OneThousandOne represents the amount of time, verbally, that it takes to count to one second. In this one second of time, a great thing happened at Nebraska Medicine. In fact, several great things probably happened. A patient was cured, a researcher found the missing link, a nurse treated an injury, a doctor comforted a family or maybe a child just smiled.
Spring | Summer 2008

The Quality Journey

An unplanned trip to the emergency room is not what most of us would consider a “memorable experience.” But when you can take an otherwise forgettable experience and turn it into a positive one, that’s something to remember. That’s what The Nebraska Medical Center did for one young couple recently confronted with a medical emergency while traveling through the state to see family over the holidays.

The McCorry family remembers that day quite well. They were traveling from Durango, Colo., to embark on a 1,500-mile road trip to South Bend, Ind., with their three children, the oldest just 5 years old. As they drove along Interstate 80, Lisa McCorry began experiencing severe back and stomach pain. A quick call to their doctor back home advised them to find the nearest hospital, and fast. Almost miraculously, as they pulled off the highway, they immediately saw a blue hospital sign which led them to The Nebraska Medical Center. When they arrived at the emergency room, Lisa was quickly whisked away while David went to park the car and unload the children.

“From the moment we arrived, we received top-notch care and attention,” says David. An emergency room attendant helped entertain the children while the medical staff diligently tended to Lisa. “We walked into a strange town that we didn’t know anything about, and we got so much help everywhere we turned,” says David. “The hospital staff helped me with everything from finding dinner to locating a hotel room. We will always be grateful to Omaha and remember the generous and selfless spirit we encountered on an otherwise forgettable road trip.”

Call it luck or call it fate that all of the stars aligned for the McCorry family that frigid night in December. But The Nebraska Medical Center likes to believe it was much more than that.

“From the moment Glenn Fosdick came on board, he has made quality our burning platform for change.”
Bill Dinsmoor
Chief Financial Officer

What happened that night is a product of the “quality journey” that The Nebraska Medical Center embarked on nearly seven years ago when CEO and President Glenn Fosdick took the helm and made it this organization’s top priority.

“From the moment Glenn Fosdick came on board, he has made quality our burning platform for change,” says Bill Dinsmoor, chief financial officer at The Nebraska Medical Center. “We are creating an environment where quality is embraced by the entire organization and has become embedded into our culture. Everything we do now involves raising the quality bar. Our primary mission is to improve the experience for all of our stakeholders from patients and their families to our employees and clinical staff.”

And this begins at the point of contact. Dinsmoor likens it to a football team. “It takes more than one or two players to win a game,” he says. “It’s about an entire team all working together toward the same goal.”

At The Nebraska Medical Center, that team consists of more than 5,000 employees all working to make sure patients have the best experience and best outcomes possible.

Fosdick says he has had his eye on quality long before he came to The Nebraska Medical Center. “During the 80s, I watched other industries delve into quality improvement and saw great things happen,” he says. “That’s when I also saw incredible relationships to healthcare.”

“The biggest problem across all industries is that we talk about quality improvement, but we don’t do much about it. It becomes the flavor of the month. As the CEO at The Nebraska Medical Center, my job is to make sure quality is reinforced in everything we do. This is the way we provide patient care here, and this is our priority as long as I am CEO. Great organizations understand what their priorities are and this is ours.”

To keep the hospital’s efforts focused, Fosdick established five “Priorities for Excellence” that form the foundation of all its quality efforts. These include: be the most attractive environment to practice medicine; be the most attractive employer; enhance clinical quality and patient safety; provide the highest quality customer service and care; and operate a culture of clinical, operational and financial accountability.

To arm the hospital with some quality fire power, the hospital has engaged its staff in a number of quality methodologies and initiatives, many borrowed from other industries such as automobile, manufacturing and aviation.

For instance, Fosdick hired a General Electric team to train staff on the Six Sigma quality program. Six Sigma, which originated at GE, is a data-driven approach and methodology aimed at eliminating defects and waste in any process. Six Sigma focuses on process improvement and variation reduction by engaging staff in Six Sigma improvement projects. The hospital recently celebrated its 50th quality Six Sigma Report-Out (a monthly meeting of managers and physicians to report on on-going quality projects), proving it isn’t just a trend, notes Fosdick.  

Then he enlisted 60 of his top-level staff to undergo training in the Change Acceleration Process (CAP). CAP involves getting key stakeholders at the table to address a problem and come to a resolution in a short time frame.?The process not only focuses on the development of the solution, but it also focuses on the acceptance of the plan by all involved – an often forgotten step that can impede implementation.

