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Providence is a health care network based in Seattle, Washington, with 51 hospitals and more than 1,000 clinics across seven western states. Over the past five years, this IHI Strategic Partner has worked on reducing waste throughout their hospital network. In 2018 alone, they saved $6 million in waste from hospital-acquired infections. Since then, they have managed to reduce serious safety events by about 70 percent.
Providence has a history of being ambitious, but providing the best care at the lowest cost is at the root of their biggest aim yet. Their goal is to operate at or below Medicare reimbursement rates by 2024. As their Chief Value Officer, Joanne Roberts, MD, will tell you, a major step in that process is the drive to eliminate waste across their network.
At Providence, reducing waste means everything from cutting down on hospital-acquired infections to reducing staff burnout. It requires creating a system that gives health care providers adequate resources to prioritize patient safety.
When first setting out, Providence leadership realized that a major change to their health care structure would be necessary. They needed to develop a system that worked in favor of their patients and consumers. They called it Health 2.0 (Figure 1).
Figure 1 – Transitioning to Health 2.0
Health care 1.0 anchored hospitals at the center, prioritizing structure as its most significant component. The focus of Health 2.0 is to serve the patient and consumer, reinforcing the importance of a humanity-centric system over a structure-centric one. In the Health 2.0 model, a decision is not automatically made based on institutional guidelines; it’s made with patients and consumers as the primary drivers.
The shift from Health 1.0 to 2.0 has not been an easy undertaking. Creating a humanity-centric system goes beyond patients. Hospital leadership have the responsibility to understand and meet the needs of the group most integral to patient safety: frontline clinicians.
Importance of Senior Sponsorship
The support of a senior sponsor can make or break improvement work. According to Roberts, senior sponsorship has been a key part of her organization’s journey to transform their system and decrease waste to increase value. “When we ask our process improvement teams why things aren’t moving more quickly or effectively,” says Roberts, “they always say it’s about sponsorship.” Every sponsor has three crucial roles:
- Set the vision of work and identify key stakeholders who can support that vision;
- Recognize and encourage acceptance of variation across the hospital systems as an opportunity to learn. (“If there is variation, it implies that someone is doing something better,” said Roberts);
- Ensure system level barriers are removed. (“There are always barriers,” says Roberts.)
An effective sponsor is close enough to the work to understand and support the needs of frontline clinicians, while simultaneously detached enough to keep the bigger picture in mind. Their distance provides the team with a system-wide lens, enabling them to be visionary leaders and assist clinicians when institutional barriers arise. They are responsible for listening to the clinicians every step of the way, lending guidance, and opening doors that might otherwise stay shut.
According to Roberts, senior sponsors should encourage collective acknowledgement of variation as a “learning journey,” not a competition. When one hospital lowers their rates of hospital-acquired infections more than others, it doesn’t mean others failed. It provides an opportunity for shared learning. At Providence, success is a group effort, and leaders seek out positive deviance to share with the entire organization.
Empowerment of Frontline Clinicians
The overarching role of a senior sponsor is to empower frontline clinicians with the tools they need to be successful, not to drive the success themselves. In alignment with principles of highly reliable learning organizations, this demonstrates deference to the expertise of those who do the work and provide the care. At Providence, a key component of empowerment is positive reinforcement. The senior sponsor is responsible for reminding clinicians they can make mistakes. Says Roberts:
“In my experience, when a project isn’t moving fast enough, the project owners usually blame themselves. They say, ‘I’m not doing a good enough job.’ I believe this speaks to the ‘shame and blame’ culture of medicine. We feel failure is personal, when often it's the system and the structures that get in the way of improvement.”
Roberts emphasizes that being a senior sponsor means redirecting this blame, bringing to light the tenancy of systemic barriers. Senior leaders must counter the belief that perfection is the norm, and that any failure should be taken as a personal fault. At Providence, creating a culture of constant learning toward improvement is vital.
Since beginning their waste and value efforts, Providence has trained over 100 people in a leadership development journey called Clinical Value Improvement. Each of the 40 Clinical Value Improvement projects has saved about $140,000.
When the leadership of a sponsor meets the skillful ambition of a frontline clinician, improvement efforts thrive. In the words of a senior sponsor, “When we put our caregivers first, patient satisfaction, equality, and affordability all follow.”
Emma Robinson is an IHI Project Coordinator.
You may also be interested in:
WIHI - Let's Get to Work on Waste in Health Care, featuring an interview with Joanne Roberts, MD, about the waste reduction work at Providence.
