Best Practices: How Successful Units Engaged Their Senior Executive Leaders (Transcript)

October 18, 2011

Operator: The following is a recording for Paul Tedrick with the American Hospital Association, Chicago, supplemental call on Tuesday, October 18, 2011, beginning at 1 p.m. Central time. Excuse me, everyone. Thank you for your patience in holding. We now have your speakers in conference. Please be aware that each of your lines is in a listen-only mode. At the conclusion of the presentation, we will open the floor for questions. At that time, instructions will be given if you would like to ask a question. I will now turn the conference over to Mari Franks. Ma’am, you may begin.

Mari Franks: Thank you so much. Good afternoon, everyone. Good morning. I think those are the only time zones we have. We’re very excited to be here today for the CLABSI supplemental call series. The call today is titled “Best Practices: How Successful Units Engaged Their Senior Executive Leaders.” And I have the pleasure of having people from both Florida and Tennessee on the line. So Jonathan Kling from Naples and then Scott Raynes, Joan Chatham, and Melissa Allen from Tennessee and we’ll conclude the presentation with a note from Craig Becker, who is from the Tennessee Hospital Association. So I am going to make sure that Jonathan is ready to go. Everyone on the line should have received a final version of the PowerPoint presentation. It should have come from Paul Tedrick. And our speakers will orient you as they move to the next slide so you know where they are in the slide deck. So with that, I’m very excited to hand it over to Jonathan Kling.

Jonathan Kling: Thank you, Mari. Good afternoon and good morning everybody. I appreciate the time to speak with you all and share our experiences and best practices in regards to this series on engaging senior executive leaders. If you would scroll to slide three on your PowerPoint, we’ll start with the first initial challenges and how they were overcome. You know, this all got started way back for us in September of 2009 when we had identified through our Infection Control Department and our Quality Department a cluster of CLABSIs in our critical care units. And once we sat down and looked at a lot of inconsistent processes, the infection control director, the quality control team, and their director said, “You know, we really have some work to do. You know, how do we present this to our senior leaders and leadership and our physicians to let them know we do have a problem, that we’ve identified it. We do not follow best practices or evidence-based practices,” and get that buy-in, because, you know, everybody knows from experience that when you tell somebody who thinks they’re doing a really great job that it’s not such a great job, it’s human nature to be very defensive. We sat down and looked at what we could do, what was out there, a lot of resources, a lot of research into the CDC guidelines and what, the Florida Hospital Association, the American Hospital Association was doing out there, before we went to our physician and senior leadership team. I think we were very fortunate and lucky that our CNO and our CMO were very receptive with acknowledging the fact that we had issues, that we had some opportunities to improve quality and thus improving cost as well. So I think that in today’s ever-changing market, especially with value-based purchasing and all the evidence-based practices out there and FHA, IHI collaboratives that we all seem to be a part of, it wasn’t too hard. I didn’t even have to show the financial impact that we all know is involved with this. So, I think it was it was very easy to get buy-ins from our staff and from our senior leaders.

The challenge that we have is with our physicians. And how we overcame that really was finding that one doctor who was open to change that had the ability to speak up with his peers because we had nine intensivists that were practicing within our units. So again, it was very challenging, but once that initial phase was over, we started showing data that was better.

So another challenge that we had was inconsistent data collection. Before we really sat down, we had some leadership changes in our executive team and our infection control team, and we had inconsistent training and practices in how we identified a CLABSI. That in itself was a challenge, to make sure that we were strictly following the guidelines, had an infection control physician that was a champion that was reviewing all CLABSIs, and making sure that that data was accurate and following the CDC guidelines. We also note that our policies, they were outdated. We had non-evidence-based policies and procedures going that are being followed or a lack of implementation on those. So it was very important that we looked at those three challenges to really get off on the right foot to build a good foundation.

Going down the solutions, consistent process was really a key. We have all probably experienced programs of the month, programs of the week, when we’re so busy, and the next thing comes up that is more important, and you press to do that. So it’s really important that this is a long-term investment and that your senior leader is aware of that and will support you on that and encourage you to continue those daily, weekly, or monthly, or bi-monthly meetings that they need to attend.

