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Published on June 11, 2015

Op-ed: Providers should collaborate to improve care quality

By Kenneth P. Rothfield, MD System Vice President and CMO, St. Vincent's HealthCare & Joel Feldman, MD Regional President, St. Vincent Hospital Indianapolis

Healthcare in America has a cultural issue, and there are lessons to be learned from other industries. In his 2008 book "Outliers: The Story of Success," Malcolm Gladwell dedicates a chapter to the effects of cultural nuances on airline safety.

Specifically, he references the high rates of Korean Air plane crashes in the 1990s. In an interview with Fortune, Gladwell explains, "When we think of airline crashes, we think, oh, they must have had old planes. They must have had badly trained pilots. No. What they were struggling with was a cultural legacy, that Korean culture is hierarchical. You are obliged to be deferential toward your elders and superiors in a way that would be unimaginable in the U.S."

While perhaps that type of culture is unimaginable in the aviation industry, as we know within America, healthcare remains largely a culture of competition and hierarchy. For years, healthcare has been delivered in a fragmented way. Physicians and surgeons, in particular, are trained to act as individuals — to use their best personal judgment in medical situations. The idea of working collaboratively can be foreign to even the most respected and open-minded in the field. As a result, surgical and procedural outcomes can suffer.

At St. Louis-based Ascension, the nation's largest nonprofit health system, we have designated June 8 through 12 as Safe Surgery and Procedure Week — a time set aside to promote awareness about maintaining quality outcomes in our surgical and procedural settings.

It's something that's needed across healthcare. In 2011, the Washington Post reported wrong-site surgery occurs 40 times a week in U.S. hospitals and clinics. Additionally, a 2011 Health Affairs study found that medical errors affect one-third of hospital patients. To reduce the occurrence of errors ranging from wrongly read X-rays to wrong-site operations, the Joint Commission implemented mandatory protocols including a "timeout checklist" prior to surgical procedures.

Yet, even with a checklist in place, and with teams of dedicated caregivers focused on doing the right thing, errors can occur. Wrong-site surgeries and post-procedure infections can happen because of systemic and cultural issues. We are working toward changing behaviors, processes and protocols across our health system to eliminate the chance of these occurrences. Since the inaugural Safe Surgery Day in 2014, Ascension has seen a 7.4 percent reduction in wrong-site surgery events across the system.

As part our Ascension promise to provide "Healthcare That Is Safe," we are purposefully creating a culture that promotes psychological safety, emphasizing interdependence that makes safety a preoccupation of all senior management and that integrates efforts of administrators and caregivers to be passionate about safety.

Changing these behaviors requires collaboration, and collaboration depends upon communication. It is imperative that we promote a culture nationwide in which physicians feel comfortable openly communicating with — not just to — their colleagues in the operating room. Every individual in a surgical environment has both the right and the responsibility to speak up if something is going on that does not make sense to her or him.

Leaders must be champions of this cause and encourage behavioral changes through example. Simple adjustments can go a long way. A head surgeon can establish a mutually respectful environment by addressing colleagues by name. Another tactic we encourage is a post-surgical debriefing. This dedicated time creates an opportunity for involved physicians and caregivers to openly discuss both positive and negative observations of a procedure.

The creation of a collaborative, open environment requires medical leaders to take ownership while also limiting the disempowerment that hierarchy can breed. It calls for leaders to demonstrate humility, respect and an understanding of what it takes to create an effective team. At Ascension hospitals, we are piloting several programs on a national scale that approach cultural and behavioral issues by encouraging open communication. Yet we know that instilling change takes time. Safe Surgery and Procedure Week is an opportunity for our health system, and others across the country, to take a step back and review our current processes and behaviors. We call on others in our industry to focus on transforming our culture. Together we can increase awareness around the importance of open communication to delivering safe, highly reliable care as a team.

View the op-ed: http://www.beckershospitalreview.com/hospital-management-administration/op-ed-providers-should-collaborate-to-improve-care-quality.html