But take a look anyway, if you have an interest in process improvement in hospitals. This is a collection of my best posts on this topic.

Thursday, January 31, 2008

Ready Resolve at NYU

Here is a really neat program at NYU's Tisch Hospital. Employee volunteers (each one serves for one hour per day for one week every other month) visit patient rooms and conduct a quick on-the-spot survey of patient needs and follow up to solve a series of common problems -- do the phone and TV work properly; are the room and bathroom clean; did you get the meal you ordered. The Ready Resolvers either fix or call in any problems imediately. The responding departments are responsible for resolving the problems within two hours. If they cannot fix the problem right away, they send a staff member to visit the patient to explain in person.

This began as a pilot in June on three units, with 27 volunteers. It was expanded in August to 4 additional units, with 63 volunteers.

Interesting, too, that the Ready Resolvers started to uncover problems that were systemic in nature, that require further hospital-wide work.

I like this idea. If you work in a hospital, here or elsewhere, do you?

Organizational Wiki

This is a request for advice. As I have noted below, we are engaged in a major process improvement and staff engagement process we now call BIDMC SPIRIT. We are designing a system that will enable staff people throughout the hospital to call out problems that they see while doing their everyday work, and then have help teams focus in on those problems, do root-cause analyses, and construct sensible solutions and diffuse them throughout the organization. This process, in part, relies on experience from Toyota, but it also uses some newer work done by other organizations.

Our folks are excited and intrigued by this and are starting to get engaged. Among other things, we plan to conduct formal training in the approach for about 600 people -- roughly 10% of our staff -- to create a core group from whom the process will spread.

Because this is a really new approach to things for an academic medical center of our size, one of my goals is to make sure that people feel they can also participate in the actual design and implementation. For example, I'd like for the training and communication process to be modified from suggestions of people as it proceeds, so that we refine it and keep things clear and relevant as we implement the program.

In essence, I want to create the organizational equivalent of a wiki -- a process that is organic during its implementation as a result of multiple and transparent contributions by the participants themselves. Think about that as allowing the people in the hospital to enhance the process improvement process itself even as that process is being rolled out. Think about it further as an incredibly and intentionally democratic design approach that puts great faith in the staff to know what will be most effective in teaching themselves about the program, for the benefit of one another. Now, add on to that characterization the fact that this needs to occur in a real-time manner and in multiple languages (English, Spanish, Creole, and others) and across multiple job categories so that all people feel confident that their points of view are heard and respected in a culturally sensitive manner.

We have some ways we are employing to do this, but I would love to hear from others -- whether in the medical field or elsewhere -- who might have tried this and can provide stories or references to their work. Please don't focus solely on computer information systems: Remember that lots of our people do not regularly look at a computer.

Monday, January 28, 2008

The votes are in!

Lots of you seem interested in the inside story on managing change in the hospital, and I am happy to share what we are doing on the chance it might be informative to those in other organizations. For those who are interested, here is a follow-up to my Thanksgiving staff email on our process improvement program for BIDMC. We conducted an election to name the program, with unlimited nominations "from the floor" and a preliminary ballot to narrow the field to seven finalists. Asking the staff to name the program is just the most visible part of encouraging their participation in its design and implementation. Here's today's email announcing the winner:

Subject: The votes are in! BIDMC SPIRIT takes first place!


In an election that has set a national standard for voter turnout and lack of negative campaigning, and a full week before Super Tuesday, we have a winner in our naming contest for the new BIDMC process improvement program.

Almost 2000 votes were cast, and the run-away winner was:

BIDMC SPIRIT (Solutions Promoting Improvement Respect Integrity & Teamwork)

Please stay tuned over the coming weeks for more about this initiative -- further explanation, training, and experimenting. Remember, the goal of BIDMC SPIRIT is that we want every BIDMC staff member to be able to answer these questions with a resounding "Yes!" every day:

Am I treated with dignity and respect by everyone I encounter, regardless of role or rank in the organization?

Am I given the knowledge, tools and support that I need in order to make a contribution to my organization and that adds meaning to my life?

Did somebody notice I did it, i.e., am I recognized for my contribution?

I'll tell you right now that we are inventing something new here. Sometimes it will feel chaotic, inefficient, or downright dumb as we do this: You will probably question my judgment many times over for even trying it. But, let's give it a chance and see what we can do together with the right BIDMC SPIRIT!

