Charles Barnett
President and CEO
Seton Family of Hospitals
“I picked up a copy of Reader’s Digest and what’s on the cover? —‘Are Hospitals Safe?’ I don’t think it’s a question of just a professional commitment or a professional understanding or a professional interest in this. I think it is a community and societal interest.” (1:22)
I’m Charles Barnett. I’m the president and CEO of the Seton Family of Hospitals in Austin, Texas. It’s a large regional health care organization that includes eight hospitals, 22 sites in which we either provide care or we support the provision of care. We have about 8,200 associates within the Seton family. We are the trauma center for the nine-county region, and we provide all the graduate and undergraduate medical education in central Texas. We provide the children’s acute care services for a 46-county region. We do all the heart transplants that are done in central Texas, so it’s a large complex health care organization. We are also the largest part of the safety net. We provided last year over 200 million dollars in uncompensated care.
We are part of Ascension. We are one of the health ministries within the Ascension Health system.
I remember I was traveling and I was in the Dallas/Ft.Worth airport which, living in Austin, is pretty much what you travel through, and I was in the news shop. I picked up a copy of Reader’s Digest and what’s on the cover? — “Are Hospitals Safe?” I don’t think it’s a question of just a professional commitment or a professional understanding or a professional interest in this. I think it is a community and societal interest in this. I think we have an obligation to get to zero preventable deaths and injuries.
“I started in an academic setting working on a PhD in the history of ideas with a special concentration in the history of medicine. As a graduate teaching assistant, I had no health insurance.” (1:46)
I started actually in an academic setting longer than 34 years ago, working on a PhD in the history of ideas with a special concentration in the history of medicine. When I was doing my dissertation research, I ended up getting a collapsed lung and I went to a hospital where my physician practiced. And I was in for about 10 days; they did a couple of tube thoracotomies and put a pleurovac on me and waited for the lung to re-inflate. After 10 days, it re-inflated and I went back home. But as a graduate teaching assistant, I had no health insurance. So about a month later I started getting bills from the hospital, and over a period of about four or five months it became clear that I needed to do something to attend to that.
So I went to the hospital and asked them if I could work as an orderly while I finished my dissertation research. They said, “You could do that, but we have an operating room technology class that’s beginning in September” — that started September ’72 — “and we would be delighted to have you as part of that class.” It was done in conjunction with the University of Cincinnati Medical School. So I went into the class and became a certified operating room technician. Then I moved from Jewish Hospital in Cincinnati to Christ [Hospital], where they needed first and second assistants because they had lost their general surgical residency program. I worked for about four or five years in a clinical setting. Then I went to school at Xavier, got a master’s in hospital administration, and started working in an administrative capacity in 1977. I’ve been in the Ascension system since 1993. At the time, it was the Daughters of Charity. Ascension began in 1999.
“We have embraced the objective that Ascension Health set in October of 2002: to have zero preventable deaths and injuries.” (0:55)
If you look at some of the things we’ve accomplished, I’d say what I’m proudest of is that we, as an organization, have embraced the objective that Ascension Health set in October of 2002: to have zero preventable deaths and injuries. It’s something that has very surprisingly captured people’s imagination. It’s captured our professional nurses’ imagination, our physicians’ imagination, and it became, I think, a clearer stake in the ground. I can remember studying clinical quality and the different approaches, the inputs, what’s the nature of your medical staff, are they all board certified? Then there was the whole process work, [Avedis] Donabedian’s work in the 70s and 80s. All of that was very useful, but I think none of it has taken us where this commitment to patient safety [has taken us] from I think the great work that the Institute of Medicine did in the late 90s.
“When we meet with our board clinical quality committee, it’s a very different conversation when a lay board member asks the physicians, ‘What could you have done to prevent it?’ as opposed to the old question, which was ‘What is the acceptable standard of care?’” (1:49)
I think one of the things we’ve done at Seton that has been useful is to take some of the learnings that we’ve gotten from our interface with IHI. I can remember being a CEO among a group of CEOs from Ascension meeting with Maureen [Bisognano], and we asked her if you had five things that you could do in your hospital that would reduce unnecessary or preventable deaths and injuries, what would those five things be? She gave us a pretty good answer from the research they had done. Critical response teams was one, improved discipline around acute myocardial infarction, and the work on ventilator-acquired pneumonias.
We’ve been able I think to take that and sequence it in a way that each one of the times that we have been able to put in place a disciplined approach to that specific opportunity, like ventilator-acquired pneumonias, we’ve seen it gain momentum and capture, I’d say, all of our associates’ hearts and minds. That is something that, while I think we’ve all been committed to clinical quality for all of the time each of us has been in health care, it has really given us a new perspective. I think the Institute of Medicine study said to us, “What you’re doing is good, but take a look at how much better you need to be.” When we meet with our board clinical quality committee, it’s a very different conversation when a lay board member asks the physicians, “What could you have done to prevent it?” as opposed to the old question, which was “What is the acceptable standard of care?” I would submit that the acceptable standard of care from the 90s produced the numbers of preventable deaths and injuries that we saw reported by the Institute of Medicine.
“One of the things I’ve seen in the dialogue between the professional nurses is an enthusiasm about the things that have always interested them, which is delivering absolutely the best/safest care to their patients. Now they’ve got a whole larger organization that shares that interest.” (1:20)
I’d say that high-reliability organizations, they create momentum to become even better. If we think of ourselves more broadly as a high-reliability organization that can accomplish zero preventable deaths and injuries, what we’re finding is that we are identifying opportunities to improve our understanding of the care and could prevent a death or injury that maybe three to five years ago we didn’t expect we could prevent.
I don’t think this is a journey that gets to a point where you are sort of at the end. I think this is a journey that will continue. It creates a tremendous amount of positive morale in your organization. We’ve got four of our hospitals that are magnet nursing hospitals, and we’ve been doing patient safety rounds with senior executives, and then we introduce the board into the patient safety rounds. I think one of the things I’ve seen in the dialogue between the professional nurses who are on the floors giving care is an enthusiasm about the things that have always interested them, which is delivering absolutely the best/safest care to their patients. Now they’ve got a whole larger organization that shares that interest. They hear it from the board members, they hear it from me, and they hear it from my colleagues and the senior executives.
07/05/2007
