Do you have any idea why health care costs keep spiralling upward? One reason is because simple and easy solutions often take a back seat to complicated and expensive. Why?
Cincinnati Children's Hospital Medical Center (CCHMC) is one institution that has implemented its own version of health-care reform, taking overall performance levels from well below average to the top 10 percent in the industry.
One of the key players is Dr. Uma Kotagal, a neonatologist with a deep-seated passion for improving the quality of care at CCHMC. In 1996, when Jim Anderson was named CEO, he convinces Kotagal to lead the hospital's improvement efforts as senior vice president of quality and transformation. Anderson, a practicing attorney with expertise in the quality improvement methods used by manufacturing firms, is joined by Chairman of the Board Lee Carter, who articulates his vision for the hospital as, "We will be the best at getting better."
The improvement effort at CCHMC gains real traction in 2002 with the award of a $1.9 million Pursuing Perfection grant from the Robert Wood Johnson Foundation. In addition to funding an improvement-science training program, the grant requires that the hospital undertake improvement projects.
Hence, Kotagal develops hospital-wide protocols with proven efficacy—for example, implementing a "forcing function" into the operating room process that keeps patients out of the OR until they've received antibiotics, thus reducing surgical site infections. For another project, she selects the hospital's Cystic Fibrosis (CF) Clinic, in part because its head physician was the only division leader who showed any interest in participating in improvement initiatives.
Because grant guidelines required CCHMC to disclose its performance, however, the CF Clinic's participation resulted in some serious soul-searching. Founded in 1883 as an academic medical center, CCHMC had considered itself to be among the best hospitals in the country, even though it had scant evidence to benchmark its performance against others. But data co-collected by the Cystic Fibrosis Foundation instead showed that the outcome for the clinic's juvenile patients measured at the 20th percentile. So hospital staff tackled the situation head-on, finding that the data galvanized families rather than angering them. The clinic went on to change its processes and communications based on input from seventeen patient-parent team members. Six years later, CF patient outcomes had risen to the 90th percentile.
A key takeaway is the power of transparency as a mechanism for change. Another is the motivational value of benchmarking themselves to an internal standard of zero accidents instead of rationalizing poor performance as an unavoidable consequence of the complexity of patient care.
Kotagal's efforts to create a culture of improvement throughout the hospital include the use of employees who serve as internal quality improvement consultants, as well as an in-house education program on improvement science that emphasizes
rapid cycles of small-scale change.
Their finding that an accumulation of small changes can add up to significant gains is leading the way for health-care reform that is just as revolutionary as its legislative equivalent.
