When she had questions about how to implement standard order sets for heart attack care in her West Coast hospital as part of IHI’s 100,000 Lives Campaign, Megan ElRif turned to a stranger in a Pennsylvania hospital for help.
“I called the DuBois Regional Medical Center and talked with Carole Berger,” says ElRif, Clinical Effectiveness Facilitator at Overlake Hospital Medical Center in Bellevue, Washington. She called DuBois, a 239-bed hospital in northwestern Pennsylvania, because it was listed on the IHI website as a Mentor Hospital for the 100,000 Lives Campaign. “They had already made the improvements and were successful at the work that we were trying to do. I wanted to clarify if we were on the right track,” says ElRif, who spoke at length with DuBois Performance Improvement Manager Carole Berger, RN, BSN.
Recognizing the unique value of learning from peers, IHI has identified more than 60 organizations to serve as Mentor Hospitals in the 100,000 Lives Campaign. “For reasons of credibility and practicality, it makes sense for improvers to look to their counterparts who are also on the front lines,” says Joe McCannon, 100,000 Lives Campaign Manager.
The network of Campaign Mentor Hospitals
— listed on the IHI website — range from large urban academic medical centers to small rural hospitals. What they share, says McCannon, is a strong commitment to continuous improvement, success at making change, and an eagerness to share their insights. “Mentor Hospitals don’t have to be the best of the best at everything,” says McCannon. “But they are high-achieving organizations with useful insights that can help others.”
Challenges in Common
The variety of hospital types serving as mentors makes it easier for those seeking advice to find a suitable peer. “Sometimes people hear about an improvement at another hospital, but think it wouldn’t work for them because their hospital is much larger or smaller or otherwise different,” says McCannon. “This gives them the opportunity to identify a Mentor Hospital that they feel is comparable to their own and tap into their experiences.”
This was exactly the case for a group of rural hospitals in Colorado, working with the Colorado Foundation for Medical Care (CFMC), a statewide quality improvement organization (QIO) that is serving as the Colorado “Node” for the 100,000 Lives Campaign. Nodes are organizations that have committed to act as Campaign field offices around the country — offering support to hospitals in a particular region, in the same system, or that share a common affinity (such as pediatric hospitals or rural hospitals).
“Rural hospitals face unique challenges,” says Cari Fouts, CFMC Project Manager, “and the rural hospitals in our network really wanted to connect with others who understood those challenges.” That’s why Fouts called Ben Chaska, MD, MBA, CPE, Medical Director and Patient Safety Officer at St. Peter Community Hospital in St. Peter, Minnesota. Located about an hour from Minneapolis-St. Paul, St. Peter Community Hospital is a 17-bed critical access hospital (the Centers for Medicare & Medicaid Services designation for small, somewhat isolated rural community hospitals that meet other specific criteria), and a Mentor Hospital for five of the six Campaign interventions.
“We organized a conference call with Dr. Chaska and the Colorado rural hospitals,” says Fouts. “The participants on the call enjoyed hearing how St. Peter had overcome barriers and it gave the hospitals hope that they could achieve the same success with similar strategies.” The most common challenge at rural hospitals, says Fouts, is how to do more with less. “Most rural hospitals are quite small, and everyone wears three or four hats,” she says. This leaves precious little time to devote to new initiatives, and requires staff to adapt the interventions to make them applicable locally.
Take Rapid Response Teams
, says Fouts, referring to a Campaign intervention that enables bedside nurses or other caregivers to summon a team of critical care specialists to the bedside of any patient showing signs of decline. Ideally, one of these people is a respiratory therapist, but often rural hospitals don’t have one on staff. “We talked about this on the conference call with Dr. Chaska,” she says. “It’s the concept of rapid response that is key, and you work with what you’ve got to achieve that goal.”
This is exactly right, says Kathy Duncan, RN, a Rapid Response Team expert working with IHI. It’s also an example of how mentor hospitals like St. Peter can convey critical learning. “In small hospitals, the respiratory coverage may not be 24/7,” says Duncan. “We encourage people not to let this slow them down, but to focus on respiratory assessment of the patient and early treatment. Often, nurses possess these skills.”
An Astounding Experience
For his part, Ben Chaska says that serving as a Campaign mentor is “an astounding experience.” Despite the fact that St. Peter has achieved remarkable improvement in the five interventions they have implemented (the hospital has no patients on ventilators so the initiative to reduce ventilator-associated pneumonia doesn’t apply to them), he says, “We didn’t even consider that others might want to learn what we are doing.”
Jo Ann Endo, IHI Communication Specialist, says this misperception is common. “People are so focused on facing their own challenges, they often don’t realize they have lessons to teach until someone asks them.” That’s exactly what happened to Ben Chaska while attending IHI’s National Forum in December 2005. “We had dozens of people asking us how a critical access hospital does these things,” he says. “They think that these interventions are for larger organizations, that they can’t do it at their small hospital. But we told them, ‘You can do it. You have the resources.’”
Chaska says he and his hospital’s CEO have received a few dozen emails and calls from other hospitals with questions, and have participated in several teleconferences. “We feel this work is really important,” says Chaska. “This stuff is powerful and reduces morbidity and mortality. Not only can we improve health care for the people in our community, but we can also help other hospitals in our situation, and sometimes even larger organizations.”
At DuBois Regional Medical Center in Pennsylvania, Carole Berger echoes Ben Chaska’s sentiments, and says the role of mentor is an extra motivation for continuous improvement. “Serving as a mentor is an honor. But we also know that if you’re going to be a mentor, you’d better be worthy of the title.”
“It makes us work harder,” agrees Daniel Ahearn, MD, Vice President of Medical Affairs at DuBois. Together, Ahearn and Berger, along with their data analyst, Steve Rutledge, serve as the hospital’s quality champions. And together, they appreciate what others may be going through who don’t yet have everything in place to deliver better care. It was Berger who fielded the call from Megan ElRif at Overlake Hospital in Washington about best practices for AMI.
“She wondered how we convinced folks to use the order sets,” recalls Berger. “I told her the stakeholders have to come to the solution themselves, that you have to find a few enthusiastic physicians and provide them with data that makes a compelling case for change.” Berger says she also put ElRif directly in touch with the Catheterization Lab manager at DuBois to discuss specific steps in reducing the time it takes to get AMI patients into the cath lab, a key element of good AMI care.
Give and Take
Teresa Neal, RN, MS, a Six Sigma Black Belt at Charleston Area Medical Center (CAMC) in West Virginia, says the benefits of the mentor system flow both ways. “One of the benefits for us of being a Mentor Hospital is it puts us in touch with other people who may be doing an excellent job in areas where we are not yet,” she says. “It helps us set the bar a little higher.”
Neal says as the primary mentor contact at CAMC she offers callers lessons from her experiences, and puts them directly in touch with others at CAMC who can help. She says she has received calls for advice on topics ranging from glucose control in surgical patients to the Ventilator Bundle
and the drug of choice for peptic ulcer disease prophylaxis.
“We have been engaged in collaborative work with IHI for many years,” says Neal, “and we’ve learned how helpful it is to look at other people’s work, to be able to ask questions of experts when you are stuck. Being a mentor is our chance to give something back to the improvement community.”
IHI’s Jo Ann Endo says she has been inspired by the enthusiasm with which Mentor Hospitals help others. While the activities between mentors and learners vary — there have been phone calls, emails, teleconferences and even site visits — the same quality lies at the heart of each interaction. “There is such a great spirit of sharing, whether it’s tools, protocols, forms, or ideas. There is enormous generosity, and the mentors seem to gain as much from the encounters as the people they are helping.”