Anna Roth
Assistant Director of Redesign
Contra Costa Regional Medical Center
"I would like to think that when I'm concerned with systems, I have not lost the experience there at the bedside." (1:04)
I'm Anna Roth and I am a nurse and I am the Assistant Director of System Redesign for Contra Costa Regional Medical Center. Contra Costa is a 166-bed community hospital. We are a safety net hospital, so we're “county.” We service the underserved population particularly and anyone really in Contra Costa in need. We have some of the most affluent communities in the California-San Francisco Bay Area to some of the most marginalized communities, so we kind of cover the gamut. Our facility really provides primary care and we contract out services with many of the specialty hospitals in the area.
I do think that I was kind of a big picture thinker when I was a nurse, but I also would like to think that now when I'm concerned with systems that I still have not lost the patient care experience and the individual experience there at the bedside. So, for me, this has been a very rewarding way to bring those two things together.
"We really do things in an unconventional way." (0:59)
I think that what I'm the most proud of and what I'd like to highlight in our organization is the cultural transformation that sort of has followed or has come out of our work. We've really sort of left rank at the door, which has allowed us to kind of have all kinds of creative thinking emerge. We really do things in an unconventional way. We did not use a nurse, a pharmacist, or a doctor to lead our medication reconciliation team, but we did, in fact, use someone who had experience working with teams that we knew that in the past she had brought up an appointment system for us. So we sent her to the [IHI] Improvement Advisor training, which turned out to give us a huge return on investment. She has taught us so much about how to run teams and that team particularly has experienced, I think, a lot of its initial success due to the fact that she is now an experienced Improvement Advisor. So we've been able to use her in other teams as well.
"We have really embraced disclosure and realized that that goes with collaboration." (0:59)
I think we now really truly value the multidisciplinary team. I think we were physician-driven prior. Sometimes nurse-driven depending on what the topic was, and every team that we use now is multidisciplinary, every team. We have really embraced disclosure and realized that that kind of goes with collaboration. You can't really truly collaborate unless you're willing to disclose.
So we may disclose barriers and challenges with other facilities, with even patients and families that we didn't before. We may talk on an IHI call. We're much more candid than we used to be. I think the use of candor even within team meetings has become an acceptable way of communication, where prior you may want to be politically correct. You may worry about what you're saying. I mean we're not just loose cannons, but we certainly use candor and critical conversations and have those crucial conversations a lot more than we used to.
"Sometimes it's hard to listen to those things from the front lines because we don't want to hear it." (1:14)
Instead of administration just pushing down ideas, we've allowed ideas to emerge from the front lines and I think that wasn't done before. Sometimes it was, but I think it's truly done now. Sometimes it's hard to listen to those things from the front lines because we don't want to hear it. Facing those brutal facts of what's going on, what's going wrong; people's feelings of despair and frustration out on the floors. This is hard to hear and hard to resist to make a knee-jerk edict and allow sort of the process to guide itself.
I'm not sure how we compare to other hospitals. We have found when we reach out and we talk to them, they talk back to us. I think that everybody, the entire community that we're engaging with right now, is pretty much at the same place. We've heard from other people that they get a kick out of us because we're pretty candid and we're very open. But we're humbled by that statement, because we've found that everyone has been sharing and open. You know we’re the smaller hospital in the community, and sometimes we'll have larger medical centers come to us and ask us things, which is kind of a role reversal for us. Because we're a little bit smaller, we can test things quicker. We've now realized we have some strengths we weren't aware of before.
"We can be excellent in providing common things." (0:55)
Our CEO explicitly wanted to challenge the victim mentality that our organization sort of fell into, the “helpless hopeless” — no more. We can be bold. We have something to contribute. We can be excellent in providing common things. In fact, we will do common things uncommonly well. So these were explicit sort of strategies that he had and myths he wanted to bust that safety net hospitals could do this. We spent quite a bit of time trying to determine what should our strategic plan be and we just decided “improvement” and “quality” — that was it. It will all center around that. We have embedded that in every initiative we have worked on, no matter what role we’ve played, whether it's been coach or developer or implementer or educator. We've stuck by those simple rules and then kind of just allowed the space so people could be creative.
03/27/2007
