'Long journey' to establish a culture of quality
'You don't just turn on a switch'
Quality managers agree that establishing and maintaining a culture of quality and safety is one of the toughest challenges they face. One facility that appears to have successfully met that challenge is Munson Medical Center in Traverse City, MI, which recently received the 2008 AHA-McKesson Quest for Quality Prize.
According to AHA, the award was "based on its culture of quality and efforts to achieve the Institute of Medicine's six quality aims for health care."
"We started down this journey way back in 1996," recalls Terry Haslinger, RN, MA, the administrator for patient safety and performance improvement. "You can't just one day turn on a switch and have everybody talking about quality."
The "journey" began with training by Philip Crosby Associates of Winter Park, FL, and Boston (Crosby is the author of Quality is Free).
Every employee in the hospital took part, says Haslinger, with vice presidents and the hospital president serving as the leadership team. There were two-, four-, and eight- hour programs, depending on whether the individual was to facilitate a team or be a member of a team. "This gave a message to our organization that this was not a 'flavor of the month' program," says Haslinger.
It also began a pattern of reliance on outside experts by Munson, particularly the Institute for Healthcare Improvement (IHI), with which the facility was a "pioneer" participant in its collaboratives.
Haslinger says she and the vice presidents of medical affairs and nursing went to a gathering of small hospitals and learned about measurement tools, data collection, and rapid cycle improvement.
When they came back, they decided to launch a pilot program on adverse drug events in two nursing units. "Every two weeks we had assignments, sent data back to IHI, worked with other hospitals and benchmarked, learned different tools and how to apply them," says Haslinger.
Another significant step was taken in the early 2000s when Munson board members began going to the IHI meetings. "They were very willing to go," says Haslinger, noting how important it is to have board support for QI.
Now, she says, there are monthly meetings in which the board reviews a matrix of quality measures to see how improvement is progressing. "They drive the organization to do better," Haslinger says. "They ask us for benchmark data."
Improvement is ongoing
Munson, it seems, never stands still on its journey. "In the last few years we've been transitioning to an even greater emphasis on patient safety," says Haslinger, noting that the hospital's president indicated that as many resources as possible should be dedicated to that issue. "He is the chairperson of the patient safety committee, and he and I put the agenda together," she explains. "We have now put two board members on the committee, so that the board will be sure to know what's going on." Not only is the board well informed, she continues, "but when the staff hear the board is asking about falls and how to prevent them, it's different than having a peer ask about them."
Technology has also helped improve quality. "For the past few years we have used the 'PEERS' reporting process for errors," says Lori Kirkey, RN, BSN, CAN, a nurse manager on a Munson heart unit. "Staff at the bedside level can enter an error, and it is processed immediately through risk management." In the "old days," she notes, these would be reported on paper and it might have been a week or two before a root cause analysis could have been started.
Staff who report errors can identify themselves if they wish, but they do not have to. "We have a non-punitive approach," Kirkey explains.
The team also adapts its approach when things don't go as planned. For example, a few years ago, Haslinger, several Munson physicians, and the president attended an IHI presentation where Sorrel King told the emotional story of her two-year-old daughter, Josie, who died while a patient at Johns Hopkins. "We bought the video, brought it back, and said we wanted every employee at Munson to see this," says Haslinger.
But the initiative, she admits, "did not exactly have the effect we expected." The staff felt that the tragedy occurred at Johns Hopkins because it was a teaching institution, and that it could not happen at Munson, she explains.
"We realized we had missed a teaching opportunity to share with the employees," says Haslinger. So, her team took an adverse event that had occurred at Munson and made a video called 'It happens here.' "It told stories of errors we had made, and we showed it to every employee," says Haslinger. "Then we followed up every month with a newsletter called It Happens Here, which talks about near misses that were caught. If we have found a root cause, we share that and discuss what people can learn." Printed copies of the newsletter are sent to all departments, she says, and also is e-mailed to the board.
Two years ago, another video, called It Still Happens Here, was created, but this one also told of successes. "We constantly keep the staff educated about what's happening here, and what we need to do to improve," says Haslinger.
[For more information, contact:
Terry Haslinger, RN, MA, Administrator for Patient Safety and Performance Improvement, Munson Medical Center, 1005 Sixth Street, Traverse City, MI 49684. Phone: (231) 935-6536.
Lori Kirkey, RN, BSN, CAN, Nurse Manager, Munson Medical Center, Traverse City, MI 49684. Phone: (231) 935-8333.]
Quality managers agree that establishing and maintaining a culture of quality and safety is one of the toughest challenges they face. One facility that appears to have successfully met that challenge is Munson Medical Center in Traverse City, MI, which recently received the 2008 AHA-McKesson Quest for Quality Prize.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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