Ask the Expert: Dr. Shawn Usery on our quality journey

In health care, there is no more important measure than the quality of care we provide to our patients.

There are many metrics health care systems use to measure quality, and CoxHealth is focused on continuous improvement across the board.

Dr. Shawn Usery, CoxHealth’s chief medical officer, is leading a systemwide effort around quality. It is a complex, ongoing effort, and improvements in our approach are already helping our teams make great strides.

In the most recent year, CoxHealth met our goals in key measures such as reducing hospital-acquired infections (HAIs) as tracked in data reported to the Centers for Medicare and Medicaid Services. HAIs are an important metric in determining hospital quality.

Dr. Usery points out that the past year was our best performance on HAIs in CoxHealth’s history. That is no small feat and it is worth of celebration. We are now challenged to improve and maintain that excellence.

“It is easier to make an ‘A’ than it is to keep one,” Dr. Usery says. “Keeping those efforts going will require us to build systems, processes and structures that allow us to keep our eyes on many moving parts at once.”

Improving our performance on key quality measures includes documenting and measuring our work more accurately, and finding ways to simply be better in areas where improvement is needed.

The core of all the effort is providing the best care for our patients.

“In all cases, when we do the right thing for patients, we see improved outcomes,” Dr. Usery says.

We spoke with Dr. Usery about the keys to a successful quality journey, and where we are headed next. Here is what he had to say:

COLLABORATION AND TEAMS

When working on issues as multifaceted as quality, taking a team approach is key.

When we look at something like infection rates from colorectal procedures, for example, we began a new model of examining instances of infection. We gathered every staff member who works with colorectal patients in a room. That includes our Infection Prevention (IP) team, our surgeons, our coding teams, and more.

The group went through the most recent infections, taking apart each case and identifying where improvements could be made. We are putting doctors, nurses and coders in a room to act as a team, together driving our quality.

In the past, some surgeons and clinicians saw the Infection Prevention team almost as an opponent – the team that catches mistakes. In reality, the IP team wants to do whatever they can to prevent these infections and help our teams improve.

Our new model, and the conversations it inspires, have led to a change in our culture. Now, physicians partner with Infection Prevention, and see them as their support system. When they have a concern or a question, they call the IP team immediately or if IP sees something, they speak with the surgeon.

Having the IP team in the room has been essential to our growth. They are there to point out what we are excelling in, and what could be done differently.

In colorectal infection rates, creating this culture of quality has led to a current rate that is less than half of what would be expected in a system our size.

We are currently expanding this model into other surgical opportunities across the health system.

DOCUMENTING BETTER, AND BEING BETTER

When you’re working to improve quality metrics in health care, there are two levers to pull: documenting better, and being better.

Quality metrics as tracked by CMS and regulatory bodies often compare a patient’s outcome to what you might statistically expect, based on the patient’s illness and overall health. All too often, we accurately document the specific reason a patient is in the hospital, but we don’t capture the full picture of their health.

Better data and documentation on the front end helps us more accurately reflect reality and make better predictions, and that can improve our quality data.

In addition to documentation and capturing the full picture, there are some areas where we simply must perform better.

One of those areas is care of our patients with sepsis. When we looked at our data, we understood that we had an opportunity to be better for some of our sickest patients. We have committed ourselves to providing the best possible care.

Again, we have taken a team approach, involving everyone from the EMT transporting the patient, to the ER nurses and doctors, to the hospitalists and critical care teams. Working together, we have reduced sepsis mortality by roughly 20% in just one quarter.

It’s an example of how, even with the most severe illness, we can make improvements by doing the right things for our patients, and doing them consistently.

IMPROVING QUALITY ACROSS THE CONTINUUM OF CARE

Doing what’s right for patients also extends far beyond the hospital walls. We have spent the last 18 months focusing on quality in the hospital, but we know quality is not just a hospital concern, it is a system concern.

We are measured on how well we do helping patients and getting them back home, and we are also evaluated on how often patients have to be readmitted.

To improve those quality metrics, we have to build processes that allow patients to move effortlessly across the continuum of care. We want our teams to be able to seamlessly transition a patient from an inpatient cardiac team, for example, to an outpatient team for follow-up care.

We are doing this by partnering with our Population Health team. Population Health works with patients who are at high-risk for readmission – heart failure is a key example – to ensure they are doing well post discharge and making follow-up appointments.

Patients who Population Health serves have seen readmissions reduced by 25%. That is a testament to how effective their work is. I know, as a physician, if there is anything I can do that improves my patient’s chances of going home and staying home, that is a really good improvement.

BUILDING PROCESSES FOR QUALITY

There are so many elements that feed into quality – everything from infection rates and falls to customer satisfaction – it is a constant effort to stay on top of it all.

To be successful, we have to build systems, processes and structures that allow us to keep our eyes on many moving parts at once. We are working with our data teams and building dashboards that let us quickly disseminate performance data to our teams.

We have worked to make the numbers real and easy to understand.

Every Friday, for example, we know how exactly many HAIs there were in the system that week, broken down by campus and by location.

We know how many infections we should expect in a year, and we have real-time data on those infections. That makes it easy for all of us to see when we are off pace, and people understand those numbers more easily than a risk-adjusted statistic.

Our data teams produce dashboards, coded in green and red. We are continually moving areas into the green. If there is an area in the red, we gather in a room with nurses, doctors, coders and registration. We sit down and show exactly how we are doing, and we ask the experts how we can do better.

Every time we ask our teams that are doing the work day in and day out how we can be better, we always hear great answers. These answers help us continue to improve across the organization.

A CULTURE OF ACCOUNTABILITY

I am proud of how our quality efforts are enhancing our culture at CoxHealth, and making us part of one cohesive team dedicated to the best care possible.

We are well known for our welcoming, kind culture that feels like a family. And we know that to continue improving we all must be willing to hold one another accountable, especially when we know we can make improvements to our care.

When we see a concern, or a way to improve, we must speak up. We always have to care enough about our patients -- and care enough about each other -- to hold one anther accountable.

We are well-positioned to build on our culture of accountability, and I know that by doing so our quality journey will lead us to new heights of excellence for the patients we serve.