Quality program fosters hospitalwide improvement: award-winning facility affects safety, satisfaction

HealthCare Benchmarks and Quality Improvement, May, 2005

Key Points

* The facility had 45 active QI projects in past year; 19 were completed.

* Improvements cover breadth of facility, from safety to satisfaction to finances.

* A total of 28,000 patients were affected in a single fiscal year.

Often, hospitals will be recognized for specific initiatives that have achieved outstanding results.

But in the case of Chicago's Northwestern Memorial Hospital, winner of the 2005 National Quality Health Care Award from The National Committee for Quality Health Care, it has been cited for a broad-based program with a "strong commitment to guaranteeing that quality is central to health care delivery."

Among Northwestern's recent accomplishments in quality improvement:

* Wait times in the emergency department have been driven down from several hours per patient to fewer than 40 minutes.

* An organ procurement match methodology has ensured 100% accuracy.

* False infant security alarms in its women's hospital have been reduced from 70 a day to two a day.

* A 6% payroll error rate in manual timecards has been cut to less than 1% with the institution of automated time reporting.

Using an approach based on Six Sigma's DMAIC (define, measure, analyze, improve, control) data-driven quality strategy, Northwestern currently has 45 active QI projects, notes Cindy Barnard, MBA, MSJS, CPHQ, director of quality strategies.

"The trend here for more than a decade has been developing quality through systematic measurement and intervention, to improve and sustain improvement," she notes. "Our key focus is measuring performance by benchmarking wherever possible, and we have a systematic approach in place to see that that improvement is sustained."

Quality improvement projects at Northwestern are not chosen "on a whim," Barnard emphasizes. "They must have a direct linkage to our strategic plan--the best patient experience from that patient's point of view, the best people, exceptional finance performance, and so on."

"Our quality measures all map to our eight dimensions of quality care. Other than that, we have a pretty well-running machine--a streamlined system for proposing what we want and running it through the appropriate committees, teams, and then the board," she notes.

The program also has the foundational components required for success, notes Jay Anderson, MBA, director of quality.

"The components we knew we needed were a strong IT infrastructure; strong organizational capabilities in PI and change management; strong infrastructure to measure and monitor systems; and training and developing staff through our academy," he adds. "Each has driven a lot of improvement."

The IT infrastructure includes organization-wide computerized physician order entry (CPOE), integrated at the point of care across the institution.

The selection of DMAIC also was key, Anderson points out, adding that "We did not just put in the methodology; we hired a group of folks with strong expertise in system design change management, while training our management, physicians, and staff."

The academy trains staff not only in PI methodology, but also in most significant interventions, he notes. "Having that to lean on allows us to engender change rapidly and fairly profusely," explains Anderson, who came on board about 3 1/2 years ago.

Multiple projects

He is perhaps proudest of the sheer volume of ongoing projects.

"There are a few things we look at as markers that actually make a difference. In our last year, we had 45 projects active and being worked on across the organization; that gave us a sense of depth and breadth. In addition, 19 of them reached completion in that year; and we are proud of that."

Why is this multiplicity of projects so important? "We do not do research projects," Anderson emphasizes. "Our goal is to make changes that impact patients and their families. Each individual project is interesting, but it pales in comparison to what you accomplish when you do multiples of projects. There were 28,000 patients we impacted in the last fiscal year; that's what we look at," he notes.

How can such a volume of activity be managed? "We have eight improvement leaders here on staff; the focus of their job is to lead projects and coach," Anderson explains.

Most of these improvement leaders have come from the consulting world, he says, "but we have looked for people from a breadth and depth of industry and nonindustry areas."

In addition, Anderson notes, "We will only be successful if we have trained our entire staff on DMAIC, and now we have them 98% trained, plus we have the engagement of operational and clinical leaders."

Broadening the focus

While Northwestern Memorial has a long history of training both management and frontline staff, "This year we will take a broader scope, focusing more on culture and systems at a very broad level," Barnard says. "We feel that's where the majority of improvement has yet to be made."

Teams of hospital staff and leaders--nurses, respiratory therapists, pharmacists, and so forth--will be presented with the latest research knowledge and tools on what it takes to design safe systems, she explains.