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What I Learned in Detroit and Pittsburgh

November 2, 2011
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Among the pioneering patient care organizations nationwide, culture is the true “x” factor

I’ve had the privilege of getting away from my desk and visiting a number of patient care organizations over the years, and the experience is always revelatory. While practical reality mandates that most of my reporting be phone-based, it is always a revelatory experience to go into a hospital or medical group and breathe in the atmosphere—to speak to end-user clinicians and staffers, to hear people’s stories, to sit in on meetings, to spend a day or two with the leaders of an organization. It’s impossible not to gain some additional, often crucial, insights in that way.

Two organizations that particularly come to mind in this regard are Children’s Hospital of Pittsburgh and the Harper/Hutzel Hospitals at Detroit Medical Center. I visited Harper/Hutzel-DMC in December of 2008, and Children’s of Pittsburgh in the summer of 2009. While different in certain ways, CHP and Harper/Hutzel shared numerous characteristics in common: both had consistently been working intensively to improve patient care quality and patient safety; both had leaders who had brought together multidisciplinary teams that encompassed senior administrative management, IT management, and all the major clinician groups (physicians, nurses, pharmacists), and had forged teams that were able to work together for the common good; and both organizations had already spent some time successfully leveraging clinical information systems to move forward in all the areas of patient safety, care quality, efficiency, and effectiveness on which those teams had been working.

At the time that I visited CHP, as well as two other hospitals in the 20-hospital University of Pittsburgh Medical Center (UPMC) health system, in 2009, I had no idea that CHP’s leadership team, led by then-CIO Jacqueline Dailey and by CMIO James Levin, M.D., Ph.D., would end up being the first-place-winning team in the Healthcare Informatics Innovator Awards program in 2010. But when I visited the Detroit Medical Center folks (led by DMC CIO Michael LeRoy) in December 2008, it was expressly to interview them about their first-place win in the program, which landed them on the cover of HCI in the April 2009 issue. In both cases, not only did everyone in each organization treat me wonderfully as a guest; both the CHP and DMC folks provided me with an open window through which I could form perceptions about their cultures.

And though no hospital culture is perfect—nothing human-created is, of course—both the Harper-Hutzel/DMC and CHP/UMPC cultures impressed me greatly, because theirs is the type of organizational culture in which true innovation can thrive. There is less territoriality in these two cultures, and there is, importantly, an atmosphere in which professionals from every clinical and administrative discipline can come together under the banner of clinical performance improvement on behalf of patients, and ask the tough questions and make needed changes.

And if you read the April 2009 and March 2010 cover story packages, you’ll see what I mean. Within both organizations, there has been a sustained willingness to drill down numerous levels to find out where the problems are in care delivery, to systemically work to fix those problems, and to come up with ingenious new solutions not only to fix problems, but to strategically move forward to create new levels of clinical and operational effectiveness. In other words, it’s no longer about piecemeal “improvements,” but rather about continuous, sustained, supported effort to rework patient care delivery on behalf of patients, families and communities.

Fundamentally, I have found that it is this cultural foundation that provides the true basis for IT-facilitated care delivery innovation, not only at Harper-Hutzel/DMC and CHP/UPMC, but at organizations across the country that are making real progress and showing real healthcare IT leadership. It is like the farmland that has carefully been prepared and fertilized in order to allow for successful planting.

So it’s not at all surprising, after a few years of our magazine’s recognizing multidisciplinary teams through our Healthcare Informatics Innovator Awards program, that the organizations whose teams have won the top three places in that program continue to consistently be ones in which the ground has been tilled, organizations whose most senior leadership has made it possible for innovation of all kinds, clinical and non-clinical, to happen. And I look forward to reviewing all the submissions to our program this year, and to our magazine’s recognizing still more teams. May the innovation proceed! (And don’t forget to send in your submission today!)