Resources and culture key steady improvement at Health Central
Back in 2011, Health Central Hospital in Ocoee was one of the last independent hospitals in Central Florida, and its board was trying to decide whether to merge with a larger health care system. According to the Orlando Sentinel’s coverage at the time, board members agonized over which system had the clearest intentions and most capabilities to serve the community. Some members told a reporter they had changed their minds several times. They finally decided on Orlando Health, a not-for-profit system which was, at that time, composed of seven hospitals. Eight years later, Leap Frog, a widely cited hospital ratings organization, selected Orlando Health - Health Central Hospital as a Top 100 Hospital nationally, one of the most competitive quality awards in the U.S.
How Health Central has steadily improved in quality is a story of a determined staff, an influx of new resources, and the creation of a culture that breaks information silos and embraces transparency of data.
“They were a free-standing entity,” said Christina McGuirk, the Chief Nursing Officer at Health Central. “So, they just didn’t have the resources they needed,” she said. However, McGuirk said she quickly noticed that the nursing team “was very engaged and they had a real drive for improving quality of care.” She was so impressed with the team, she applied to become CNO as soon as the position opened.
An immediate opportunity was to encourage the Health Central nurses and medical professionals to take advantage of the continuing education and whole-care classes that were already in place throughout the Orlando Health system, said McGuirk. Another immediate step was to call in nurses from other Orlando Health hospitals who were at the tops of their fields in certain specialties like Critical Care Nursing or Emergency Nursing to shadow Health Central team members and to develop recommendations for the education and training resources that could have the most impact.
These nursing leaders encouraged the best practices they observed, and they were able to identify ways to align the education plan for the clinical team members, said McGuirk. “What that also did was to aid in building relationships across the Orlando Health system, in fostering collaboration between Health Central and the rest of the system they had just joined.”
The resources were important, but the most pressing need at Health Central – as it is for any merger of organizations – was to ensure that the Orlando Health culture took root and flourished. This is one of the biggest challenges for any organization. The legendary business consultant Peter Drucker famously observed that in any organization “Culture eats strategy for breakfast.”
That insight was central to the quality improvement strategy for Health Central from the point of view of both McGuirk and Antonio Velardi, MD, the Chief Quality Officer for Health Central.
“We needed to create a culture of shared governance,” said McGuirk. “And we did that by nurturing the clinical team members to feel empowered to be part of that practice change, to be able to identify the outcomes we currently have and then to look at evidence-based practices and how we can improve the outcomes for our patients collectively.”
“We must have a culture in which people know they are not going to be punished for reporting mistakes,” said Velardi. “If you are afraid of repercussions, you tend to hide what you did that was wrong. If the organization is focused on improving its policies and procedures instead of punishing people, we have a much more open working environment.”
In addition to these elements of shared responsibility and openness, is the desire to break the silos that tend to develop within highly technical organizations.
“We really focused on being transparent with our leadership team and on bringing down those walls, so we made sure everyone understood how their specific jobs affected the overall outcomes.”
“Every step of a patient’s time in care is carefully monitored,” said Velardi. “Even something seemingly as simple as a transporter taking a patient from their hospital room to radiology for an x-ray has multiple steps that are recorded and monitored. Any ‘variances’ – gaps between what should occur and what did occur get the attention of managers quickly.”
McGuirk described that in daily meetings, not only would direct care team members review the previous day’s data, but that every department possible would be represented.
This intense focus paid off in tangible improvements in patient outcomes. For example, Velardi used the example of sepsis statistics. Sepsis is a condition that arises when an infection someone already has—in the skin, lungs, urinary tract, or somewhere else—triggers a chain reaction throughout body. If not treated rapidly and aggressively, it can lead to very serious problems for the patient, including death. In 2013, national hospital mortality rate for patients who developed sepsis was about 25 percent. At Orlando Health-Health Central that rate has been cut in half to 12.5 percent.
Health Central’s improvements have been receiving a lot of attention. In addition to the Leapfrog Top 100 designation, the hospital earned an “A” grade for patient safety. The hospital began earning recognitions for reductions in infections as early as 2014. And by 2018 it had earned the Florida Hospital Association Award for Most Improved Hospital.
“I am so proud of the team and the work that is done here,” said McGuirk. Sometimes old data keeps getting reported in the community, so it’s really good when awards like this can help draw attention to all the progress everyone has worked so hard to achieve.”
