Becker's Clinical Quality & Infection Control

22 QUALITY IMPROVEMENT & MEASUREMENT How Keck Medicine is doubling down on care quality By Mackenzie Bean B uilding a strong foundation for safe and equitable care is no easy task, especially amid pandemic-related disruptions and workforce shortages. But Keck Medicine of USC is clearly doing something right — Keck Hospital of USC is a seven-time Leapfrog "A" safety grade awardee, and USC Norris Cancer Hospital was recently named one of Leapfrog's top teaching hospitals for the second consecutive year. e health system is doubling down on quality improvement efforts with the creation of two new executive roles and a quality institute. In November, the system appointed Tom Bates, RN, as its inaugural chief quality officer. His first major priority has been launching the Keck Medicine of USC Quality Institute, which aims to optimize quality and safety practices across the Los Angeles-based system's growing footprint. Keck Medicine also named Mary Virgallito, MSN, RN, as the first chief quality officer of Glendale, Calif.-based USC Verdugo Hills Hospital last fall. She most recently served as the community hospital's executive administrator of quality and patient safety. Becker's recently connected with Mr. Bates and Ms. Virgallito about their new roles, their top priorities for 2023 and the impetus for the new quality institute. Editor's note: Responses have been lightly edited for length and clarity. Question: What are your top quality or safety priorities for 2023? Tom Bates: e Keck Medicine of USC Quality Institute, in collaboration with the appointment of our first-ever chief diversity and inclusion officer, will focus on advancing equitable healthcare for all patients. We are in the process of refining our data acquisition and analysis strategy to ensure our quality and safety initiatives meet the care delivery needs of our specific patient populations. For example, we are working to enhance our ability to screen all patients for social drivers of health (food insecurity, housing instability, transportation needs, utility difficulties and interpersonal safety), and then determine how we might address those factors to improve the health and well- being of patients. Secondly, the Quality Institute is tasked with not only further improving the health system's existing quality initiatives, but innovating to ensure we have a solid quality and safety foundation as Keck Medicine continues to grow and expand its footprint in Southern California and beyond. Our desire is to facilitate a systemwide culture that encourages continuous learning and growing. is foundational approach will be accomplished by embracing and implementing the management practices and leadership principles found in the Institute for Healthcare Improvement's framework for "Whole System Quality." One of the things we are doing to achieve this goal is preparing to roll out systemwide education related to the science of quality improvement, including the use of quality improvement tools such as the Institute for Healthcare Improvement's Model for Improvement and the use of the Plan-Do- Study-Act. Mary Virgallito: As a well-established community hospital serving Glendale and surrounding communities for 50 years, USC Verdugo Hills Hospital is focused on two key quality objectives. First, we are focused on seamlessly transitioning the hospital out of the pandemic emergency by continuing new processes implemented during the pandemic that have proven effective, while returning to pre-pandemic protocols that are now appropriate. For example, we began robust illness screening protocols (not testing) for visitors during the pandemic, which is something we are continuing as we begin to transition out of the pandemic. Similarly, we are now reimplementing broader visitation protocols that were phased out during the pandemic as COVID-19-related hospitalizations have significantly decreased. Secondly, we are committed to mitigating staff turnover by fostering a safe and efficient work environment through strategic, effective quality initiatives. Q: Can you share more details about the Keck Medicine of USC Quality Institute? What was the impetus for this institute and how will it function? TB: e Keck Medicine of USC Quality Institute was born out of the health system's desire to ensure a healthcare delivery system that is clinically effective and efficient, equitable, patient-centered, safe and ultimately meeting the diverse healthcare needs of all Keck Medicine patients. e Quality Institute was created to assist the USC Health System Board in its oversight of the systemwide unified quality and safety agenda. Members of the Quality Institute include quality and safety senior executives and leaders from across the enterprise who collaborate to move Keck Medicine of USC toward a "whole system quality" culture. Q: What have been the biggest quality or safety challenges you've encountered so far, and how have you overcome them? TB: Identifying particular quality initiatives to focus on first and implementing those seamlessly and effectively throughout the entire health system is our greatest challenge given the size and complexity of our health system. Keck Medicine of USC includes Keck Hospital of USC, USC Norris Cancer Hospital, USC Verdugo Hills Hospital, USC Arcadia Hospital and more than 100 unique clinics in Los Angeles, Orange, Kern, Tulare and Ventura counties. We have found the most success through interdisciplinary collaboration between executives and leaders from the Quality Institute and various relevant departments to implement systemwide quality initiatives. For example, one quality metric we are focusing on first is collecting patient- reported outcome data before and aer patients undergo total hip arthroplasty and/ or total knee arthroplasty. MV: COVID-19 presented a unique challenge because it truly disrupted the healthcare industry, particularly from a quality standpoint, because spikes in hospital censuses required an immediate shi in how hospitals provided care with little time and resources to readjust quality measures. USC Verdugo Hills Hospital was able to continue providing quality healthcare throughout the pandemic using several techniques. First, we maintained transparent communications with staff, patients and community through daily forums, department-specific rounds and a robust website to provide as much up- to-date information as possible. Second,

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