Transparency arises in the South

Novant Health is a not-for-profit health care organization serving more than five million residents from Virginia to South Carolina. Their team recently decided to dramatically expand the degree of transparency they provide with regard to clinical outcomes.

Paul Wiles, Novant's President, said to me: "We are delighted that you are willing to let your readers know of our efforts to enhance the field with respect to transparency of clinical information."

If you go to this website and click through the various categories, you will see an honest and open exposition of how they are doing on central line infections, ventilator associated pneumonia, and other important items. They mean it when they say that they are "committed to providing clear, accurate and honest information about the quality of care we offer to all of our patients."

Here's the VAP chart, which is illustrative, too, of the presentation of quite recent data. Why wait two years for national numbers based on administrative data when virtually every hospital collects real-time data on actual clinical outcomes?


Paul continued, "Our latest quarter is now posted. We had some improvements, some the same and unfortunately some declines in our performance. With our results in the public domain we have a real incentive to make our results better."

This view is consistent with what I have said before:

Transparency's major societal and strategic imperative is to provide creative tension within hospitals so that they hold themselves accountable. This accountability is what will drive doctors, nurses, and administrators to seek constant improvements in the quality and safety of patient care.

Congratulations to everyone at Novant for making this commitment. Do I detect a movement? Will the Boston hospitals join in?

Mungerson Lecture

I was honored to present the 2010 Mungerson Lecture at Advocate Illinois Masonic Medical Center today. The lecture is named for Gerald Mungerson, an inspiring leader and a passionate advocate for the health and wellness of the communities he served. This included Boston, where, prior to going to Chicago, he served with distinction as General Director of what is today is part of the Brigham and Women’s Hospital. (You see his son, Andy, and wife, Cynthia, in the accompanying picture.)

As explained to me by Susan Nordstrom Lopez, President, "Each year we select the Mungerson lecturer on the basis of his or her dedication to health care and record in improving a health institution, practice or community. Like Jerry, the Mungerson Lecture balances clinical rigor with the critical need to involve lay people in understanding, supporting and improving health care."

I was asked to expand on a topic covered on this blog, "On Purpose," with a particular emphasis on the role of quality, safety, transparency, process improvement, and patient involvement in the new health care environment. Of course, this was a bit like preaching to the choir, as Advocate Illinois Masonic Medical Center does an excellent job on these fronts. Their commitment to transparency is exemplified in these posters on the various floors of the hospital, where staff, patient, and visitors can see progress on a variety of indicators and metrics.

The cath lab goes Lean

I had a chance yesterday to get a presentation on the use of Lean process improvement techniques and philosophy in our catheterization lab. This is a very busy place where diagnostic and interventional cardiologists string catheters through people's blood vessels to evaluate the extent of cardiovascular disease, open up blockages, and extend lives.

Tech Kenny Lee and nurse Eric Harrington, along with Kimberly Eng from our Business Transformation group, led me through the analysis that has been done of the current state and the proposed future state. There will be dramatic improvements in the quality of people's work day as a result. In addition, staff and patient safety in and around radiation-rich areas will be enhanced. There have already been substantial improvements in inventory control, too, leading to major cost reductions. The renovations of the space and continued reorganization of supplies and equipment designed during the Lean process will take place in the coming weeks.

Here's a video tour. If you cannot see the video, click here.

Joint Commission Report

Representatives from the Joint Commission visited us last week for their periodic survey. I post below today's email from me to our staff. As noted, the actual report is available for all to see. We view that as an essential way to make sure all people here can benefit from this appraisal of our clinical quality.

Beyond the report and the email below, I want to mention an important item for your consideration. Many readers here will recall our dedication to transparency about a wrong-side surgery event several years ago. With full staff participation, we then devised a new pre-surgical protocol.

During this survey, this protocol was viewed in actual surgical settings by one of the surveyors, who said, "That is the finest time-out I’ve ever seen." The JC surveyors said they would recommend it as a "best practice" to be shared with other hospitals throughout the country.

I view this as yet another validation of the use of transparency to help obtain process improvement.

Here's the email:

Dear BIDMC,
As many of you know, we recently had a visit from the Joint Commission, the organization that accredits all of the hospitals in America. The surveyors from the Joint Commission spent several days here in intense review of our physical facilities, our information systems, and -- most importantly -- our actual delivery of care to patients.

As is the current practice, this was an unannounced visit, with the surveyors showing up on a Monday morning with just a few hours notice. The people who came were excellent, thoughtful, and comprehensive. There were six surveyors who spent a total of 24 surveyors days with us. In all, they talked with almost 300 of our staff members and visited 49 unique sites on and off campus.

They found some things that needed improvement, but they also had many compliments for the hospital in general and for many, many of you in particular.

My favorite quotes from them during the week were, “The team is impressive – it’s a privilege to be a witness to the care being provided;” and "They are completely committed to what they do -- inspirational."

Consistent with our practice, we want you to have the advantage of their work product, so we have posted it on our website. Please read it.

With gratitude and appreciation,

Paul