I think when people see the senior leadership there, the physicians, the staff tend to have more buy-in, in my experience. We probably all have trained our nurses or talked to our staff about quality measures or outcomes or things to do to improve outcomes, and then it’s received so much better when you had that physician that could be saying, “Yes, this is how it’s going.” So really, a key to success is having that strong physician champion there with you at all your staff meetings and all of your trainings.

Then we spent lots of time obviously revising our policies to make sure they were in line with evidence-based practice. And in 2009, we had joined the Florida Hospital Association CLABSI Collaborative and really borrowed a lot of what was already been done and done very well. One thing I want to kind of get back into as far as challenges in senior leadership: we were very fortunate that when we started this process, our CEO, Dr. Weiss, has a relationship with Johns Hopkins and actually, we brought in speakers from there and we talked about, and we had nationally renowned speakers come in and talk to us and our staff. And that really helped with our physicians. We brought Dr. Pronovost in, and everybody’s probably heard of the Dr. Pronovost story with the young child that had a line infection and ended up dying in the world-renowned teaching hospital. So, that right there, we were very fortunate that our senior leadership was really in line with what we were doing and willing to do a lot for us. And then, also, you know, with consistent data collection and timely communication, it was clear it was very easy to show the ROI for cost and quality, improvement in cost when quality is improved.

So if you go to the next slide on slide four and talking about best practices, and this is the key: consistent application of the insertion bundle always. And we all out there probably have gotten in our bedside kits, our carts and try to standardize the whole process from start to finish. Obviously, we have a set of recommendation for the sites, the most appropriate sites, the head-to-toe gown. Everyone in the room is either sterile or clean at all times, depending on what they are doing, and then sterile best dressing documentation on that line and then continuous assessment of lines. And where we were able to show success and able to make that part of the culture is that daily auditing of every single patient, every single day, both shifts. So there again, audits twice a day and that takes some effort and some commitment from your managers and from the directors and from the quality team and the infection control team, but when everybody’s on the same page, it does work.

And then we always talk about that consistent line care and maintenance and scrubbing the hub. That is the biggest challenge, I think. When nurses are in a hurry and we’re busy, especially in the critical care units, it’s difficult to always scrub the hub for that 15, 20 seconds, so we are looking at processes and products to help with that as well.

Go to the next slide. On slide number five, lessons to bring home to your hospitals that we can hopefully share with you and take some feedback to your staff. This definitely has to be collaborative from the executive team to the physician team to quality control, infection control, bedside RNs, and interventionist radiology. That was a big key because we had a large population with PICC lines, and we were seeing a higher issue with PICC lines than with our traditional central lines. So, we had mandatory staff education for all nurses, and it was a busy month of classes on both shifts, both campuses, and very aggressive education. Then, we also did quality contracts with our staff that we had a commitment to quality in our patients. And then we also had training for all of our physicians and several of our intervention radiologists that had the most insertions at the bedside and down in the IR Department. And then, just make sure that your policies are in line with all evidence-based practices and by joining the FHA Collaborative, we were really able to use and borrow things that were already being done out there and really took advantage of the best practices there, and set some relationships up with some very good people out there.

And then make sure that clear direction is set with your senior leadership. I can’t say enough about the support they showed. And it wasn’t a quick fix, it wasn’t a cheap fix, but obviously, the return on the investment is improvement in quality because I think we all know that the mortality rate goes up by about 30 percent with central line infections based on the national data. So it’s not just about money; it’s about quality. And again, to repeat again, the strong physician champion is really vital to the success.

And then, you know, looking also at your products, we had our central supply team, our supply chain management team we call them now, excuse me, was very important with us or very vital in helping us look at products, look at the track records, look at the evidence out there and how they worked because there’s all kinds of companies trying to sell you products that everything is proven to reduce CLABSIs, but it’s real important that you take your time in finding them. And then consistent use of those bundles, those evidence-based bundles on every single insertion, and have the ability and empower your staff to tell the physicians, “Hey, you’re not head-to-toe gown.” That was one of the biggest challenges for my staff to look that doctor in the eye and say, you know, “We’re not doing this line insertion until you follow this bundle.” After we got through that hurdle, it was all downhill. It was very easy and the quality showed. And then also consistent re-education and auditing on a daily basis is really, really the key.

