Becker's Hospital Review

114 THOUGHT LEADERSHIP Steal this idea: How a 'D' grade redefined the role of quality teams at Piedmont Health By Leo Vartorella L eigh Hamby, MD, CMO of Atlan- ta-based Piedmont Health, thought his system was effectively executing quality initiatives when a surprising Leap- frog rating shook the status quo. Suddenly, he realized his team needed to reexamine their understanding of quality. Dr. Hamby and his team consolidated in- dividual quality programs from hospitals across the Piedmont system to form the System Quality Office, which standardized all quality efforts. As part of Becker's "Steal this idea" series, Dr. Hamby discusses how he instituted and scaled the System Quality Office and how it has helped all 11 of Pied- mont Health's hospitals. Dr. Hamby invites you to steal this idea. Editor's note: Responses have been lightly ed- ited for length and clarity Question: What led you to create the System Quality Office? Dr. Leigh Hamby: In 2014, our largest flag- ship hospital received a 'D' in the Leapfrog ratings. It was really a wake-up call because, prior to that, all of the ongoing quality indi- cators we held ourselves to were fine. At the time, our structure for quality was pretty traditional, with each hospital determining its own quality priorities. The Leapfrog rating really forced us to think about the function of our quality departments and the service quality teams deliver at the bedside. We asked all the folks that work in quality roles to tell us what they did on a daily basis to achieve this function. Our hypothesis was that you really need four things to improve care at the bed- side: surveillance, analysis, design change and implementation change. We found 80 percent of what our people were doing was surveillance and analysis. They were reviewing charts and defects. If somebody had an infection, they'd run over there, re- view the chart and say what went wrong. In terms of the time spent actually designing and implementing improvement at the bed- side, we had very little activity — I would say 20 percent. So we had people that were good at counting things — and again, that's an important skill — but that's about all we could do. Q: What did you do to address this issue? LH: We redefined all the job descriptions in our collective functions. At the time it was all hospital-based. We brought it into a single corporate office with 100 employees to say all of these resources are going to be corporate assets that we move around the system as needed, based on where the problems are. We mapped out a standard work process. We realized we have three or four people looking at the same chart three or four times. Instead of eight people spending 10 percent of their time on surveillance at hospitals, let's have one person do it for the whole system, and let's automate it. Let's build a computer algo- rithm that says if the lab result is normal, you don't even need to look at it. We wrote pretty simple computer algorithms that highlight the reports we should probably start with so we could surveil the whole system with just one or two people. en we reloaded our labor balance. Instead of being 80 percent finding problems, 20 per- cent fixing problems, we changed it to 50-50. Fiy percent of the labor hours we had were surveillance and analysis, the other 50 per- cent were people who were going to drive im- provement teams that would define standard work processes and actually help implement them at the bedside. en we said let's define the top three or four existing problems we already know about, and let's fix those so they stay fixed rather than re- view more charts looking for more problems. Q: What is the design process like? LH: We needed people who could actually de- sign standardized processes. So we actually got process engineers, and now half of our staff is clinical and half are process engineers. Our two business units are led by a process engineer. One leads a surveillance and analysis group, and the other leads the improvement group. We've actually gotten really good clinical feedback. Because these engineers don't have a lot of clinical experience, they can ask ques- tions and involve the clinical staff to design these processes that help standardize care and lower incident rates. It helps to have a di- alogue where a surgeon or physician explains the rationale behind their process. ose in- sights allow the engineers to have a good, un- biased conversation with clinicians. Every order set or every standard work process is co-designed with physicians who have these engineers alongside them, as well as the other clinicians. e doctors like having the engi- neers help them pull the data, ask the ques- tions and map the process so they can really be le to think about the actual delivery of care. Q: How do you implement these standard processes? LH: We have a very specific way of doing it, so that as we move along, we share it with the rest of the organization. We test processes for 60 days before we roll them out systemwide. We have a very systematic approach, and we are constantly looking for feedback. Most organizations already know about all of the problems, but they don't work on a lot of them. So in our way of looking at things, we don't go actively looking for more problems. We focus on the ones that we know about and work on them. Our effectiveness measure is to reduce harm to patients. When someone comes to me and goes, "Hey, there's a really important project, I need your help with X, Y, and Z," the first thing I'm going to ask is how many people are being harmed by that now, because I've got my team cur- rently working on something that we know has either caused harm in the past or is suffi- "In 2014, our largest flagship hospital received a 'D' in the Leapfrog ratings. It was really a wake-up call because, prior to that, all of the ongoing quality indicators we held ourselves to were fine." — Dr. Leigh Hamby, CMO, Piedmont Health

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