In 2010, the leaders at Memorial Medical Center recognized that health care reform requires an unprecedented focus on outcomes, and to get there Memorial's quality and safety culture needed to evolve. It adopted the mantra “Structure, Process and Outcome” to re-engineer a system that aligns with the Institute of Medicine’s Six Aims of quality health care, better engages with medical staff, deploys Lean Six Sigma as its change process, and produces meaningful outcomes that last.
“We knew that physician engagement was crucial to success, and they want to help, but too often administration squanders this potential through efforts marked by vague objectives, unspecified timelines and meager results,” says Charles Callahan, Memorial Health System executive vice president and chief operating officer. Lean Six Sigma is a rapid, data-based method from industry that produces quality, service and cost benefits that matter to stakeholders. A key early win came from one initiative that reduced hospital-acquired pressure ulcers by 81 percent across 17 inpatient units and won the state quality award.
The organization has since advocated its “30/30/30 Solution,” meaning each year it will certify 30 percent more Lean Six Sigma staff (“belts”), complete 30 percent more projects in an average of 120 days, and show average project improvement of at least 30 percent. Led by senior executives, more than 1,500 employees and 500 physicians have earned LSS certification, and 300 additional projects have been completed.
Average project improvement is now 43 percent, with the quality program contributing $30 million of financial value since 2012. Regarding this aggressive approach to improvement, Callahan says:“Our patients deserve it, and you must reach escape velocity. If you relax, you’ll go back to the old, comfortable ways.”
Improvement ideas come from the entire staff, from physicians to volunteers, through Memorial’s electronic event reporting system, SENSOR (Safety Event Notification System for Organizational Reliability). Near-misses and events are evaluated during biweekly defect huddles, allowing quality staff to identify trends that lead to improvement projects. For example, medication errors in the emergency department for drugs dosed by weight spurred an initiative. Emergency staff members often entered estimated patient weights into the electronic health record to speed ED check-in, says Todd Roberts, the system’s administrator of quality and safety. The project improved access to electronic scales and modified the admitting process to give staff more time to weigh patients. The changes save about $1.5 million a year and prevent 175 medication errors, Roberts estimates.
In 2015, the organization opened the four-story, 70,000-square-foot Memorial Center for Learning and Innovation. The facility houses an advanced Simulation Center, including exact replicas of a hospital nursing station, patient care room, operating room, emergency/trauma bay, dual-purpose intensive care and labor/delivery room, and physician exam room, plus an ambulance and a home setting.
The facility includes surgical skills labs, a high-tech conference center, classrooms and collaboration rooms. Physicians, nurses and other hospital staff, residents from the Southern Illinois University School of Medicine, and emergency medical technicians use the center for training and to test innovations before using them in patient care. “It’s not like grandma’s living room where it looks nice but you can’t touch it,” Callahan says. “People are in and out of there all day long.”
The center also is home to the Midwest Healthcare Quality Alliance, a partnership between Memorial Health System and the SIU School of Medicine. The alliance offers a federally certified patient safety organization and is certified by the American Board of Medical Specialties to offer physician maintenance-of-certification training. When doctors must perform a quality improvement project for board recertification, the alliance provides Lean Six Sigma mentoring in quality improvement and new project development or implementation of existing evidence-based protocols. “The doctors get their certification, which they need; they learn how to do something interesting, which they want; and the region benefits because we’re getting empirical-based care fired all at once across the region,” Callahan says.
The spread of quality innovation beyond the hospital into the community is a primary strategy for Memorial. This commitment to community is reflected in the hospital's behavioral health efforts. With more patients presenting to the ED because of mental health needs, the hospital’s embedded psychiatric response team of licensed therapists coordinates with on-call psychiatrists to develop care plans ranging from inpatient admission to community care.
Memorial also has embedded psychiatrists and counselors within in its patient-centered medical home primary care practices. “Think about how mental health affects other conditions,” Roberts says. “If you have someone with diabetes who also has behavioral health issues, they’re not taking their medications or doing the things they need to do to keep themselves healthy.”
Ultimately, Memorial’s approach is founded on the idea of quality in operations, addressing customer requirements across all venues of care, and impacting practice, research and education.
The Memorial Medical Center Team: Seated from left, Todd Roberts, administrator of quality and safety, Memorial Health System; Chuck Callahan, system executive vice president and chief operating officer; Rajesh Govindaiah, M.D., system senior vice president and chief medical officer; and Marsha Prater, R.N., system senior vice president and chief nursing officer. Standing from left, Ed Curtis, system president and CEO, Memorial Health System; and Jerry Kruse, M.D., dean and provost, Southern Illinois University School of Medicine.
About the Prize
The American Hospital Association-McKesson Quest for Quality Prize is presented annually to honor leadership and innovation in quality improvement and safety in patient care. The 2016 award recognizes hospitals that (1) have committed systematically to achieving safety, patient-centeredness, effectiveness, efficiency, timeliness and equity; (2) can document progress in each; and (3) provide replicable models and approaches for the hospital field. The prize is supported by a grant from McKesson Corp.
This year, the winner received $75,000, the finalist received $12,500, and one additional hospital was a Citation of Merit honoree. All U.S. hospitals were eligible for the AHA-McKesson Quest for Quality Prize. The price is directed and staffed by AHA’s Office of the Secretary.
The awards were presented in July at the Health Forum–AHA Leadership Summit in San Diego.
For more on the prize, visit the AHA website.