Quality Care:? Where Does It Start?

Dan, 54,  had been a CEO of a respected community medical center for more than 12 years.  He loved his job.  He was paid very well and his family was established in the community on multiple levels — civic work, schools and extra-curricular activities, club memberships and church.

His medical staff and board seemed happy with his performance.  The community, based on his latest patient satisfaction scores, was very happy.  He felt secure… until he attended that quality committee meeting, his first in four or five months.

Dan realized there was a real threat brewing that could capsize his perfect professional and personal lifestyle.

On this day he came face to face with the realization that his hospital had a growing problem with quality of care and patient safety.  Several physician members of the quality committee who had historically been low-key with their concerns, loudly demanded that the hospital come to grips with this dangerous trend.  A well-known patient had suffered three major preventable mistakes — a medication error, a wound-site infection and a fall — all during the same hospitalization.  That was outrageous.  The community would never stand for it.  Apparently these events, this patient,  was the trigger that unleashed their frustration.  They said their concerns would be an important part of the quality report at the next board meeting.

This physician outburst, plus some tough comments made following the last Joint Commission survey less than four months ago, pointed to Dan’s lack of follow-up.  He knew it, and worse, the doctors knew it.  His Chief Medical Officer who had voiced concerns to Dan in the past, sat back and listened as the physicians pointed to Dan’s leadership failings on this critical issue.

After the meeting, Dan left the office and drove to his golf club.  He reasoned that hitting some golf balls would reduce his stress.  He needed to put a damper on his rising fears that were being fueled by a sense of guilt rooted in his own lack of attention to this issue which he knew pointed to a dramatic absence of any sense of urgency on his part.

This was not a problem that blew up overnight and Dan realized that fact made things even worse.  There had been talk for more than a year that something should be done but no one seemed overly concerned, including the medical staff leadership, and the quality reports to the board did not seem to stir any heart burn with his directors.  So, he did not focus much attention.  He did not want to rock anyone’s boat.  He was, after all, only an executive and he felt uncomfortable challenging powerful admitting physicians about the way they practiced, nor did he want to embarrass the nursing staff.  His Chief Nursing Officer, the person he planned to recommend to replace the retiring Chief Operating Officer, was not focused on this issue, but Dan was loathe to do anything publicly that might derail the commitment he had made to her.

Working on his golf game did not help.  He could not concentrate and the longer he stayed on the practice tee, near the expansive glass windows of the club’s dining room, the more evident it became that being there after a noisy quality committee meeting did not send the right signal to any of his physicians who might be arriving for an early dinner.  He loaded his clubs into his car and drove home to be out of site and try to come up with a strategy.  He knew he had to get on top of this and fast.  If he went to the board meeting without a plan and evidence that he was on top of the issue it could severely compromise his standing as  competent leader and that was only two or three steps from being asked to leave, he feared.

After a quick meal, he retired to his study.  His normal upbeat, confident mood was in tatters. As he sat at his desk feeling the emotional weight of gloom, he decided to call a former mentor, a retired CEO from the hospital where Dan had worked as COO before this.

When his former boss answered, Dan spilled out his story in a rapid-fire manner.  His old mentor had no time to ask questions, so he just listened.  When Dan ran out of gas and asked for advice, his old friend told him not to make this too overly complicated and difficult.

“Dan, you just need to get back to the basics.

“I am guessing you are upset because you know you have not been leading on this and probably some other issues as well,” his friend said. “ I learned early in my career that if you sit back and ride the wave of financial success, basking in the glory that inevitably comes, you are just setting yourself up for this kind of situation.

“This is not a job-ender, Dan, but you have to get out front on this issue and you have to be honest with everyone involved, including the Board Chair and, by the way, he should be your first stop in the morning.  In fact, he should be your first call tonight when we hang up.  Then seek out those physicians who blew the whistle on you and then sit down with your CMO and fill him in on your plan.  Apologize for not acting sooner and make him part of the solution.”

Over the next 45 minutes, Dan’s former boss outlined a strategy he had used himself years earlier in dealing with a similar crisis.  “It worked because it was not based on gimmicks or any hint of sidestepping blame.  If you don’t accept full accountability for this now and tomorrow start doing something about it, your job will get a lot harder.”

Here were the retired CEO’s suggestions:

1. Don’t hire consultants to help you understand the problem – You know what the issues are.  Hiring consultants to address a rapidly developing crisis will look like you do not own it and suggests that you lack the confidence of your convictions.  If you want to implement a longer term solution like Six Sigma great, hire specialists to implement, but first you have to address this now.
2. Be visible, make rounds – You should make rounds at least once every day, I do not care how busy you think you are, sitting in your office or racing off to meetings outside the hospital, sends a bad signal in the short term.  And while you are on the patient floors talking to the staff, stop in to say hello to the patients.  Give them your card and let them know if they have any concerns, to call you.  But the way, your CNO and CMO should accompany you for all subsequent rounding.  This is a team event.  You have to lead but you will need a lot of buy-in to move the needle.
3. Emphasize the QSS sermon – In every meeting you run, or at every meeting you attend, you need to emphasize the QSS sermon — quality, safety and satisfaction as the most important priorities your organization has.  When you are making rounds, you need to have a daily message about the importance of quality and safety and the importance of ensuring that patients and their family members are satisfied.  This is not a remote activity.  You cannot sit in your nice office and send emails or rely on website and social media postings.  This is personal and they must hear it from you — every day.  From now on.
4. Trust your team – You must empower your CMO to make this a priority issue, not muzzle him because you are afraid he will upset the medical staff political applecart.  When patients are at risk, when patients get hurt, who cares whether the applecart is upright or not.  I am betting this fear is more your issue than it is with your physicians.
5. Make it personal – Make this personal approach to leadership on quality, safety and satisfaction the cornerstone of who you are as a leader, not just a PR routine to use until you feel the crisis has passed.  If you stop making rounds, if you stop making this an every day personal priority,  it will say a lot about who you are as a leader, and none of it will be good.