that the enthusiasm and optimism shown by these Houston hospitals will motivate others to keep aiming high!
-- Jonah Borrelli
Memorial Hermann celebrates their success in the 5 Million Lives Campaign.
Wednesday, August 15, 2007: New Delaware Node is off to a great start
IHI Director Marie Schall and I had a great trip to Delaware on August 15. Our workshop on Spread and Sustainability marked the kick-off event for the Campaign with Quality Insights leading Delaware as the new Node. With all Delaware hospitals in attendance, round table conversations and sharing were truly impressive. Over some delicious chocolate mousse pie, hospitals shared on best cardiac, infection and board work. We learned that Nantioke Memorial Hospital hasn’t had a VAP in over 2 years! This day-long workshop was a great beginning to the work we hope to achieve with the hospitals in Delaware. Their tendencies towards collaboration and cooperation were very impressive.
-- Katie O'Rourke
Thursday, July 26 and Friday, July 27, 2007: The spirit of sharing thrives in Music City, USA
What a great trip we had to Nashville (even without a visit to the honky-tonk bars)!
At the end of July, National Campaign Field Manager Jen Chi; IHI Director Diane Jacobson; and I went to Nashville for a quality-filled two days. (Vibeke Rischel of OperationLife – an initiative in Denmark inspired by the 100,000 Lives Campaign – was also along for the ride to learn about Campaign field visits in the US.) Starting with a Town Hall-style event at the Tennessee Hospital Association, we had a great dialogue about Rapid Response Team implementation and heard a wonderful presentation from Jefferson Memorial on how their Rapid Response Team works in a small, rural setting. Afterward, we attended a press conference announcing the opening of the Tennessee Center for Patient Safety and heard presentations from Craig Becker, president of the Tennessee Hospital Association, and Tennessee Health Commissioner Susan R. Cooper.
While we were in the Nashville area, we also had a joint visit with St. Thomas Hospital, Baptist Hospital, and Middle Tennessee Medical Center. One highlight of the day was spending some quality time with "Noelle," the Baptist Hospital maternal and neonatal patient simulator.
To finish off the visit to Tennessee, we had an excellent round table discussion about Southern Hills Medical Center’s work on the Campaign interventions. We were particularly impressed with their work on reducing MRSA.
Everyone in Nashville demonstrated the spirit of sharing that is so important to quality improvement!
-- Katie O'Rourke
Jennifer Chi, Katie O'Rourke,and Diane Jacobsen of IHI and Vibeke Rischel of Denmark's OperationLife campaign before they prepared to meet Baptist Hospital's maternal and neonatal patient simulator.
Tuesday, July 17, 2007: Great Pressure Ulcer Prevention Work in New Jersey
Hello all! This is Kathy Duncan, 5 Million Lives Campaign faculty and new member of the Campaign field team. I am so excited about the great work done in New Jersey in the area of pressure ulcer prevention! Yesterday, I had the privilege of participating in the state’s celebration of their two-year collaborative. One hundred and fifty-five (155) health care organizations from across the care continuum (including acute care, rehab, long term care, home health, and skilled nursing facilities) banded together to reduce the incidence of pressure ulcers. Some of their outcomes include incidence reduced by 70 percent (from 18 percent to an average of 5 percent across all organizations) and 48 organizations achieved results of 0 new pressure ulcers for three months or more. I also identified a number of new potential Campaign Mentor Hospitals. Aline Holmes, Carolyn Zagury and Theresa Edelstein from the New Jersey Hospital Association led the teams to great, great outcomes and the good citizens of New Jersey are safer as a result!
-- Kathy Duncan
Friday, June 22, 2007: Kaiser Permanente Site Visit in Oakland, CA
Hello from Oakland! Today we met with Kaiser Permanente Hospitals in Northern California. Dr. Bruce Spurlock of the Bay Area Patient Safety Collaborative facilitated a great discussion addressing Campaign challenges, barriers, and solutions. All attendees were provided with an opportunity to share experiences, materials, and ideas. IHI Directors, Diane Jacobsen and Frank Federico, contributed to the discussion and spoke about how to successfully implement a small test of change. The Campaign’s National Field Manager, Jennifer Chi, also attended, and contributed Campaign updates. Keep up the great collaboration KP!
