Thursday, January 17, 2008

Aspirations for BIDMC and BID~Needham

Here is an email I sent last night to the staff of BIDMC and our community hospital, BID~Needham. Thanks to CEO Cleve Killingsworth and others at Blue Cross Blue Shield of MA for being our partners in the Board training and providing other assistance and encouragement that helped lead to this step: Please see Jeff Krasner's story and an editorial in today's Boston Globe. Special thanks to Jim Conway at the Institute for Healthcare Improvement for his wise counsel and for conducting a significant segment of our Boards' training, and to three unnamed patients who addressed the Boards and powerfully made these issues tangible. Finally, after the text of this email, please read the statement we received on this matter from State Senator Richard T. Moore (Senate Chair of the Joint Committee on Health Care Financing).

There are some things that we do that are meant to transform our hospital, to set us on a path to very high standards that, at first blush, appear so audacious as to be unachievable. But if you never take the leap and set out the goals, you never know what you really can achieve.

Today, we announce such goals, in the hope that they will set the stage for such a transformation.

Several weeks ago, the Board of Directors of BIDMC and the Board of Trustees of BID~Needham met and had serious discussions about what their hopes were for our two hospitals. As the representatives of the community who have fiduciary responsibility for our two non-profit organizations, they decided on a pair of goals that represent their aspirations for us. Of course, the clinical and administrative leadership of the hospital were deeply involved in these discussions as well and provided the technical support for the decisions that were made.

The Boards decided that two overarching types of goals were important. The first relates to patient satisfaction. The second relates to safety and quality of care. Here is the vote that was taken by the BIDMC Board (and a virtually identical one was taken by the BID~Needham Board):

WHEREAS, the Board of Directors, Patient Care Assessment and Quality Committee ("PCAC"), and Patient Care Services Committee ("PCS Committee") of Beth Israel Deaconess Medical Center ("BIDMC") have determined that it is in the best interest of BIDMC to set ambitious and overarching goals related to healthcare quality and patient safety, and patient satisfaction.

To approve the following goals for BIDMC related to healthcare quality and patient safety, and patient satisfaction:

BIDMC will create a consistently excellent patient experience. We will measure ourselves based on national benchmarks and, by January 1, 2012, be in the top 2% of hospitals in the country, based on national survey responses to "willingness to recommend." For this goal, BIDMC will measure itself against a national dataset of all hospitals.

BIDMC will eliminate all preventable harm by January 1, 2012. We will accomplish this by continually monitoring all preventable and non-preventable occurrences of harm, and continuously improving our systems to allow the greatest opportunity to reduce harm.

That Management will develop and implement action plans and programs to achieve these goals, to be reviewed and approved by the PCAC Committee, PCS Committee, and the Board, and will report to the Board, PCAC, and PCS Committee on at least a quarterly basis using defined metrics against which performance will be measured.

Daunting, eh? You bet. Here's more. We will be publicizing our progress towards these goals on our external website for the world to see. In other words, we will be holding ourselves accountable to the public for our actions and deeds. Our steps towards transparency have just been notched up a level.

These Board votes certainly do not mean that we are not already doing a good job now. Our Boards have immense respect and affection for all of the staff who work in our hospitals. They know you take really good care of patients and provide a warm and caring environment for patients and families. But the votes mean that our Board members who represent the community want us to do even better, out of a sense of public service and also out of a sense of pride that we can do better.

Over the last several months, we have seen a hint of what is possible. Our efforts at infection control on the floors and in the ICUs are but a few examples. Meanwhile, too, we have made process and customer service improvements in a number of clinics. We have saved lives, reduced adverse events, improved customer satisfaction, and made life a bit less hectic for some of our staff. (You know from previous emails that I am working hard to make even more improvements on that latter point.)

We have come a long way. Six years ago, both of our hospitals were close to being sold or shuttered. Four years ago, we had passed through a turn-around and proved our ability to survive. These past two years, we have shown that we are vibrant members of the Boston and Harvard medical communities. Now, we rise to the largest challenge yet -- setting standards for patient satisfaction and reduction of harm that are truly world class.

Stay tuned as we roll this out and decide on the yearly priorities and work plans that will eventually lead to reaching these audacious goals. In the meantime, as always, please keep in touch with your ideas, suggestions, and criticisms.


Here is Senator Moore's statement:

“BI-Deaconess deserves to be strongly commended for taking this challenging, bold step to improve health quality and transparency. By including a small community hospital (BID-Needham) as well as a major academic medical center, BI-Deaconess becomes a true champion of health care quality and patient safety. Their leadership in promoting transparency is unprecedented in the Commonwealth, and is fully consistent with the principles behind legislative initiatives such as Senate Bill No. 1277/House Bill No. 2226, An Act Improving Consumer Healthcare Quality. They obviously understand the meaning of 'First, Do No Harm.' They get it right!”

Thank you, Senator!


Anonymous said...

This is truly exciting!

As an RN, I am so proud to be apart of the BIDMC team.

What would the world be with out "audacious" goals. All great discoveries require this level of courage and big thinking. You posted on Dr. Folkman yesterday. It seems that seemingly "audacious and unachievable goals" were the constants in his life which enabled him to do amazing things.

We all have the power to shape our futures... including our nations hospitals. Reaching beyond our perceived limits will bring new discoveries!!

I am grateful for the transparency because I believe that there are barriers inherent to hospital systems that can handicap providers.

I wonder if this provocative move towards transparency will encourage area hospitals to do the same?


Will you be reflecting

Anonymous said...

Very, very excellent, Paul. After making sure your hospitals survived, you turned to the one area where hospital administrators can truly make the most difference to patient care, and are serving as champion to drive it forward. I hope all hospital CEO's look to you as an example and mentor.

EB said...

Boy oh boy. Keep this up, Paul, and I will be relocating to Boston to come work for your place.

Anonymous said...

Could this be stated any better? Are you hiring?

“Beth Israel Deaconess Medical Center already does a very good job on quality measurements and in making patient safety the overriding focus of everything we do. But very good is not good enough,” said Lois E. Silverman, Chair of the BIDMC Board of Directors.

Anonymous said...

Wow, pretty powerful. I wish you luck.

Anonymous said...

I think the idea and the goals are great things, that benefit both patients and staff. However, I object to the term "harm". The article in the Boston Globe Business section today used that term, and made it seem as if we at BIDMC were originally striving to harm patients, and that we are just now deciding NOT to harm them. Although I understand the term as you mean it, I dont think the general public will fully understand how hard we work to keep our patients safe every day. And that this new initiative is to make ourselves that much better than all the other hospitals. Love the idea, hate the terminology.

Anonymous said...

I find this so refreshing and hopeful, both in light of recent bad press about ER waits and service and as a mother whose kid has spent plenty of time in acute care settings.

We've been fortunate in our hospital experiences so far and mostly encountered truly compassionate and knowledgeable pediatric staffs, but still--it's easy to feel like we're in the dark among all the medical professionals.

I don't live in Boston, so here's hoping more hospitals around the country follow your lead.