“If you can accomplish it in Florence, then you can accomplish it anywhere.” (1:27)
I’m Donna Isgett. I’m the Vice President for Clinical Effectiveness at McLeod Health in Florence, South Carolina. I oversee the quality work for the McLeod Health Care System. We’re a three-hospital system. I actually joined the health care system in 1997 and started this work in 1998.
Our community is very interesting. I call us “Hospital USA.” Most of the time when people think of people that are in the news, or getting attention, it’s big university settings and big cities, those sort of places. We are a typical hospital. We’re a tertiary care facility, serving the poorest part of South Carolina. It’s very rural; we have a large minority patient base in our actual community. Poverty is extremely high. It’s very dependent upon a lot of your agricultural things, and some of the manufacturing industry which has been dropping tremendously. I like to say, “If we can do it, anyone can do it,” because we have made tremendous strides, but it’s not because there is one special element that you can put your hands on. It’s because we all came together with a united focus and we’re determined to move down that road. So it doesn’t take some extraordinary one thing, it really takes a united effort to move forward, and if you can accomplish it in Florence, then you can accomplish it anywhere.
“I saw quality as a separate thing; I didn’t see it as an integration of the work we were actually doing.” (1:10)
I am a nurse by original training, critical care master’s degree in nursing, and was running a transport service. It started originally from an associate degree in nursing and kind of worked through the system, but very much moved over to the emergency side of things. When I first came to McLeod, I was hired by the Chief Nursing Officer, who is still there, and is my colleague, she asked me about some of the opportunities and interests that I might have, and one of them was in the quality arena. I said, “Well, I’ll do anything, but I really know nothing about quality.” I saw quality as a separate thing; I didn’t see it as an integration of the work we were actually doing. So we laugh about that now, but really the task or the skills that I brought to this organization, I think, I’m a real “get things done” kind of person, and that really was driven from my love of the emergency department and transport. If we’re going to do it, let’s go! If we’re going to accomplish results, then let’s do it! Let’s see what they are, let’s monitor them, and let’s get better. I’m also very optimistic. I don’t believe there is a mountain we can’t climb.
“Why can’t everybody be right, and why can’t every patient get what’s right?” (1:15)
It’s a real tightrope between acknowledging how bad it is and not creating panic in everyone. But when I was pregnant with our first child, the doctors put me in and out of the hospital three times. One doctor would put me in, and say, “We must deliver this baby emergently; you don’t have enough amniotic fluid,” only to be met at the door by another physician who would send me home. I remember my mother standing over my bed, in her traditional different generation, saying, “The problem is, you think you know too much,” and I said, “The problem is, I do know too much and somebody’s right, and somebody’s wrong, and my child’s life is resting on that.” That’s when some of the passionate drive of, but why is somebody right, and somebody wrong, why do we have a system that there’s that much disparity? Why can’t everybody be right, and why can’t every patient get what’s right? Why can’t we create a reliable health care system that would deliver that, so that there will be no doubt about the survivability of my child. Who did survive, and is a beautiful, beautiful 7-year-old daughter.
“If you go ask any staff nurse, he or she can tell you what’s wrong with our health care system.” (1:44)
Nurses do have some unique qualifications to do quality improvement. Number one, they have the passion. Nurses went into nursing to make a difference, to care for someone. It was much more of a calling for them, than a choice of this would be a good job to have. So, they are unique in the fact that they are passionate, traditionally, about their work, number one. They are very good organizers, because they have had to, in their career, organize the care of multiple patients and multiple things they need to accomplish for those patients. Part of the quality improvement work, requires and calls upon that organizational skill that is so critically important. They are natural negotiators, because they’ve been the patient’s advocate. They’ve been the one that is often times there, to bring together what the physical therapist was coming in to do, and the occupational therapist, and the physician and the pharmacist. They were the person, bringing it around to a central whole; they were the person staying at the bedside, taking care of that. If you go ask any staff nurse, he or she can tell you, here is what’s wrong in our healthcare system; here is where I have seen the ball drop; here’s where we need to work, because they are living with the patient. Our Chief Nursing Officer says patients only come to the hospital for nursing care, she’s right, patients can see a physician on an outpatient basis. But it is when they can no longer care for themselves, do they come into a healthcare facility. In the healthcare facility the uniqueness that is offered, is the care of the nurse, directed by the physician, but it is the care of the nurse that is unique about being in the hospital setting.
“How can you argue with providing better health care? What’s the rebuttal to that?” (1:38)
Yes, I’m very persuasive. I make a logical case that’s hard to argue with. How can you argue with providing better health care? What’s the rebuttal to that? How can you argue with taking the barriers out of the system that prohibit you from doing that? How can you argue with win-win? And just telling that message. The other is designing the systems, and being extremely open and fluid to change. Meaning, if we try it this way, we haven’t failed, just back up and try it another way, and back up and try it another way, because we can get there and just having that consistency of purpose, not being married to a methodology, in which to arrive. I’m very persistent. I’m very driven. I’m very supported; I’m surrounded by a CEO that this is his passion. He is the quieter of the leader, but it is his passion, and he believes that we are only in healthcare to do the right thing. I’m also surrounded by staff members that are brilliant. It’s a team. This is not something that Donna does. This is something that Donna and hundreds of other people, those closest in the actual work, all of the physicians; over half of our medical staff has been actively engaged in the performance improvement. They’ve led it, let it from the actual knowledge base side, we’ve been the support system to help them get there, and our CEO and some of those physicians have had that vision of where we need to go.
“We believe that we’re creating our own health care system... that will some day care for us.” (1:01)
The culture has long standing executive leadership of the same folks. I’m the little young chick (laughing), not in my physical age, but in my length of time on the executive team, or by length of time being with the organization, because most of the folks have been there 15-20 years. What they had done there, was create a culture, of safety and warmth, not of one of stagnation, now you couldn’t just not do your job, but more one of we were a family, we were a team. Some of that is the culture of the community, some of that southern culture, but all those things played in to create an organization that was ripe for movement. See, we believe that those patients, that somebody’s mother, or somebody’s father, or somebody’s brother or sister, and heaven forbid someday, us, so we’re building our own healthcare system that will some day care for us, the way we want to be cared for and the way the patients of today deserve to be cared for.
05/10/2005
