On October 17, 2007, IHM hosted its second annual quality symposium. Speakers included Nancy Kane, a MEDPAC Advisory Board Member as well as Professor of Management at Harvard School of Public Health. In addition, three hospital CMOs gave practical advice on what works to improve quality. In this newsletter, we present highlights from the meeting.

Improving Quality in American Health Care: What is Working Today?

Across any number of measures, the American health care system is sick, especially when compared to the health care systems of other countries. Hospitals are at the forefront of the charge for change, but what really works to improve quality? What day-to-day steps can hospitals take to respond to performance improvement challenges?

At IHM’s annual quality conference, three CMOs weighed in on these questions. Across their presentations, several common themes arose:

Have a physician champion for each program or set of core measures to be improved
Organize the team so that everyone is on board
Measure outcomes constantly so that progress can be evaluated

John Fudyma, MD (Erie County Medical Center, Buffalo, New York)

John Fudyma, MD, knows about meeting challenges in quality improvement. He’s been the CMO of the Erie County Medical Center (ECMC), a 586-bed teaching hospital in Buffalo, New York, since July 2003. Not only does ECMC face stiff regional competition from two other health care systems, it has also been faced with massive CEO turnover: five CEOs in the past five years. Yet, in that time, ECMC has become the only hospital in New York State to be a three-time recipient of the U.S. Department of Health and Human Services Medal of Honor for Organ Donation for achieving and sustaining a donation rate of 75% or more of eligible donors. In addition, ECMC has improved their transplant program such that the average wait for transplantation is less than half the national average, ranking them consistently at or near #1 in the country for transplantation wait times.

In his presentation, Fudyma outlined three key factors that he has utilized to improve ECMC’s organ donor conversion rates and transplantation wait times. The first was to have a champion for each program or core measure set to be improved. “What you need is a physician who will champion the cause and who will force collaboration in order to improve,” he said. “These champions should not let up. In our case, we had two champions who were continually leading the way, seeking to improve, and getting everyone on board.”

The second key factor was organizing the quality improvement team in such a way so that everyone gets on board with the goals. Again, the physician champion is critical. “What you want is not a top-down strategy for improvement,” said Fudyma. “You need a culture of improvement that starts from the ground up. Culture eats strategy for breakfast!”

What does this look like? At ECMC, there was a self-organizing team of staff from the hospital that was led by the physician champion. First, they developed an action plan with the goals set high. Next, they collaborated closely with Upstate New York Transplant Services, Inc., the leading organ procurement organization in the area, making UNYTS’s presence well-known throughout the hospital. The team also introduced mandatory education programs for nurses—and the nurses were on-board because the changes came from their peers, not as a mandate from above. “What we had was a team of hospital staff that committed all their energy to making collaborations,” said Fudyma.

The third key factor was measurement of outcomes, including after action reviews of all organ donor referrals, real time review of any missed referrals, and a monthly review of their donation statistics. “You’ve got to change your methods and make adjustments according to your data,” said Fudyma.

William Kose, MD (Blanchard Valley Health System, Findlay, Ohio)

William Kose, MD, is the Senior Vice President of Medical Affairs at Blanchard Valley Health System, a non-profit integrated regional health system based in Findlay, Ohio. The Blanchard Valley Hospital, a 150-bed facility, was ranked in the Solucient Top 100 Hospitals of 2006. What’s working at Blanchard Valley?

Kose really focused in on two points: creating a culture of change throughout the entire hospital, and then measuring that change to constantly adjust goals and strategies.

When considering the culture of change, a lot depends on your quality improvement team, according to Kose. One of the most common mistakes is a lack of purpose. The team needs to be able to answer the questions:

Why does this team exist?
How do we know when we’ve achieved success?
What are our goals, both short- and long-term?

Once the team has developed a plan, they need to make the ideas stick with hospital staff. “Keep it simple,” suggested Kose. “Have an easy-to-remember theme that the team—and then the whole hospital staff—can rally around. For example, to improve our door to cardiac catheterization time, our theme was ‘Time Is Muscle’.”

Another suggestion was to make the need for quality improvement more human by bringing in patients who may have been injured to speak to the Board of Directors or even hospital staff.

Lastly, Kose strongly emphasized the need to measure outcomes so the team can evaluate whether milestones have been achieved and then can tweak the action plan accordingly. “Measure everything you can, with as much real-time data as you can,” he said. “But avoid ‘DRIP’—being data rich but information poor. At many hospitals, people are collecting reams of data, but don’t know what to do with it. Avoid that at all costs. Do whatever it takes to get meaningful, actionable data.”

Darrell Dixon, MD (CHRISTUS Health, Southwest Louisiana)

Darrell Dixon, MD, is the Regional Chief Medical Officer for CHRISTUS Health, Southwest Louisiana—and this region leads all of the CHRISTUS Health regions in quality measure performance and service excellence. He’s spent the past four years focusing on performance improvement and quality initiatives. During this time, Dixon has found that the secret to quality improvement is to hone the science of process management.

What does that mean on the ground? He explained that health care delivery is a system made up of thousands of interlinked processes. Changing the way healthcare is delivered means changing the entire system—changing the way people think, the way people act, the things they take for granted, and the information environment that envelopes them. “You have got to show all the players in the entire system how changing will benefit themselves as well as patients and the community,” said Dixon. “The only way to do that is with data.”

The science of process management rests firmly on having the right data, in the right format, at the right time, and in the right hands. “Data has to be presented simply, and it has to be as close to real-time as you can get,” said Dixon. “It needs to be in the hands of the clinicians who operate the process, and it has to be believable. Often the first thing that clinicians will say when viewing data showing poor performance is ‘I don’t believe that data’.”

Dixon has made the data believable by relying on a set of Performance Improvement Activity Report forms. Each quality improvement measure or initiative has its own form that defines goals and progress toward those goals monthly. “How it’s done is not critical,” he notes, “but evaluating progress toward your goals must be done regularly. You manage what you measure.”

To see how IHM can help you manage the quality improvement process through unique data analysis tools, please visit us at www.healthmetrics.org or email info@healthmetrics.org.