How Keck Medicine is doubling down on care quality

Building a strong foundation for safe and equitable care is no easy task, especially amid pandemic-related disruptions and workforce shortages. But Keck Medicine of USC is clearly doing something right — Keck Hospital of USC is a seven-time Leapfrog "A" safety grade awardee, and USC Norris Cancer Hospital was recently named one of Leapfrog's top teaching hospitals for the second consecutive year. 

The health system is doubling down on quality improvement efforts with the creation of two new executive roles and a quality institute. In November, the system appointed Tom Bates, RN, as its inaugural chief quality officer. His first major priority has been launching the Keck Medicine of USC Quality Institute, which aims to optimize quality and safety practices across the Los Angeles-based system's growing footprint.  

Keck Medicine also named Mary Virgallito, MSN, RN, as the first chief quality officer of  Glendale, Calif.-based USC Verdugo Hills Hospital last fall. She most recently served as the community hospital's executive administrator of quality and patient safety.

Becker's recently connected with Mr. Bates and Ms. Virgallito about their new roles, their top priorities for 2023 and the impetus for the new quality institute.

Editor's note: Responses have been lightly edited for length and clarity. 

Question: What are your top quality or safety priorities for 2023?

Tom Bates: The Keck Medicine of USC Quality Institute, in collaboration with the appointment of our first-ever chief diversity and inclusion officer, will focus on advancing equitable healthcare for all patients. We are in the process of refining our data acquisition and analysis strategy to ensure our quality and safety initiatives meet the care delivery needs of our specific patient populations. For example, we are working to enhance our ability to screen all patients for social drivers of health (food insecurity, housing instability, transportation needs, utility difficulties and interpersonal safety), and then determine how we might address those factors to improve the health and well-being of patients.

Secondly, the Quality Institute is tasked with not only further improving the health system's existing quality initiatives, but innovating to ensure we have a solid quality and safety foundation as Keck Medicine continues to grow and expand its footprint in Southern California and beyond.

Our desire is to facilitate a systemwide culture that encourages continuous learning and growing. This foundational approach will be accomplished by embracing and implementing the management practices and leadership principles found in the Institute for Healthcare Improvement's framework for "Whole System Quality." One of the things we are doing to achieve this goal is preparing to roll out systemwide education related to the science of quality improvement, including the use of quality improvement tools such as the Institute for Healthcare Improvement's Model for Improvement and the use of the Plan-Do-Study-Act.

Mary Virgallito: As a well-established community hospital serving Glendale and surrounding communities for 50 years, USC Verdugo Hills Hospital is focused on two key quality objectives.

First, we are focused on seamlessly transitioning the hospital out of the pandemic emergency by continuing new processes implemented during the pandemic that have proven effective, while returning to pre-pandemic protocols that are now appropriate. For example, we began robust illness screening protocols (not testing) for visitors during the pandemic, which is something we are continuing as we begin to transition out of the pandemic. Similarly, we are now reimplementing broader visitation protocols that were phased out during the pandemic as COVID-19-related hospitalizations have significantly decreased.

Secondly, we are committed to mitigating staff turnover by fostering a safe and efficient work environment through strategic, effective quality initiatives.

Q: Can you share more details about the Keck Medicine of USC Quality Institute? What was the impetus for this institute and how will it function?

TB: The Keck Medicine of USC Quality Institute was born out of the health system's desire to ensure a healthcare delivery system that is clinically effective and efficient, equitable, patient-centered, safe and ultimately meeting the diverse healthcare needs of all Keck Medicine patients. The Quality Institute was created to assist the USC Health System Board in its oversight of the systemwide unified quality and safety agenda. Members of the Quality Institute include quality and safety senior executives and leaders from across the enterprise who collaborate to move Keck Medicine of USC toward a "whole system quality" culture.

Q: What have been the biggest quality or safety challenges you've encountered so far, and how have you overcome them?

TB: Identifying particular quality initiatives to focus on first and implementing those seamlessly and effectively throughout the entire health system is our greatest challenge given the size and complexity of our health system. Keck Medicine of USC includes Keck Hospital of USC, USC Norris Cancer Hospital, USC Verdugo Hills Hospital, USC Arcadia Hospital and more than 100 unique clinics in Los Angeles, Orange, Kern, Tulare and Ventura counties.

We have found the most success through interdisciplinary collaboration between executives and leaders from the Quality Institute and various relevant departments to implement systemwide quality initiatives. For example, one quality metric we are focusing on first is collecting patient-reported outcome data before and after patients undergo total hip arthroplasty and/or total knee arthroplasty. 

MV: COVID-19 presented a unique challenge because it truly disrupted the healthcare industry, particularly from a quality standpoint, because spikes in hospital censuses required an immediate shift in how hospitals provided care with little time and resources to readjust quality measures.

USC Verdugo Hills Hospital was able to continue providing quality healthcare throughout the pandemic using several techniques. First, we maintained transparent communications with staff, patients and community through daily forums, department-specific rounds and a robust website to provide as much up-to-date information as possible. Second, we remained open-minded and met often, sometimes multiple times a day, to evaluate process changes and address issues based on staff and patient feedback. Lastly, USC-VHH leadership made themselves available to support staff and answer questions, address patient concerns and develop effective, sustainable solutions to maintain quality patient care. 

Q: What role can chief quality officers play in improving caregiver satisfaction and mitigating staffing shortages?

TB: Chief quality officers have an opportunity to help improve workplace experiences for healthcare staff and faculty in a number of ways. 

First, using traditional lean methodologies and quality improvement approaches such as the Model for Improvement and PDSA, chief quality officers can promote the analysis and adaptation of workflows and processes to optimize efficacy. This can help decrease workplace stress and burnout by allowing staff and faculty to spend more time at patient bedsides. Chief quality officers can also promote an environment that empowers staff to speak up when they see an unsafe condition or feel they are in an unsafe situation.

CQOs should be engaged in rounding in clinical areas on a routine basis. They can talk to staff, faculty and patients, building relationships and soliciting new ideas and suggestions on how to improve quality and safety. Some of the best ideas come from those working closest to the patients and the patients themselves. 

Last, as a senior leader, I believe chief quality officers can help contribute to destigmatizing mental health support. It's no secret that these have been some of the most difficult years in recent memory for healthcare providers, and promoting mental health should be a top priority. Keck Medicine provides this kind of support through the Care the Caregiver program including financial support, peer mentoring, resiliency training, mental health services and more. 

MV: The healthcare industry is experiencing very high rates of burnout and turnover, which poses unique and serious challenges to hospitals trying to balance increasing workforce costs and quality patient care.

USC-VHH strives to facilitate staff retention by developing and implementing flexible, integrated quality improvement plans that empower staff to provide excellent care for patients while avoiding burnout by overburdening staff or doing too much, too quickly. 

As a chief quality officer, I have a vested interest in helping facilitate staff retention because high turnover rates decrease hospitalwide knowledge of quality protocols and initiatives, which requires more time spent training new hires.

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