Archive for September, 2010

Leaders at McLeod Learn from Canadian Visit – I

Thursday, September 30th, 2010

The Centre for Health Quality Improvement in Toronto, Ontario, selected McLeod Health as a partner for improvement in quality and safety for patients.  McLeod Health was paired with a health system in Toronto, Trillium Health Centre.  The leadership team from Trillium visited McLeod in November of 2009.  McLeod leaders recently returned a visit to Trillium to learn more about health care in Canada.  Both visits resulted in understanding many common challenges and initiatives shared by the two organizations. 

The McLeod team included Dr. Fred Krainin, Medical Director of the McLeod Clinical Effectiveness Program and a cardiologist in Pee Dee Cardiology; Donna Isgett, Senior Vice President of Quality & Safety for McLeod Health; and Fulton Ervin, Senior Vice President & CFO for McLeod Health.  After talking with them about their visit to Trillium Health Centre, I thought it would be interesting for you to hear some of their thoughts. This blog reflects Dr. Krainin’s responses from a physician perspective.

RC:  What was one of the insights you gained from the visit to the Canadian healthcare system in Toronto, Ontario?

Dr. Fred Krainin: Despite all one hears about the Canadian health care system … long wait times for elective  procedures, limited funding, etc…., the quality of care in the Trillium Hospital System in Toronto is equal to, or in some ways ahead of the typical health care system in the U.S.  For example, they are way ahead of most areas of the U.S.  in ‘home to balloon time,’ … where the clock starts when EMS arrives at the patient’s front door, not when the patient arrived in the Emergency Department.  With a heart attack, time saves heart muscle and improved recovery.  They also have an outpatient Heart Failure clinic that would  be the envy of most U.S. systems. In Ontario, they provide high quality health care to 100% of their citizens and are adept at managing chronic diseases to help keep patients out of the hospital. They are paid for performance and outcomes measures, incentives to reduce hospitalizations and readmissions.

RC:  What good ideas did you see that we can study for improving our processes and patient care at McLeod Health?

Dr. Fred Krainin:  They have extremely enthusiastic and energetic employees. The most  memorable encounter we had was a random meeting with a housekeeping staff member who proudly demonstrated their new and improved system for cleaning and storing medical  equipment, and having them readily accessible for use by nursing personnel.  They have made a science of efficiency in reducing unnecessary steps and  improving efficiency among nursing and technical staff. They can’t afford private rooms for every patient, but their semi-private rooms are designed to be as close to private as possible. Their resources are limited, but they have learned to maximize the resources they have.

RC:  Is there anything about health care reform in America that may be similar to what you learned in Canada?

Dr. Fred Krainin:  There is a phobia among Americans about health care “rationing.”  In Ontario, the Canadian system allots a certain number of health care dollars to each hospital per year, based on the expected incidence of disease and procedures for a given population.  It is up to the hospital to utilize those dollars wisely and efficiently.  Those health systems that are well managed and efficient thrive in this system.  Those that are not well run will be in trouble.  The government does not decide who gets heart by-pass surgery or who receives a hip replacement.  Health care providers make those decisions based upon the need of the patient.  If someone needs a procedure urgently, we did not find that they would have to wait.

Additionally, hospitals in a given region of the Province specialize in different areas.  For  example, one hospital performs all the open heart procedures.  One hospital does all the orthopedic joint replacements.  One hospital provides all the inpatient dialysis. This system operates by regionalizing care, and unnecessary duplication of care is avoided.  The rationale is that treating high volumes of patients with a specific condition generally breeds excellence in care.  Having multiple low volume centers in a defined geographic area, as we have here in the U.S., is inefficient, and may not promote excellence in quality.  I also found it interesting that they have  found that it is more efficient for them to transfer certain neuro-surgical  procedures to Buffalo, NY, which is about an hour away, than to attempt to build  a program within their own center.  All this seems to make empiric sense.

RC:  Is there anything else you want to share about the visit?

Dr. Fred Krainin:  I came away very impressed with the improvement work at Trillium. I am sure every organization or health system has challenges, and not all of their programs would work here, but I think we could learn a lot from their model.

We have much to learn in our quest for quality and safety.  We appreciate the Centre for Healthcare Quality Improvement for sponsoring this exciting exchange program.  If you would like to learn more about our colleagues at Trillium Health Centre, please find their website at  We also express our thanks to Janet Davidson, President & CEO of Trillium, and her team for continuing the cross-border learning journey as we prepare for health reform and look for models of improving care for patients and families.


Improving Outcomes in Care for Patients.

Tuesday, September 21st, 2010

Last week at the South Carolina Hospital Association meeting, two of our leaders participated in the presentations for the meeting:  Donna Isgett, Senior Vice President of Quality & Safety, and Dr. Mike Rose, Vice President of Surgical Services, both presented on topics related to improving outcomes in care for patients.  Donna served in a panel discussion on the “New Laws of Nature and the Characteristics of High Performing Hospitals” and Dr. Rose served on a panel discussion on the “Way Forward: Building Lessons and Success from the Past.” It is exciting to see these leaders impact patient care with our teams in the region and now also have a role at the state level.  Here is a related announcement by the South Carolina Hospital Association about a new project for 2011.