If you go to that final slide for me, number six, the keys to success, again, clear vision and direction and strong senior leadership, buy-in of physician and staff alike, and this cannot be done quickly or without support of a large multidisciplinary team. It’s really, really important that you have that support, and it can’t be 6 months and go onto the next project. This project will never go away here at NCH. There will always be CLABSI meetings. There will always be daily audits and, you know, never say, “Good is good enough.” We got down to zero in a lot of units, but there’s always better line maintenance; there’s better line care. And just to give you a few quick stats: We have a two-hospital system. It’s a 681 licenced beds, soon to open up 64 more. And in our CVIC, we’ve gone 20 months without a central line infection and that’s a 9-bed unit. In an 11-bed ICU, we’ve gone 17 months without a central line infection. In our surgical ICU, we’ve gone 10 months and actually out of the last 18 months we’ve had one line infection 10 months ago there. At our North Naples ICU, 6 months without a line infection and our IC step down, we’ve had 10 months. This calendar year from January 1st till today, we’ve only had one line infection in all 62 of our beds year-to-date, so we’re not to zero, but we’ve had some units almost going on 2 1/2 years of no line infections. So it’s a journey, and I appreciate all the help out there and being able to participate in this call. Thank you.

Mari Franks: That’s wonderful. Jonathan, thank you so much, and congratulations on all the hard work. It looks like it’s obviously paying off, and I look forward to all kinds of questions that hopefully folks will ask you about your success at NCH. Well, let’s move on to, I believe it’s slide seven. The presenters for the next half of the call are from NorthCrest Medical Center. We have Scott Raynes, who is the chief executive officer, along with Melissa Allen, who is the director of infection control, and Joan Chatham, who is the director of quality. So at this time, I am excited to turn it over to the group at NorthCrest.

Scott Raynes: Thank you. This is Scott Raynes at NorthCrest Medical Center. I’ll take you straight to slide eight, and without reading the slide to you just for the sake of reading it, I’ll point out probably what I believe is the most important bullet point, and that is the third bullet point. While we started our project way back when, and it seems like decades ago when, in fact, that wasn’t the case, we started it very organically within the organization and in doing so was driven at a variety of levels. And I think the important level in that particular bullet point is the board level. We acknowledged A, we wanted to know where we were, and B, we knew where we wanted to go, and C, we felt very confidently that the only way that was going to happen is if there was collective commitment across the board. Started with the board of trustees, went into the senior administration group to be able to provide and empower our nurses, our nurse leaders and our clinical team with the ability to do all that they needed to do. So that’s really the important point of slide eight.

Of course, I’m missing out in saying that the physicians are in there, as well. And I’d like to say that they happily jumped on board, but the fact of the matter is the physicians here at our hospital were on board, but when we’re talking to physicians, we need dependable data, good information and a reason to do something. And so I think we did a good job coming out of the gate of providing that, by taking all the data and all the information that was out there that John spoke of, framed it up, and presented it in such a way that physicians, thus, were changed.

The next slide, just with regards to best practices, and I’ll keep this brief. At the very top, keeping senior leadership informed, the thing that I’ll expand upon there is we believe information is power, and so we keep this in front of senior leadership. But we keep our performance in front of our entire workforce and our board of trustees. So to say that we’re transparent, I would say that we are maniacally transparent throughout our organization. So right along the time that we kicked off is when the hospital association in Tennessee and the Center for Patient Safety as a board and as the hospitals across the State agreed, and I believe this was December of ’09. I may be mistaken on the date. But we started on our path of our move to zero, zero harm. And so I’m proud that we were kind of in front of that. But having the hospital association come in and get on board in such an aggressive and matter-of-fact way only empowered and validated what we were doing and really pushed the needle forward.

So when we took off on this journey, we had our data. But all of a sudden we were able to look at what the hospital association was providing, and that is an aggregate group of data of how the State was performing. We could compare ourselves there and even in a more precise way, and then share that with our workforce and our physicians, and that built momentum. You see the clinical best practices. Quite candidly, we’ve plagiarized what’s going on everywhere else that’s working and made it scalable to our organization. All of those things I think everybody’s doing in some form or fashion or, certainly, they should be. Much of that is standardized. And then you figure out how does it work for you, so there is a little variation in there so long as you don’t get away from what those true best practices are. Along that same line, when we talk about monitoring every insertion and share compliance results with staff, we do just that. We do it to that degree of specificity, with that degree of intensity. And,  candidly, we believe that if we did not do that, we would not be as successful as we are, and we know that is what prompted change within this organization. And, again, that’s really just something that’s supported at a senior level out to the masses with the managers and the frontline staff.

