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Creating and Sustaining Quality-Driven Transformation at North Memorial

February 9, 2014
by Mark Hagland
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Jeffrey Vespa, M.D., shares his perspectives on system-wide quality work at North Memorial HealthCare

Hospitals and health systems nationwide are struggling these days to create a healthcare system of improved care quality and patient safety, efficiency, cost-effectiveness, accountability, and transparency. Yet a small number of pioneering organizations are already charting a bold, clear course—among them, North Memorial HealthCare, a two-community-hospital health system based in Robbinsdale, a suburb of Minneapolis-St. Paul, which encompasses the 300-bed North Memorial Medical center in Robbinsdale and the 100-bed Maple Grove Hospital.

Leaders there have launched themselves on a path that will position their organization beautifully to adopt the principles of the new healthcare, and it is one that is already reaping rewards. The core of what the leaders at North Memorial are doing is to leverage healthcare IT to facilitate enterprise-wide continuous quality improvement, not only for its own sake, but to achieve clinical transformation across diverse patient care service lines in the organization.

As a result, the leaders at North Memorial HealthCare were named the co-second-place winning team in the Healthcare Informatics Innovator Awards program. They will be honored at the Healthcare Informatics Innovator Awards reception in Orlando in February, during the annual HIMSS Conference.

All the members of the leadership team provided HCI with extensive interviews. Below are excerpts from HCI Editor-in-Chief Mark Hagland’s interview with Jeffrey Vespa, M.D., medical director for clinical quality for the health system. Dr. Vespa shared his perspectives with Hagland on the work that he and his colleagues are doing at North Memorial. Previously, an interview with J. Kevin Croston, M.D., the organization’s chief medical officer, was published; additional interviews with other leaders at North Memorial will be published forthwith. Below are excerpts from the interview with Dr. Vespa.

In my interview with him, Dr. Croston offered his perspective on the enterprise-wide quality initiative at North Memorial, from his CMO perspective. As medical director for clinical quality for the system, what do you see as the factors driving you and your colleagues forward in this broad initiative?

A lot of it is centered around the value proposition that’s out there for healthcare. Considering that quality-cost equation, we’ve elected to pursue the quality part of it, assuming that we will gain the cost benefit along the way. And historically, when it comes to quality improvement work, we’ve employed a traditional model where you build a team and goals, and try to implement a project, and that of course, is not new. The opportunity we saw was that, without good, real-time data, it was hard to show improvement and then provide the feedback to individuals and teams about their performance. People may try to impalement change, but then the question is, did you really do it?

Jeffrey Vespa. M.D.

And we’ve found that, after an initial year where you have a focus on a process, and you do well, you would sort of lose your gains over time. And the flame would sort of dwindle over time on quality processes. But the data lives forever. And so we can put that data back into leadership’s hands, to feed that back to their frontline staffs, even after a team may not be assembled anymore, you can sustain change. Another factor involved in traditional quality work has to do with turnover of staff. You might have a great physician leader; for example, we had a great physician leader helping to guide a program around readmissions work, and he started some really great processes, but then he left the organization, and the gains evaporated. So by building these data systems, even if someone were to leave, we knew we could sustain work that we’ve done.

What timeframe has been involved in this broad initiative?

We really started the new, conceptual approach in 2011. And that was in a partnership with Health Catalyst, an electronic data warehouse company. They’re a vendor. And that was a very important piece of all of this, building that electronic data warehouse.

This was your first enterprise data warehouse?


And when did that go live?

In 2011, under the management of Greg Kern, the manager, measurement and reporting, for the health system. And, at the same time, Actually, we also formed COLT, the Clinical Operations Leadership Team. And the intention there was to ensure that our leadership was aligned between and among physicians, nursing, finance, informatics, measurement and reporting, and quality. All those leaders are involved in COLT. Currently, there are probably about 25.

What was it that you all decided?