Four years ago, our hospital embarked on a journey to improve our mortality rates. We had compared our mortality numbers numbers to hospitals just like us and discovered that we ranked near the end in terms of mortality rates. As recognition sunk in, an unsettling blend of embarrassment, fear, confusion and realization followed. Wide eyed after seeing the numbers, our hospital's quality manager turned to me and asked, "What do we do?"
Honestly, we didn't know our mortality ratio until we benchmarked our data next to top-performing hospitals across the nation — and theirs was much better. Was there more we could be doing to keep people alive? What were they doing that we weren't?
Today, our small community hospital in the East Tennessee mountains is a top performer among those very hospitals — more than 300 of them nationwide that participate in QUEST®, a Premier healthcare alliance performance improvement initiative. But it took a village at Sycamore Shoals Hospital; all of our hospital leaders, physicians, nurses and team members had to work together and create an environment of clinical safety and excellence.
One day, a physician came to me and said, "Your nurses are questioning me," to which I replied, "Yes, we are mentoring them to do that." Nurses should feel comfortable advocating for their patients and asking questions about their care and treatment plan, and they should feel empowered to do so. It's when we started placing patients correctly that we saw a big improvement in mortality rates.
As suggested, two-way communication is the most valuable form. So, the hospital CEO and I began meeting monthly with our physicians, hospitalists and the emergency department medical director. This meeting allows us to discuss information about patients transferred to a higher level of care within 48 hours of admission. Even if we can't change anything for those patients, we can identify better practices to prevent unexpected outcomes, such as harm or readmissions, from happening in the future.
QUEST hospitals also helped us establish protocols to screen through the ED, especially in sepsis. Many of the other hospitals participating already had answers to our problems, and there's no sense in reinventing the wheel. We were able to bounce ideas off of other facilities that were struggling with the same things. It helped propel us to success more quickly.
Celebrating continued success reinforces the hard work being done to achieve our goals. Whether it's special meals or pats on the back, we have to recognize what our diligent team members are doing to get there. Staff is incented on reaching QUEST's top performance levels in mortality, harm, readmissions, cost, evidence-based care and patient satisfaction. When all measures of performance are met, front-line team members receive a $500 bonus. Managers and directors get a slightly higher bonus. Also, a portion of salaries for our vice presidents and beyond is at risk if they don't meet those goals.
You have to know the good, the bad and the ugly of where you are before you can know where you’re going. If we look at how other hospitals are doing, we can compare ourselves to see how we measure up. Hospitals with top performance in certain areas set the standard that we strive to reach. It really helps keep a focus on what is important to challenge.
With health reform and constrained resources, there's a lot of uncertainty and lack of understanding about what lies ahead. Being able to share and receive feedback on our concerns, goals and strategies has helped us frame a clear focus around what we know is coming and make it more manageable.
The days of being last are long gone, replaced by a new optimism that comes from successfully meeting and beating many difficult challenges so we can do the right thing for our patients.
Melanie S. Stanton, RN, BSN, MBA, NEA-BC, is a graduate of East Tennessee State University earning a BBA in Accounting and a BS in Nursing. In 2006, she earned an MBA from King College. She is board certified as an advanced nurse executive by the American Nurses Credentialing Center. Melanie has experience in medical surgical nursing, house supervision and has held various leadership positions within Mountain States Health Alliance. She is currently the chief nursing officer at Sycamore Shoals Hospital in Elizabethton, Tennessee.
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Honestly, we didn't know our mortality ratio until we benchmarked our data next to top-performing hospitals across the nation — and theirs was much better. Was there more we could be doing to keep people alive? What were they doing that we weren't?
Today, our small community hospital in the East Tennessee mountains is a top performer among those very hospitals — more than 300 of them nationwide that participate in QUEST®, a Premier healthcare alliance performance improvement initiative. But it took a village at Sycamore Shoals Hospital; all of our hospital leaders, physicians, nurses and team members had to work together and create an environment of clinical safety and excellence.
Triage your processes
We immediately began examining every single patient death to identify our greatest opportunities for improvement. We found that patients weren't always being placed in the appropriate level of care upon admission, and we needed a better end-of-life care model. We also saw that sepsis (a life-threatening complication of an infection) was our number one cause of mortality, so we needed to identify signs of sepsis earlier.Mend what's damaged
From day one, we began engaging physicians and empowering nurses to work together in a spirit of collaboration. We pulled physicians into the development of our end-of-life treatment plans. The plans were greatly influenced by nursing staff, and the process helped with more accurately coding patient care. Now, we have the opportunity for the family, the physician, the nurse and the patient to sign the end-of-life treatment plan so that everyone understands what outcomes to expect and documents accordingly.One day, a physician came to me and said, "Your nurses are questioning me," to which I replied, "Yes, we are mentoring them to do that." Nurses should feel comfortable advocating for their patients and asking questions about their care and treatment plan, and they should feel empowered to do so. It's when we started placing patients correctly that we saw a big improvement in mortality rates.
As suggested, two-way communication is the most valuable form. So, the hospital CEO and I began meeting monthly with our physicians, hospitalists and the emergency department medical director. This meeting allows us to discuss information about patients transferred to a higher level of care within 48 hours of admission. Even if we can't change anything for those patients, we can identify better practices to prevent unexpected outcomes, such as harm or readmissions, from happening in the future.
QUEST hospitals also helped us establish protocols to screen through the ED, especially in sepsis. Many of the other hospitals participating already had answers to our problems, and there's no sense in reinventing the wheel. We were able to bounce ideas off of other facilities that were struggling with the same things. It helped propel us to success more quickly.
Celebrating continued success reinforces the hard work being done to achieve our goals. Whether it's special meals or pats on the back, we have to recognize what our diligent team members are doing to get there. Staff is incented on reaching QUEST's top performance levels in mortality, harm, readmissions, cost, evidence-based care and patient satisfaction. When all measures of performance are met, front-line team members receive a $500 bonus. Managers and directors get a slightly higher bonus. Also, a portion of salaries for our vice presidents and beyond is at risk if they don't meet those goals.
Exercise improvement
It's not just our hospital. Other hospitals in Mountain States Health Alliance are doing this too, and it's helping us develop as a system by working on improvements together. Culture shifts are slow to occur, but we keep getting better.You have to know the good, the bad and the ugly of where you are before you can know where you’re going. If we look at how other hospitals are doing, we can compare ourselves to see how we measure up. Hospitals with top performance in certain areas set the standard that we strive to reach. It really helps keep a focus on what is important to challenge.
With health reform and constrained resources, there's a lot of uncertainty and lack of understanding about what lies ahead. Being able to share and receive feedback on our concerns, goals and strategies has helped us frame a clear focus around what we know is coming and make it more manageable.
The days of being last are long gone, replaced by a new optimism that comes from successfully meeting and beating many difficult challenges so we can do the right thing for our patients.
Melanie S. Stanton, RN, BSN, MBA, NEA-BC, is a graduate of East Tennessee State University earning a BBA in Accounting and a BS in Nursing. In 2006, she earned an MBA from King College. She is board certified as an advanced nurse executive by the American Nurses Credentialing Center. Melanie has experience in medical surgical nursing, house supervision and has held various leadership positions within Mountain States Health Alliance. She is currently the chief nursing officer at Sycamore Shoals Hospital in Elizabethton, Tennessee.
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