The hospital also adopted Lean, a quality improvement process developed by Toyota that focuses on standardization, quality improvement, cost reduction, and efficiency to increase overall customer value. The process has been credited with Toyota's steady growth from a small player to the most valuable and the biggest car company in the world. The Lean process invites staff to identify a process to be changed, the barriers that are present, solutions to remove the barrier and measurements for effectiveness.

And one of the most recent quality initiatives – Crew Resource Management (CRM) – is a set of proven communication tools and safety processes adopted by the aviation industry over the last 25 years. These safety tools have been attributed to helping reduce flight accidents and transform the aviation industry into one of the safest in the world. “Patient safety and quality are top initiatives for our institution,” says Stephen Smith, MD, chief medical officer of The Nebraska Medical Center. “We think CRM will take us another huge step closer to becoming one of the safest medical centers in the country.”

A willingness to “think outside of the box” has been key to the hospital’s successful quality efforts, notes Fosdick. “I said from the beginning, we have to stop thinking like a hospital.”

“I said from the beginning, we have to stop thinking like a hospital.”
Glenn Fosdick, FCHE
Chief Executive Officer and President

And it’s paying off in big dividends.

With The Nebraska Medical Center’s quality movement in full speed, the hospital has seen steady improvements and efficiencies in numerous areas including customer service, delivery of care, patient and employee satisfaction, reduction of medical errors, lowering average lengths of stays and mortality.

Joe Graham, chief operating officer, says Fosdick’s steadfast commitment to quality has been critical. “Without a commitment from leadership, it’s like pushing a rock up hill,” he says. “A keen focus on quality has required a redirecting of resources and a change in culture. These things would not be possible without the vision and leadership of the CEO.”

“Mr. Fosdick has always stated that if you have quality, everything else, including the bottom line, will follow,” says Dr. Smith. “Research indicates that if top administration and boards are highly engaged in quality, it trickles down to the frontline staff, which in turn impacts quality of care; patient, employee and physician satisfaction; staff retention; and community perception of your hospital. They are all tightly intertwined.”

Some of these quality improvements are clearly visible to the consumer. For instance, the Emergency Department’s recent expansion and remodel includes such patient amenities as a bigger, more comfortable waiting area, more convenient access, private rooms, state-of-the-art X-ray equipment and MRI and CAT scans just a few steps away. In the cancer treatment center, staff was able to reduce the waiting time from check-in to start of treatment to 20 minutes or less by making changes to patient flow and processes.

In another quality improvement project, the hospital reduced lab turnaround by 20 percent. Part of this was obtained by looking at the distance lab personnel traveled each day to deliver lab tests. By making some simple changes, the department was able to reduce 177 miles of walking distance normally traveled by lab staff each year. For the consumer, that translates into quicker lab results, less waiting time and faster initiation of treatments.

Other important quality improvement efforts have focused on how clinicians provide care to improve outcomes and reduce errors. For instance, the hospital is working toward 24/7 staffing of its intensive care units by board-certified intensivists to provide a more consistent level of care at all times of the day. The medication reconciliation program requires that all medication orders undergo a second review by a pharmacist to prevent medication errors.

The hospital’s focus on clinical quality has also landed it recognition for its nursing excellence. In 2007, The Nebraska Medical Center was designated a Magnet Hospital by the American Nurses Credentialing Center (ANCC) for extraordinary nursing care. The Magnet achievement is widely viewed as the “gold standard” in the nursing profession and is one of the highest honors a medical center can achieve.

“The components necessary to achieve the Magnet designation require institutions to really function a level above other hospitals – it’s going beyond the norm,” says Rosanna Morris, RN, senior vice president and chief nursing officer at The Nebraska Medical Center. “We have solid systems and programs in place to achieve high-end clinical quality, professional growth and development of staff as well as research initiatives.

“When there is a strong organizational focus on quality, all boats rise, because it challenges all clinicians and departments to look at their clinical practice and ensure we have good systems in place to offer optimal care in everything we do. All of these efforts combine to elevate the quality of care we provide.”

As a result of quality improvement efforts in stroke and heart care, The Nebraska Medical Center was recently awarded the Gold Seal of Approval from The Joint Commission for its stroke program, myocardial infarction and heart failure disease management programs. Joint Commission accreditation is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards that result in optimal patient care.

“Adopting these quality improvement programs has armed us with some very powerful tools to bring about profitable change in this organization,” says Dinsmoor. “It has been very exciting to see how people have refocused their energies and bound together to create change.”

Carl Greiner, MD, chief of the medical staff from 2006-07, says he has seen significant changes in the way medicine is practiced in the 25 years he has been at The Nebraska Medical Center. “Back then, medicine was like a cottage industry of craftsmen who practiced as they saw fit,” he says. “Today, we’ve developed a more corporate model to practicing medicine in which physicians must work under certain guidelines and standards. It provides more consistency in the care we provide and it holds doctors accountable.