(By the way, will the person who suggested this name please contact me?)




Wow, within minutes, I have already received the following comments back from the email:

Good morning, Excellent choice, that was my choice. Have a great day. Thank you.
Whoever named this did a great job....
Congratulations on running a great campaign
BRAVO!! Congratulations.....
wow.........I finally picked a winner....now if I could only make up my mind about the democratic primary..........
Junior Seau said this week over and over again the same thing you did -- "let's just give it a chance, everyone just needs a chance" -- and look where he is now!!!!! I voted for this one too!
I am very excited the BIDMC SPIRIT was selected! I had suggested it during the original polling process… but I am glad that so many people resonated with it!
I would love to have an active role in this campaign of BIDMC SPIRIT.
An abbreviation better than WMD.
Love the name.

And this really nice one later on:

Although I cannot take credit for the name or idea of this program, I think it is an important concept. I am happy to know that this is going to be implemented and feel as though everyone will benefit from it in the end (especially the patients). From my perspective, there is nothing more rewarding than taking care of individuals during a time of need. We will all experience this vulnerability at some point in our lives. The key (again in my opinion) is to deliver quality care in a supportive, nurturing environment. It is evident that happier employees ultimately equals a more positive work environment which in turn equals quality care.

Thank you for supporting this program and also for taking the time to recognize the individual who is responsible for creating the name. You send a powerful message and it sounds like you are getting a positive response.

Monday, January 21, 2008

Responses to our new goals

As promised below, I am sharing some of the responses I received from members of the staff and also outside observers after we announced our new goals for patient satisfaction and quality and safety. As you will see, there is a variety of opinion on the issue. This is not expected. I am going to divide them up by doctors, nurses and other staff, and outside folks who read the story or editorial in the newspaper or heard a radio interview.

I am not including my replies to these emails. You can offer your own replies in the comments!


#1 -- How does BIDMC plan to determine if harm prevention measures are actually causing unintended harm? This isn't an idle question - we have bypassed much of the usual science of medicine when invoking quality improvement. We assume that if we force providers to don gloves and gowns before examining patients in an ICU that they will still go into the rooms just as much. We assume that the pass-off errors caused by resident work-hour changes won't exceed the benefits from reduced fatigue errors. We assume that the benefit of infections prevented by forms and checklists with central venous catheters makes up for the occasional delay in acute resuscitation. We assume that the benefits of medication reconciliation in the outpatient world will exceed the harm done by the loss of precious minutes spent actually talking with patients (my department can't even provide projected numbers on how long it should take the average MD to type in an average med list for our patients.) These are all measurable questions. Perhaps we assume too much? Auerbach's editorial on the question in the NEJM should have been a clarion call for us to redouble our efforts to evaluate change before declaring it beneficial.

#2 -- I am delighted to hear from your email of the Hospitals' re-affirmation to emphasizing patient satisfaction.

#3 -- (A) Makes me proud. I think that this is in part an ethics issue: there are few moral responsibilities we have as serious and widely acknowledged as the Hipprocratic admonition to “Do No Harm.”

(B) At our monthly Ethics Rounds (held in every ICU and 15-20 units total) we should consider moving from asking about “any cases of adverse events in the past month that you think weren’t disclosed/reported properly?” to “any cases in the past month where a patient was harmed by something we did that was preventable?”

(C) We could also encourage our individual Ethics Liaisons (designated by the chiefs of more than 50 clinical and administrative units) to think about ways they can help foster a culture in which we take moral responsibility for not harming patients, and constructive “preventive ethics” efforts not to do so in the future.

We have found our many Ethics Rounds a useful tool in the past for exploring in a BIDMC-wide way the views or experiences of front-line clinical staff about ethical aspects of issues such as a possible VIP unit. Our Ethics Liaisons Program is already proving it has great potential for engaging a large group of individuals across multiple departments.

#4 -- (Reply comment from another doctor:) RE "C", I would emphasize even more strongly that the moral responsibility is to learn as much as possible from every episode of harm in order to prevent that harm from recurring. We need to remain clear that competent and well intentioned providers may find themselves part of an event in which there is harm, and foster the culture where people see these as learning opportunities to prevent future harm.

