Mass General Brigham's rigorous approach to the 'mundane'

The rollout of Mass General Brigham's new quality strategy comes with a subtle culture change — one where those working at the organization should always assume that there is room for improvement. 

"It's really easy to have on blinders — especially when you're from a place like Harvard with Mass General and Brigham and Women's — who has this sort of storied legacy where we always assume we're the best," Rachel Sisodia, MD, chief quality officer at the Somerville, Mass.-based system, told Becker's in an interview surrounding the debut of a newly launched quality strategy called "For Every Patient."

The initiative was debuted internally to team members in June. At its core, the strategy is meant to improve patient outcomes by standardizing quality and safety priorities and practices across the system, which includes Massachusetts General Hospital and Brigham and Women's Hospital in Boston and a collection of community hospitals. Standardizing means doing away with the separateness that has traditionally underpinned quality work in healthcare. In the past, one hospital within the system may have been prioritizing X — readmission rates, for example — while another was prioritizing Y,  such as healthcare-associated infections. And they likely each took different approaches to tackle the same problems. 

With For Every Patient, no longer. Systemwide, hospitals will all work toward the same quality goals in four key areas: Effective care, which covers areas such as preventive services and reducing heart disease burden; Safe care, which includes preventing HAIs and adverse events; Equitable care — achieving equitable outcomes among patient populations; and Personalized experience, which focuses on effective communication between patients and clinicians. Clear goals are tied to each of these areas: for instance, reducing all HAIs to the top decile in the country. 

"We're going to single-mindedly pursue a small set of goals," Dr. Sisodia said. "It may be at one hospital they need to work on CAUTIs and in another we need to work on CLASBIs — line infections versus catheter infections … but it's not going to be that some hospital is not working on infection. Everybody is working on that."

And facilities will pursue their goals with the same strategy. 

"We set the guardrails and then people work on what's most important, but I can assure you we're not going to have seven different C. diff strategies. We're going to reduce C. diff the same way — the evidence-based way, the data-driven way," she said. 

The best by any external benchmark 

For Every Patient involves a heavy pivot to external benchmarking, meaning hospitals will focus less so on outperforming themselves and mostly on outperforming their peers across the country. The academic medical centers will benchmark against other top AMCs, community hospitals against other top community hospitals — a step further than CMS benchmarks. 

"Where we are interested is being the best of each class in the country and ideally the world … we want to be able to hold our heads up and say we, by any external validation, are the best in the country," Dr. Sisodia said. 

The shift hasn't come without its challenges. Historically, peer comparisons have not been the norm in healthcare, so it can be jarring for clinicians when they're initially shown their hospital's performance on different measures compared to their peers. But once leaders communicate the "why" and are intentional with explaining that it's not intended to be punitive or cause shame, initial shock turns into a hunger for improvement. 

"They see some areas where they're doing the best in the country and other areas where there's opportunity," Dr. Sisodia said. "It's about constantly holding our performance up to [others] in a really transparent way and seeing how we perform and always having that humility and hunger to do better."

A rigorous approach to the mundane 

The new quality strategy aligns with Mass General Brigham's rich history of innovation. Massachusetts General Hospital houses the nation's largest hospital-based research enterprise. And the system is home to many medical firsts and inventions, such as the technologies behind MRI. Today, there are more than 2,700 ongoing clinical trials systemwide. 

"We've been the best for 200 years because we've always been innovated and embraced change ... but we haven't always done it on our basic operations," Dr. Sisodia said. "We have historically not devoted the same level of rigor to more mundane things," which the new quality strategy aims to change through relentless focus on common conditions affecting patients. 

"We're never going to stop being that hub of medical innovation, but in addition to that we are going to double down on the most common things that kill patients and people in the U.S.; cardiovascular disease, hypertension, infections, in-hospital mortality for things like sepsis — that's where we're going to put our focus over the next five years."

Dr. Sisodia underscored that the strategy rollout is a multiyear project that requires ongoing communication surrounding why the shift is happening, as well as high reliability training for the workforce.

"We're doing this because it's the right thing to do. There's no budget associated with this,  there's no financial target. The targets are around the patients," she said. 

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