Julie Morath, RN, MS, has just celebrated her one-year anniversary as the chief quality and patient safety officer at Vanderbilt University Medical Center. She moved to Nashville from the Twin Cities in January 2009 to oversee system-wide initiatives impacting the adult and children inpatient hospitals, ambulatory settings, behavioral health units and home care.

 

“Within my portfolio is the Center for Clinical Care Improvement, but really my work is more system wide, providing strategy and leadership. A lot of my work is about alignment, collaboration and leveraging,” she said. “Vanderbilt has a long history of focusing on quality. It’s been through many iterations and with each iteration, it becomes more expansive and deep.”

 

Currently, Morath and her team are building curriculum around quality with courses on interpreting data, factoring in the human factor, and designing and implementing a PDSA rapid cycle improvement project. Of course, she is quick to say such an emphasis on quality improvement is certainly not exclusive to Vanderbilt.

 

She noted there is ample research that clearly shows the importance of practicing evidence-based medicine in terms of safety and cost efficiency. However, she noted, “Many of these efforts have been siloed and have had limited scope in their spread.” Her job is to find a way to break through those silos to pull efforts together in a more comprehensive and cohesive manner across departments and specialties.

 

To stay on track, Vanderbilt has created a number of pillars. “Our pillar goals are our north star,” explained Morath. “They are the really big things … the overarching goals.” She continued, “All of the units and departments have cascading goals that contribute to the pillar goals.”

 

The quality pillar contains five key measurable areas — observed to expected mortality, reducing hospital acquired infections, reducing adverse events, maximizing performance in all clinical programs per national benchmarks and peer comparison, and creating reliable systems. “They’re deceptively simple,” Morath said of the goals, but added the actual workload under each pillar is intense.

 

For the first goal, Morath said Vanderbilt is measuring how many more patients survive than would be expected based on their severity, through the use of evidence-based medicine, timeliness in treatment, expert specialists and teams, and state-of-the-art technologies. To reduce adverse events and maximize performance, Vanderbilt is relying not only on national benchmarks but has also joined the University HealthSystem Consortium, which enables the leadership to gauge performance over time and in comparison to peer academic institutions. All four goals rely heavily on the fifth mandate to improve systems and processes to keep all employees focused on best practice guidelines.

 

Morath said achieving reliable systems and processes takes a multi-pronged approach. She noted it is particularly important to focus on the ways in which team members and departments communicate during the transfer and transition of patient care. Increased emphasis is being placed on the multitude of hand-offs that occur on a regular basis including shift changes, transfers between departments or units, and movement in the level of acuity. Equally important is the transition to home. “We track readmissions and how people are doing functionally at 30 days post-discharge,” she said. Morath added that while these aren’t new items on the checklist, VUMC is committed to building even more robust systems to try to close gaps in the care continuum.

 

Also within the “reliable systems” pillar is the establishment of universal protocols. Morath said these are “the timeouts before any surgical or invasive procedure to ensure right patient, right site, right procedure.” Similarly, medication reconciliation from verifying dosing to timing to ordered medication at every point of care should significantly reduce the opportunities for mistakes.

 

Unfortunately, when reimbursements are cut and the economy gets tight, technology and quality improvement initiatives can be the first items to be put on the back burner. Morath said this is a major mistake.

 

“Historic, short-sighted responses to budget cuts are around quality development and education of your staff. My belief is that’s when you need to invest the most,” she said. “The greatest cost in healthcare is waste, redundancy and complications that can result from poor quality of care. I firmly believe when you have a highly reliable system of care that’s being executed upon by well-trained, competent teams of professionals, the costs of poor quality and waste in healthcare are reduced.”