So, I would like to think, and I believe that my CFO and my VP of HR can recite where we stand with regards to our performance on all these various quality measures, which leads me to one other statement and that is we have organizational goals and with regards to central line infections and, for that matter, any and all infections acquired within in the hospital, a reduction of them is part of our organizational goal aggregately. And it drops down to each and every department in some way, shape, or form. And all of that information is pressed down and also shared back up again to a senior admin and board of trustee level with a variety of committees that meet and discuss performance techniques, protocols, how-to’s, what’s different, what changes, and how do we improve on an ongoing basis at least monthly.

So you see then on slide 10 kind of where we stand and just how we really work to simplify virtually everything. And that simplification, I think, really cuts through any barriers of communication. Anyone and everyone understands what’s going on.

Moving to slide 11, we infuse this into our orientation process. It’s a situation where we don’t want to backslide. We want to keep pace and, therefore, in the world of turnover today -- and we live in an area that is nearby an Army base, so we do have some turnover as a result of people deploying in and out and husbands and wives leaving the area and have an impact on that -- so while we have an organizational goal around turnover, we actually have a hardwire process with regards to how we orient our staff that are performing these skills. We’re happy to share that with you.

And I’ll stop right there. I think that’s probably a good takeoff point without being redundant to anything that John said, and I guess it’s turned over to Craig at this point.

Mari Franks: Great. Thank you so much, Scott. Appreciate your presentation. And at this time, Craig, if you are ready, we’ll move to slide 13 and Craig can speak to the Tennessee Hospital Association Board’s aim.

Craig Becker: Thanks, Mari, and for those of you who don’t know, I’m the president of the Tennessee Hospital Association, and I want to thank all of you who are on this call, particularly for all that you do for our patients because without you, we certainly would not be able to be able to brag a little bit about some of the improvements that we’ve been able to make.

You know, our journey probably wasn’t as easy as what John’s was at NCH Health Care. I mean, ours was a bit more of a struggle in terms of getting the attention of our leadership, and probably I was one of the first ones that had to be made a believer. And I think, having worked in this field for over 30 years, I believe like many other leaders that this is all about collateral damage and that this is out there to save lives and not necessarily to worry about the problems of hospital-acquired infections. So I was probably the first one that had to be turned around.

And 6 years ago, I had the opportunity to go to a IHI meeting, and at that point I really realized that what I had seen in my own hospital experiences with friends that I knew who were having adverse reactions in hospitals was not just happenstance but that it was something that was happening on a regular basis. And I really realized this is a national and State problem in addition to just something that’s local. So educating me was the first thing that had to be done.

And then after that I really started going on a journey of trying to sell it to my board, and I got kind of the same reactions in the beginning, with certainly, “Yeah, yeah, yeah. We need to deal with that, but we want you to go out and keep whining for dollars because that’s what you’re getting paid for.”

But we kept it up here at THA and tried to keep the focus on it, and then I realized truly that the only two things that were going to drive the membership were embarrassment and money. And so fortunately, we’ve been able to do kind of both of those. At an executive session with my board, we were able to show statistically that we had killed 59 patients with central line infections in the previous year. And I asked them flat out, “Aren’t you embarrassed by that? Is that something that’s all right?” And our board at that point kind of said, “Oh, okay, now we get it.” And I think the whole idea with CMS tying payment to hospital-acquired infections as well has helped to drive a lot of what’s going on.

But, having said that, I think our board has really stepped up. They have really been a leader in terms of making sure that the rest of the State understands that this is not right. The heck with the money, heck with the embarrassment -- this is just not a right thing to be doing harm to patients.

Another thing that we’ve done, and I think has helped to drive some of this, has been working with the State Department of Health to publish the central line rates. Again, that falls into my embarrassment category, and that helps certainly to drive some of the real larger hospitals that were having some significant problems. But, again, I think that just trying to put that spotlight on it was probably the secret in terms of turning around a lot of this.

