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North Shore-LIJ wins NQF quality award
North Shore-Long Island Jewish Health System based in Great Neck, NY, was awarded with the National Quality Forum's 2010 National Quality Healthcare Award.
Asked what the indicators of a high-quality institution are, Karen Nelson, RN, vice president of the institute of clinical excellence and quality for the North Shore-Long Island Jewish Health System, lists:
"We've set our benchmarks at the top decile of performance nationwide. Being at the national average is not good enough, and we don't limit ourselves to being the best in the state. We're striving to reach top decile performance across the nation in every one of our quality indicators," Nelson says.
In 2008, the health system developed a three-year strategic plan for clinical excellence "to clearly articulate our strategic imperatives, actionable initiatives, and measures of success. The plan aligned with the NQF national priorities and the markers of success on the system dashboard." Along those lines, she says, the strategic imperatives for the system are reducing unnecessary variation and overuse, improving care coordination and patient safety, integrating the continuum of care, population health improvement, and increasing stakeholder trust by engaging patients and families.
Nelson says the organization also has a culture of both internal and external transparency and posts data publicly including infection rates, CMS appropriate care scores, and use of evidence-based care for stroke on its web site.
As far as methodologies, "physician and nursing leaders partner to co-chair our clinical initiatives, utilize data to review performance, reduce variation in care through use of evidence-based guidelines, and ensure patient safety," she says. "We developed tools for the improvement of care coordination, and through our collaborative care model, we engage patients and their families."
Internally, hospitals within the system share adverse events, lessons learned, and best practices. "Adverse events and risk reduction strategies are shared among institutions, enabling leaders to perform a risk analysis at their own site to make sure that appropriate processes are in place to prevent an adverse event from occurring," she says.
"People want to do the right thing. They want to provide the best care to their patients — physicians as well as frontline staff at the bedside. And I think that involving caregivers in any process that you're looking to change, being a voice at the table... helps give you the buy in and results. It cannot be a mandate from leadership to say, 'This is the way you need to do it.' You need to engage the stakeholders," Nelson says.
One area of focus was the system's rates of central line-associated bacteremias (CLABs), which were examined to improve patient care and safety in 22 intensive care units encompassing more than 330 ICU beds. Work included standardizing evidence-based infection control practices, policies and procedures, reporting, and training modules. When an infection occurs, a root-cause analysis is conducted to assess opportunities for improvement.
"The message of zero tolerance was spread to all employees through these surveillance efforts, as well as through the intranet, collaborative care councils, and newsletter articles. The outcome of this targeted intervention has resulted in a 60.3% decrease in the CLABs rate from 2004 to 2008. In addition, central line days decreased by 8.7%," Nelson says.
The system also has improved its hand hygiene compliance by 81%, through technology and innovation, Nelson says. Compliance is observed through a remotely monitored video camera. The camera "is used to assess and calculate compliance with hand hygiene events. Real-time performance feedback is transmitted every 10 minutes and displayed on two separate LED boards in the unit." The purpose of the "real-time performance feedback," Nelson says, is not punitive for noncompliant individuals. It's about creating enhanced awareness and constant feedback.