-- Jordana Pickman
Thursday, June 21, 2007: Town Hall in Walnut Creek, CA
Hello from Jordana Pickman, the Campaign’s new Western Region Field Coordinator. Today in Walnut Creek, 50 representatives from surrounding hospitals gathered to learn more about the Campaign. Debby Rogers from the California Hospital Association and Sue Bartlett from the Hospital Council organized the event held at the John Muir Medical Center. We were greeted by John Muir’s President and CEO, Ken Anderson, who acknowledged the importance of support for the Campaign from the administration. Dr. Bruce Spurlock of the Bay Area Patient Safety Collaborative talked about how we can bridge the gap between intent and reality and deliver reliable care. IHI Director, Diane Jacobsen, spoke about MRSA prevention and surgical care improvement, which led to a great discussion and sharing session about the topics among attendees. The final speaker at the conference was Lisa Tisdale, Manager of the Cardiac Rhythm Center, who spoke about the great CHF work being done at John Muir Medical Center in Walnut Creek.
-- Jordana Pickman
Wednesday, April 18, 2007: Campaign Activity Flourishes in Kentucky
Today marked the Campaign Team’s second visit to Kentucky this year. After attending the Kentucky Hospital Association’s Annual Quality Meeting in January, I was delighted to be able to revisit the always welcoming Bluegrass State.
The gracious host today was Health Care Excel of Kentucky, with grant support from the American Heart Association. Amongst the many distinguished speakers, Dr. Frederick Masoudi, Director of Echocardiography at the Denver Health Medical Center and Associate Professor of Medicine at the University of Colorado, spoke on performance measurement and the variability of heart care. Dr. David Hunt, Medical Officer for the Centers for Medicare and Medicaid Services and task leader for the Surgical Care Improvement Project (SCIP) special study, spoke on quality of care for pneumonia and surgical patients, and emphasized the importance of collaboration.
Several participants expressed new interest in joining the Campaign, while veteran Campaign hospitals shared how they have successfully integrated the Campaign with other patient safety work in their facilities. From recent enrollees to veterans of the Campaign, it is clear that the 5 Million Lives Campaign is revving up in Kentucky!
- Jennifer Chi
Thursday, April 12, 2007: South Carolina Hospitals Continue to Impress
Hello from the South Carolina kickoff of the 5 Million Lives Campaign! Led by the South Carolina Hospital Association (SCHA) and PHT Services, 120 representatives from South Carolina’s hospitals and Node partners convened in Columbia today.
South Carolina hospitals came, they met, and they continue to impress. Setting a tone of unity and resolve, Dr. Rick Foster, Senior Vice President for Quality and Patient Safety at SCHA, began the meeting with a sketch of the statewide plan to support South Carolina hospitals in the Campaign.
Dr. Foster also challenged this state’s hospitals to augment their contribution to the national Campaign through the mentor network. There is no dearth of know-how in South Carolina, where the break-out presentations on medication reconciliation, pressure ulcers, Rapid Response Teams, and central line infections highlighted the work of many current and potential mentor hospitals.
Participants also had the opportunity to interface with Jeff Spade of the Rural Affinity Group and the North Carolina Rural Health Center; meet with National Campaign Field Manager, Matt Louchheim; and get down to work on medication-related interventions with IHI Director, Frank Federico.
Leaving South Carolina, the Campaign Team is already looking forward to our next trip to the Palmetto State.
- Jennifer Chi
Thursday, March 29, 2007: Reducing MRSA and more in New Mexico
Greetings from the great state of New Mexico! Today we participated in the 5 Million Lives Campaign kickoff event co-sponsored by the New Mexico Medical Review Association and the New Mexico Hospital Association. The event was held at the new conference facility of Lovelace Medical Center - Downtown in Albuquerque.
The collaborative tone for the day was set by Clay Holderman, the CEO of Lovelace Medical Center - Downtown, and further reinforced by the speakers from hospitals all over the state. The meeting attendees also heard IHI Director, Diane Jacobsen, make the case for reducing MRSA and preventing surgical complications and Dr. Susan M. Kellie of the New Mexico VA Health Care System shared an impressive MRSA reduction protocol that included a great cost benefit analysis.
The room was filled with over 100 eager participants, demonstrating to all present that there is great will out there to improve the way health care is delivered in New Mexico.
- Gabriel Kleinman
March 23, 2007: Campaign activity booms in the Eastern Region
March has been an action-packed month for the Campaign. In the eastern region alone, the Campaign Team has had the opportunity to connect with QIOs at the AHQA Annual Meeting, and over five state meetings focusing on Rapid Response Teams, MRSA, and other patient safety topics.
