Becker's Hospital Review

19 CMO / CARE DELIVERY "Sometimes the challenge is, how do we marry our big-picture and top-down priorities with those that are at the local level, which may be related to very specific patient populations," said April Taylor, vice president of operations and COO at e Johns Hopkins Hospital in Baltimore. One of Johns Hopkins Medicine's strategic pillars is clinical excellence, which encompasses quality and safety. Within that, there is a shared set of systemwide goals and priorities, much of which are foundational measures of quality and safety that are tracked annually and do not change — elements such as hospital-acquired infections, readmissions and length of stay. Reviewing safety dashboards during daily unit huddles and multidisciplinary rounds are a core part of centering care team members' focus on these areas at all of the health system's hospitals. Each hospital also has a structure in which clinicians in different specialties partner with leadership to ensure there is enough flexibility for them to address challenges that may be highly specific to the patients for whom they are caring, Ms. Taylor said. "ere needs to be a level of flexibility and fluidity in terms of how we work with folks to really be able to address challenges at the local level because the challenges for neuroscience, for example, are going to be very different than those of heart and vascular or pediatrics," she said. Similarly, Jefferson Health leverages its OnPoint platform to elevate focus on systemwide quality and safety goals. Each day, units review leading indicator real-time dashboards during their huddles, which flag opportunities for things such as removing a foley catheter or performing a CHG bath to prevent a central line infection. "at is something that's very deeply embedded for us," Dr. Henwood said. "ose dashboards get run multiple times during unit huddles that happen at shi change across the entire organization and have helped us with improvement efforts in the domains that we have focused on in those radar dashboards," such as sepsis. She described the OnPoint team's role as serving as an enabler to embed quality deeper into the organization. Rather than being a separate department that owns responsibility for quality improvement, the team designs systems to best support clinicians in delivering safe care and centering their focus on core quality and safety metrics. "How can we ensure the best outcomes, recognizing that our teams are very busy — sometimes there's an interruption and they might miss something or forget," Dr. Henwood said. "So how can we support them in delivering those outcomes?" ese structures help maintain attention on evidence-based care and reduce unnecessary variation, while still enabling local teams to tailor care as needed. "We try to have things as similar as possible, but as different as necessary," Dr. Henwood said. "We recognize that we have a lot of different care settings, from designated rural hospitals to quaternary urban referral settings, and that we need to think about the things that can and should be similar across those domains in terms of evidence- based care pathways, but also recognizing that there's different resources that different locations have and/or different challenges that our patients are facing." n MedStar's 'game changer' in closing maternal care gaps By Mariah Taylor M edStar Washington (D.C.) Hospital Center is closing the gap on maternal and infant health disparities with a new program, The Washington Post reported Jan. 21. Black birthing people in the district account for about half of births, but 90% of pregnancy-related deaths, according to a CMS maternal mortality review committee. Black mothers were less likely to enter prenatal care in the first trimester and twice as likely to have a baby with low birth rate, health department data found. "A lot of people have tried to crack the nut on disparities and it hasn't moved, but to actually see movement, we're very proud of that," said Angela Thomas, vice president of health-care delivery research at MedStar Health and lead author of a case study published in The New England Journal of Medicine, told the Post. The Safe Babies Safe Moms program devotes equal attention to patients' medical and social needs. The program, funded by a $27 million grant and $3 million investment from the hospital, launched in 2020. It consists of 70 interventions available to patients during pregnancy and until their child turns 3 years old. Services include behavioral health screening and counseling, breastfeeding support, remote monitoring of blood pressure, and access to food, housing, legal and transportation assistance. Tamika Auguste, head of women and infant services at the hospital, called the approach "a game changer." "This is the way you do prenatal care and you take care of patients," she told the Post. "It is making sure that as healthcare providers, not just physicians, [but also] midwives, nurse practitioners, our nurses, all of us together, making sure that we really understood where our patients came from." The results speak for themselves. Black patients in the program are less likely to have babies with very low or low birth weight (born under 3.3 pounds or 5.5 pounds before 37 weeks), than Black or white patients who received prenatal care at other facilities. The MedStar program has helped 13,700 births over four years. It plans to expand to six other MedStar facilities in the district and Maryland. n

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