Virtually all hospitals believe they put patients first. The patients themselves may not agree,
as they sit in pain in the emergency waiting room, or spend the first half-hour of a
non-emergency stay on an uncomfortable beige chair in the admitting office.
But at Chicago's Northwestern Memorial Hospital, the busy urban emergency department competes
with itself to see how long it can keep its waiting room closed each day, by whisking patients
right into a treatment room the moment they arrive. "I've seen them get to two or three in the
afternoon before they have to open the waiting room," says chief executive officer Dean Harrison,
even though the department sees between 180 and 210 patients a day. "We know that's a great
patient satisfier, and it also happens to be great clinical care."
And there's no inpatient admitting area at all. Patients go right to their rooms. Registration
information is taken at the bedside by a staff member who, concierge-like, also assists with
non-medical concerns throughout the patient's stay.
Northwestern's dedication to its "Patients First" mission is one factor that made it the winner
of the 12th annual NCQHC National Quality Health Care Award, given by the National Committee for
Quality Health Care and supported by corporate sponsor Cardinal Health and Legacy Partner Modern
Measurement is the hallmark of Northwestern's quality initiatives, Harrison says, and if they can
measure it, they can improve it.
"We've realized that our systems are a lot more predictable than we thought, " says Julie
Creamer, vice president of operations and quality. "We have an inpatient scheduling project that
gives each patient a schedule of their tests and treatments for the day. If we know someone's
going home, we can schedule their tests early. That frees up their room in order to admit someone
sooner from the ED."
"Measurement is powerful," Harrison says. "If something takes 23 minutes, what would it take to
make it 18 minutes? It's something that gets an organization excited, because everyone can
Following are a few examples of how Northwestern fulfills the award criteria in the seven key
The leadership structure at Northwestern Memorial is designed around quality and safety. Key
bodies include the professional standards committee of the board of directors, quality management
committees for both the administration and the medical staff, and the clinical care evaluation
The patient safety and research team, led by the medical director of healthcare epidemiology and
quality and the director of quality strategies, includes nurses and pharmacists, a statistician
and a health services researcher.
The process improvement team, led by the director of operations and quality, is responsible for
implementing the infrastructure for performance improvement. The eight-member team uses the DMAIC
methodology (Define-Measure-Analyze-Improve-Control). Ninety-eight percent of hospital managers
have received training in the use of DMAIC tools.
In the early 1990s, Northwestern Memorial started a major long-term building program in which
every aspect of hospital design and layout was considered from the patient's perspective.
The newest inpatient pavilion has large, all-private rooms with shelves for flowers and cards and
large, low windows that allow patients to see the outdoors from their beds. A special window seat
converts to a bed for family members to use overnight. Staff and public spaces are separated, so
that gowned patients can be transported through more private zones. Patients give the new
facility high marks on satisfaction surveys.
The outpatient pavilion has a state-of-the-art health information library, offering books,
videos, journals, internet service and a curriculum of 15 health education classes. Extensive
health education is also available via the organization's web site, which is due to offer online
transactions and interactive health assessments later this year.
To improve patient safety, a clinical care evaluation committee was launched in 2002. Senior
management and physicians meet weekly to assess adverse events and look for ways to prevent them.
A fall prevention program established standardized risk assessments for falls, and simplified
fall precautions. All employees in direct patient care areas were enlisted to prevent falls. The
program reduced falls nearly 10 percent within a year, to less than 2.5 per 1,000 patients.
Another initiative looked at the accuracy and safety of the surgical sponge and
instrument-counting process during surgery. New protocols were put in place to prevent surgical
miscounts and improve interventions when miscounts occur.
Short and long-term strategic planning
A long-range financial plan lays out financial performance goals and sources and uses of capital
over ten years. An annual implementation plan identifies initiatives that will help achieve the
goals of the long-range plan. To monitor and report progress on strategic initiatives, leaders
maintain "dashboards" for each of four goal areas: Best Patient Experience, Best People,
Exceptional Financial Performance and Information Technology.