Among these events were the Alabama Statewide Quality Forum, the Pennsylvania Patient Safety Symposium, a meeting with New Hampshire Infection Control and Epidemiology Professionals, the New Jersey Hospital Association’s RWJ-funded Rapid Response Team Collaborative Close-out, and the Louisiana Hospital Association’s annual meeting for the Louisiana Organization of Nurse Executives.
On the road, we met many new partners who had great enthusiasm! As always, we continue to learn and gain energy from the field. What will April hold for the Campaign?! I look forward to finding out!
- Jennifer Chi
Wednesday, March 21, 2007: Celebrating Rapid Response Teams in Seattle
Today Dr. Don Berwick, Kathy Duncan, and I joined hospitals in Washington State to celebrate the culmination of its Rapid Response Team Collaborative (sponsored by the Robert Wood Johnson Foundation). With the support and coordinating efforts of the state’s Node, led by the Washington State Hospital Association (WSHA) and Qualis Health, this particular Campaign intervention has spread rapidly across the state, winning the buy-in of nurses, doctors, and patients and their families. In fact, we were pleased to see how the conversation has shifted from “getting started” to “early warning systems” and “patient and family activation” (which appears to be very popular.)
After the collaborative, we had the privilege of meeting with the health care leaders on WSHA’s Patient Safety Committee, where we continued to learn about the state’s robust patient safety agenda and uniformly favorable response to Rapid Response Teams. One of the committee members, Mike Glenn of Providence Health & Services, reported hearing from one nurse, "Rapid Response Teams are one of the best things that has ever happened for nursing." The Committee has also offered their unwavering support for the 5 Million Lives Campaign, encouraging all of the hospitals in Washington to implement as many of the interventions as possible. With their track record, we have little doubt that they will succeed.
- Matt Louchheim
Kathy Duncan, Matt Louchheim, and Dr. Don Berwick with the Washington State Hospital Association Patient Safety Committee.
Wednesday, March 14, 2007: AR Node and Campaign hospitals blaze a new trail!
Today was the state of Arkansas' official kick-off of the 5 Million Lives Campaign. To celebrate the event, a group of us from IHI -- including Jonah Borrelli (Field Coordinator, Central Region), Kathy Duncan (IHI's faculty expert for Rapid Response Teams and Pressure Ulcers -- and an Arkansan through and through), Joe McCannon (who needs no introduction), and me (Jane Roessner, designated blogger) -- traveled to what we all now agree is the most hospitable state in the union. Pam Brown, Hospital Leader at the Arkansas Foundation for Medical Care, organized the event with help from the Arkansas Hospital Association.
At breakfast, Kathy presented us with Razorbacks lapel pins -- "just so we'd fit in" -- which we wore proudly, right next to our 5 Million Lives Campaign pins. (Joe's day had started a couple hours earlier, with a live interview on the local TV station.) The kick-off event, well attended by doctors, nurses, and health care leaders from across the state, began with a series of warm welcomes: from Paul Cunningham of the Arkansas Hospital Association, who read an official proclamation by the governor declaring March 14 "Saving Arkansas Patients from Harm Day"; from Dr. Nick Paslidis, President and CEO of the Arkansas Foundation for Medical Care, who pledged his commitment to the Campaign; and from Dustin McDaniel, the Arkansas Attorney General, who displayed impressive in-depth knowledge about and commitment to improving health care.
Joe provided an overview of the 5 Million Lives Campaign, followed by Kathy presenting an explanation of how to implement Rapid Response Teams. In addition to these informative presentations, attendees treated themselves to special 5M cookies, which Pam ordered from a local bakery (see photo below). The event wrapped up with the presentation of the "Arkansas Traveler Award," a handsomely framed proclamation, to a completely surprised Joe McCannon.
From Little Rock, we headed to a "Town Hall" meeting at White County Medical Center in Searcy, an hour's drive northwest. Peggy Turner, RN, and assistant vice president of medical services, gave a presentation explaining how the Medical Center had implemented Rapid Response Teams. The meeting was attended by folks from several different hospitals, who shared their challenges and their learning about lots of issues, including how to implement medication reconciliation; how to get clinicians to wash their hands and "gown up" when inserting central lines; and more.