“The sense of empowerment that every staff member can make a difference and the idea that mistakes require review and assessment has been powerful. In the old days, we used to say that mistakes sometimes happen. Now we say, ‘how do we prevent that from happening again?’ It has been a very powerful thing for American medicine.”

“Every hospital today is trying to improve,” says Graham. “But I doubt anyone is moving on as many fronts as we are. Quality is something we have really embraced as an organization. Quality improvement is a way of life and a way of doing business. It has really set the stage for everything we do.”

Fosdick says he looks forward to the day in the not-so-distant future, that key quality and service performance indicators will be available to the public to allow the health system to differentiate itself from its competitors.

“As medicine changes and evolves, we will continue to find ways to practice medicine more effectively and efficiently,” says Fosdick. “This is not just a passing fad. I believe we have moral responsibility to the people we serve to do everything we can to ensure we provide the safest and highest quality of care possible.” And so, the quality journey continues.

A Symbol of Quality

In every industry, there seems to be a brand or product that rises above the others to provide a quality product or stellar customer care. For instance, Toyota has become known for its reliability. You know you can count on Federal Express to get your package delivered on time. And at IBM, service is number one.

The Nebraska Medical Center is striving to become a symbol of quality and superior customer care in healthcare.

Since embarking on a quality journey nearly seven years ago, CEO and President Glenn Fosdick has made quality and safety the hospital’s number one priority throughout the entire organization. And from all counts, it’s beginning to pay off. The hospital has stacked up an impressive number of awards and recognitions over the past few years for its extraordinary care and commitment to quality.

J.D. Power and Associates

For the third consecutive year, The Nebraska Medical Center is being recognized for its extraordinary patient care by J.D. Power and Associates. Based on the opinion of inpatients, The Nebraska Medical Center has been designated as a Distinguished Hospital for Service Excellence and for Cardiology Services. The Nebraska Medical Center joins a select group of hospitals nationwide that has demonstrated the ability to consistently deliver an outstanding patient experience.

Consumer Choice Awards

The Nebraska Medical Center is the only hospital in Nebraska to earn the 2007 Consumer Choice Award, which represents the voices of thousands of patients across the state. The National Research Corporation (NRC), an independent research firm based in Lincoln, Neb., interviewed more than 200,000 households to find out which hospitals offer the highest quality of care. This is the fifth time in six years that The Nebraska Medical Center has earned the Consumer Choice Award.

Thomson 100 Top Hospitals:
Performance Improvement Leaders

The Thomson 100 Top Hospitals national list identifies those U.S. hospitals that are improving the fastest and most consistently in clinical quality and efficiency. Collectively, the 100 Top Hospitals Performance Improvement Leaders had fewer than expected deaths and complications and increased expenses just 6 percent on average, during the five-year study period compared to an 18 percent increase at other hospitals.

Edgerton Award

The hospital achieved recognition in the Edgerton Award Program at the level of Progress from the state of Nebraska. Not only does this quality award program recognize The Nebraska Medical Center’s emphasis on quality healthcare for patients and their families, it also distinguishes the hospital’s commitment to quality management and corporate practices which are designed to grow and support excellence. The Edgerton Quality Award Program is administered by the Nebraska Department of Economic Development in collaboration with the Nebraska Manufacturing Extension Partnership.

Quest for Excellence

The hospital has been recognized for two consecutive years by the Quest for Excellence award, presented annually by the Nebraska Hospital Association, CIMRO of Nebraska, the Nebraska Department of Health and Human Services and the Nebraska Association for Healthcare Quality for showcasing exemplary and reproducible models of patient care to the rest of the healthcare community.

Rising Star Award

The Nebraska Medical Center was recognized by the University HealthSystem Consortium (UHC) as a “Rising Star” along with six other UHC-member organizations for its significant improvement in ranking over a 12-month period in UHC’s 2007 Quality and Accountability Study. The study looked at performance in patient safety, mortality, clinical effectiveness and equity of care. The UHC is an association of 97 academic medical centers and 153 allied hospitals that represent nearly 90 percent of the nation’s nonprofit academic medical centers.

Radiation Oncology Services Accreditation

The Nebraska Medical Center is the only hospital in Nebraska and in the region to be awarded a three-year term of accreditation in Radiation Oncology Services as a result of a recent survey by the American College of Radiology (ACR). The ACR is a national organization serving more than 32,000 diagnostic-interventional radiologists, radiation oncologists, and nuclear medicine and medical physicists with programs focusing on the practice of medical imaging and radiation oncology and the delivery of comprehensive healthcare services. The ACR awards accreditation to facilities for the achievement of high practice standards related to quality patient care after a peer-review evaluation of the practice.

Next article in the Spring | Summer 2008 issue of One Thousand And One:
Gift of Life