Keeping the Focus on Quality & Safety
By MELANIE KILGORE-HILL
LifePoint Health Efforts Recognized & Shared Nationally
Quality and patient safety are benchmarks for any healthcare organization. In Middle Tennessee, LifePoint Health is redefining expectations through its innovative National Quality Program, a structured process for ensuring consistent, high standards of quality and patient safety.
In fact, in March, the company became the first investor-owned health system to receive the John M. Eisenberg Award for Innovation in Patient Safety at the Local Level. Presented annually by The Joint Commission and the National Quality Forum, the prestigious Eisenberg Awards acknowledge major achievements in healthcare quality and patient safety.
Created in partnership with Duke University Health System, the LifePoint program has led to significant enhancements across the hospital company's network, including a more than 60 percent improvement in aggregate patient safety.
Rusty Holman, MD
"One of the most important and pivotal moments for LifePoint was in 2011, when we were selected by the CMS Innovation Center to participate in their hospital engagement network (HEN)," said LifePoint Chief Medical Officer Rusty Holman, MD. LifePoint was among 26 organizations tasked with reducing patient harm in hospitals by 40 percent in three years - and the only for-profit system in the mix.
"We were already aligned very closely with where CMS was going in patient safety and quality and that enabled us to work with CMS as a partner to share results, learn from other organizations and spread best practices," Holman said. "We also have a unique, non-urban footprint, and CMS is interested in how to advance healthcare in rural communities."
LifePoint not only rose to the challenge ... but exceeded the CMS goals nine months ahead of schedule. So how does a 54-hospital system* spread across 19 states make that kind of impact across its footprint? Very intentionally, Holman said.
Their results-driven model, now being used as a catalyst for health systems nationwide, was based on three elements - defined leadership, evidence-based performance methods (i.e. not reinventing the wheel), and developing a culture of safety - objectively measured with validation surveys used to create a better environment for front line workers and physicians. "We've not only seen massive improvement in patient safety through reduction of complications, but we've seen a progressive year-over-year statistically significant improvement in a culture of safety across the entire enterprise," said Holman, noting implementation of the plan in every department and unit of every LifePoint hospital.
Holman believes their results are possible for any organization - for-profit or not - with an unequivocal commitment from executive leadership. Companies also need a reliable framework for improvement across the entire organization. LifePoint's framework was developed through a partnership with Duke Health System, which helped develop a sustainable model built to outlast their CMS partnership. "You need a scalable model, because you can't just expect a single facility to figure it out on their own and do things their own way," Holman said.
The third pillar of success is that LifePoint didn't separate quality and patient safety accountability from day-to-day operations. "We embedded quality and safety into every part of the operation of the company," Holman said. "When our operators and financial teams get together and do monthly operating reviews, they spend as much time on quality and safety as they do on operations. That sends a clear signal as to what's important, and it's managed with as much rigor as financial operational metrics."
That's no small task, particularly in an organization with 46,000 people. And while big changes inevitably yield pushback, Holman said it's absolutely doable. "The hardest thing to do in an organization this size is get everyone on the same page," he said. "It's not easy, but it's not rocket science either."
For LifePoint, that meant being unequivocal about the importance of quality and safety objectives. Underscoring that importance requires being unapologetically repetitive and taking every opportunity to communicate the message at every level of the organization. They also made heroes of those who helped advanced their quality and safety agenda and hired to those standards, as well.
Seven years later, LifePoint continues to push their quality and safety message to ensure their baseline as goals are met and standards improved. "We've shown that we can make rapid improvements in the hospital setting in a short period of time, because we're responsible for nearly all variables within the hospital," Holman said.
Outside the hospital, leaders realized that controlling social determinants of health like access to medication, healthy food and transportation was a different challenge altogether. Soon, they began reducing readmission rates by working with local resources and agencies to create community coalitions - health programs that address challenges unique to each community.
"In community coalitions, our hospitals take on a new role in serving as a convener of a wide variety of community resources," said Holman. "We're an anchor for bringing those diverse organizations together and discussing the most pressing community health needs. By working together, we've found that we're able to achieve things better and do it faster."
Now, LifePoint Health is looking at innovative ways to take the lessons learned and improve outcomes in outpatient physician practices.
Holman also is committed to sharing LifePoint's success with other healthcare organizations, and encouraging them to start the process. "Create a vision for where you want to go and make it tangible," he said. "Our CMS partnership was invaluable because it gave us clear goals in a clear time frame and served as a rallying point for us."
He urges executives to take a hard look in the mirror and ask if quality and safety are something they're absolutely committed to focusing on, both personally and for their organization. Executives also should examine the organization's capabilities and identify where they need to reorganize, reinvest and make improvements. For LifePoint, that meant making significant investments in people and data systems within the first two years. "Without the right people and good information, this is just an idea that will sit there," Holman said.
Finally, he encourages leaders to find a realistic way to act on opportunities and choose a framework that will resonate with everyone in the organization. "We don't have a proprietary approach, and our model isn't unique to us, although we made it ours by requiring very specific behaviors and expectations," he said. "This is not a linear undertaking but a winding road where you're constantly looking at improving and learning."
* Total number of LifePoint hospitals when the company first participated as a hospital engagement network.