How to Rank in Top Five Percent of All US...

How to Rank in Top Five Percent of All US Hospitals in Safety – Year After Year
Carol Smith, MBA, RN, NEA-BC, Compass Clinical Consulting
Tammy Cole-Poklewski, MS, BSN, RN, Cooley Dickinson Hospital
In today’s rapidly changing environment, nursing leaders need to
enlist frontline staff in the quality agenda, focus employees on the
organization’s mission, vision and values, and develop accountability
systems to improve systems and sustain quality improvements.
This presentation maps Cooley Dickinson Hospital’s journey in
implementing principles that achieved a ranking in the top 5 percent
of all U.S. hospitals in patient safety by Healthgrades® for the past 4
years and a ranking in the top 10 percent in overall value by The
Leapfrog Group.
With the multiple challenges in health care, the time for
accountability is now. However, without changes in the systems we
use to do our work, we cannot hope to make sustainable
improvements at the necessary speed.
The purpose of this presentation is to provide the learner a framework for hardwiring accountability structures and processes from the
frontline to the C-Suite and to describe how the establishment and
implementation of ongoing organizational structural supports create
a culture of quality that will sustain improvement.
Measures from C-Suite
to the Front Line
This presentation also
outlines the changes made at
Cooley Dickinson Hospital to
accomplish accountability for
process improvement at all
levels of the organization and
to sustain outcomes by utilizing the organization’s values as a mantra
to change the culture.
Methods and Materials:
Evidence-based methods used:
• Care Transitions Intervention model
• Dartmouth Institute Clinical Microsystems
Improvement methodology
• The Oz Principle
• Nolan’s Execution Model
An organizational accountability framework for performance
improvement and enlisting frontline staff is necessary to improve the
work and to sustain improved quality.
Zero defects =
Just Say No to Bugs!
Creating a feedback loop that provides continual review of process
and outcome measures is necessary to assist the frontline staff in
evaluating their work and making necessary changes to sustain
Examples of Hardwiring
Accountability at the Front Line:
• Lowering Hospital-Acquired
Infections – The CDH Infection Prevention nurses worked
closely with the Environmental Staff to standardize cleaning
processes and implement the use of ultraviolet light room disinfection as part of the terminal cleaning process. These
interventions resulted in a 54% decrease in hospital acquired
C. difficile infections, a 58% decrease in MRSA colonization/
infections and a 65% decrease in VRE infections during 2011.
Chart 1. Hospital Acquired Cdiff Deaths
Chart 3. Acute Care Readmission Rate
Chart 2. Hospital Acquired Clostridium difficile Infections 2009- Q3 2012
Chart 4. Heart Failure Readmission Rate – Post Care
Transitions Intervention
• Decreasing Readmissions for High Risk Patients –
In January 2011, Cooley Dickinson Hospital implemented the
evidence-based Care Transitions Program™ developed by
Dr. Eric Coleman. The CDH mean 30-day readmission rate prior
to implementing Care Transitions Coaching was 9.357%. Since
April 2011, the CDH mean 30-day readmission rate has
decreased to 8.424%.
At the foundation of the Clinical Microsystems approach to
improving healthcare, are the concepts of: 1) frontline staff
involvement, 2) rapid-cycle tests of change, and 3) using data to
drive the decisions for how to improve. Senior leadership adopted a
ZERO defect philosophy.
Every employee in an organization must be focused on process
improvement in order to achieve sustained outcomes:
• All staff have two jobs – “to do their job and to improve their
• By implementing a framework of accountability at all levels of
the organization and reinforcing organizational values, systems
and outcomes can be improved and sustained.
• A fundamental building block of sustained systems and outcome
improvement is the engagement of the frontline staff.
• By being transparent with information and giving frontline staff
the time and tools and trusting employees to “own it,” they can
create processes that far exceed expectations.
• Organizational transformation occurs one department at a time.
-Coleman, E. A., Parry, C., Chalmers, S., & Sung-joon, M. (2006).
The care transitions intervention: results of a randomized control
trial. Archives Internal Medicine, 166, 1822-1828. Retrieved from
-Connors, R. (2011). Change the culture, change the game: The
breakthrough strategy for energizing your organization and creating
accountability for results. New York: Portfolio Penguin.
-Connors, R. (2002). Journey to the Emerald City: Implement the Oz
Principle to achieve a competitive edge through a culture of accountability. Paramus, N.J: Prentice Hall Press.
-Kegan, R. (2001). How the way we talk can change the way we
work: seven languages for transformation. San Francisco: JosseyBass.
-Nelson, E. C., Batalden, P. B., & Godfrey, M. M. (2007). Quality
by design, a clinical Microsystems approach. San Francisco: JosseyBass.
-Nolan TW. Execution of Strategic Improvement Initiatives to
Produce System-Level Results. IHI Innovation Series white paper.
Cambridge, MA: Institute for Healthcare Improvement; 2007.
-Peters, T. (1982). In search of excellence: Lessons from America’s
best-run companies. New York: Harper & Row.
Carol M. Smith, MBA, RN, NEA-BC
Tammy Cole-Poklewski, MS, BSN, RN
Director of Quality and Patient Safety
Compass Clinical Consulting
Cooley Dickinson Hospital
2181 Victory Parkway
30 Locust Street
Cincinnati, OH 45206
Northampton, MA 01061
[email protected]
[email protected]
Christine Orlen, Care Transition
Coach, left, visits Polly Peterson at
Peterson’s home. Photo courtesy of
the Daily Hampshire Gazette.