Michael Alkire 2When our ancestors looked to the heavens, they had a lot of unanswered questions. Why did some stars appear in every season and others only sometimes? Why did some stars seem brighter when others were faint? Which stars could be used as guides?

They didn’t have the tools to make sense of the pinpricks of light above. They had only a vague impression of their meaning.

To make sense of them all, ancient observers organized the stars to create a clearer picture of the universe. Taking abstract inputs—each point of light—they developed constellations to connect the dots, paint a picture, and create a map.

Hospitals and health systems in today’s healthcare environment also are searching for answers. With the market in such a state of flux, they’re looking for a way to organize all of their resources and data in a way that tells a story and guides action. They need their own constellations to make sense of the vast challenges they face, and then use them to create a map for total quality improvement.

This is particularly the case when we look at harm. Although preventing harmful events continues to be a major focus for hospitals, proactively identifying and tracking inpatient harm is an imprecise science. To do it correctly, hospitals often require real-time data feeds, predictive analytics, and alerting capabilities to notify clinical staff of potential problems.

Both individual hospitals and hospital alliances are drawing constellations, using distinct measures of “potential harm” (e.g., ventilator-associated pneumonia, sepsis, acute renal failure) spanning across the hospital inpatient setting, and pulling together disparate teams and methods to make a difference in patients’ lives.

Consider the obstetrics ward of a hospital. Few areas are more complex, requiring care providers to treat two distinctly different types of patients—infants and adults—simultaneously. Although harmful events are rare and often unavoidable, preventable events are usually the result of communication gaps among care providers.

To prevent these gaps, Summa Akron City Hospital in Akron, Ohio, is pulling together multidisciplinary teams, data sets, and tactics to ensure seamless communication and effective decision making. These teams rely on a teamwork system originally developed by the Department of Defense, designed to produce highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes for patients. They perform drills and simulations using lifelike mannequins that are programmed to transition through the various stages of labor and delivery that mothers and babies undergo during the birth process. They practice the delivery of care bundles, or a set of processes that together help clinical staff remember to take all the necessary steps to provide optimal care to every patient, every time. And they harness data to track their performance over time, identify outlier cases and address root causes.

In taking a holistic approach, Summa is drawing new connections—making sense out of the science and making a difference for mothers and babies alike.

The Savannah, Ga.-based Memorial Health University Medical Center (MUMC) also is drawing its own constellations to prevent harm.

There, clinical teams conduct concurrent reviews of all medical records to identify patients who may be at risk for postoperative respiratory failure. The teams use a questionnaire that helps them identify patients with obstructive sleep apnea, an often-undiagnosed condition that significantly raises the risk of death among patients who must be sedated and intubated prior to surgery. Using this tool, MUMC is able to treat the sleep apnea prior to surgical procedures and carefully monitor patients post-surgery with additional respiratory care bundles that ensure better outcomes.

Since implementing these processes, along with continuous monitoring of successes through harm dashboards, MUMC has seen a threefold decrease in postoperative respiratory failure.

When it comes to the challenge of preventing harm, many care providers are turning the “impossible” into “possible.” They are integrating fragmented data sets and connecting the dots to form solutions that enable a network of connections and insight that serving as constellations. And with these guideposts in place, they are able to drive continuous cost and quality improvements to the benefit of the communities they serve.


Michael J. Alkire is COO, Premier healthcare alliance, Charlotte, N.C.

Publication Date: Tuesday, June 24, 2014