Top executives at Memorial Hermann Greater Heights Hospital don’t just talk about the organization’s commitment quality improvement, they demonstrate it daily to staff.
Hospital Senior Vice President and CEO Susan Jadlowski and other executives round regularly to talk with staff about quality goals and to ask how they can help staff members keep patients safe. “The conversation takes place in many avenues in many places every day,” Jadlowski says.
Vice President and Chief Nursing Officer Melody Dickerson, R.N., shadows nurses quarterly and is in the midst of a series of small-group meetings with all nurses to celebrate the year’s accomplishments and to explain the hospital’s latest strategic initiatives. “It’s amazing what you find out when you make rounds and make those touches with people,” says Dickerson, who recently spent a night feeding babies in the neonatal intensive care unit.
Jadlowski and Dickerson read and evaluate every entry in the hospital’s electronic variance reporting system, where staff members can report safety events, near-misses and internal disputes. “We’re constantly looking for process errors and failures and those near-misses because that’s where your bread and butter is,” Dickerson says. “If you can identify those near-misses and work on those processes, rather than try to react to an event after it’s already touched the patient, that’s where you’re going to get the most impact.”
Quality improvement projects also are generated from analysis of monthly quality reports. One such initiative focused on catheter-associated urinary tract infections. Changes included staff education on overuse of more infection-prone silicone catheters, creation of a badge card listing CAUTI-prevention bundle elements, and a shift away from emergency department catheter placement except when necessary.
The hospital as of June had gone 18 months without a CAUTI and without a serious safety event for three and a half years.
Memorial Hermann has responded to community need by providing care access points that help people to avoid costly and unnecessary emergency center visits. “We’re caring for not just the physical but for the financial welfare of the patient,” Jadlowski says. One example is the Mental Health Crisis Clinic–Spring Branch, opened in 2015. It gives the psychiatric response team a place to refer patients who don’t have access to follow-up mental health care.
Hospital leaders also averted near-closure of Memorial Hermann’s Neighborhood Health Center, serving low-income patients, because of insufficient volume. ED staff and other physicians were educated about the clinic, adjacent to the hospital, as a resource for patients seeking routine care in the ED and for newly discharged patients who lack a medical home.
“The emergency physician can give them a voucher and give them the option of receiving care in our ED or going literally around the hospital to this clinic where they can receive the same treatment and prescriptions at a much lower cost,” Dickerson says. The effort has increased volume from 2,500 patients in 2010 to 6,400 patients in 2015.
As another alternative to the ED, Memorial Hermann opened an urgent care center in March 2016 about five miles from the hospital. A convenient care center, expected to open in 2017, will complete a “triangle of care” in the hospital’s service area, Jadlowski says. The center, currently under construction, will house an ED, imaging, sports medicine and rehabilitation, primary care, and to-be-determined specialty care.
Memorial Hermann takes into account the diverse needs of its patient population. When its community needs assessment identified diabetes as a leading concern, the hospital hired a diabetes educator who works in the inpatient setting with newly diagnosed diabetic patients and those who aren’t managing their disease well, but also offers outpatient education and established a support group.
In the emergency center, instead of only treating patients with HIV/AIDS for whatever prompted their visit, staff connect them to community resources for their underlying disease. “It gets them to the right care and also at subsidized cost so they don’t have the financial burden,” says Jason Glover, director of business development.
The Memorial Hermann Greater Heights Hospital team: From left: M. Michael Shabot, M.D., chief medical officer of the Memorial Hermann Health System; Susan Jadlowski, R.N., senior vice president of the hospital; Benjamin Chu, M.D., system president and CEO; and Melody Dickerson, R.N., the hospital’s vice president and chief nursing officer.
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.