Solucient 'Top 100' hospital scores 'three-peat'

Leadership employs 'critical principles'

When the Solucient 100 Top Hospitals were announced this year, Danbury (CT) Hospital was on the list — for the third year in a row. Hospital leaders say that for patients, this means a higher survival rate in certain medical procedures, fewer complications, better safety, and shorter lengths of stay.

What are the keys to achieving such a high level of performance — and more important, how is that level maintained year after year? "There's nothing earth-shattering about what we do to keep our eye on the prize, but there are a few critical principles at work," says Matthew A. Miller, MD, chief medical officer at Danbury. "One is that the focus on quality and safety has to be driven by the board and by senior leadership — the CEO, chairman, and top executives; they must believe that they are very important."

This must be more than just lip service, he continues; it involves setting critical goals and having incentives for senior leadership that are at least partially dependent on outcomes. "We set high-level goals every year under various pillars, and the first one is quality," says Miller. "Under that we identify nine or 10 critical quality safety indicators that must be within certain national benchmarks." Each year, he says, the hospital establishes several organization-wide initiatives "We want to get right this year."

If you don't set targets, he explains, "That's almost a circuit breaker."

Board behind safety, quality

In the last couple of years, says Miller, the board has "ratcheted up" its involvement in quality and safety. "I am expected to be at every meeting, and we spend 20-25 minutes each time talking about quality and safety," he says. The board does more than just ask about quality and safety indicators, he continues. "They say, 'Tell me what's going wrong,'" he shares. "When something bad happens [they want to know about it], and what we're going to do about it so it will never happen again."

The board, he says, has "zero tolerance" for error. "For example, the National Quality Forum has its 27 never events," Miller notes. "The board will say, 'Has this ever happened here? What are you doing to make sure that it never does?' Some of these are very hard to do, but your tolerance has to be zero."

The board also keeps close tabs on Centers for Medicare & Medicaid Services (CMS) core measures, says Miller. "Take MI; the board might ask how many patients that had an MI have had to be reported to CMS, or how many times we got it all right," he offers. "If we do it right only 95% of the time, then not all patients are being delivered the highest form of care."

There are other principles Miller keeps front and center, such as transparency. "Unless you are comfortable telling people how you are doing, you can't really hold yourself accountable — within the organization, to the board, or to the public," Miller insists. "We were one of the first hospitals to actually do a public report card. We also have a commitment this year to revamp our web site; we will put on a lot of quality indicators, [to show we are] externally validated."

Finally, he says, with all that focus on quality and transparency, there must be careful attention paid to reporting. "You have to have a way of capturing data when things go wrong," he notes.

In order to do that, he says, you have to have a non-punitive culture of safety. "The entire organization has to feel comfortable [reporting]," he notes. "We collect over 100 adverse events each month, though they are not necessarily errors; we track and trend." The serious ones are investigated in real-time, and root cause analyses are conducted.

[For more information, contact:

Matthew A. Miller, MD, Chief Medical Officer, Danbury Hospital. Phone: (203) 797-7375.]