Quality award winner engages patients

What do you have in common with the winners?

The American Hospital Association and McKesson have chosen Boston’s Beth Israel Deaconess Medical Center (BIDMC) as the 2013 Quest for Quality prize winner, citing the hospital’s emphasis on achieving the Institute of Medicine’s six quality aims for healthcare — care that is safe, effective, efficient, timely, patient-centered, and equitable. The hospital was chosen by a multidisciplinary committee and received a cash award of $75,000.

"We haven’t decided what to do with it yet," says Kathleen P. Murray, the director of performance assessment and regulatory compliance at BIDMC’s Silverman Institute for Health Care Quality and Safety. "I know it will be used to benefit everyone, because everyone here was involved in the quality that was recognized. Quality is part of everyone’s job."

She thinks that what sets BIDMC apart and makes it a good choice as the prize winner is the utter dedication of the leadership — from the board, to the C-suite, to directors and managers — to quality and safety. All have absorbed the culture of safety. "We make it known through the actions of everyone that quality is the priority here," says Murray. "If you come here and visit, you can tell, just like the committee did when they were considering us for the award."

BIDMC prizes its quality transparency — the data about quality is available on the hospital’s website and includes things that many hospitals don’t, such as the Joint Commission reports they receive post-survey. They also keep all staff updated about adverse events in real time on the organization’s intranet, and openly and regularly discuss failures. Indeed, the theme of the last annual hospitalwide quality conference was "spectacular institutional failures."

The overall knowledge of how the organization is doing creates "a healthy tension" in the employees and providers that encourages them not just to attain goals, but to try to surpass them, says Murray. Everyone sees via visible dashboards in the hallways just how well or poorly they are doing on key metrics.

One of the reasons BIDMC was singled out was the way the organization engages patients. Murray says that when there is a problem to be solved, patient advisory council members are asked for input. "They are game changers," she says. For instance, when the hospital was working on a fall prevention program and wanted to make sure that patients and their families understood the risks, the council members said using dry statistics wouldn’t make them care. What they needed to include were real stories about real patients. BIDMC’s fall prevention pamphlet now includes a letter from a patient who was put on a fall prevention program but didn’t think she needed it. She fell. That makes more of an impact than numbers, Murray notes, and it has led to other patient engagement programs making use of stories, which garner more attention than data among many people.

In a way, the notion of stories is something that has helped make quality a priority for everyone in the system. Each audience relates to something different, Murray explains. If you need to convince your CFO that quality is worth more resources, you need to put it in story form, in terms that will make sense to that particular person. For instance, if you don’t reach quality goals, you will lose revenue, and if you meet them, you might gain some. For the board, you might make the stories about market share and how improved patient satisfaction can raise that, or how being able to tout great QI results can be a talking point in the community.

In the end, regardless of how you get them there, Murray says that the way to emulate BIDMC is to make quality the job of every single person in the hospital. "It’s not just our job," she says. "We are just the connector, the educator, the facilitator."

Other hospitals recognized

BIDMC was one of four hospitals that the AHA and McKesson recognized. The others included Franklin Woods Community Hospital, which was named a finalist and won $12,500. It’s a new hospital, and was honored for making patient-centered care part of its very design, which was based in part on patient input. As a result, there is a lot of natural light and elements of nature included in the building. The facility also created patient advisory councils, and requires employees to expressly commit through a contract to uphold the mission and principles of the hospital, including a dedication to patient-centered care.

St. Mary’s Hospital in Centralia, IL, and Vidant Medical Center in Greenville, NC, received citations of merit from Quest for Quality.

St. Mary’s was singled out for its "pervasive culture of safety, strong leadership and significant patient and family engagement in the care process," according to the AHA-McKesson prize materials. Among the strengths at the hospital are its shared governance structure, which gets everyone involved in decisions that affect the culture of safety and teamwork.

Vidant Medical Center achieved notice for having a complete turnaround in quality over the last several years, says Rebecca Ross, RN, MBA, assistant vice president for patient safety and quality. With 909 beds and more than 6,000 employees, analogies of big ships and how hard they are to stop and turn are inevitable. But Vidant Medical Center has turned it to the point that every single person who works at the hospital takes his or her responsibility for safety seriously and personally, she says.

The engagement of the board has been cited by the Institute for Healthcare Improvement as a "board on board" with quality.

Patients are highly involved, too. Ross says almost every quarterly board meeting includes a patient who tells a story about his or her experience with quality care. There are also patient advisors on the QI committee who are involved in decision making, including the policies, procedures, and facility design of a new children’s hospital that the Vidant health system is building. "We engage them in the care process, too," she notes.

One example of the deep involvement of patients relates to a college student injured in a home invasion robbery. He was petrified, but strict visitation rules at the time left him without the comfort of family and friends for most of the day. When he succumbed to his injuries, he died alone. The sister told that story to the board. As a result, visitation rules were changed. "More importantly, I think that helped change the culture of the facility and got them thinking differently about patient-centered care," Ross notes.

There are elements of each honored organization’s story that repeat through them all: a top-down culture of quality; quality as the responsibility of everyone; the use of stories to effect change; and the engagement of patients deeply within all aspects of the care provided.

For more information on this topic contact:

Rebecca Ross, RN, MBA, Assistant Vice President, Patient Safety and Quality, Vidant Health, Greenville, NC. Email: [email protected].
Kathleen P. Murray, Director, Performance Assessment & Regulatory Compliance, Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center, Boston MA. Email: [email protected].