#5 -- This is good, and it is clear that goal number one can be published because it only provides a measuring stick (new for BIDMC) for something we have already been doing. But goal number two: How does the hospital elegantly air this goal without the fear of being criticized for not having been doing this all along? Perhaps a better wording would be to emulate the wording of the first goal and say that we will establish new measures to ensure that our preventive measures work, so that we can fix them if they don't.

#6 -- I really liked your very thoughtful and important words on public radio this morning.

# 7 -- I am concerned about the wording of the second goal- there is a problem when you set an unobtainable goal, only to publicly show that you couldn't achieve it. Here is the unobtainable goal:

"BIDMC will eliminate all preventable harm by January 1, 2012."

This cannot be done, because it is stated in absolute terms. Eliminating "all preventable harm" is a noble ideal, but it is unrealistic given the complexity of delivering health care by multiple layers of teams and individuals. The best that any hospital can do is to develop mechanisms to reduce preventable harm, not to guarantee that all harm will be prevented. Any preventable harm, even if it was humanly impossible to foresee it, and even if no other hospital could prevent it, will be held against us as a failure to achieve what we promised.

I suggest that this second goal be revised as follows:

BIDMC will continue to create an environment that reduces preventable harm to the fullest extent possible. To this end, by January 1, 2012 we will be recognized as a national leader in the field of patient safety. We will accomplish this by continually monitoring all preventable and non-preventable occurrences of harm, and continuously improving our systems to allow the greatest opportunity to reduce harm.

This is also a noble goal, but it has the merit of being achievable....

#8 -- This is great, and the report in yesterday’s Globe has a lot of people elsewhere talking about it, and very favorably. May I suggest that the next step, given your interest and ability to be well ahead of the curve, would be – where the specific data permits such granularity – to know and report whether results were similar or different segmented by race, ethnicity, age group and gender. It would be fabulous to be able to say, with respect to various indices of care, that there was no difference at BIDMC when examined by race, ethnicity, gender and age group.

Nurses and other staff

#1 -- I treasure my place here and I imagine it will be a very long time before I will look elsewhere. I love this safety and quality initiative and I even love the naming exercise for the "thing"!!! Thanks for being who you are- it makes it possible for us to be who we are as well.

#2 -- Thank you for taking the lead in making and returning BIDMC a wonderful place for patients. I hope to contribute to the attainment of this goal as a clinical nurse.

#3 -- I am a nurse working at [a specified floor], and was just wondering if this meeting was in response to latest news that medical insurance will not be reimbursing hospitals for preventable occurrences (aside from the obvious that we care and value patient safety and prove that we are one if not the BEST hospital in Boston)?

#4 -- Take the leaps...set the goals...Count Me In!

#5 -- These are goals we can certainly reach. Over the last two years, we've made great strides creating performance measures in the Department of Medicine's divisions. After many meetings with our colleagues and data collection, it feels good to see the improvements based on our results.

#6 -- You have my support...please let me know what I can do to attain the goals you have set.
This is an awesome hospital....and I'd like to help make the patient experience even better.

#7 -- Although the initiatives you are describing relate to patient care, I believe that all subjects in research studies are patients as well. Please do not hesitate to contact me if I can lend my support and experience to any committees under development or in any way you see fit.

#8 -- WOW!

#9 -- These initiatives are terrific. I appreciate them both as an employee but more importantly, I appreciate it as a patient. Should I, or my family, be so sick that we need to be hospitalized, I want to feel confident, when we are most vulnerable, that we will be cared for safely. While we have not ever been hospitalized, we have utilized the outpatient services and have run up against some significant gaps in quality care. I've raised those issues with the appropriate managers and in both cases they responded quickly and appropriately. We have a way to go at all levels. You can count on me to help work toward these goals.

#10 -- I appreciate your and the Board's "raising the bar" at BIDMC and BID-Needham. I am looking forward to doing my part.

I want to make sure you're aware of something I saw at the FDA website. I imagine you are aware of it but since it appears to be right in line with the announced aspirations and "The Thing" I felt I should take a chance at being redundant. The title of the FDA program is "AHRQ Releases Toolkits to Help Providers and Patients Implement Safer HealthCare Practices" and here is the link.

