Reinertsen honored with Eisenberg award

Show board human side of safety work

Despite his modesty about his work and life, James L. Reinertsen, MD, received a 2010 John M. Eisenberg Patient Safety and Quality award for individual achievement from The Joint Commission and the National Quality Forum.

A senior fellow with the Institute for Healthcare Improvement, Reinertsen now heads a consulting group, the Reinertsen Group in Alta, WY. He practiced rheumatology for more than 20 years and served as CEO of CareGroup, Beth Israel Deaconess Medical Center, and Park Nicollet Health Services.

In his own words, "probably most of my professional life has been spent, instead of working in a system, working on a system... And, during those 15 years as a CEO, my primary interest — in fact, my primary interest since I started seeing how the system works — has been to improve the safety and quality of care."

He says he has focused specifically on working within the quality realm with the board, senior leaders, and physicians. "The award probably reflects the results that they have achieved rather than anything that I have done. I've just prodded them into making the necessary changes in processes and in culture," he says.

Health care organizations must support the quality leaders and personnel, Reinertsen says. When those leaders "see a change that's evidence-based and works and they now want to extend it to the whole organization" but they encounter any kind of resistance — whether it's resistant doctors or nurses or other providers or whether it's financial resistance to support the change, they need the "backbone" or "will" of senior leadership, he says. "You need a board and a senior executive team that has backbone and is committed to this and has the will to make it happen. And that's really the primary leverage point that I have been able to work with over the years."

He acknowledges that quality leaders deal with complex and myriad initiatives across a hospital or system. In "order to activate boards, for them to really generate the backbone and the will to make these changes happen and give support," he says, first boards must "see" the problems. Board members should see the safety issues. You don't do that by sending them data that are difficult to understand or too technical, he says. "You send them and tell them stories about harm that's happening in your hospital this month," and then you can give them the data, which he phrases as "removing the denominator."

"If there are 4.2% of your people getting some particular problem, how many actual people is that? Count them. That's what you report to the board. You don't report the rate; you report the number of people affected." Going further, he says, many quality professionals he works with now show their boards the first name and last initial of the patient, and the date and name of the event. "That's what they report to the board. Not technical data in complicated charts, but people. In essence, what I'm saying is that you make the board see the human side of this problem."

Then the board must own the problem, he says. Unfortunately, he says, historically boards and senior executives see problems and think that's the physicians' problems. Today, they must see, own, and solve problems.

Smith says, "As my friend Paul O'Neill [former secretary of the treasury] is fond of saying: 'Leaders are responsible for everything that happens in an organization, especially what goes wrong.'"