HEALTHCARE ORGANIZATIONS TRANSFORMATIONAL CHANGE

Healthcare Organizations: Transformational Change

Healthcare Organizations: Transformational Change

A Transformational Change Process at Ascension Health

Ascension Health has worked toward transformational change by creating a structure for continuous improvement. In November 2002, 120 strategy leaders came together in support of Ascension Health's Call to Action: to provide Healthcare That Works, Healthcare That Is Safe, and Healthcare That Leaves No One Behind. Through this strategy, Ascension Health aims to improve clinical excellence and safety, create innovative, patient-centered healing environments, and expand access to care for the uninsured and underserved. The system is formally committed to safe health care, with a goal of eliminating preventable deaths and injuries by July 2008.

During the next six months, a Clinical Excellence Team representing chief medical officers, chief nursing executives, chief executive officers, and a mission executive developed a Clinical Excellence Destination Statement to guide the pursuit of this goal. The statement, which was adopted by the system's board of directors, incorporates the Institute of Medicine's (IOM) six aims for the health care system—safe, effective, patient-centered, timely, efficient, and equitable care—plus a seventh aim to reflect the system's spiritual mission.[2] It also embraces the IOM's 10 rules for transformation of the health care system and identifies five challenges that must be overcome to achieve transformational change.

In September 2003, a 39-member planning team, supported by individuals from the Institute for Healthcare Improvement (a strategic partner), identified eight Priorities For Action to achieve the overall safety goal (see Key Measures). To validate these priorities, selected Ascension Health hospitals reviewed medical records of the last 50 patients who had died in the hospital. This review found that, among patients who were not admitted for end-of-life care, about 15 percent of deaths were considered potentially preventable and all involved at least one of the Priorities For Action.

In December 2003, Ascension Health's Clinical Leadership Forum—chief medical officers, chief nursing executives, risk managers, and chiefs of staff from throughout the system—ratified these priorities. All hospitals began work on addressing the first three Priorities For Action: preventable deaths, adverse drug events, and JCAHO core measures.

Eight volunteer "alpha sites" were selected to develop prototype strategies for addressing the remaining five Priorities For Action, and a ninth alpha site was selected to focus on addressing overall mortality. Alpha sites were selected based on their past performance and capabilities—such as resources, time, and leadership—for leading quality improvement. The alpha site selected to address pressure ulcers, for example, had undertaken improvement work on that topic (see sidebar).

In February 2004, the alpha site teams met to agree on how they would work. Each alpha site team developed a "change package" for its priority area that included standard metrics and methods for measuring and improving performance. Each group selected its own short-term process and outcome variables, with all groups working toward improving long-term outcomes such as lower mortality rates. The teams based their approaches both on evidence from the clinical literature and their own experience and used a rapid-cycle prototyping model to test ...