#11 -- A thought about patient feedback: The several times I have been hospitalized, the efforts of staff to go beyond courtesy to make me feel taken care of and cared about have always stayed with me more than anything else about a hospital stay. And of course, apathy, lassitude or grumpiness has made an equally strong impression on me. There were times when I felt mistreated by “bad apples” (not at BIDMC). At the time, I wished I had had the opportunity to give feedback to the hospital. However, in the weakened state of illness, patients do not have the physical or mental energy to seek recourse on their own. If patients were given feedback cards (as often happens in restaurants) when they are admitted (not on leaving, when the memory is less accurate), this would help in more ways than one: the patient would feel he/she had recourse, and would thus leave feeling the hospital cared, even if the “bad apple” didn’t appear to, and 2) if they know patients have this forum, bad apples are likely to take more care how they treat patients.

Question regarding the phrase in your email: “We will measure ourselves based on national benchmarks”: I was just wondering if national benchmarks include a measure of staff satisfaction, since patient satisfaction depends daily on the way they are treated.

Outside folks

#1 -- I can say that after my experiences @ BI & my husband's experiences at an unnamed hospital, you are well ahead in the process & examples.

#2 -- Bravo!

#3 -- Bravo! I will follow with great interest.

#4 -- Reading today's Globe, I was once again struck by how very proud I am to be associated with Beth Israel Deaconess Medical Center. Not only do I appreciate your forward thinking but am amazed at your goal to not only be first, but to do right.

Congratulations. This is a great day.

#5 -- Congratulations to both of you and your Boards for this outstanding initiative.

#6 -- Hearty congratulations and a bold and positive step!

#7 -- First rate and I am sure will be supported by all of us.

One issue to think about over time. You can make the hospital experience great and are doing that. However, with the advent of out patient care and day surgery, much of the experience takes place in the doctor's office. Some are not so great at continuing the great feeling one gets at the hospital.

As a lawyer I represent many banks. I am acutely aware that how I treat the bank's customer in documenting the transaction reflects back at the bank.

I hope you can (or can continue to) foster that feeling in your doctors.

Regards and with continuing admiration for what you are doing.

#8 -- Congratulations on your quality goals. Nice to see someone put a stake in the ground and focus on what this business is really about.

#9 -- Impressive move by you and your board. That's the way to push the envelope. Let's hope others take up the challenge as well.

#10 -- Great Globe Editorial today! I’m so proud to now be a BI patient!

#11 -- Good luck with the initiative. It’s a big undertaking.

#12 -- I am really delighted that you have chosen to meet this head on. Obtaining accurate data and putting the CARE back into healthcare will continue to keep us in the forefront both in Boston and nationally.

#13 -- I can’t tell you how excited I am by your commitment to avoid all preventable harm to patients. It is simply the right thing to do. In a similar vein, I first learned of Ascension Health’s commitment to “no preventable deaths by 2008” in the fall of 2004. I have known Dr. Sandy Tolchin for many years and have had the opportunity to learn of his efforts, initially at Borgess Health Alliance in Kalamazoo and now as VP Clinical Excellence in collaboration with David Prior and others at Ascension Health. When I last spoke with him in the late fall, he said, “We have now demonstrated that flawless care is achievable.”

Saturday, January 19, 2008

What's in a PCAC?

Following on our theme below, I am presenting a bit more on our governance of hospital safety and quality to provide background to others in the field who might be interested. A friend asked me how our Patient Care Assessment and Quality Committee (PCAC) is constituted and what its charter is. Here it is in its entirety. The key points are that its job is related to the overall institutional goals established by the Board of Directors (the ones mentioned below), as well as statutory responsibilities. Also, that membership by the lay leadership (entitled "Medical Center Governance" below) always exceeds that of internal management and clinical leadership. Note, too, the inclusion of the Vice President of Education to ensure that quality and safety programs are integrated into the educational programs for both medical students and residents -- very important in an academic medical center.

This is a hard-working committee for the volunteer leadership, meeting monthly and dealing with difficult and challenging issues. We have great appreciation for those people, who devote hours well beyond the committee meetings in staying informed and thinking about the most important topics on the Board's agenda.

BIDMC Committee Charter
Patient Care Assessment and Quality Committee (PCAC)

Reports To: BIDMC Board of Directors

The mission of the Patient Care Assessment and Quality Committee (PCAC) is to support the aspirations for clinical quality and safety for BIDMC as set forth by the Board of Directors, and make appropriate recommendations for improvement. The PCAC shall also serve the role of Medical Peer Review Committee as defined under the statutes of the Commonwealth of Massachusetts.

