CHICAGO—Typically, the pressures of federal regulatory requirements don't lead health care leaders—or executives in any industry, for that matter—to immediately think of creativity and innovation. But that's exactly the point Connie Jastremski, R.N., vice president of nursing and patient care services at Bassett Healthcare Network in Cooperstown, N.Y., made yesterday during a keynote presentation at the Joint Commission's Annual Conference on Quality and Patient Safety in downtown Chicago. Between provisions of health care reform and other patient safety requirements, Jastremski argued that hospitals are essentially being forced to think creatively about how they deliver care and allocate resources.

"We're expected to do more than we're doing today with less reimbursement," Jastremski noted. "That's the critical equation." For instance, she pointed out that  "bundled payment means paying everyone out of one bundle. …You have to get pretty creative about that."

So how do Jastremski and other leaders at Bassett, an integrated system with six affiliated hospitals spread over 5,600 square miles of upstate New York, inspire creativity in challenging times? The system puts a big emphasis on finding time for leaders and staff to take away from their day-to-day workload to pursue new ideas—a policy achieved through paid sabbatical days. The system also encourages regular reflection on the question, "Can an employee two steps lower on the organizational chart ask a question that challenges the firmly held opinion of a leader?" That policy, Jastremski said, has occasionally led to questions about why a given employee stepped out of the chain of command to raise an issue with leadership, but she stressed that supporting open discussion is essential to an environment of innovation.

The system also relies on executive patient safety rounds to connect senior leadership with front-line staff. When the program began six years ago, Jastremski said, "The staff fell over. They hadn't seen the CEO in a patient safety unit in a while."

But Bassett leaders went beyond simply the goodwill that sending the CEO to a patient floor might provide. The system set aside a fund for purchases related to issues raised during executive rounding, which has since resulted in 500 suggestions and $300,000 in purchases, including patient safety lifts and new IV pumps throughout the hospital.

Not all innovations, of course, are met with immediate, widespread approval. As part of Bassett's handwashing compliance strategy, clinicians now wear buttons reading, "Ask me if I washed my hands."

"I've had buttons thrown at me," Jastremski said. "But people wear them now."

Overall, Jastremski said the changes—with an emphasis on driving behavioral change as the end result—have worked. But it's a long process, and one that requires buy-in from everyone. That came up during the Q-and-A at the end of the session, when an attendee said she'd been trying to get executive rounding going in her institution but was having trouble getting senior leadership on board with the idea. Jastremski told her to try to find one champion to promote the issue with other executives, and then made a telling comment that sums up the challenges any institution has with embracing innovation and change.

"You know why they don't want to go?" Jastremski asked regarding executives' skepticism to rounding. "They're afraid. They don't spend time every day in that world. They spend their time making decisions about that world every day but they don't spend their time in that world. That's why they're afraid."