When Holyoke Hospital joined 200 hospitals and other health care agencies throughout North America in the Improvement Action Network (IMPACT), the idea was simple: to take what works and make it better.
That happened when the hospital targeted the way medications are dispensed in the hospital last year, and now Holyoke is turning its attention to critical care.
“For years, Holyoke Hospital has had a quality-assurance program,” said Clark Fenn, vice president of Management Services. “Partnering with IMPACT allows us to focus our activities in ways that have been tried and found successful.”
Because the endeavor is a partnership, Holyoke can take advantage of strategies that have been put into practice and have worked elsewhere, Fenn said. The hospital also can confer with other organizations to see how different approaches to various aspects of caring for patients will improve that care.
“The idea is to take the philosophy of the Institute of Healthcare Improvement (IHI), look at our organization, and move us toward even better delivery of health services,” he said. “We have things to model, and we adapt them to fit our own organization. The ultimate goal is to provide the highest quality of care in a patient-centered fashion.”
Right now, Holyoke is engaged in a project to develop better outcomes in its critical-care efforts. The aim is to make the entire critical-care service work in a more timely, efficient, and successful way in order to provide the best care possible for each patient.
The method is incremental, with small steps of change that are tested at each step to ensure good patient outcomes and improved care.
“We start small. One patient, one doctor, one nurse, one procedure,” Fenn said. “We test it, change it if it needs changing, then expand it so it benefits everyone.
“Starting small is crucial,” he continued. “If a change is made throughout the whole hospital, it’s difficult to determine what is working properly and what may need tweaking. Testing one step at a time makes it possible to ensure that the changes are beneficial.”
To Dawn Chartier, manager of Holyoke’s Intensive Care Unit, IMPACT is a clear method of making things better for patients, families, and the hospital staff.
“Our goal is to improve care in the critical care areas – cutting the lengths of stay in the ICU, reducing mortality, and decreasing the number of days patients are on ventilators,” Chartier said. “This project helps us with evidence-based practices to achieve these goals. We have the evidence to show us that the practices work.”
In critical care, the staff is concentrating on four projects.
One includes setting up daily goal sheets. A nurse looks at all aspects of care for a particular patient and then writes it clearly on a goal sheet. This way, everything is followed through, and the nurse on the night shift checks to see if the goals have been met. It’s basically a communication sheet, Chartier said.
Another step involves multi-disciplinary rounds. This group of staff, each with his or her own area of expertise — including employees from pharmacy, physical therapy, respiratory therapy, dietary, case management, and the registered nurse who is caring for the patient — meets twice a week, going over the goals for the patient and determining if anything needs to be changed or added.
“Staff involvement is key,” Fenn said, “and we have had great response from our staff.”
Chartier said the Holyoke Hospital staff members are excited about being an integral part of improving the quality of care at the facility.
“At first, people thought some of the changes were just another thing to do. Now, they’re our biggest spokespeople. We are actually making changes, and they play a big part in those changes,” she said.
IMPACT, Fenn said, is providing a valuable opportunity for Holyoke to communicate with other hospitals across the nation, such as Johns Hopkins Hospital, Dana-Farber Cancer Institute, the Navy Bureau of Medicine and Surgery, and Cedars-Sinai Health System in Los Angeles.
“It’s great that Holyoke Hospital is partnering with some major health care institutions in the country,” he said, “to make sure that the care we give is the highest quality of care possible in a community hospital.”