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Healthcare Journal of new orleans
I
JUL / AUG 2014
15
feels pretty good about where they are and
I think they feel phenomenal about where
we are going.
Editor:
So the key issue was the employment
transition. Did things change operationally
in the hospital?
Cindy Nuesslein:
Not initially. We are doing
some fairly substantial reengineering. One
of the big books of work we have to do is
something called transition planning. That’s
developing a new owner/operator’s manual
for the new hospital. So we are looking at all
our systems here and work flows, and fig-
uring out which ones we want to take and
which ones we want to leave behind. And
at the same time correcting some of those
because we had some real inefficiencies here
and we didn’t necessarily do everything as
well as we want to. So we are improving this
and at the same time designing best practices
we canmove across the street. It seems easy
to just jump across a two-lane, right? No, it’s
a big deal. Lots of engagement. Lots of hours
of work. It is the most significant piece of
work that we are doing right
now. We have a lot of other
things that are happening,
but this is the most signifi-
cant piece of work we are
doing right now.
Editor:
Did the culture have to
change to this process improve-
ment or quality improvement focus?
Cindy Nuesslein:
One of the things we deploy
here in quality—and we use it for lots of dif-
ferent reasons other than its primary pur-
pose—is a type of root cause analysis. And if
you know anything about Joint Commission,
they demand you do a root cause analysis if
you have any serious safety event or sentinel
event. But the process itself is exquisite and
training people how to really look at issues
that arise and designing systems that have
a safety net so you prevent that issue from
reoccurring. So as opposed to doing it just for
any serious safety event, we say for any event
we are going to do a root cause analysis.
What we’ve done is we’ve brought in staff
from all levels—med students, residents,
faculty, hospital staff. We sit them at a table
and say, “Okay, here’s what happened, how
do we fix it?” and then engage them all in a
conversation, because it’s not about finding
fault or blame, and then we use that envi-
ronment and those individuals and we tell
them, “You can’t go back and talk about the
incident, but go back and talk about the pro-
cess.”We really want to have a non-punitive
approach to patient safety. It’s critical if we
want to improve our performance. It’s really
a very healthy process and the dialogue is
really healthy. I think now that we’ve been
doing it for nine months, people are really
engaged in it andwhen they hear about it and
they get invited and they come, even if they
are not involved in the problem or maybe
only tangentially, they recognize that the hos-
pital is serious about patient safety.
The other thing we are doing is deploy-
ing something that we call 903-Safe and
by May 31st everyone in our organization,
regardless of whether you are employed by
us or not, will know 903-Safe and you can
dial 903-Safe and let somebody know that
there’s an issue. You can do it anonymously
or leave your name and we will get back to
you. So from, “I don’t have a washcloth and
it’s 2 o’clock in the morning” to “I can’t get
this supply” to “I walk in the hospital every
day and the same puddle of water is on the
floor” to “We had a medication error.” It’s a
collection tool that allows us to really get a
handle on everything that’s going on in our
organization and everybody participates—
fromhousekeeping to nursing to the faculty
to the students. We are rolling out this initia-
tive because on June 1st the ExecutiveMan-
agement Team is going to walk through this
hospital and stop everybody and say, “Okay
if you’ve got a patient safety concern what
do you do?”And we hope they say 903-Safe.
I am pretty confident the vast majority will.
So I think those kinds of things are really
starting to help all of us. All of the constitu-
encies, all of the providers, all of the support
services recognize that quality is job one. If
we trulywant to build aworld class academic
medical center with a national and interna-
tional reputation, which is our vision, then
we’ve got to provide awesome care, hands
down. People around the country are going to
have to say, “Wow, we’re having this problemI
wonder what we can do?”And I want them to
think, “Call UMC, they’ll have the answer.”So
that’s wherewe’re going but you’ve got to talk
the talk every day. It’s the first thing I say in the
morning and the last thing I say before I leave
at night so hopefully that’s filtering down. I
think it is. I think the faculty and the medical
staff are on board.Theywant this.Whowould
not want this, right? So we are going to have
this incredible newdress and she’s gorgeous,
stunningly, she’s a very smart building, but
it’s more about what’s inside and I think they
know that. We need a new dress because we
have a very tired and worn one, but it really
is much more about people.
Editor:
As far as patient care and safety
issues, what specifically have you noticed
has changed so far? You’ve got the process
going, but have you noticed any difference
in outcomes yet or are you still gathering
that information?