Abha Agrawal, M.D., chief operating officer and vice president of medical affairs at Norwegian American Hospital in Chicago, has a very impactful story to share about quality transformation in hospital care delivery and operations. Recruited by Jose R. Sanchez, who in October 2010 became president and CEO of the 200-bed community hospital, Agrawal joined a senior executive team determined to transform what had been a floundering care facility into a model of the new healthcare. Dr. Agrawal arrived a year and a half ago, as the push for transformation was gaining speed, and proceeded to use all of her considerable energy to help the executive team move from a situation in which the Joint Commission had been threatening to strip Norwegian American of its accreditation over patient safety and cleanliness problems, to one in which the hospital, which serves an underprivileged community on Chicago’s Near Northwest Side, is becoming a model of care delivery transformation.
Dr. Agrawal will be giving the closing presentation on Wednesday, June 11, at the Health IT Summit in Chicago, to be held June 10-11, sponsored by the Institute for Health Technology Transformation (iHT2). (Since December 2013, iHT2 has been in partnership with Healthcare Informatics, through its parent company, the Vendome Group LLC.) She spoke with HCI Editor-in-Chief Mark Hagland recently regarding her involvement in clinical transformation at Norwegian American Hospital. Below are excerpts from that interview.
The journey that you and your colleagues at Norwegian American Hospital have been on has been quite a remarkable one, hasn’t it?
Yes, and it’s really been about progress around a blend of quality and patient safety improvement, and the electronic health record. So… I started here a year and a half ago. It’s been one of the most challenging yet rewarding experiences for me professionally. This is a hospital that had very serious challenges and might have been on the verge of closing two years ago. We were in a financial hole, losing money every year; there were regulatory challenges and citations from CMS [the federal Centers for Medicare and Medicaid Services]. The [patient safety and care quality] scores were low. Three or four years later, it’s a true story of transformation on multiple accounts. On the financial side, which is very important, well, you know the old saying about no mission without margin. In fact, we have closed two years in a row in the black; the same for this fiscal year. In fact, we made a small profit last year, which is a tremendous accomplishment for a hospital like this.
Abha Agrawal, M.D.
How did that happen?
Our primary focus was quality. We made a very deliberate decision that if we are not providing quality care, we were not going to improve financially; and vice versa. When I arrived here, we got an “F” from the Leapfrog Group, which is the lowest score you can get. Even before receiving the score, one of the most pressing tasks I had before me when I joined was to improve quality and safety. So we put structures in place, created quality metrics and dashboards, quality committees, and really created a campaign of engaging the staff and raising awareness over how crucial this was.
In fact, I put a sign on my desk that says, “How does it help the patient?” Any discussion, if it doesn’t answer the question, how does it help the patient, I didn’t want to pursue it. I made the statement that quality should become a part of our DNA. As a result, in one year, by last year, we went from F to C, and this year, to B. So we’ve gone from an F to a B in two years. And on a personal note, that was the first time I danced with joy over getting a C, personally. My parents would have been embarrassed. We physicians are high achievers! But we were above average on quality, on value of care, and we had about a 250-400 percent improvement on quality, resource utilization, and value of care. That was a tremendous achievement.
How did you achieve that?
My CEO chose me because of my background; in my former role in New York, I put tremendous emphasis on quality and patient safety. That’s when I started to edit my book on quality and patient safety as well. And you know, there are no shortcuts. We established a team, hired a very good director of quality; built a quality team; have a new chief nursing officer, and have a number of new nurse leaders. And then we created momentum, I would say, around quality and safety. That needed to become a part of our culture. Every town hall meeting we had, we talked about quality and safety. We started senior leaders’ rounds, where several of our senior executives would round on a unit on a monthly basis; and each one of us adopted a unit and rounded on that unit once a month.
So we created this whole movement to make quality and safety a part of our fabric. I personally went to every departmental meeting and town hall, and talked about quality. And there are many more people talking about it now, and my little sign is being replicated everywhere. I think people got inspired by that singular focus on improving the quality of care for the patient. Our singular mission is to provide the highest quality of care for every patient in Humboldt Park. And this is a socially disadvantaged area; but our patients still deserve the highest quality of care we can provide.