Kxnowledge Prescription Blog

Here live from the Scottsdale Institute Spring meeting at the Camelback Inn some initial observations are bubbling to the surface.  The entire program is focused on how to implement technology tools better to achieve zero preventable death.  The better involves a focus on "people" and "processes."  The Wednesday Executive Presentations I attended yesterday were by Jeff Rose, MD and David Pryor, MD clinical leaders from Ascension Health who discussed their success realizing clinical excellence and "Healthcare that Safe" - one of the three Ascension Health "Call to Action."

"Culture eats strategy for lunch everyday" is the basic premise of their efforts to achieve zero preventable deaths.  Both leaders delivered compelling stories about how Ascension Health is making significant progress to achieve ZPD and overall clincal excellence.  Jeff described the four "C's" of Cultural Transformation and shared stories from the past and future that illustrated how to realize cultural change better:

- Collaboration

- Convergence

- Coordination

- Compassion

- Communication

David focused on sharing the how's of the significant achievements Ascension Health has made in the last three years across 3 universal prioirities and their Priorities for Action - Adverse Drug Events, Mortality Reduction, Nosocomial Infection, Pressure Ulcers, Reducing Harm in the ICU, Falls and Fall Injuries, Perinatal Safety, Rapid Response Teams and Surgical Complications. Ascension Health performance is way below the national average and approaches the 3 sigma level. The factors that have led to success have many dimensions.  A couple of key points is that if you can "create a culture of learning, change and compassion" around saving lives, reducing errors and being a high quality and reliable organization" you have laid the right foundation for growth and quality that supports the right use of technology. During the question and answer he did expand on the critical elements necessary:

1. Clinical Informatics technology tools - but this is not the most important

2. Collaboration sharing infrastructure across electronic and live forum. The e-forum for his organization is the Ascension Health Exchange

3. People and the support in change and learning that is provided

He emphasized it's about setting goals about what "should" be the performance (e.g. Zero Preventable Deaths) not about what he thought they could achieve.  Ascension Health has 434 days left to realize the ZPD goal. 

Much of this hit home because I have been fortunate to be part of the Ascension Health team supporting the change.  But also recently with my Dad being in the hospital for two weeks mostly due to a MRSA and hospital acquired pneumonia after a fall, I had the chance to see first hand a hospital with electronic health record at the bedside.  The EMR did NOT help avoid the two hospital acquired conditions.  In fact in this one instance, the way his nurse used the EMR actually in my opinion added a shield of technology - she didn't delivery compassionate nursing - she was and extension of the machine delivering and checking to insure no additional errors of medication etc.  I didn't see much compassionate nursing going on. The issue here is not the EMR — it's a necessary tool.  The issue is the compassion and workflow reengineering around the use of the EMR tool.  Perhaps in this case it was the way this nurse nurses or the fact that the EMR was slammed in without the 5 C's described by Jeff being addressed.  I would like to see the Ganey scores for the overall organization before and after their EMR along with other stats. Regardless, it points out that engagement of all the staff in becoming a safe high quality organization with a multi-dimensional approach using the 5 C's is essential.

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