GRAF: Informed trustees will drive the leadership team. And with the forthcoming changes in reimbursement, it will be a hard push. It can’t be business as usual. Board involvement is essential.

MODERATOR: What’s the role of the patient in all of this? How do you involve them in the conversation?

BIBBO: Even having all of the data available, we’re going to need patient navigators to keep patients on track. We’re going to have too much data unless we hire someone to manage that patient’s data. So, when they go to a rehab center or a skilled nursing facility, somebody’s got to manage all of that information.

MILTON: Right. We use navigators to manage patients who have a history of at least 12 ED visits in a year. We have 10 navigators working with about 200 patients. They go to the patient’s home; they assist with getting medications. It’s the only way to truly impact their behavior. These are patients who don’t follow up postdischarge. They don’t follow up with their primary care physician. It’s a whole different level of operations management. It’s just outside of our four walls.

GRAF: There’s a whole cottage industry of companies that are springing up to provide these services for hospitals.

BIBBO: That’s very interesting. What other industry requires different businesses to meld together for the purpose of serving the customer, in this case, a patient? We’re in such a predicament here where we are literally responsible for those patients who either refuse or are unable to follow up with their care. There’s no other industry that requires all these businesses to come together.

MYERS: In the hospital business, we’re reactive instead of being proactive in managing people before they develop chronic conditions. We need to change the approach to care. How do we take care of patients before they get to the hospital? We need an engaged, knowledgeable consumer.

LOVEJOY: I want to get back to something that was discussed earlier. How do you effect a cultural change, or what’s necessary so that improvements are sustainable?

MYERS: It has to be hardwired into the system. We have to have constant communication, so the dashboard doesn’t go away. It needs to be embedded into the organization and the culture so that when people leave the organization, it won’t get lost. There has to be continuous feedback of the dashboard every week. It needs to be reported to the board. If it’s something that’s that important, it has to have visibility.

LOVEJOY: So, it’s accountability and value, right? Accountability is what you were describing: the data, the information has to be out there. But the value proposition is one that can never be underestimated in any of these projects because if it’s not valuable to the end user, it doesn’t create value. We talked earlier about the hoarding of pumps. If organizations can create technology or workflow processes that make it easier for a person to do his or her job, clinicians inherently will want to do it that way. And those changes will stick.

DIRKSMEIER: I can give a real-world example. Washing hands is incredibly important, yet many people don’t do it. We’ve developed this system to monitor hand hygiene. We stressed the need to not interrupt existing workflows. If clinicians wash their hands, they get credit. If they don’t, they won’t. We found that people wash their hands about 50 percent of the time. When people know they are being tracked, the number goes up. The CEO of the hospital started a contest to see who had the highest number. The number of people who wash their hands went from 50 to 80 percent and it hasn’t gone below that level since. They use the information as a coaching tool. They know individual-level and department-level compliance levels. The CEO has really taken a personal interest in hand washing and keeps the data visible in his office. Once he got behind it and deemed it as a coaching opportunity, the rest of the organization followed. The percentage is in the 90s today. So, that’s an example of sharing important data, understanding why and then positioning it in a way that gets people to take action.

MILTON: What’s the reward?

DIRKSMEIER: It was really something simple, like movie tickets.

BIBBO: Transparency of data creates a competitive environment, because everyone wants to be the best.

MYERS: If the CEO left, would there still be the culture and focus on hand hygiene? If you bring in the patient to the equation, it will help to sustain it. And by that, I mean sharing the patient experience. What would a blood stream infection mean for the patient? The patient may not survive. It may lead to an additional 10 days in the hospital and poorer outcomes. We do incredible, heroic things to get people through prognoses that are not so great. It would be a shame to have something happen because we didn’t practice one of the basic fundamentals of care — like not washing our hands.

MILTON: The accountability will keep it in check a little bit, but the value piece will sustain it.