So our board did adopt a zero infections, and we had a big debate about that. Is this a crazy number to go for? We know we’re not going to get to zero. But then we all said, “Okay, what’s an acceptable number? 20 percent? 10 percent? 30 percent?” And really, we felt that the only acceptable number was zero, and again, as Don Berwick likes to say, sometime is not a time, and we said 3 years. I think we knew that we wouldn’t get there, but we really wanted to put a stake in the ground in terms of where we thought we should be and how we should have kind of the urgency to get there. The other thing that we said was that we want to be in the top quartile of public measures. Right now, well actually I guess about 2 years ago, we were at the top of the bottom quartile, which was essentially known as the cream of the crap, and that’s not exactly where we wanted to be, either. We wanted to be up in that top quartile for a change, and we actually are moving up on our public measures as well. We feel like we are well on our way.

One of the other things that’s really driven a lot of this was an initiative we took on getting our boards onboard, getting our hospital boards and advisory boards to buy into this whole notion. I know every time I’ve made a presentation we talk a little bit about Johns Hopkins. We do have a relationship with them, as well. But Sorrel King is an even more powerful messenger out there who has talked about losing her daughter to an incident at Johns Hopkins, of all the hospitals that is one of the top in the country. And so every time I would make the presentation and show a tape with Sorrel speaking, the boards would just say, “We’re not going to allow that to happen here,” so I think that also helped to move our needle quite a bit as well.

You know, we talked a lot about the team approach, and that’s the one thing the Tennessee Center for Patient Safety and all the folks who work here really, really stress is that this is a team effort, and that if we can’t do it as a team -- meaning physicians, nurses, pharmacists, CEO’s, administrators, whomever -- then we’re not going to be successful. And so we took that same theme to heart in that we felt that if it was just the hospital association out there trying to do this thing, that there was no way that we were going to do it. So we’ve tried to take that same team approach, and our first partner in this was our Blue Cross of Tennessee. It’s an independent Blue Cross. Well, so far in the last 4 years, they’ve given us $7 million to keep moving our numbers into the right direction for our Tennessee Center for Patient Safety. The other group that we’ve worked very closely with, as I mentioned before, was the Tennessee Department of Health. The person who runs that aspect of it has been a good friend and certainly somebody who has been very much in tune with what we’re trying to do. And finally, the last one we’ve worked with is with our QIO, which I guess is pretty unusual, but we’ve had a great partnership with them and, in fact, we have applied for a HEC grant with our QIO as one of our major partners in that. So I’m happy to report at least on a statewide basis, in about a year we’ve been able to reduce our CLABSI’s both peds and adult by 36 percent and 47 percent movement in our neonatal units. And one thing I would just report, too, we have one of our NICUs at East Tennessee Children’s Hospital-Knoxville is about to celebrate a 1-year celebration so I don't want to jinx them, but I just say that as if you can do it in a NICU, you can do it just about in any unit that’s out there. So, Mari, I think that’s pretty much what I wanted to report on. As I say, it’s not been an easy road. We’ve had leaders like Scott Raynes, who you heard earlier, who have really done a lot in terms of pushing it, and I’ve got probably, oh, eight or nine true leaders throughout the State who run very large systems who have kind of cracked the whip and got on their peers about making sure that we are moving towards a zero preventable harm to our patients.

Mari Franks: Wonderful. Thank you so, so much. That was very helpful, and I think that all three speakers have done an excellent job. Thank you so much for sharing your stories with us and your strategies, and congratulations to all of you for obviously so much hard work that is very much paying off.

At this time, I believe it is question and answer. Hopefully, folks have been listening intently and have had an opportunity to write down some questions. So, operator, at this time, I’d like to do the question and answer session.

Operator: Okay. At this time, if you would like to ask a question, please press the star key followed by the 1 key on your touchtone phone now. Again, that’s star 1 on your telephone keypad if you would like to ask a question. If at any time you’d like to remove yourself from the questioning queue, you may press star 2. Again, that’s star 1 to ask a question. And we’ll hold just a moment for questions.

Mari Franks: Great. Well, again, this is Mari Franks from HRET. While we are waiting for some questions, Jonathan, you talked about a bit in your presentation about how once you empowered staff to speak up when things were not being done appropriately. You said that was a hurdle. Could you talk a little bit about how you worked with your staff to allow folks to feel comfortable to speak up when a physician or whomever was not doing something correctly?

