This is part of an ongoing series of audio profiles of front-line improvers.
Senior Analyst/Improvement Advisor
Delnor Community Hospital
My name is William Peters and I’m from a medium-sized hospital, about 140 beds, outside of Chicago, Illinois — in Geneva, Illinois. It’s the combination of two very small community hospitals. Around 1990-91, they both were combined into what is now Delnor Community Hospital, and we’re getting another 40 beds coming online in another three or four months. So we’re undergoing rapid, rapid growth. In around ‘98 or ‘99 we had an operating margin of about 1 percent and the customer service was around the 60th percentile, 70th percentile pretty consistently, when the board and senior leadership made a drive to get that a lot better. And then a mere three or four years later we’re now consistently ranked in the 99th percentile in any one of the five patient satisfaction surveys from Press Ganey. And we turned the 1 percent operating margin around; this year [we had] an operating margin of about 12 percent. We’re not going to get that next year, probably around six [percent], but six is still really, really good these days.
To the board’s credit, the last two years, they’ve really been starting to ask tough questions like, “Our quality is no better or worse than the hospitals around us, but can we do better?”
It’s a rich payer mix, quite literally; it’s an affluent area. That, I think, even puts more pressure on our management to say, “We’re in a position that a lot of hospitals aren’t in, so we’d better be a lot more successful in regards to quality.”
We’re very rich in financial analysts, but we’re very poor in clinical quality data analysts, so that’s what I would call myself. The funny thing is I came from Price Waterhouse Coopers. Well, I used to be a mental health therapist some 12 years ago, and then I finagled my way into the IT industry and really got my hands on large amounts of data. And then, some six years ago when I was laid off from Price Waterhouse, when the bubble burst, I got a hold of Michael Kittoe — he’s the CFO at Delnor, he’s a really great guy, he’s a great listener — and I called him and I said, “Listen, here’s my skill set.” And he just happened to have a need for that. No one collects more data than health care. We collect oodles and oodles of data, and the funny thing is the deficiency in how we look at that data. There’s a big deficiency whereas I have a friend that works at Sears, they collect terabytes full of data, 300 million customer records. They’re rich in data analysis. But health care for some reason is real poor in data analysis, so he [Kittoe] saw the need to bring someone in that knew how to “manhandle” large chunks of data.
I went to see Bob Lloyd
present at an IHA conference (Illinois Hospital Association) and he really dropped upon me this idea of looking at data over time and how insane it is when people over-interpret random variation. I really glommed onto his message and from there sunk myself into learning the second question and at that time I didn’t know anything about the Model for Improvement
, but unbeknownst to me I had become kind of this real expert at this second question, “How do you know a change is an improvement?” Then I came to IA [Improvement Advisor
] training and realized there’s a first and a third question, “What are you trying to accomplish?” and “What changes can you make to lead to improvement?” That’s when I got kind of the total picture.
I’m very vocal, maybe Gen Xer, being more of a vocal person, but when I see something I think is not right I just flat out say what’s on my mind, and I’m just open and honest.
I’m consistently the only male and the youngest person in a lot of the meetings, but that’s a good thing, and I think our hospital kind of sees that as a good thing, you know? You need somebody that’s willing to challenge the status quo. And I think right now in health care there’s a dichotomy of quality administrators right now. There’s the old school quality administrator that pushes a lot of policies and procedures and spends most of their day in meetings — it’s called “administrivia”— a lot of paper, a lot of meetings. To me the new school is being explicit, using the Model for Improvement, understanding Deming’s 14 principles, being explicit in what you’re doing. “What is our aim?” Instead of working on 100 different things kind of haphazardly, work on 10 things and work on them very well. Define a very specific aim or unit to measure a population and time expectation. Measure your data over time, so be a little more just scientific about it.
When you go through the Improvement Advisor training and you hear a lot of the concepts for the first time, you’re never really the same the way you think. It almost kind of taints your mind permanently. I’ve never really graduated, you’re never really a full IA. It’s kind of a lifetime process.
I had to learn the hard way. I tend to be the child that you probably said, “The stove’s hot!” But I had to put my hand on the stove and then I’m like “Oh, sure, that stove is hot, it’s true.” So I had to learn some things some hard ways. I’d start some projects like “percentage of discharges before noon” where we had this aim that we wanted to get a lot of people out [of the hospital] before noon. This group that had already been meeting for a year, they were very, very frustrated and they saw me come in and they said, “Oh, here’s this Improvement Advisor.” And they flat out told me, “This is going nowhere and we want to tell you that and we’re already really frustrated because the physicians aren’t on board.” Well, I had just come out of training so I said, “Oh, well, all we need to do is just apply some change concepts, test things on small scales, and we can get some improvement and build knowledge sequentially, right?” Just a little programmed robot, right out of training. What I learned within two months is, “Duh, these tools don’t work if you don’t have the right people on the team.” But now I know that. If I’ve got a process that we’re working on that’s heavily physician-driven and I don’t have physicians on the team, I move on. The interesting thing is those nurses on that team, those discharge planners told me that immediately. I didn’t hear it because I hadn’t learned it for myself. Now I understand that.
I tell people now on teams, “If you come up with an idea for change and people abhor it, and then they run from it and say, ‘It just can’t work,’ you’re probably onto something.” Because humans inherently hate change. So if you can come up with an idea that people don’t like, you might have something. Not always, but you might have something there.
There have been times when I’ve felt like I’d like to ditch health care and go and work in an industry where I can work with machines and people who are working on machines, but when you have success within health care I think it makes it a lot more meaningful. And I feel morally obligated that if there are better ways of doing things, then we should be doing them.
I also really, really like getting out to other hospitals and speaking there and bringing the message of the Model for Improvement and the whole idea of “There’s a different way to improve.” You can improve at your current rate or you can adopt some of these ideas that have been proven for 50 to 60 years by Deming and the Japanese and, to a certain degree, the Americans. I like spreading the message.