Charge and Scope:
Monitor the occurrence of harm to BIDMC patients, with a focus on response and corrective action when harm occurs.
Select and monitor priority metrics that evaluate clinical quality and safety processes and outcomes achieved within BIDMC.
Recommend to the Board of Directors, at least annually, priority initiatives for improving quality and safety of care at BIDMC, and monitor the extent to which approved priority initiatives are satisfactorily executed.
Ensure that BIDMC remains alert to current best practices for quality and safety, at BIDMC and other entities (in health care as well as other settings), and recommends appropriate adoption. This shall include ensuring that best practices within BIDMC itself are spread and implemented throughout the organization.
Approve annually the Qualified Patient Care Assessment Program.
Ensure that all regulatory reporting mandates for clinical performance, including the filing of major incident reports to the Commonwealth, are met.
Ensure that members of the Committee have the appropriate knowledge and training necessary to carry out the mission of the committee.

Committee Chair:
Member of BIDMC Governance, Appointed by Chair of Board of Directors

Chair (Member of Medical Center Governance)
Vice Chair (Member of Medical Center Governance)
Chair, Board of Directors, ex officio
CEO, ex officio
President, faculty practice, ex officio
Chair, Medical Executive Committee, ex officio
Chair, Deptartment of Surgery, ex officio
Chair, Department of Medicine, ex officio
Chair, Academic Department (Rotating 1 year appointment, appointed by the Chair of the Medical Executive Committee)
Vice President, Education, ex officio
11-24 Members (Members of Medical Center Governance)

Chief Operating Officer
Senior Vice President, Clinical Operations
Senior Vice President, Health Care Quality
Patient Care Assessment Coordinator

Meeting Schedule:
Monthly (except no August meeting)

Thursday, January 17, 2008

Source material on quality, safety, and patient satisfaction

As a follow-up to the post below on the quality, safety, and patient satisfaction goals established by the BIDMC and BID~Needham Boards, I thought some of you might be interested in reading the material that led to the votes. It is a bit long, but descriptive of the issues that were considered. For some of you, this might be more than you want to know. For others, it might provide primary source information that could be valuable for your own institutions. My hope is that more hospitals will find themselves moving in this direction, and if the accompanying memo helps in your own consideration, please feel free to use it. (In the memo below, the LEAD program refers to a partnership between our hospitals and Blue Cross Blue Shield of MA, under which auspices the Board training program was held.)

In my next posting, I plan to give you a sense of the internal feedback that I have received since making this announcement.

To: BIDMC Board of Directors and PCAC Members
BID-Needham Board of Trustees and PCAC Members

From: Lois E. Silverman, Chair, BIDMC Board of Directors
Seth Medalie, Chair, BID-Needham Board of Trustees
Robert Melzer, Chair, BIDMC PCAC
Paula Ivey Henry, Vice Chair, BIDMC PCAC
Christoph Hoffmann, Chair, BID-Needham PCAC
Paul F. Levy, CEO, BIDMC
Jeffrey H. Liebman, CEO, BID-Needham
Ken Sands, MD, Senior Vice President, Healthcare Quality
Stan Lewis, MD, Senior Vice President, Network Development
Dianne Anderson, Senior Vice President, Clinical Operations

Re: LEAD Board Program Follow-up

Date: November 30, 2007

Dear Board Members,

Following our immensely engaging LEAD retreat last month, a group of us got together to draft a proposal on quality and safety goals for both hospitals for your formal consideration.

It was clear from the retreat discussions that there should be two ambitious overarching goals for both institutions: One for the quality and safety of care and another for patient satisfaction.

The group agreed that the Board’s role is to set an expectation for organizational performance for these two areas. Management is then expected to devise programs for achieving these goals, and to determine the metrics against which performance will be measured. We anticipate that the structure of the Board meetings will change to include systematic reviews of the programs related to these goals on a quarterly basis.

On the patient satisfaction front, we propose the following goal:

BIDMC and BID-Needham will create a consistently excellent patient experience. We will measure ourselves based on national benchmarks and, by January 1, 2012, be in the top 2% of hospitals in the country, based on national survey responses to “willingness to recommend.” For this goal, BID-Needham will measure itself against national peer group hospitals and BIDMC against a national dataset of all hospitals.
A top 2% goal means that effectively nine out of every ten patients rate the hospital in the top tier category on national surveys for willingness to recommend. BIDMC is presently performing in the top 10-15% range, on average. BID-Needham is in the top 30%. This goal represents a steep climb in performance for both institutions.