Jonathan Kling: Sure, absolutely. That was a big hurdle, and that’s why several times in my presentation I mentioned a strong physician champion. And for us, Dr. Harrington was that physician champion we needed to go to those nine people that were all practicing differently but thought they were doing the best. And the nurses, they got to be there with the physician all day or in there with that patient, so at the beginning it was a different, a difficult culture shift for our nurses to do that. But once they realized that our physician champion knew they were doing what’s right for the patient, knew that he had their back, so to speak, and that they were supported from management executive leaders and a physician to do what was right for the patient, the physicians finally said, “Okay, we realize that this is right,” and it just snowballed from there. You could just feel it in the change in the nurses’ behaviors, the buy-in from all physicians. It was really a nice thing. It did take time, but that’s why that physician champion was so important.

Mari Franks: Excellent. Thank you for that. Operator, do we have any questions at this time?

Operator: Yes, ma’am, we do have a couple questions.

Mari Franks: Great.

Operator: Our first question comes from Sue Moeslein with Riverside Regional Medical Center.

Sue Moeslein: Hey there, Jonathan. Can you guys hear me?

Jonathan Kling: Yes.

Sue Moeslein: Okay, great. I’ve got a question about, and I might have missed what you said so if you said this very clearly and I missed it, I apologize. When you talked about the monitoring and the feedback of both the insertion as well as the bundle compliance, who did you have actually doing that and then how quickly did that feedback get back to the staff? I’m guessing you were monitoring all different areas where these lines are being inserted. As an example, at my facility I might have a line placed in the emergency room emergently. I might have one in the OR. I might have one in our special procedures. And I might have one in our intensive care unit. So how were you capturing that? I don't know if you have an electronic and how quickly did your get feedback and how many people did you have helping do that?

Jonathan Kling: Good question. We have all those same challenges and departments that you just spoke of. I’ll start with, during our initial kickoff process, our ED physicians and ED nurses and our intervention radiology nurses and physicians all had the same education. We used a paper insertion checklist to start out with. Once we had the insertion bundle in place and it was running smoothly, we did go to an electronic solution that was easier obviously to audit. But for the first 6 or 8 months, we did have paper checks, and my unit’s going to have five different units on both campuses. We have a clinical coordinator who is the charge nurse for all the units, and they would be called to every single insertion by the staff, not to be Big Brother, but just to make sure that when everything was busy that they could be the reminder person to make sure that they were empowered to do what was right and to document it. As far as if a line was put in without the coordinator there or the insertion checklist was missed, every 12 hours that line was being audited by a charge nurse or a manager, and that feedback went immediately back to the staff at the bedside with education. Never was there a corrective action or write-ups or coachings. It was just teaching and showing how to do best practices. Now it’s all paid off. Staff knew they would not be in trouble if it was wrong, and they knew it was an education opportunity.

Sue Moeslein: Thanks.

Jonathan Kling: Thank you.

Operator: Thank you. Our next question comes from Diana Faltermeier with Shawnee Mission Medical Center.

Diana Faltermeier: Hello. I had a question for Jonathan, the first speaker, about quality contracts. Could you speak to that a little more? Do you have any samples or examples that you could share?

Jonathan Kling: Actually, I can get your email afterwards or from Mari and send you our copy of it. We actually borrowed it from our Florida Hospital Association collaborative, one of the other clients we’re using. Like other speakers, we plagiarized it and kind of tweaked it to what we thought, and it really was. After the initial 1- to 2-hour education session was done with all the PowerPoint slides and the teaching, at the end, we just had that contract for nurses. And then every single year we have them re-sign that contract with their yearly education and our skills. So I think it was more impactful for the culture, not just for a practice, and I think it worked very well. I’d be happy to send you the hard copy and you can tweak it however you would like it for your system.

Diana Faltermeier: Okay. That would be great. Thank you.

Mari Franks: And this is Mari from HRET. Feel free to email either myself or Paul Tedrick, and we’ll make sure we get it out to the group.

Diana Faltermeier: Okay, thanks.

Operator: Thank you for your question. Again, if you would like to ask a question, please press star 1 on your telephone keypad. At this time, I’m showing no further questions in the queue.

Mari Franks: Wonderful. Thank you. I actually have a question for either the folks from Tennessee Hospital Association or NorthCrest. Thinking a little bit about the NICU experience, I know that that is something that HRET is working to launch a NICU effort here. Can you talk a little bit about your experience with reducing NICU to zero, which is as you had mentioned very difficult.

Craig Becker: I’m going to turn it over to Darlene Swart who’s the head of our Tennessee Center for Patient Safety. She’s got a little bit more of the detail on that.

