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When asked what she likes most about her work, she offered: “being involved with GHLI long enough to see many of the graduates of our programs move into ever-greater positions of responsibility and impact. I am inspired by each new group of men and women who enroll in our management training programs. I know the GHLI model of engagement works.”
Itumeleng Ntatamala, M.D., Community Service Medical Officer
Working in a lower income country’s public health sector is usually fraught with challenges, but this work can be equally fulfilling when a smile is shared…or a life is saved. It was in my first year as a medical intern at Mokopane Regional Hospital in rural South Africa that I found myself faced with either giving into an inefficient system or helping to transform it. Being selected to partake in the Advanced Health Management Programme (AHMP) and Yale University’s GHLI, was life changing as it jump-started an exciting journey of profound self-discovery and professional development.
The AHMP approach to health management is the concept of action research, which requires identifying challenges and then conducting research and continuous self-inquiry to solve those challenges. It was this approach that forced me to reflect on why I was concerned about health systems and how my own values tied into this work — a far cry from my previous notion of leadership that oft times neglected the self and only focused on “getting the job done.” I undertook a collaborative hospital renovation project that saw our hospital’s pediatric ward — which was originally designed for adult patients — morph into a conducive healing environment for children with the support of colleagues, local business and interested community members. Colorful murals and paintings adorned previously dull walls, a kitchen was built to teach parents about healthy ways to prepare children’s food and a secure playground was erected to the children’s delight. The Limpopo Province recognized the transformation of the ward with the Limpopo Province Premiers’ Service Excellence Silver Award for “Innovation in the Public Service.”
As I reflect on this past year, I started out as a frustrated young health professional in a small town and am now a confident professional with the skills and capacity to lead an award winning team to help improve hospital efficiency and patient care. I am grateful for this work and the group of people with which I get to work. Each day I have the opportunity to redefine my concept of health leadership.
Kim Miyauchi, Chief Nursing Officer
Kingman Regional Medical Center, AZ
Saving the lives of heart attack patients is one of the biggest challenges for hospitals. When every minute counts, we all need to be looking at the same clock…that is one of the key messages our hospital learned when we examined mortality rates of patients with acute myocardial infarction (AMI).
Kingman Regional Medical Center (KRMC) discovered that sometimes the simplest solutions can be the keys to saving lives. As part of the Leadership Saves Lives program, KRMC partnered with the Yale Global Health Leadership Institute and we were challenged to examine our hospital culture and treatment methods for patients with AMIs. We were part of 10 U.S. hospitals involved in the two-year program to determine causes of high AMI mortality rates.
To reduce the AMI mortality rate at KRMC, we examined several possible determinants and honed in on three: 1) timeliness of EKGS; 2) protocols, pathways and guidelines; and 3) discharge process. We first addressed the causes by encouraging more teamwork. We created committees to examine each of the three causes contributing to our high AMI mortality rate. As teams engaged with each other and with other hospital staff they were better able to understand how and why goals weren’t being met and how to improve the results.
For example, a large number KRMC patients arrive at the hospital by private vehicle – delaying the electrocardiogram (EKG) process that normally would take place in an emergency vehicle. Kingman Regional Medical Center strives to complete EKGs within 10 minutes of an AMI patient’s arrival. However, when we reviewed patient charts, we discovered our EKG completion times were inconsistent and recorded times depended on which clock a staff member was using. We had eight clocks in the ER and they were not synchronized. This had to be addressed to improve patient care.
Our hospital replaced all of the ER clocks and synchronized them with our computer system. This simple, inexpensive solution, along with its other efforts ended up significantly improving timeliness of care. Although all of KRMC’s process changes were not as simple as replacing clocks, we have already seen the efforts paying off with a decrease in AMI mortality rates.
Amanda Brewster, Ph.D., GHLI research and education associate
Health care professionals constantly invest time, effort and expense trying new methods to improve care only to see promising innovations evaporate rather than become part of everyday work habits. When this happens, hospitals miss potential performance improvements, waste money and time, and feed quality improvement fatigue among staff.
New evidence published in Implementation Science from the Yale Global Leadership Health Institute shows that there are predictable patterns in what it takes to make change “stick.” Reviewing data from hospitals that participated in the State Action on Avoidable Rehospitalizations (STAAR) initiative, GHLI researchers examined different strategies hospitals tried to reduce readmissions.
The research showed that getting new practices integrated depended on how the integration process was executed. When hospitals appointed staff to oversee that a new practice was performed regularly for several months up to a year, more permanent integrating mechanisms had time to start working. Staff had a chance to feel direct benefits from the new practice – like greater job satisfaction or less stress – which motivated them to keep doing it even without close oversight. Or failing that, job expectations had a chance to catch up with the new practice, making it a non-negotiable part of work.
What should hospital leaders make of these results? Truly integrating a new practice takes patience and extended effort over time. And, staff members’ own desires to improve patient outcomes can give a powerful boost to quality improvement. Ensuring that staff responsible for implementing a new practice have the opportunity to see the positive impacts – through data feedback as well as personal interactions – can enlist them as partners in integrating the innovation into the permanent fabric of the organization. Finally, the work does not ever go on auto-pilot, but incorporating the effort into ongoing management oversight efforts allow champions to move onto the next burning platform.