Wednesday ended with a two-hour drive to Hot Springs, where a wrong turn sent us into the old part of town where people used to come to take the healing waters (and maybe do some gambling on the side.) The next morning we headed to another Town Hall meeting at St. Joseph's Mercy Health Center, where a large group presented on their reductions in central line infections, ventilator-associated pneumonia, and surgical site infections. As in Searcy, the meeting brought together people from lots of different organizations, who shared their work, their frustrations, their questions, and above all their dedication to making health care better.
Arkansas kicked off the 5 Million Lives Campaign in style. Now the challenge is to have at least 50 percent of all Arkansas hospitals sign up for the Campaign by June 2007. Based on the energy we saw in the state in March, we have no doubt they can do it.
- Jane Roessner
Meeting attendees at the Arkansas kick-off of the 5 Million Lives Campaign were treated to special Campaign cookies.
Monday, March 5, 2007: Collaboration and Shared Learning in Boise
Hello from the chilly state of Idaho and the First Annual Idaho Patient Safety Forum! Co-hosted by St. Lukes and St. Alphonsus Hospitals in Boise, interest in this meeting was so high that conference attendance had to be capped at 230 (with a videoconference broadcast to 40 additional participants.)
In his opening remarks, Dr. Robert Polk, VP of St. Alphonsus Regional Medical Center, set the tone for the day by emphasizing the importance of collaboration and learning with colleagues. Keynote speaker, IHI Senior VP, Jim Conway, then mesmerized and energized the audience, sharing his compelling stories of patients harmed by medical errors and the strides being made to prevent such tragedies from happening in the future. Attendees found his remarks inspiring and thought-provoking.
What an exciting event to be a part of!
- Gabriel Kleinman
Tuesday, February 27, 2007: Virginia transitions from 100K to the 5 Million Lives Campaign
The Virginia Health Quality Center’s Learning Session was an impressive showcase of the leadership and expertise of Virginia hospitals. The spirit of sharing was electric, from a panel of Campaign Mentor Hospitals (with speakers from Centra Health, Fauquier Hospital, Franklin Square Hospital Center, Prince William Hospital, Sentara Norfolk General Hospital, and Upper Chesapeake Medical Center), to the sessions on improving AMI care and preventing pressure ulcers. The contributions from both Virginia and Maryland mentor hospitals also accented the “Mid-Atlantic” collaboration between Delmarva, VHQC, and the Virginia Hospital and Healthcare Association. As a participant in the AMI care and pressure ulcers sessions, I found the potential for additional Campaign Mentor Hospitals from Virginia especially exciting!
The IHI Campaign Team was thrilled to participate in this event where we heard improvement strategies to highlight at the national level. On our visits to Bon Secours St. Mary’s Hospital, Henrico Doctor’s, and Bon Secours Richmond Community Hospital, we also had to opportunity to meet and learn from some of the front line staff driving this work.
- Jennifer Chi
Tuesday, January 30, 2007: Bay Area Patient Safety Collaborative wraps up 100K and looks towards their 5M future
Greetings from San Francisco and the first Bay Area Patient Safety Collaborative (BAPSC) wrap up meeting! There was a packed agenda today as the collaborative debriefed their past 18 months and talked about the future of health care in the region.
We heard remarks from the President and CEO of the Hospital Council of Northern and Central California, Art Sponseller, and Dr. Bruce Spurlock, the consultant for BAPSC. Dr. Spurlock commented that “seeing hundreds of dedicated clinicians taking better care of their patients because they wanted to, not because they were being forced to,” was one of the most memorable experiences of his career. We also heard from collaborative participants that “never in their careers have they seen competitors share more” and the BAPSC “is a kick start to getting more organizations to [practice] evidence-based medicine.”
The morning activities were followed by a reliability talk given by Dr. Spurlock and a writing exercise to encourage participants to describe one of their memorable 100,000 Lives Campaign experiences. Later, after breakout sessions on CLI, VAP, and Rapid Response Teams, Campaign National Field Manager, Matt Louchheim, and I talked to the group about the 5 Million Lives Campaign.
The goal of the BAPSC is to make the Bay Area the safest place to receive medical care in the world and they are well on their way!
- Gabriel Kleinman
Thursday, January 25, 2007: Discovering more hospital successes in Texas
This week, IHI Director, Fran Griffin, joined me on what was my third trip to Texas in the last 12 months. This one was just as memorable as the others. We began with some site visits in the Dallas Metro Area, accompanied by dedicated members of TMF Health Quality Institute, partners in the Texas Node. First, we visited Methodist Dallas Medical Center, where we saw a strong showing of senior leaders, frontline staff and quality improvement staff from the Methodist Health System. Fran and I were blown away by their strong Rapid Response Team work, heard about their national recognition for AMI care and applauded Methodist Charlton for going more than a year without a VAP (putting them on a short list of US hospitals with this distinction.)