Mari Franks: Wonderful. Thank you.

Darlene Swart: Hi, this is Darlene, and I have to say, when we first started and we were modeling our program a lot after the Michigan, the adult, and but we threw in the peds. And when we kicked off in 2008, looking at the central line blood stream infections with Dr. Pronovost and Chris Goeschel. At that time at our first kickoff meeting, we had about seven or eight people here from East Tennessee Children’s Hospital, and after the meeting, they sort of approached us and said, “None of this was for NICU.” And so we started a dialogue after that, and basically they came up with the motto that has just been kind of forefront since day one: “If you shoot for the moon, even if you fall, you’ll be among the stars.” And they went back to their facility and also working with what we call TIPQ is the Tennessee Initiative for Perinatal Quality. It’s a group here that’s funded by the State that works for a lot of the NICU projects and did a pilot, and doing it in NICU where they made their own toolkit and just took it forward that way. And they have just been wonderful. And actually, the medical group that works with East Tennessee Children’s and Sherry and Carla are on the HRET task force that will be helping to put out the toolkit and everything for NICU. And they have just been some of the strong champions since day one, and they’ve even gone to a lot of our other facilities, some of the larger ones, and we’ve had the same kind of results at Vanderbilt. We’ve had the same kind of results at Erlanger. So most of our very large NICUs have found the same kind of results when everybody said a couple years ago it couldn’t be done.

Craig Becker: We’re more than happy to share that, and I’m sure they are too so we’ll be glad to send that on.

Mari Franks: Wonderful. Thank you so much for that update. It was very helpful. Operator, do we have any questions at this time?

Operator: At this time, there are still no questions in the queue, but if you would like to ask a question, please press star 1 on your telephone keypad.

Mari Franks: Thank you. Now I have one final question. Just this is for NorthCrest and if you could speak a little bit about on your final thoughts. You talk about you teach the process to new graduate nurses during their orientation so they start out knowing the process. Can you give us a little bit more detail around what you focus on specifically for these new people who are coming into your hospital, into your health system, and what do you really drive home in this orientation?

Melissa Allen: This is Melissa. The most important thing that we impress upon them is that patient safety comes first. I’m a nurse that graduated in the 80s so I was taught to give up my seat to a physician if they came in, and I was certainly taught not to backtalk to a doctor or question anything a doctor did. But we want these new grads to know that patient safety depends on them, so if they see a physician doing something that should not be done, then they know that we will stick up for them if they speak up for what is right for the patient.

Mari Franks: That’s wonderful. It’s obviously helping and it works. Do you feel that the nurse, the new nurses are adapting this mentality or is it a challenge?

Melissa Allen: I think it’s actually easier for the new nurses to grasp it than it is for the older nurses to grasp it. I think that the newer nurses get more patient safety emphasis in their schooling than say I did in the 80s. Actually, we have more problems with the older nurses being able to speak up.

Mari Franks: Interesting. Thank you for that. Operator, if we don’t have any more questions at this time, obviously we do not want to keep people on the phone. I know how precious time is to everyone. So I just want to confirm no more questions at this time. Right, operator?

Operator: No, ma’am. No more questions.

Mari Franks: Okay. Well I just, on behalf of HRET and my team here, we are so grateful for all the speakers and the State hospital associations and your efforts to make sure that we are constantly improving care and driving down all of our hospital-acquired infections, specifically CLABSI, and we could not do this without you, so thank you so much and we look forward to working with everyone here in the future, and please stay tuned. We’re going to have a November 15th teleconference, that’s our next series, our next call in this series, November 15th, same time. We will be focusing on how CUSP empowers nurses. So we touched upon it a little bit at the end of this call here, but we’re going to devote an hour with two separate hospitals and their experiences speaking about what they did and their strategy and best practices to bring home to your own hospital, so stay tuned for that. Paul will be sending out notification regarding details with that session. So thank you again to everyone and to our presenters. It was a wonderful call. Have a great afternoon.

Male Speaker: Thank you.

Operator: This concludes our teleconference. You may now disconnect your line.

Page last reviewed April 2013
Page originally created April 2013
Internet Citation: Best Practices: How Successful Units Engaged Their Senior Executive Leaders (Transcript). Content last reviewed April 2013. Agency for Healthcare Research and Quality, Rockville, MD.