Quality meetings should dig deep into documentation to identify the root causes of problems that hinder quality healthcare delivery, says Trinity Medical Center’s CEO Keith Granger.
When healthcare C-suite leaders consistently communicate and evaluate how process improvements are saving lives and improving patient care, those mission-driven employees will become deeply engaged in developing ways to deliver higher-quality care at a lower cost.
For example, at Trinity Medical Center, Birmingham, Ala., president and CEO Keith Granger regularly meets with quality leaders and hospital administrators to tackle quality and cost challenges. Those quality meetings have paid off. Since 2012, Trinity Medical Center has ranked in the top one percentile for Centers for Medicare and Medicaid Services (CMS) process of care measures.
Transformation Through Collaborative Meetings
Interested in replicating Granger’s results? Here are the steps he takes to run successful quality meetings:
Meet with stakeholders on a monthly basis. At Trinity Medical Center, Granger runs the monthly 60- to 90-minute quality meetings. The group consists of 20 to 25 individuals, including quality managers and five to seven administrative leaders. Other departments are invited depending on the issues under review. For example, Granger may invite leaders from nursing (e.g., nurse manager/unit director of the operating room, intensive care unit, medical/surgical unit, or the recovery room), pharmacy, materials management, and the lab, as well as staff nurses who can share their hands-on experiences at patients’ bedsides.
While there is no formal agenda, attendees receive information packets that consist of performance results for each of the CMS process of care measures, variations in these processes, and trend charts. Trinity Medical Center closely monitors acute myocardial infarction, congestive heart failure, pneumonia, inpatient and outpatient surgical care projects, ED measures, and venous thromboembolism. After variances and near misses are reviewed, follow-up goals and assignments are identified to prepare for the next scheduled meeting.
Focus the discussion. The group arrives at the meeting ready to solve problems. Although the hospital delivers positive outcomes 99.6 percent of the time, the meeting attendees use a root-cause approach to focus on its few outlier cases and any variances in quality metrics. “What if that one failure was your grandmother, sister, mother, or daughter? The goal must be zero!” Granger says.
Set a tone of high expectations and personal accountability. Granger sets the expectation that incidents will be reviewed by the individuals involved. Although physicians generally don’t attend the meetings because of time conflicts with private practice hours, their input is obtained prior to or after the meeting. The attendees bring a written recap to the meeting and explain what happened, how it happened, and what the organization can learn from it so it never occurs again. “Instead of the leader going to the employee and talking while the employee nods, we reverse that. The employee does the talking so we can understand what he or she understands and has absorbed,” notes Granger.
Anticipate more efficient meetings over time. If the team is doing its job effectively, there should be fewer clinical variances to examine. At Trinity Medical Center, the initial meetings used to last as long as three hours. However, as performance improved and the number of variances and outliers requiring review decreased, the meetings now frequently take just 30 minutes.
Also, as staff have become more focused on improving care, preparation time for analyzing the data before and during the meetings is becoming more efficient. “We often use the remaining time to talk about how process improvements could be applied to other areas, like our readmissions process, mortality review, or how we handle preoperative patients,” Granger says.
Embrace a “no excuses” culture. At the meeting, Granger and his group dissects the monthly variance report line by line in each core measure or outcomes area. For example, when an antibiotic wasn’t delivered on time to meet the core measure standard, the nurse for that patient explained that the medication was not administered because she needed to focus her attention on the patient’s blood loss.
“I stopped the meeting and suggested that if the root cause was blood loss, perhaps we should pull the lab reports to see how we performed with respect to that so we could find out when the blood was ordered and if it was really an impediment to the antibiotic administration,” Granger says.
“What we learned is that we not only missed the goal with respect to the antibiotic but also with respect to administering the blood order. In fact, we pulled 25 patient records to assess our effectiveness on taking orders off the chart at time of admission and implementing initial orders to understand the root of the problem. We really dig to look at documentation and evaluate care,” says Granger.
Provide training. To perform regular reviews of performance on CMS quality measures, staff must understand the agency’s rules. Granger’s team began by studying CMS rules and guidelines and then training staff on the requirements. They also learned from other high performers in the industry and by examining their own performance.
Structure the process. Granger credits the success of the quality meetings to the team’s monthly review process. Once the team understood CMS’s requirements, they developed the quality meeting structure to share their expertise, knowledge, and results. By examining variances in performance on CMS measures every month on real patients and situations, they are able to identify solutions so problems don’t reoccur.
Find the time. “Leaders will often say they don’t have time to run quality meetings,” says Granger. “Yet, we find time to review financials and budgets. We find time to review strategic plans. We must find time to ensure the same excellence in clinical outcomes for our patients and the reputation of our organizations.”
Open Communication Leads to Solutions
The collaborative process behind Trinity Medical Center’s quality meetings has created an open atmosphere that encourages hospital leaders and staff to recommend solutions, rather than make excuses. Through bottom-up discussions led by team members closest to the problem, hospital leaders can determine the root causes of near misses and outlier cases and take steps to resolve problems that hinder quality
Dan Collard is a senior leader, coach, and national speaker for Studer Group, Gulf Breeze, Fla.
Publication Date: Monday, December 09, 2013