Greek Health Center
Kelly Rakowski is the managing principal for performance solutions, the consulting division of GE Healthcare. In her role she is responsible for the development of consulting offerings, business development, and quality delivery of GE's services to health care providers across the United States.
Ms. Rakowski has more than 20 years of experience in the health care industry, the last 13 as a health care consultant serving health care providers across the United States. Prior to joining GE's Performance Solutions in 2005, she was a vice president with Capgemini Health consulting, and led the MidAtlantic Market. She has successfully led hundreds of strategic and operational transformation engagements, assisting her clients in achieving sustained financial strength, operational excellence and improved quality outcomes.
Ms. Rakowski has a bachelor of arts in economics from the University of Rochester and a master of health services management and policy from the University of Michigan.
Carolyn Pexton has more than 20 years experience in communications and health care and has served as the director of public relations and communications for Performance Solutions at GE Healthcare since 2000. In this role, she manages PR and strategic communication for GE Healthcare's consulting business. She works closely with customers to publicize their performance improvement achievements through articles and speaking engagements. Prior roles include communications director for MECON, Inc., (prior to acquisition by GE) and ten years with the Tennessee Hospital Association as director of information management.
Ms. Pexton is a certified Six Sigma Green Belt and has presented and published on a variety of topics including Lean Six Sigma, change management and communication within the health care industry.
Ms. Rakowski and Ms. Pexton respond to questions from the Greek Health Center
What do you think are the 3 major barriers to improving quality of care in an organization and what can hospital leaders do to eliminate them?
Kelly Rakowski:
Quality and patient safety are not named as top strategic priorities
Unless they are named as strategic priorities, there usually aren't enough resources to make substantial gains in quality or safety. Although recent executive surveys indicate an increasing focus on quality, we haven't yet seen it rise to the top of the list with finance and operations.
The environment does not encourage safety practices
Many organizations have a culture and environment that is not conducive to driving safety. People are generally categorized into professional or departmental silos, lacking accountability and sufficient communication, which can result in poor outcomes. You can see the impact of this siloed environment especially in issues related to handoffs and coordination of care.
Leadership
The board needs to set the quality and patient safety agenda. The executive leadership-CMO, CNO, COO, CFO, CEO-all have to lead the call. Also, these leaders need the right experience, skills and tools to ensure organizational efforts are successful. Often, health care managers have the right clinical background, but lack sufficient management skills. For too long, quality and patient safety issues have been delegated to clinical teams without strong leadership support and involvement. That needs to change.
Carolyn Pexton:
Cost
I would add cost as a perceived barrier. There is a perception among health care executives that implementing a new quality initiative requires too large an investment of resources, money and time. However, these executives aren't taking into account the high cost of poor quality. Healthcare organizations lack the ability to accurately measure the cost of errors and inefficiency. For instance, there is a financial loss associated with redundant processes and the additional care required from hospital-acquired infections. In addition, there is the loss of reputation in the community and the cost burden of trying to retain quality employees. All of these things should be taken into consideration when one argues that quality and safety initiatives are too costly.
Most hospitals will tell you that they deliver high quality care. However, when you study the research, this is not the case. How do you define high quality care? How do you measure it?
CP:
I think the IOM definition of quality care is the best and most concise definition we've seen so far:
"The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." (http://www.iom.edu/CMS/8089.aspx)
KR:
To boil it down, quality is really delivering the right care at the right time for the right patient. The trouble is how do you put definitions around the right care? There are no shortages of measures but what is the mark of a good measure? Which ones will help leaders achieve the desired and expected outcomes? We do know that limiting process variation using tools such as Six Sigma can help to reduce errors, while Lean is useful in removing waste from the system. But in terms of maintaining quality improvement, consistency matters. Focus on measuring the right things and don't get sidetracked. Don't take on too many projects, and make sure they are aligned with the organization's key objectives. Prioritize and focus in order to have an impact on improving quality. Choose what to work on and then strive for perfection.
Patient-centeredness is one of the 6 IOM aims. How do you define patient-centeredness? What do hospital leaders need to do in order to effectively provide care that is patient-centered?
KR:
It has to do with how the hospital structures its care team. Is the patient at the center, included in the decision-making process? Are you respecting their values and needs? This type of care relies on giving the patient and family the opportunity to participate and assume greater responsibility. There is a generation gap among patients. Older patients tend not to challenge their physicians. Baby boomers, however, are generally better informed about their care and conscious of their health status. These folks are essentially replacing the patriarchal structure of the health care system a patient-centered matrix-type structure. The next step for leaders to work on is how to truly integrate the patient across the continuum of care. This is a huge opportunity for health leaders.
CP:
It all starts with the voice of the consumer (VOC). What bests suits the patient? If you design your process around the VOC, you will be more likely to have patient-centered care.
Many hospitals right now are on a journey to "transform care." However they define care transformation, one common denominator in all the journeys is the ability to effectively manage change. What common traits do leaders who effectively manage change possess?
KR:
Change management is a huge part of a new initiative. We have seen many transformations fail because the leaders did not manage change effectively. There are five things that are common to all organizations and leaders who effectively manage change. First, have a clear vision. Create a shared need among all stakeholders and then communicate that vision from the board all the way to the front line staff.
Second, make your commitment visible to all. Leaders need to personally show up and be part of the action. Raise the bar and hold people accountable if you want the initiative to have any staying power. Third, successful leaders also enable and empower people. This gets them involved, and allows them to own the project. Give them the right tools and allow them to make decisions. Tie their performance to rewards and incentives, which means that there needs to be measures and continued monitoring. The fourth key is not to accept poor performance. Some employees won't have the ability or courage to make the change. Finally, what sets great leaders apart from the rest is their ability to inspire and engage others.
You cannot over communicate. Celebrate the success. Make sure it's not a punitive environment. Don't micro-manage, empower your employees.
Explain what the Institute for Transformational Healthcare Leadership will accomplish. What should health care leaders know about the Institute?
The National Center for Healthcare Leadership and GE Healthcare are partnering to create the Institute for Transformational Healthcare Leadership. With the upcoming workforce challenges, there will be an increased demand for health care leaders. The Institute plans to help organizations develop competent leaders. We are combining GE's management systems with NCHL's leadership evidence-based research in healthcare and expertise. In addition to educational programs, we will offer advisory services. The Institute can be used as a stepladder for all levels of management, from front line managers to the c-suite. Our plan is to build leadership capabilities for both the individual and the organization as a whole.
