Beryl Rosenstein, M.D.
As one of the top-rated academic health systems in the United States, executives at Baltimore-based Johns Hopkins Medicine assumed they delivered the safest care possible. However, when data from an internal survey on patient safety revealed a gap between such perception and reality, leadership knew changes were necessary.
“We started thinking about how we could get hospital leaders involved in knowing what goes on at the front line and understanding patient care at the grassroots level,” says Beryl Rosenstein, M.D., vice president for Medical Affairs at Johns Hopkins Hospital.
After brainstorming, Johns Hopkins developed an initiative calling for senior leaders to adopt a hospital unit. This entailed holding monthly meetings with the staff, going on rounds, and acting as they unit's advocate.
Since 2003, around 35 leaders have adopted units, where they help manage issues that can be as simple as needing a new computer or an extra EKG machine, or as complex as preventing patient falls or deploying order entry. “Whether they are improvement changes, which don't require a big investment, or capital-intensive changes that take place over a longer period of time,” says Rosenstein, “I think just having the executives there gives the frontline staff a sense that they really care and that things can change.”
Chip Davis, M.D., vice president for Innovation and Safety at Johns Hopkins Medicine, agrees. “We found that senior leaders can knock down barriers and move things along that perhaps the units themselves haven't been able to,” he says.
The goal, Rosenstein says, was also to make the organization seem a bit smaller, although it was no simple feat. John Hopkins Medicine is a $4.1 billion system that includes the Johns Hopkins School of Medicine and three facilities: Bayview Medical Center, Howard County General Hospital, and Johns Hopkins Hospital, which houses 1,017 beds and employs 1,714 full-time attending physicians and 1,089 residents and fellows.
With an organization of that size, it can be easy for staff to feel they are just a number. That's where the Center for Innovations in Patient Care and Quality comes into play. Led by Davis, who serves as executive director, the Center was created to improve care by providing staff with the means to correct system flaws and direct organizational change through initiatives like the adopt-a-unit program, also referred to as Comprehensive Unit Safety Program (CUSP).
Rosenstein says the initiative, which was led by Peter Pronovost, M.D., a professor of anesthesiology and critical care medicine, is “part of a broader institutional commitment to improve patient safety.” (See sidebar). Units that have benefited from CUSP include the Pediatric Intensive Care Unit (PICU), the Blood Bank and the Wilmer Eye Institute.
Case #1: The PICU
Three years ago, during a week in which her workload was uncharacteristically light, Stephanie Reel, CIO and vice president for Information Services at Johns Hopkins Medicine, spent a few days in the PICU. Reel learned, through shadowing a nurse, that the unit needed more needle containers in places that were easily accessible.
“I made a phone call that night and they got extra n eedle stick containers,” Reel says. “It was a very easy thing, but it was something that the nurse said would make the environment safer, so we did it.” By making herself available, even for seemingly minor issues, Reel was able to earn the staff's trust. As a result, Reel says, more clinicians started attending the monthly meetings she held in the unit and offering suggestions for improvement.
Ivor Berkowitz, M.D., the PICU's medical director, asked Reel to install video conferencing at the community hospital so he could consult with patients before they were transported to Johns Hopkins Hospital. “We were able to put inexpensive video technology in the other hospital's emergency room,” Reel says. “It was an example of something we were able to do fairly quickly to hopefully make a difference in a child's outcome.”
Another benefit of the initiative is its effect on larger IT projects. When Johns Hopkins was rolling out physician order entry, Reel was able to monitor the progress nurses and clinicians were making with the new system, which helped her both as CIO and as an adopted leader of the PICU. “We wanted to make sure that order entry was making it safer for patients in the ICU,” she says. So when the nurses explained that if they could view two sets of information simultaneously, it would improve their decision-making, Reel gave the green light to deploy dual-monitored computers-on-wheels in the unit. “It was the right decision for that particular group,” she says.