Next, we traveled to Huguley Memorial in Fort Worth where much of their Rapid Response Team success is attributed to their spirit of joy and celebration: nurses who make use of the SBAR tool are given ribbons and the team created a poster showcasing their operational improvements, personified by the “Extreme Makeover” of their Rapid Response Team leader (see photo below).
Our final destination was the the Texas Node’s 5 Million Lives Campaign Kick-off event where we met up with the Campaign’s National Field Manager, Matt Louchheim. This event was held in conjunction with the Alliance for Rural and Community Hospitals meeting. Charles Barnett, CEO of the Seton Healthcare Network, delivered the keynote address, in which he told the story of how Seton’s Board became more engaged in their quality agenda. Matt and I talked about the new Campaign initiative, while Fran spoke on MRSA and the IHI Global Trigger Tool. Throughout the meeting, we emphasized the relevance of the interventions to rural settings and cited examples of rural hospitals that have made tremendous contributions to the Campaign.
TMF is an incredibly valuable partner in the Campaign and a fun group of folks to boot! The strengths and the specific needs of their hospitals run deep in the heart of the Texas Node.
- Jonah Borrelli
Huguley Memorial's “Extreme Makeover” Rapid Response Team poster.
Wednesday, January 17, 2007: Node Collaboration kicks off the 5 Million Lives Campaign in the Southeast
On January 17, Nodes from across the southeast US convened as a group for the first time in Atlanta at the offices of our gracious hosts, the Georgia Hospital Association, with assistance from the South Carolina Node. With 27 representatives in attendance, the Southeast Regional Node Meeting set a Campaign record for most participants at a regional Node gathering! Joe McCannon, IHI VP and Campaign Manager, Matt Louchheim, National Campaign Field Manger, and I were also present.
Attendees from Alabama, the American Heart Association, Arkansas, Georgia, Kentucky, Premier, North Carolina, South Carolina, Tenet, Tennessee, and VHA had stimulating discussions about how to improve support to hospitals enrolled in the Campaign. Representatives also shared best practices within and external to the Campaign, and brainstormed future opportunities for collaboration. Judging from the enthusiasm of the participants and the multitude of ideas and strategies that were shared, networking amongst southeastern Nodes is sure to have a significant impact on reducing harm.
- Jennifer Chi
Monday, January 15, 2007: Excellence in Indiana
Hello from Lindsay Swain, IMPACT Project Manager, along for the ride to Indiana with the Campaign Team. Field Coordinator, Jonah Borelli, IHI Director, Frank Federico and I landed in Indianapolis. We then headed south to meet Field Manager, Matt Louchheim, and IHI Director, Betsy Lee, for a visit to Columbus Regional Hospital (CRH), a Campaign Mentor Hospital and IMPACT member. We weren’t prepared for the architectural splendor of Columbus and we were even less prepared for Columbus Regional.
CRH President and CEO, Doug Leonard, and his team gave us a tour of the hospital – itself an architectural gem. From the beautiful entryway to the stunningly unique chapel, the hospital had no shortage of aesthetic appeal. Even more remarkable, however, were the people we met along the way.
In the afternoon, the CRH staff presented the results of their participation in the 100,000 Lives Campaign and their plans for 5 Million Lives Campaign implementation. One of the most memorable presentations was from Director of Facilities, Dave Lenart, on the role of their non-clinical departments in the Campaign. He described engaging the cleaning staff in the prevention of hospital-acquired infections and the engineering team in improving AMI care. He asked the audience, “Are support services solely a necessary business function? [Or] can support departments be an effective partner in improving clinical outcomes?” By the end of the day, it was clear this type of thinking was not unique at CRH. From the non-clinical staff to the hospital’s board of directors, Columbus Regional proved it is an outstanding hospital that is actively committed to finding ways to be even better.
- Lindsay Swain
Columbus Regional Hospital CEO, Doug Leonard; CMO, Dr. Tom Sonderman; and Director of Medical Quality Management, Kathy Wallace, hosted an IHI visit to Indiana.
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100,000 Lives Campaign Success Stories