Formulating a goal for quality and safety proved more challenging, as there is a broad spectrum of definitions for harm and error, and consequently a broad range of implications for goal setting. First, there is a distinction between preventable and non-preventable harm. The latter type occurs when a patient is harmed as a result of a cause that could not have been predicted or prevented, such as the administration of a drug resulting in an adverse reaction that a patient’s history would not have indicated. Preventable harm, on the other hand, occurs when there is a failure on the part of either an individual or a system to render ideal care, such as when the administration of an incorrect dose or medication results in an adverse outcome causing actual injury to the patient.

It should further be noted that there is a distinction between harm and error, and that not all errors result in harm to the patient. For example, an incorrect dose of a particular drug administered to a patient might not affect the patient. The Institute for Healthcare Improvement (IHI) reports that only 10 to 20% of errors are ever reported, and of those, 90 to 95% cause no harm to patients. While much can be learned from all errors, many (including IHI) recommend that institutional governance focus on those causing actual harm. The theory is that by discussing openly those events actually experienced by patients, a hospital begins to foster a culture of safety that shifts from individual blame for errors to comprehensive system design and therefore lasting improvement in safety.

The first step in identifying harm is to develop a clear definition. Our small group reviewed several definitions of harm, ranging from IHI’s very comprehensive definition of all harm, including preventable and non-preventable harm, to the Ascension Healthcare System’s quality goal of no preventable harm. We felt that we needed to focus our resources where we can have the greatest impact, on eliminating preventable harm. At the same time, we wanted to maintain an organizational awareness of all harm, including non-preventable adverse events, and to seek to reduce our overall incidence of harm. The goal that we propose for quality and safety, therefore, is:

BIDMC and BID-Needham will eliminate all preventable harm by January 1, 2012. We will accomplish this by continually monitoring all preventable and non-preventable occurrences of harm, and continuously improving our systems to allow the greatest opportunity to reduce harm.
To determine and clarify how we would actually measure harm, we propose a modification of the categorization developed by the National Coordinating Council for Medication Error and Reporting and Prevention, known as the “NCC-MERP” Framework, to consist of the following categories of evidence of harm:

- Required hospitalization or extended hospitalization
- Permanent harm or disease progression
- Patient death

We feel that focusing on these categories will give us the greatest opportunity to achieve a meaningful and sustainable reduction in harm, while making the best use of our resources. The occurrence of harm that falls into any one of these categories would qualify for individual case review. In addition, while the boards of our institutions will focus on “preventable harm,” we also expect our respective PCAC committees to develop systems for periodic assessment and reporting on the occurrences of harm that are not within the categories listed above.

It is important for the Boards and the respective organizations to understand that these goals represent a far-reaching aspiration for our hospitals and for the level of care that we seek to provide. We must acknowledge that getting there will be a three to four year journey that will require further strengthening of our culture of safety and transparency. It will mean further bolstering our efforts to create an environment where caregivers feel safe discussing the occurrence of harm.

We discussed and propose the following timeline: At the December Board meetings, each Board will discuss and vote on these proposed goals and the attached resolution. Management would then be charged with outlining specific programs with measurable milestones to achieve these goals. In January, staff will be asked to present to their respective PCAC committee a timetable for these programs for the following year, along with a trajectory of performance towards the end goals. Upon review and approval by the respective PCAC committee, the action plans and milestones will be brought to the Board at its first subsequent meeting. A quarterly review of progress towards these goals would then become a regular element of each institution’s Board and PCAC meetings. In addition, the Compensation Committee of each hospital will be charged with building these quality and safety goals into the annual incentive plans for senior management.

We welcome your feedback and questions on these proposed goals, and look forward to our discussions at the December Board meetings.

Aspirations for BIDMC and BID~Needham

Here is an email I sent last night to the staff of BIDMC and our community hospital, BID~Needham. Thanks to CEO Cleve Killingsworth and others at Blue Cross Blue Shield of MA for being our partners in the Board training and providing other assistance and encouragement that helped lead to this step: Please see Jeff Krasner's story and an editorial in today's Boston Globe. Special thanks to Jim Conway at the Institute for Healthcare Improvement for his wise counsel and for conducting a significant segment of our Boards' training, and to three unnamed patients who addressed the Boards and powerfully made these issues tangible. Finally, after the text of this email, please read the statement we received on this matter from State Senator Richard T. Moore (Senate Chair of the Joint Committee on Health Care Financing).

