"Pillars" of quality help hospital win recognition

Family-centered care one key ingredient for success

Memorial Regional Hospital in Hollywood, FL, recently received the top "Quest for Quality" award, presented by the American Hospital Association and McKesson Corp., and the Memorial Health System's senior vice president thinks he knows why. "A lot of it has been accomplished with regard to the IOM's "Six Aims" and great integration with our seven pillars of excellence," says Zeff Ross, FACHE, who is also the CEO of Memorial Hospital. Those pillars, which he can quickly enumerate from memory, are: safety, quality, service, people, finance, growth, and community. "We keep our focus on them," he says.

One aspect of Memorial's approach to quality, which touches on several of the pillars, is patient/family-centered care. "We have a number of examples that include some novel ideas, like our patient family-friendly MAR — medication administration record," Ross says. "If you're a patient in the hospital, you actually receive a listing of all your medications, what they're for, and when they're supposed to be given, and we discuss the potential side effects with you when we give them." So, for example, a nurse might enter the patient's room and say, "It's time for your Lasix; one of the side effects may be urinating little more."

"There's a lot of safety involved in this," Ross says. "A patient can double-check the nurse, and, if the patient desires, the family can be aware of all this information and can assist as well. For example, they might say, 'Wait, this is not on his list — why are you giving him that?'" The hospital has many safety checks, he adds, including bar code administration, making sure the right patient gets the right medications, "but this is also a safety check and requires a true understanding by the patient and family."

Patients and their family members are also an integral part of a process called "help alerts." There is a special line they can call and get a rapid response team to come to the room. "If we've educated the patient correctly, they will not call because their toast came cold," says Ross. He explains that when patients are admitted they are told about the program, what it is, and when and why they should use it.

"This is not a 'gotcha' on the staff," Ross says. "But we all need additional eyes." Accordingly, the registrar goes through the program, there is signage about it throughout the hospital, and the nurses also reassure patients that they want them to be comfortable, and if they feel something is awry, then please call "help alert."

Ross says programs like these have resulted in improved patient satisfaction scores, as well as better safety. "We may not always know what we saved a patient from, but you have a good idea when the rapid response team comes and says, 'we now recognize why you feel this way' that we know we made saves," he says.

Infection rates down

Memorial has also achieved significant improvement when it comes to infection rates. "At Joe DiMaggio Regional five years ago, we started out with about a 6% central line-associated bloodstream infection rate; in 2010 we ended up with just over 1%," Ross says. "The key is a lot of focus, recognizing that nobody comes into the hospital to get sick, but we do not want infections."

The improvement, he adds, is attributable to a combination of improved techniques and better hand-washing, and recognizing a greater responsibility to the patients. "We put up greater signage and we tell patients upon admission that if any health care worker comes in and they do not see them wash up first to please ask them to do so," Ross notes. "We have a very high compliance rate now. Also, we have people making rounds looking at our practice — are we practicing what we preach?"

Having physicians act as role models is also critical, and Ross shares how Memorial gets them on board. "We don't necessarily say it's important to wash your hands, but we might say it's important to prevent an infection and having the patient become ill and possibly die from it; now it becomes something they understand and everything is connected," he says.

This approach has also dropped the rate of ventilator-associated pneumonia (VAP). "Where we would have had at Regional alone 60 in a year, by having greater adherence to bundles we've brought it down to three," says Ross. "Don't get me wrong; three is not tolerable, but to think we've brought the rate down by 95% is phenomenal."

Storytelling is a key ingredient to successful compliance, Ross asserts. "When you tell a story literally about how one time you cared for a patient who did get VAP and they had to spend an additional week in the hospital, or be put on antibiotics, the other staff members can internalize what could have happened and realize it could possibly lead to mortality, or at the very least an increased length of stay," he says. Ross notes that stories are told by administrators to department leaders, department leaders to employees, and sometimes from employees to employees. "We also involve a Patient Family Advisory Council, which includes guest patients and family members who are also able to get up and talk with us — about the good and the bad," says Ross. "Transparency is very important to us."

[For more information, contact: Zeff Ross, FACHE, Senior Vice President, Memorial Health System, 3501 Johnson Street Hollywood, FL 33021. Phone: (954) 987-2000.]