Dr. Russell Holman, chief medical officer of Brentwood, Tenn.-based LifePoint Health since 2013, values patient feedback. Under his guidance, the 72-hospital chain has created various patient advisory boards to gain their insight on safety and quality efforts going on at the organization. Some LifePoint hospitals reserve a seat on their board of directors for a former patient so their voices aren't lost when big decisions are made in the C-suite. Holman also has led efforts aimed at reducing patient harm events and hospital-acquired infections across the organization to zero. He recently spoke with Modern Healthcare safety and quality reporter Maria Castellucci about his goals for LifePoint, the importance of patient insight to improve care and the system's past work with the CMS' Innovation Center. The following is an edited transcript.
Modern Healthcare: What are some of the key areas LifePoint is looking at to improve patient safety and quality of care?
Dr. Russell Holman: As chief medical officer, my goal is primarily to advance quality and safety and the patient experience. We have undertaken a progressive path along that journey for the last several years with pretty distinct milestones, and those milestones become important as it shapes both how we do things—the culture of the organization—as well as some key performance metrics that we've achieved.
We're 72 hospitals in 22 states and there is a lot of nuance and variation in the populations and composition of those communities, both in terms of the healthcare community, but the broader population as well. When we look at models of care that need to reliably improve quality and patient safety, it has to be something that is flexible enough to adapt to the environment, but also something that has a structure and a framework to it that can be repeated over and over. I can say with great confidence that we've landed on that framework, that we have fully embedded it into our operations. So one thing I think is very gratifying is that quality and patient safety for us are not an afterthought; they are not something off to the side; they are fully embedded in how we run our business.
A very important part of our journey as well is ensuring that the environment in which everyone is working, and in which everyone is receiving care, upholds the principles of patient safety, upholds the principles of learning, the principles of teamwork and collaboration, and the principles of trying to recognize that everyone has a voice when it comes to quality and safety.
MH: What are some ways you include the patient—and the patient's family—in achieving improved quality of care?
Holman: The first area is patient–family involvement in their own care and in their own health and in making decisions for themselves. On the other side of the equation is patient and family voice and influence in the design of the healthcare system itself. On the involvement around and engagement around their own care, the first thing that we have done is to standardize and implement a new process of nurse/patient interaction at the bedside that is called Bedside Shift Report.
Traditionally, when nurses change shifts in the hospital, they take a patient list and go through it with one another. They talk about the needs of each patient and the plan of care and any active issues or things that need to be related in terms of ongoing continuity of care. That interaction typically took place in a conference room within or off to the side of a certain patient unit.
We have completely changed that interaction at the time of shift change so that handoff and that exchange of information take place in the patient's room, involving the patient and involving present family members, reviewing progress, plan of care, medications, certain care needs, and reviewing things that need to be done in the upcoming minutes, hours and days ahead. This allows for patients and families to ask questions, to provide clarifications, and to help shape what that plan of care and what that interaction looks like so that there is a fully shared understanding of what has happened and what will happen moving forward. There is an exhaustive and extensive training and mentorship process that we have to take to ensure that it is happening. As you can imagine, this is changing the way nurses perform their work after having done it a certain way for decades.
At the national level … we have created a patient and family advisory board made up of former patients and family members, which we convene regularly throughout the year and set an agenda that not only talks about important strategic areas for LifePoint, but then have active working sessions to be able to do tangible things that provide a sustained influence. As an example, we've been working to standardize patient education materials and patient handbooks and a variety of other materials that take into account things like health literacy and disparities in care.
There are other ways patients have become involved in the care design itself. Some of our hospitals reserve a board seat for a former patient. They are exclusively representing the view and the voice of our patients and families, and we don't want to take for granted that others on the board may have received care or family members may have received care. We want to be very explicit around having a dedicated patient seat on the board in our hospitals, so that's one mechanism.
MH: Can you tell me a little about the LifePoint National Quality Program?
Holman: Every organization has certain milestones and pivotal moments. LifePoint has had a couple of recent pivotal moments. In 2011, LifePoint became a Hospital Engagement Network through the Center for Medicare and Medicaid Innovation. The goal for the CMS in those contracts was to reduce patient harm in hospitals by 40%, and that was a very audacious, ambitious goal over three years. And by the way, the literature at that time said about 44% of harm is preventable, so it was essentially saying go ahead and eliminate all harm in your hospital.
LifePoint took up the challenge and was a little bit unique in our partnership with the CMS at that point; LifePoint was the only for-profit organization of the 26 Hospital Engagement Networks. We not only met the 40% reduction in patient harm by the goal of three years, we did so nine months ahead of the target date. Since that time we have not only sustained those results but have continued to push improvements beyond 40%.
Now six years into this, we are sitting at about 63% reduction in patient harm and have been called out by the CMS as a top performer. We are now moving toward driving some of those patient safety areas, not to a percentage reduction, but actually driving them to zero. We set goals in 2016 and 2017 for zero central-line infections across the entire enterprise and have achieved those goals for extended periods of time.
In 2015, we officially launched our National Quality Program. We have on-boarded all hospitals within our enterprise into that program, which is a comprehensive assessment and gap analysis in creating plans of actions to improve that have very measurable and objective targets. You also need a system of accountability, so on a regular basis throughout the year, each of our hospital CEOs appears before a quality oversight committee and presents their facilities' results and their communities' results in quality and safety in a very structured and standardized format. That oversight committee can identify leading practices where they have been very successful and then help spread those throughout the organization.
MH: Let's talk a little about how you are addressing the continuum of care, including looking at social determinants.
Holman: I'll call out three areas. The first is around the transition of patients from the hospital to another care setting. As part of our National Quality Program, we have fully embedded our case management staff and case management teams, as well as our social work teams, around everything from identifying high-risk individuals after discharge to also making sure that eligible patients are enrolled and are receiving all benefits and support that they need in aftercare settings.
The second area that we're very focused on is looking at metrics and performance in the ambulatory setting for physician practices, and that may be in the office, it may be in the ambulatory surgery center, or it may be in a variety of other locations, particularly as MACRA and MIPS and other programs like that are on a progressive schedule. We have an entire team within our national quality program looking at lessons learned and a framework that we used in the hospital and how that can parlay into the ambulatory setting.
The third piece relates to this idea of what we are calling "community coalitions." The backdrop is we have proven that when we look at improvements that occur within the four walls of our hospital, we can do that at scale because we manage most all of the variables within the facility itself or just adjacent to the facility itself.
When we start looking at more complex and diverse challenges—and here I'm talking about readmissions, chronic care management, access and affordability of primary care, and medications and equipment and when we look at social determinants of care and how patients and families make healthcare decisions relative to the rest of their lives—these are much more complicated, much more multifactorial, and multiple stakeholders are involved.
We have taken the topic of readmissions, for example, as a call to action, because we have found that a reason for readmission is because someone could not afford their medications or because their medications were not delivered or because they couldn't get transportation to their primary-care office. So by pulling these resources together, we can begin working together to address important problems.
