Culture change is critical part in improved outcomes

Underscores opportunities for improvement

Children’s National Medical Center in Washington, DC, has made significant improvement in its clinical outcomes through benchmark utilization. For example, it has been able to reduce infections by 55% in post-op ventricular peritoneal (VP) shunt infections and has achieved an 82% reduction in 180-day readmission rates.

But none of that would have been possible without first successfully engendering a hospitalwide culture change, says Kathy Chavanu, RN, MSN, executive director of quality and clinical support services.

"We’d been doing benchmarking since the late 1990s; I think we needed to start looking at our data from more of an external perspective, to see where we were in the market area," she recalls. "But [it wasn’t optimized] until we really took hold of our culture and integrated benchmarking fully, to where the clinicians were fully engaged, which was about 2001-2002. This culture shift was emphasized by our CEO and by our VP of patient services."

Education critical

Education was a critical component of the culture change, Chavanu says.

"A lot of education had to happen around the benchmarking tools we were using," she recalls. "We needed to establish trust of the data with clinicians. They are used to seeing ’P’ values, so when they don’t see them you need to demonstrate the integrity of the data before it is believed."

That was made easier through leadership buy-in, Chavanu adds. "We integrated benchmarking into our quality program, and we had some clinician champions. Once we were able to do that, with the help of a dedicated data manager, we were able to demonstrate to the clinicians how benchmarking could be used in their clinical practice."

Another important step was to establish a set of guiding principles, she explains. "One of those said we would use benchmarking from a patient safety and quality perspective, and then look at things like cost and increased revenues. That was a very important message for our clinicians to hear, as they had been hearing so much about cutting costs in recent years."

To address the need to improve clinical quality and efficiency, Children’s used the Pediatric Health Information System (PHIS), from the Child Health Corp. of America in Shawnee Mission, KS.

That system gives them access to information from approximately 40 other children’s hospitals. "It contains a wealth of information — about 10 million patient visits," Chavanu notes.

Using PHIS, Children’s is able to benchmark anything from utilization measures to outcomes, she explains. "You can examine data such as what percentage of the hospital’s surgical procedure patients had infections," she observes. You can also call up comorbidities and mortalities, Chavanu adds.

"For starters, we mined our database; and through that mining, we were able to prioritize initiatives," she notes. "We focused on diagnoses and processes of care, and within diagnoses, how we could use benchmarking to leverage ourselves with payers. More recently, we have even used it for R&D."

Infection rates tackled

When the staff initially examined their PHIS data, "as related to infection rates, we were below the average," Chavanu recalls. "We also recognized our 180-day readmission rate was higher than average." The infection rate team, led by a neurosurgeon and operating room nurse director and supported by a multidisciplinary group and the data manager, decided to reduce the infection rate by 50%.

"The team looked at all of the opportunities for improvement," she reports. "With close coordination between the OR and the nursing staff, we adjusted the timing and change of antibiotics and improved surgical prep changes, such as double-gloving in the OR."

As a result, Children’s achieved the previously mentioned 55% reduction in post-op VP shunt infections, as well as an 82% reduction in the 180-day readmission rates.

In another initiative made possible through benchmarking, Children’s is repositioning itself with payers in terms of diabetic care. "Five years ago, we had one particular high-volume payer who felt we did not provide efficient care, so when their patients came to our ED, they would send them to another hospital," Chavanu adds. "We used the PHIS data, created a new clinical pathway, and now have one of the lowest lengths of stay for diabetic care in the country." (Their LOS dropped from 2.75 days to 1.5 days, while seeing an increase in volume of more than 136%).

As a result of this improvement, she says, "That same payer came back to us and told us that we provided such efficient care that they’d like to contract with us for regional diabetic care."

Need More Information?

For more information, contact:

  • Kathy Chavanu, RN, MSN, Executive Director, Quality and Clinical Support Services, Children’s National Medical Center, Washington, DC. E-mail: kchavanu@cnmc.org.