Research, leadership put Houston hospital on top

Shorter meetings don’t hurt

If you look closely at two lists from U.S. News & World Report’s annual health care survey, you’ll see an overlap. The Institute for Rehabilitation and Research (TIRR) in Houston makes its 14th appearance on the list of the best rehab hospitals in America. TIRR grabbed the No. 2 ranking for the third year in a row. Now look at the list of America’s best physicians, and you’ll find no fewer than five doctors associated with TIRR.

"That says a lot about this organization," says John Kajander, CEO and president of TIRR Systems, which includes the hospital, 21 outpatient locations and TIRR Foundation, a philanthropic organization that supports hospital operations, education, and research. TIRR, located in the Texas Medical Center, enjoys an extraordinary set of partnerships for research and patient care with area institutions including Baylor College of Medicine, the University of Texas (UT) Medical School at Houston, the UT Medical Branch at Galveston, and Texas A&M University Institute of Biosciences and Technology.

TIRR and all four of those schools participate in Mission Connect, a $10 million project that seeks to improve function of patients with spinal cord and brain injury by affecting the biology of the injured nervous system. Teams made up of investigators from the different institutions are working on projects such as:

  • preventing or breaking down formation of scar tissue at the site of spinal cord injury to encourage natural regrowth of damaged nerve cells;
  • understanding what proteins are needed to accelerate neuron production and improve cell repair;
  • testing in sheep to determine if surgical connection of nerves in the chest wall to damaged bladder nerves could improve bladder function in patients with spinal cord injuries;
  • stimulating memory function after brain injury;
  • investigating how to make stem cells become the exact kind of nerve cell needed at the site of brain or spinal cord injury.

TIRR also participates in a unique physical medicine and rehabilitation alliance with Baylor and the UT Medical Center that provides physicians for TIRR and $40 million worth of research on spinal cord and traumatic brain injury, making it one of the largest research and education programs in the nation.

"The model we use for research is collaboration," Kajander says. "We really believe that by bringing these partners together that we can accomplish far more. We think it makes a material difference for patients, and we think that’s one of the reasons we continue to receive recognition in U.S. News & World Report."

The collaboration model also is what TIRR uses to run its operations and provide quality patient care. The management team includes the chairpeople from the departments of physical medicine and rehabilitation at both Baylor and the UT Medical School. Those physician chairpeople are not employed by TIRR, but they have the opportunity to work on every major strategic decision the hospital makes.

The management team meets weekly to discuss strategic issues, and Kajander has made it a personal goal to keep the meetings on track and on time. "The management team approach is really an outgrowth of the clinical protocols we use for patient care," he says. "The physician truly sits down on a colleague basis with the therapists, social workers, case managers, and nurses to design a care plan for each patient. We have learned to use that teamwork concept that we do for every patient in our management decisions."

Kajander has worked to eliminate as many meetings as possible so staff can concentrate on patient care. "I had every person write down the number of meetings they attend," he said. "We cut out close to 1,000 hours of meetings per year. It’s so important to get the caregivers more time with the patients. We found sometimes too many people were in the meetings." The role model is the weekly management team meeting, which previously ran as long as three hours. Kajander has cut it to 90 minutes by limiting the discussion to strategic issues and allowing members to review the agenda beforehand and challenge items that would be better discussed elsewhere. "I’m hell-bent on 90 minutes," he said.

Jean Herzog, executive vice president and chief operating officer, says TIRR’s approach to developing leadership has led to a culture that is open to both suggestions and criticism. "We’ve created a safe environment to suggest ideas from top management all the way through the organization," she says. "Any organization needs to create a culture that is open and encourages people to be creative and to look at better ways to do things."

TIRR doesn’t just leave this strategy to chance. About 10 years ago, TIRR began this effort with a formal program called Transformational Leader-ship that looked at the principles of communication at all levels. The program has gone through several metamorphoses over the years, but continues to work through a train-the-trainers approach. "One component is how to develop a project so that you’re looking at all components so you have a much greater chance of success," Herzog says.

"Make sure you have the right people involved, that you look at all aspects, that you examine everything thoroughly. There is a format for the development of projects, and we use that a great deal. Our preparation for [the prospective payment system] used those techniques," she says. 

Need more information?

Jean Herzog, Executive Vice President and Chief Operating Officer, The Institute for Rehabilitation and Research, 1333 Moursund St., Houston, TX 77030. Telephone: (713) 797-5278. E-mail:

John Kajander, CEO and President, TIRR Systems, 5100 Travis St., Houston, Texas 77002-9746. Telephone: (713) 942-6176. E-mail: Kajanj@TIRR.TMC.EDU.