Q&A: Joanne Inman on Sentara Healthcare's systems approach to improving operations

Even though Norfolk, Va.-based Sentara Healthcare is nationally known for its gains in patient care, Joanne Inman is hardly satisfied with the status quo. Appointed president of Sentara Leigh Hospital in Norfolk in 2016, Inman, like the rest of her peers across the 12-hospital system, is constantly looking for ways to push the organization to the next level. Inman, who was named one of Modern Healthcare's Up and Comers for 2018, recently talked with Managing Editor Matthew Weinstock. The following is an edited transcript.

MH: What's it been like to be in charge of that hospital?

Inman: It's fun. I really enjoy operations. My prior role was vice president of operations of Virginia Beach General. And it's a daily grind, putting out fires, and working a lot as a leadership team to improve efficiency and quality and partnering with the physician and nursing teams to do that.

I love strategy, I love working with physicians to create new things. I like to develop people and develop teams, and I feel like I've had the chance to do a lot more of that in this role.

My predecessor did a great job taking the hospital to the next level, so it's been fun to continue to polish it and to continue to water it so that it grows. I've spent a lot of my time doing things from an assistant perspective and looking at things like reducing clinical variation and then doing a lot with our physicians in terms of both quality improvement and program development and growth.

I just try to help them be successful. So it's fun.

Everything we're doing around clinical variation and our high-performance teams across the system is about improving value and decreasing harm, making sure that we're delivering appropriate care. Sometimes that means we have to stop doing things we're currently doing. What I really value about being part of Sentara and having this system approach is that it allows us to align with a lot of the different things that are happening from a national perspective, from a state perspective.

MH: Let's talk a little bit about that systems approach. As the leader of an individual hospital, what's the process for you and how do you lean on your partners across the entire 12-hospital system?

Inman: It's tremendous. It allows me to go really deep on something and I know I have peers who are going really deep. Right now, I have responsibility for patient flow and I have a peer who has responsibility for readmissions and another peer who's working on mortality. And then, of course, all of our service lines are working to sustain gains that we had and they'll raise the alarm if there's a slip.

MH: What are you seeing in your work in patient flow? What needs to be addressed?

Inman: What doesn't need to be addressed? We've done a lot around the emergency department. Our clinicians about two years ago went to an Institute for Healthcare Improvement conference and saw the Kaiser Permanente model.

We sent our medical director out to California and he brought the leading concepts back which are focused on vertical care and reducing waste in the system. We call it swarming. We want our team to swarm a patient as opposed to a patient coming in, telling the triage nurse his story, then going to sit down and coming back up and telling registration his story, going back down and then telling the nurse the story again. You can see all of the spaghetti strings that get drawn.

Now we do it once. You get a quick triage, then you go to the level of care that you need as quickly as possible and the physician and the tech and the nurse hear your story once. That means the time to care goes down, the frustration of the patient improves and we get folks treated and released much more quickly.

MH: Sentara does very well on clinical scores. What's the challenge for you to get to that next 1% to 2% improvement?

Inman: I don't know how to answer that question because what comes to my mind when you ask that I have other things that aren't yet at 90% or even at 75%. So before I'm going try to go from 90 to 91, I feel like I owe it to the patients and the community to go from 50 to 75. What we are focused on once we get to 90 is not so much getting to 91, but sustaining 90. And it takes a lot of effort to sustain 90.

When you have, say a 12% staff turnover, that's a significant part of the workforce that you now have to re-educate and train and make sure that what you did before is in place. One of the things we're finding is the more things improve and the more variation we reduce, there's a lot of ongoing maintenance that comes with that. So that's something that we, as an organization, are trying to figure out.

MH: High mortality from cancer came up in your last community needs assessment. And you're slated to open a new cancer center in 2020, right?

Inman: I credit (Sentara Healthcare CEO) Howard Kern. It's his vision; it's something that he felt was important having looked at the data and I think personal experiences that he and others have had that really led us to make that big commitment to establish the cancer center.

We want to be able to take care of our patients and our community, and we want to be able to improve their outcomes. We saw that opportunity and I think that's what the cancer center allows us to do.

There are certain ZIP codes where we see a higher incidence of cancer and a later stage of diagnosis, so it's something that we need to improve.

MH: Given your background, having run some cancer programs before, what are your hopes for the center?

Inman: We're hoping to have a multidisciplinary approach to care. We are not an employed medical group. So the physicians and the groups we're partnering with are community-based in large part. Trying to bring together all of the medical subspecialties into one place in a patient-centered way is what we hope to accomplish. By doing that, we hope to be able to improve care for our patients and improve their experience.

It's a big building, but it's really what happens within that building—investment and research, investment and survivorship, and making sure that we're looking at the burden of care for our patients, how we do a better job of prevention, how we address those social disparities so we can get to patients sooner, make sure they're getting the screening they need so they don't get diagnosed so late.

MH: How engaged has the physician community been around the creation of the center?

Inman: Very engaged. It's something we talked about for a long time. It's been 15 years or so when we really started to take a systems approach to cancer care and getting invested in establishing a cancer network and being Commission on Cancer accredited both at individual sites and from a system perspective.

There are some large physician groups that want to be a part of this, but everybody has their own interests that they're trying to balance.

MH: The 2016 community needs assessment, which predates you taking over, also identified chronic care, behavioral health and opioids as areas for attention. What are you doing to address some of those things?

Inman: Some of those things we try and address through our high-performance teams. I had the privilege and eye-opening experience of starting up our behavioral health service line back in 2012. We expanded inpatient capacity, we hired, smartly, a vice president of behavioral health—Alison Land— who had experience in behavioral health and is doing wonderful things. She just started some outpatient programs in Virginia Beach and is looking to expand those into Norfolk. She got involved with one of the statewide commissions and is working at the legislative level and with the governor to help make some recommendations on behavioral health.

So we're expanding our services, we're looking at how we establish outcome measures; how we resource our emergency departments, our hospitals, our inpatient facilities to make sure we can meet the needs of behavioral health patients, so that's one example.

From an opioid crisis perspective, that's one we're still trying to crack. We spend a lot of time talking about that in the emergency medicine high-performance team. Virginia just implemented a new electronic database that allows providers to see certain information about a patient and their access in other emergency departments across the state.

That allows them to know what kind of narcotics they've been prescribed and, we hope, get to the point where we'll see what their care plan looks like.

But it also starts with education and prevention. Our surgery leadership and anesthesia providers talk about the measures that they're taking to reduce prescribing. So that's another side of it, partnering with our primary-care physicians to make sure that we're not prescribing opioids unnecessarily.