​This story originally appeared in IHI's 2008 Annual Progress Report.

Senior Medical Director Steven Tremain, MD, says that the culture of interdisciplinary collaboration at Contra Costa Regional Medical Center in Martinez, California, is in part a natural result of the fact that the hospital is owned and operated by the county. “Probably 90 percent of the people who work here are county employees, and together we own the work,” he says.

But really, there is far more to it. What he describes as “tremendous collegiality” between doctors, nurses, respiratory therapists — in fact all staff — does not just happen. It is the result of a conscious effort from the top down and the bottom up to create a culture of collaboration and teamwork.

Through teamwork, Contra Costa has been able to improve care processes and patient outcomes in areas ranging from reducing surgical site infections to reducing heart attacks. Working together to implement the bundle of steps recommended by IHI to reduce ventilator-associated pneumonia (VAP), staff reduced cases of VAP from 20 per 1,000 ventilator days in 2003, to 1.3 in 2006.

To hammer home the importance of the bundle steps, Tremain says the head respiratory therapist built a simple model of a trachea, and placed a ventilator tube into it. To show that the cuff surrounding the tube does not reliably keep extraneous material from slipping down into the lungs, he poured pea soup around the tube. “In 24 hours it had leaked past the cuff,” says Tremain. “It was a visual cue that reminded everyone on the team to do the bundle elements, because we can’t assume the cuff forms a perfect barrier. If we do, we are in trouble,” says Tremain.