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Spotlight on St. Charles: Establishing a Sense of Urgency

By IHI Open School | Wednesday, June 5, 2013

This is the second post in an occasional series by Kyle E. Johnson, PMP, Administrative Fellow, St. Charles Health System. Click here to see his first post.


How do you get an entire health system to recognize the value of 23 hours of mandatory online education? This is the challenge of the St. Charles Health System, which has adopted the IHI Open School curriculum as its primary framework for quality improvement education and training.

While many managers have begun working on their Basic Certificates and are excited about the Open School program, there are others who feel that this is just something extra that’s been added to their already full plates. The Open School program provides many of the technical tools and methodologies necessary to improve patient care and safety. However, it cannot, by itself, create the organizational will necessary to transform our culture into one of continuous improvement.

The well-known change management expert, John Kotter, has identified eight critical factors for successfully leading change. The first step is establishing a sense of urgency, which in today’s health care environment doesn’t seem like a difficult feat. However, when we look at some of the highest performing organizations in health care today, we see grains of truth behind Winston Churchill’s quip that: “The United States invariably does the right thing, after having exhausted every other alternative.” All too often, health care organizations don’t make the needed and known changes until something terrible happens to prompt them. Below are a few examples of high-performing health care organizations that used tragedy to create a shared sense of urgency around quality initiatives.


From Tragedy to Urgency  

  1. ThedaCare is a top-tier health system based in Wisconsin. In 2004, one of its surgical units had four wrong-site surgeries take place in the span of eight weeks. The president of ThedaCare hospitals shut down the surgical suites and wouldn’t reopen them until there was a plan to ensure patient safety. ThedaCare is now one of the highest performing Lean health care systems in the United States.
  2. Johns Hopkins is a world-renowned academic medical institution and an industry leader in patient safety. In 2001, a string of medical errors resulted in the death of 18-month old Josie King. Johns Hopkins leadership worked with the King family to create the Josie King Pediatric Patient Safety Program that is now a model for children’s hospitals throughout the United States. 
  3. Virginia Mason Medical Center in Seattle was recently named the “Top Hospital of the Decade,” by a well-known quality organization. In 2004, Mary McClinton, a 69-year-old woman from Alaska, died after she was mistakenly injected with an extremely toxic antiseptic solution. Virginia Mason publicly apologized for the error and set out to make sure it would never happen again. There is now a prestigious patient safety award that Virginia Mason gives out each year in honor of Mary McClinton.


St. Charles cannot wait for tragedy to spur its transformation into a continuous improvement culture. At the same time, we recognize that there is a risk of losing caregiver engagement due to the barrage of changes currently taking place in health care. The challenge of implementing Kotter’s first step in our improvement journey is to create a steady sense of urgency that is neither too banal, nor too alarmist. In other words, if we whisper our message, then no one will hear, but if we constantly yell, then no one will listen. The transformational journey to a culture of continuous improvement must be carefully orchestrated to gauge balance and effect.

At St. Charles, we are using internal data to help gain support for the IHI Open School program. But data alone isn’t sufficient to create new paradigms and to catalyze change. In order to create the sense of shared urgency, we must pair data with context. For St. Charles, this means telling the story of our own near misses and errors. We must talk openly about our data and highlight the individual stories that provide invaluable context. Data without context does little to create a sense of urgency, but a true story that lends credence to data can make all the difference in the world.

Next month, we will begin telling the stories of some of the good and bad experiences that have come about since starting our Open School Chapter this past January.


St. Charles
Pictured above: St. Charles in Bend, Oregon

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