Norman Regional Nationally Recognized for High Quality Care
August, 2006 – Norman Regional Health System has been nationally recognized for their success in implementing culture change to create an environment for high quality care. Norman was selected to be a part of the Transformational Grand Rounds (TGR) webinar series, a pilot program through the Medicare Quality Improvement Program.
Through the program, Norman received national exposure as they shared with the quality improvement community their strategies for improving healthcare delivery through transformational change efforts.
“Norman is an outstanding example of a healthcare organization transforming care for Medicare beneficiaries and all other patients,” said Dr. Donna Daniel, of Qualis Health, the Washington State Quality Improvement Organization (QIO) who spearheaded the pilot program. “We chose to feature Norman because they have created an organization that embraces quality improvement in daily activities, which sets them apart from many other hospitals.”
Dr. John Krodel, chairman of Norman’s Performance Improvement Council, says that over the past few years, the facility has seen great gains in staff satisfaction, as well as improvement on quality of care measures related to conditions such as acute myocardial infarction (AMI), heart failure and pneumonia.
The percentage of patients receiving appropriate care for AMI, for example, increased from 72 percent to 83 percent. In addition, appropriate care for heart failure and for pneumonia was 93 percent, compared with 75 percent and 78 percent, respectively.
Krodel said that working with the QIO program was a primary motivator for hospital officials to instigate significant performance improvement strategies. Through a statewide collaborative with Oklahoma Foundation for Medical Quality (OFMQ), the state’s Medicare Quality Improvement Organization (QIO), Norman focused on improving care for patients with AMI, heart failure and pneumonia.
LaWanna Halstead, OFMQ Healthcare Quality Improvement Program Director, said, “It was a privilege for an Oklahoma hospital to be the first selected for the Transformational Grand Rounds project. Because of their demonstrated improvement and practical tools, Norman Regional Hospital has received requests from across the country to make presentations and share their tools.”
Norman’s Strategies for Implementing Culture Change
Implementing a culture of quality started at the top. Hospital leaders set a goal to be recognized as the best, not only in the state, but also in the region and nationwide. By looking at publicly reported data, Norman’s board recognized opportunities to improve, asking why mortality and other rates were not the best in the state.
To ensure the quality message was pervasive, officials at Norman updated the mission and vision statements for the facility. They included “quality” for the first time in the facility’s strategy statement, which documented that the goal of the hospital was to be recognized as the health system of choice. Later on, the facility set goals to benchmark itself against others across the country.
Performance incentives were implemented for contracted employees and Norman also set aside funds to reward employees for a job well done.
Quality improvement (QI) staff not only studied the measures, but they also presented the data at monthly board and managers’ meetings, discussing outliers and sharing what worked and what did not work in trying to correct the outliers. Data was posted monthly on a “dashboard” on the hospital’s Intranet for everyone to see and the Chief Executive Officer reported regularly on the figures at quarterly staff forums.
Data was also used with the implementation of physician report cards. Report cards provided specialty comparisons among physicians as well as hospital comparisons.
An aggressive clinical pharmacy component rounded out the efforts aimed at creating a total culture of quality. The hospital identifies patients that should receive an influenza or pneumococcal vaccination, for instance, and clinical pharmacists developed a new system to assess heart failure patients. Every patient that has a cardiology consult is also assessed by clinical pharmacy staff to ensure all quality measures are addressed. Once the “target” patients are identified, a concurrent chart review takes place, says Darin Smith, PharmD and clinical pharmacy manager.
Above all, QI staff emphasized the importance of taking action while patients are still onsite. “You need to do things that impact patients while they’re in the hospital and that goes back to systems design, making process changes so that [staff] can do the right thing every time,” says Smith.
Norma Bradley, Quality Improvement Specialist at OFMQ, said, “Norman Regional has engaged board members, pharmacy, front line staff and other areas of care. They have even developed ways to communicate beyond their hospital walls and provide patient centered care in working with the nursing homes and others in the community. Their quality improvement projects touch everybody in the system and that is what makes them successful. They were an excellent example to show many other hospitals the possibilities you can accomplish without a wealth of resources and that it is possible to make this transformation in their facility as well.”