Mass General Brigham took its academic medical centers from the bottom quartile in the nation on mortality to the top five with two changes.
“There’s been an increasing disconnect between the front line and hospital administration,” Rachel Sisodia, MD, chief quality officer for the Somerville, Mass.-based system, told Becker’s. “Historically, we have not been clear about the outcome we want to achieve, which is to be the best research healthcare enterprise in the world and the best clinical care delivery system in the world.”
Unclear expectations along with an exhausted front-line staff led to frustration and poor performance. But coming out of the COVID-19 pandemic in 2022, the system’s leaders decided to change that. They started with a five-year change plan to help Mass General Brigham become the best research enterprise in the world and have the best clinical care delivery system. This required massive structural and process changes.
The biggest change was implementing Patient Care Performance Management committees, a monthly huddle between unit and C-suite leaders. Each C-suite leader hosts up to three unit monthly huddles to review performance scorecards.
These scorecards are customized to the unit and created by the medical and nursing directors, along with their C-suite adviser. The measures are limited to the areas that require the most improvement. Once the scorecard is built, they send it to a dedicated project manager that automates a weekly refresh for that data. Project managers work with unit leaders to review the data on a weekly basis, and then compile reports into a monthly report for the committee to sit down with C-suite leaders.
“Our commitment to the front-line staff is this: ‘Yes, we will hold you accountable for outcomes, but you should hold us accountable, too,'” Dr. Sisodia said. “That’s the piece that’s generally missed. If you tell us you want mortality lower but we didn’t provide what you needed, we own that. We fix it by the next monthly meeting. If there’s something I genuinely can’t fix, I tell them that, and I tell them why.”
These monthly meetings have improved the hospital culture and helped teams improve patient outcomes.
“People are genuinely grateful to have a clear, structured monthly meeting with the most senior people in the organization where they can say, ‘You didn’t give us what we needed,’ or ‘Look what we accomplished,'” she said.
These committees have been implemented on about half of the inpatient units, with the goal of having them in all inpatient units by the end of this year, and all ambulatory clinics in the following 18 months.
C-suite leaders are also using weekly data reports to better inform their budget. The system has a unified, systemwide safety event platform that compiles harm events across hospitals. That report is sent weekly to board members and senior leaders across the system.
“When your senior leaders see month over month that you’re having medication reconciliation problems, they’re going to think about that when a medication-related budget request comes in,” Dr. Sisodia said. “They’re going to be better decision-makers because they understand the risks on the ground.”
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