There are some things that we do that are meant to transform our hospital, to set us on a path to very high standards that, at first blush, appear so audacious as to be unachievable. But if you never take the leap and set out the goals, you never know what you really can achieve.

Today, we announce such goals, in the hope that they will set the stage for such a transformation.

Several weeks ago, the Board of Directors of BIDMC and the Board of Trustees of BID~Needham met and had serious discussions about what their hopes were for our two hospitals. As the representatives of the community who have fiduciary responsibility for our two non-profit organizations, they decided on a pair of goals that represent their aspirations for us. Of course, the clinical and administrative leadership of the hospital were deeply involved in these discussions as well and provided the technical support for the decisions that were made.

The Boards decided that two overarching types of goals were important. The first relates to patient satisfaction. The second relates to safety and quality of care. Here is the vote that was taken by the BIDMC Board (and a virtually identical one was taken by the BID~Needham Board):

WHEREAS, the Board of Directors, Patient Care Assessment and Quality Committee ("PCAC"), and Patient Care Services Committee ("PCS Committee") of Beth Israel Deaconess Medical Center ("BIDMC") have determined that it is in the best interest of BIDMC to set ambitious and overarching goals related to healthcare quality and patient safety, and patient satisfaction.

To approve the following goals for BIDMC related to healthcare quality and patient safety, and patient satisfaction:

BIDMC will create a consistently excellent patient experience. We will measure ourselves based on national benchmarks and, by January 1, 2012, be in the top 2% of hospitals in the country, based on national survey responses to "willingness to recommend." For this goal, BIDMC will measure itself against a national dataset of all hospitals.

BIDMC will eliminate all preventable harm by January 1, 2012. We will accomplish this by continually monitoring all preventable and non-preventable occurrences of harm, and continuously improving our systems to allow the greatest opportunity to reduce harm.

That Management will develop and implement action plans and programs to achieve these goals, to be reviewed and approved by the PCAC Committee, PCS Committee, and the Board, and will report to the Board, PCAC, and PCS Committee on at least a quarterly basis using defined metrics against which performance will be measured.

Daunting, eh? You bet. Here's more. We will be publicizing our progress towards these goals on our external website for the world to see. In other words, we will be holding ourselves accountable to the public for our actions and deeds. Our steps towards transparency have just been notched up a level.

These Board votes certainly do not mean that we are not already doing a good job now. Our Boards have immense respect and affection for all of the staff who work in our hospitals. They know you take really good care of patients and provide a warm and caring environment for patients and families. But the votes mean that our Board members who represent the community want us to do even better, out of a sense of public service and also out of a sense of pride that we can do better.

Over the last several months, we have seen a hint of what is possible. Our efforts at infection control on the floors and in the ICUs are but a few examples. Meanwhile, too, we have made process and customer service improvements in a number of clinics. We have saved lives, reduced adverse events, improved customer satisfaction, and made life a bit less hectic for some of our staff. (You know from previous emails that I am working hard to make even more improvements on that latter point.)

We have come a long way. Six years ago, both of our hospitals were close to being sold or shuttered. Four years ago, we had passed through a turn-around and proved our ability to survive. These past two years, we have shown that we are vibrant members of the Boston and Harvard medical communities. Now, we rise to the largest challenge yet -- setting standards for patient satisfaction and reduction of harm that are truly world class.

Stay tuned as we roll this out and decide on the yearly priorities and work plans that will eventually lead to reaching these audacious goals. In the meantime, as always, please keep in touch with your ideas, suggestions, and criticisms.


Here is Senator Moore's statement:

“BI-Deaconess deserves to be strongly commended for taking this challenging, bold step to improve health quality and transparency. By including a small community hospital (BID-Needham) as well as a major academic medical center, BI-Deaconess becomes a true champion of health care quality and patient safety. Their leadership in promoting transparency is unprecedented in the Commonwealth, and is fully consistent with the principles behind legislative initiatives such as Senate Bill No. 1277/House Bill No. 2226, An Act Improving Consumer Healthcare Quality. They obviously understand the meaning of 'First, Do No Harm.' They get it right!”

Thank you, Senator!