Senior management meets monthly with department heads to discuss strategies and progress. All
employees get information on strategic initiatives through a monthly internal newsletter, an
employee intranet, and an annual meeting where senior leaders present the hospital-wide
achievements and goals for the coming year.
Innovative informatics and use of new technologies
Northwestern Memorial has been implementing an electronic health record and computerized
physician order entry. In fiscal year 2004, 78 percent of all inpatients had medication
administration documented online and 94 percent of internal medicine inpatients had electronic
medical records available. The organization expects to have physicians enter at least 75 percent
of medication orders online by mid-2005, which will make it one of a handful of hospitals to meet
the standard set by the Leapfrog Group.
"We were very careful to make sure we had all the foundational aspects in place -- pharmacy,
nursing documentation, medication delivery -- before we went to physicians actually ordering,"
says Charles Watts, M.D., senior vice president of medical affairs. "That way, the orders are
able to take advantage of the entire power of the system. We trained physicians early,
conceptually and then in practice. We had one-on-one trainers follow them around."
In preparation for CPOE, a team of clinical quality and informatics experts evaluated more than
140 existing order sets, to standardize common elements of care consistent with published
Nearly three million laboratory tests are processed annually at Northwestern Memorial. Bar coding
and robotic technology have reduced result turnaround time by 32 percent, and increased the
accuracy of results.
Northwestern Memorial's capital plan includes a $100 million investment in new information
technology over ten years.
Building a committed workforce
Northwestern has established baseline employee satisfaction numbers through a Gallup survey to
which 80 percent of the employees responded.
Each year, the CEO reviews each director and manager, to identify high-potential talent early and
to develop succession plans for critical positions.
The Northwestern Memorial Academy centralizes all training, education and staff development
activities. It provided 50,000 hours of education in 2004.
Northwestern also has training schools in nuclear medicine technology, radiation therapy and
sonography that offer 12- to 18-month post-college certificate programs. They're open to both
employees and the public. The programs help the hospital fill vacancies in areas where trained
workers are scarce, and save $1 million a year in staff overtime and agency usage.
Science-based performance evaluation systems
Clinical leaders in Northwestern's six medical-surgical intensive care units were challenged to
standardize care processes to reflect ICU protocols developed by the Institute for Healthcare
Improvement. The project team implemented the protocols for ventilator and glucose management in
one surgical unit, and saw continuous improvement in quality measures.
"We've embedded those protocols in our computerized physician order entry system for all the
ICUs, and the early results have been rewarding," says Charles Watts. "The degree of compliance
has been very high. The physicians are completely engaged, and one of the most important things
to them is moving ahead to implement the new protocols in day-to-day practice. One of the really
discouraging realities is that it may take 10 years or more for a proven protocol to become part
of day to day practice and we're trying to shorten that gap."
Northwestern Memorial has a history of strong financial performance and is currently one of only
four healthcare organizations in the country whose bonds are rated AA+ by Standard & Poor's. In
2003, the organization made exceptional financial performance an explicit goal of its strategic
Two new patient pavilions opened in May 1999, on time and on budget, and are among the nation's
most advanced health care facilities. A new women's hospital is scheduled to open in 2007. Over
the next seven years, the long-range plan includes $1.5 billion in capital investments in
construction projects and information technology.
Since 2003, the use of process improvement tools has yielded $7 million in annual benefits.
The hospital has undertaken a multi-year strategy to reduce preventable errors and improve claims
management, thereby reducing professional liability insurance costs.
Community health needs
Northwestern Memorial is the only hospital in downtown Chicago. It's the sixth largest hospital
provider of Medicaid services in Illinois and provided $50.6 million in charity care in fiscal
year 2004. In fiscal year 2003, Northwestern sponsored 38 community outreach programs, serving
more than 327,000 Chicago residents. It supports two community health centers that provide almost
40,000 patient visits a year.
A women's ambulatory clinic provides comprehensive gynecological and obstetric care and education
on a sliding fee scale. The clinic provides special support to HIV positive women. Since it was
launched in 1999, nearly all infants of mothers in that program have been born HIV-free.