September 2005

Core Strategy: Quality Work Groups Tackle Clinical Quality Initiatives


09-05Workgroups1 Photo

Catholic Health Initiatives' clinical knowledge communities collaborate on new approaches to care that can benefit patients such as Jane Eibersen and Sharon Bridges, seen here consulting with Sherif Ibrahim, MD, at St. Vincent Medical Center, Little Rock, Ark.

Catholic Health Initiatives' National Clinical Services Group has formed five work groups, each devoted to some of the most critical issues related to clinical quality in health care today. They are:
  • Safety and Quality
  • Knowledge Communities
  • Person-Centered Care
  • Physician Alignment
  • Clinical Information
Each work group addresses one or more of the key indicators of quality care identified by Catholic Health Initiatives. These indicators are collectively known as STEEEP, which stands for Safe, Timely, Effective, Efficient, Equitable and Person-centered care. "Each indicator is an essential component in an overall framework for clinical quality," said John Anderson, MD, chief medical officer for Catholic Health Initiatives. "Whenever we think about quality, we need to think about them all." For the purposes of developing programs and tools, however, the work has been divided among the five work groups. While the Person-Centered Care, Physician Alignment and Clinical Information work groups are developing rapidly, the Safety and Quality and Knowledge Communities groups have had the greatest impact to date. Knowledge Communities Promote Consistent Care While knowledge communities have been established by many groups within Catholic Health Initiatives, clinicians have been particularly active in these information-sharing groups. "We have clinical knowledge communities set up around specific diagnoses and areas of patient care," said Debbi Honey, RN, vice president of clinical services for Catholic Health Initiatives. "They provide a collaborative approach to improving performance by sharing knowledge." Active knowledge communities for Catholic Health Initiatives' clinicians include those for emergency departments; orthopedics; hospitalists; and radiology. "Clinical knowledge communities have already been through quite an evolution," Honey said. "At first, they sent out surveys to gather basic information. Now, they are standardizing best practices and working collaboratively on new approaches to patient care. They are a great tool for promoting a consistently high level of care across our system." Safety and Quality Link to Core Values Quality care is so closely intertwined with patient safety that one workgroup is addressing both topics. "Quality and safety also link directly to the core values of Catholic Health Initiatives," said Barry Silbaugh, MD, vice president of medical operations for Catholic Health Initiatives. "Providing safe, quality patient care with Reverence, Integrity, Compassion and Excellence is why our clinicians entered the health care field in the first place." With many ways to approach the enhancement of patient safety and quality care, the work group is focusing on approaches that have a solid base of evidence to show their effectiveness. "For example, we have embraced the six proven life-saving interventions promoted by the Institute for Healthcare Improvement's (IHI) 100,000 Lives Campaign (see "Proven Strategies for Reduced Mortality" on page 9)," said Silbaugh. "Our hospitals were already working successfully on many of these interventions." Rapid Response Teams Established Of the six interventions, the fastest-growing within Catholic Health Initiatives may be the establishment of Rapid Response Teams. These cross-functional teams are available 24 hours a day to help nurses stabilize hospital patients. "Nurses are typically the first to notice a change or decline in a patient's status," said Silbaugh. "Rapid Response Teams can quickly bring the right resources to a struggling patient. These teams have been shown to reduce cardiac arrests and patient deaths, and to improve nurse and patient satisfaction. We want every market-based organization to implement Rapid Response Teams."

Rapid Response Teams are already in place at Mercy Medical Center, Nampa, Idaho; at Saint Francis Medical Center, Grand Island, Neb.; and in Centura Health's hospitals in Colorado. "The teams' intent is to support and collaborate with nurses caring for patients," said Terry O'Rourke, MD, chief medical officer for Centura Health. "They're available to facilitate discussions with physicians on the patient's condition and make recommendations for treatment. The teams will help us to develop standardized criteria, documentation and measures that will help enhance patient care." To help fund the development of Rapid Response Teams, Catholic Health Initiatives recently applied to the Robert Wood Johnson Foundation for a $100,000 grant. "The foundation just asked us to resubmit the application, adding $45,000 to the request because of the importance of this concept," said Silbaugh. "Should we receive the grant, we're very excited about the possibilities." Training Under Development; Surveys Underway Another focus for the Safety and Quality Work Group is the development of training for market-based safety officers. "This is something that our market-based organizations asked for," said Jeff Norton, director of clinical services for Catholic Health Initiatives. "We know that safety isn't about adopting slogans, but about adopting specific behaviors that improve safety. Our goal is to develop world-class training for safety officers that will give them the tools they need to drive positive change in behaviors that affect safety in their organizations." The Safety and Quality Work Group is also gathering the results of a "culture of safety" survey. More than half of Catholic Health Initiatives' hospitals have completed or are in the process of completing the brief survey, developed by the Agency for Healthcare Research and Quality. "The results are giving us a baseline measure of quality and safety activity in our system," said Norton. The data also shows that our hospitals have already implemented plans and solutions for patient safety," said Silbaugh. "A lot of activity stems from the people who deliver bedside patient care - those closest to the problems." Sherif Ibrahim, MD, listens to the lungs of Jane Eibersen. "Throughout Catholic Health Initiatives, the amount of talent we have providing patient care is just phenomenal," said Barry Silbaugh, MD, vice president of medical operations for Catholic Health Initiatives. Catholic Health Initiatives Leading the Way While improvement in patient safety and quality of care is a continuing journey, Silbaugh emphasizes that Catholic Health Initiatives' clinicians have much to be proud of. "In working with IHI and others, we believe that Catholic Health Initiatives is really leading the way in some of this work," he said. "One reason is that throughout Catholic Health Initiatives, the amount of talent we have providing patient care is just phenomenal. The diverse perspectives, ideas and inspirations of our clinicians truly drive patient safety and other clinical initiatives."