"With the piloting approach, adoption can sometimes die and not really produce the results that we want. It's also hard to keep track of numerous pilots," said Dr. Lakshmi Halasyamani, chief quality and transformation officer for the system. "Once we understand the best practices, we are broadly implementing them."
NorthShore has been on the 100 Top Hospitals list 19 times, more than any other hospital.
The broad implementation approach was used when NorthShore worked to improve how it prevents central line-associated bloodstream infections. The system found that bedside nurses weren't consistently monitoring and managing the central lines to prevent the infections. "There was too much variation across the nursing staff in the day-to-day management of the central lines," Halasyamani said.
To tackle this inconsistency, the system decided it would charge the vascular access team with the daily management of central lines at hospitals. The vascular access teams are registered nurses at NorthShore who insert central lines, but they weren't in charge of continuously monitoring them.
Their workflows were changed so the team has the time to check on all patients with central lines at least once per day. They look for signs of infection and make sure the dressing is appropriate. The nurses also monitor whether or not the patient still needs the line. If they decide it's time to take it out, they discuss it with the patient's physician.
Last year, NorthShore averaged one such infection per month; since January, there haven't been any. "We've eliminated a lot of variation," she said.
The health system also strives for consistency with the technology it uses. Leaders found that clinician adoption of new gadgets is low unless it's integrated into its electronic health record system.
That's not to say widespread adoption of new initiatives is easy, though. Halasyamani said she and other leaders spend a lot of time explaining why changes are made.
"You have to make sure you are engaging people in the 'what' and the 'how.' But that process of engagement can be very time-consuming because frequently people have different opinions and you have to create an environment where that can be unearthed," she said.