This is part of an ongoing series of audio profiles of front-line improvers.
Karen Scott Collins
Deputy Chief Medical Officer
New York City Health and Hospitals Corporation
I’m Karen Scott Collins. I’m the Deputy Chief Medical Officer for the New York City Health and Hospitals Corporation and I oversee our office of Healthcare Quality and Clinical Services.
This is the largest public hospital system in the country, municipal hospital system in the country. So we have 11 public hospitals across New York City, six large primary care centers, a number of smaller clinics affiliated with the hospitals, as well as long-term care services and home care services.
Focusing on quality improvement and putting the efforts and resources into quality improvement we see very much in line with the national agenda around reducing health care disparities by improving the quality of care and assuring people coming to our facilities are getting the same quality care as if they were insured and could go anywhere.
What really clicked with me was hearing people say we know so much about the right thing to do. We can keep funding research and coming up with more great ideas, but there’s already so much that we know would work and make such a difference in people’s lives if we just figured out how to do it all of the time.
The structure from the Breakthrough Series Collaborative
and those improvement methods has really been enormously powerful in helping me figure out how to organize an incredibly large organization to focus on the same set of objectives, using the same models and the same framework for where we want to get to.
So we started with 15 clinical improvement teams in the first year working on diabetes and heart failure. We just finished the second year where we have 26 improvement teams working on diabetes, heart failure, depression, and pediatric asthma. We have been able to show across all of these teams some really significant improvements in the patients’ outcomes, you know, on the clinical measures, on blood pressure, and Hemoglobin A1c, LDL, we’re keeping patients — heart failure patients — out of the hospital.
The other thing that’s really wonderful about the work I think is that it has been an amazing way to both develop and identify talent around the corporation. I think it’s wonderful that I can have a physician assistant from one of our hospitals get up and talk about the Model for Improvement
better than I can. Because, I mean, we’ve really then achieved something.
While these initiatives have had very clinical foci and very specific clinical outcomes to reach, there’s also very much an element of changing the way people work, the way they think about the problems, the way they think about, you know, why we’re measuring something, and what we’re using the data for, which is quite different. And that it really is part of learning and deciding what we’re going to do next, as opposed to lining people up and comparing them.
I think the first reaction, particularly within our system, is that if you have data on 11 hospitals, you’re going to put up 11 bars, and you’re going to look for the worst bars and then focus on what’s wrong with those people. And with the improvement work, you know, we’re developing much more of a culture and a comfort level that this data is useful and that nobody is doing so incredibly well that they’re going to be perfect all the time, and no one’s doing so incredibly badly that they’ll always be at the bottom. When we first started looking at the mortality data, one of the things that impressed me was that the conversation with the medical directors was more about, well, "This is interesting. Yeah. We can do a little bit better here and, you know, can we look at it this way as well?" They knew it was not perfect data, but it was a starting point for the kind of conversation we needed to have that day.
I think that there’s a great potential for public hospital systems like ours and safety net providers like community health centers to add to the body of knowledge about how to apply different changes, and improvement ideas, and tools to different populations. So when we test, you know, self-management support strategies from the Chronic Care Model, we have to think about how are we going to do this in 12 different languages? It may work great to have an English group visit, but if we can’t figure out how you have four different languages going in the visit, or how many different groups you can do, it’s not going to be sustainable in our system.
I think, similarly, we’ll probably see it as part of the ICU work, they’re beginning to look at some end-of-life decision making processes, and I think that’s another area, certainly, where culture and the fact that we have both very diverse clinician staff, as well as patient population, will certainly come into play in terms of understanding how those types of decisions get made.
So I see us now in a position to really be, you know, contributing to all of the work that’s out there.