South Carolina Chosen as Pilot for National Effort to Improve Surgical Safety

Last week at the TAP (Trustees, Administrators, Physicians) Conference, we unveiled a new patient safety program that can potentially save hundreds of patient lives each year and reduce the number of major surgical complications by as much as 30 percent. South Carolina is partnering with renowned surgeon and author Atul Gawande to adopt a Surgical Safety Checklist in every operating room in the state.  

Dr. Gawande currently serves as the lead of the World Health Organization’s Safe Surgery Saves Lives Initiative, an initiative built around a three-part surgical checklist that has been demonstrated to reduce surgical complications by more than one-third. Most recently, Dr. Gawande documented his experience creating and testing the WHO Surgical Safety Checklist in his New York Times Best-seller, “The Checklist Manifesto.” He was unable to attend the TAP Conference in person, but he delivered the following invitation to partner with South Carolina’s hospitals by video.  

“We selected South Carolina to be the first state to partner with us to help improve surgical safety around the entire country,” said Gawande. “South Carolina has a tremendous history of successfully introducing other quality initiatives such as improving the care of heart attack patients and reducing infection. South Carolina hospitals have already demonstrated their commitment to improving surgical safety by initially testing the World Health Organization’s Surgical Safety Checklist in more than 80 percent of the state’s hospitals, many of which have since adopted the checklist as a routine component of surgical care. We would like to collaborate with South Carolina hospitals in developing a model to improve surgical safety at a state level that other U.S. states can follow.”  

South Carolina was recently ranked by the federal government as one of five states making the greatest improvements in the quality and safety of health care. The safe surgery partnership with Dr. Gawande is exciting because it is strong proof that our state hospital community is leading the nation in important areas. The enthusiasm expressed by participants at the TAP Conference was gratifying, especially in light of the number of surgeons who asked if they could be involved as leaders of the state campaign. According to my count, every hospital present at TAP indicated their intent to present the Gawande initiative to their medical staff and hospital leadership. We hope those of you unable to attend last week’s conference will do likewise. For more information or to get involved with the campaign, please contact Dr. Rick Foster at

We look forward to working with others in the state to improve care for patients.



The Value of the Person

Wednesday, September 15th, 2010

Judy Bibbo

I spoke with Judy Bibbo, Vice President of Patient Services at McLeod Regional Medical Center, about her recent experience working along side the team in IV Therapy.  In addition to working with staff, Judy also focused on the patients.  In the IV Therapy Department, these patients often have multiple treatments in the department over a defined period of time.  Here is a note she sent to me about her observations.


I was able to spend time in IV Therapy observing our staff and spending time with patients and families.  It was an extremely worthwhile experience for me as a leader.  We were able to hear directly from our cancer patients and families about some of the ideas that are important to them as they come to us for their treatment.

This information and perspective is helpful to me as we prepare to plan our new Cancer Center at McLeod. Spending time in each of the patient areas has provided me with better insight into the great relationship the staff have with their patients and their  commitment to Service Excellence standards. One of the patients told me that she normally has a family or church member accompany her  to treatments, but on that day, no one could come with her. It gave me the opportunity to take a little extra time to spend with her … to let her tell me about her journey. I was able to hear about her family and the things that are important to her.

I  was reminded how important it is for us to pause and  truly  listen to our patients about  aspects of their care that really matter to them.  As I moved from room to room in the IV Therapy Department, I watched staff and patients interact.  It was very obvious to me that the IV Therapy team  demonstrate compassion and caring with each of their patients and families.  Some of the patients made comments to me about how the staff are like an extended part of their family and they look to them for support.  One of the patients was a social worker.  She not only shared her experience with me, but explained that she had been in IV Therapy many times with a friend who was treated with chemotherapy.  Even though she lives in Clarendon County, she wanted to come to the McLeod IV Therapy Department for her treatments because she had seen the quality of care provided when her friend was here.  Another couple travelled from Kingstree, South Carolina, … and when I listened to the staff and patient, I  knew they  shared a very personal relationship . Wow, what a great group of staff!!!


One of our four core values is the Value of the Person.  It means that we will strive to treat people with the respect and dignity that we would want our loved ones to receive.  I can see and hear  this value in the report Judy provided about her working experience in IV Therapy.  In Service Excellence we teach that courtesy means:

–Make Eye contact with and acknowledge each person you pass in hallways, elevators and public areas.
–Immediately acknowledge people who enter your work area with eye contact, a smile, and a greeting.
–Allow patients and visitors to exit and enter doorways and elevators first, and hold doors open for them.
–Use a social title and the patient’s last name (Mr. Jones or Ms. Smith) unless the person expresses a wish to be called by another name.
–Use “Please” and “Thank you.”
–Personal calls or conversations should never take place in public areas where patients or visitors are present.
–At the conclusion of any customer interaction, always ask, “Is there anything else I can do for you?”
–Recognize your own body language — it can say a lot about your attitude of service.

Thanks Judy for spending time and helping at the ‘front line’ of patient care.  Thanks to our leaders in the department … Gwendolyn Lowery, Director of Outpatient Oncology, and Aquanetta Nesbitt, Patient Care Supervisor … and  thanks to the entire IV Therapy Department for demonstrating the Value of the Person through their friendliness and courtesy.  May we all make a conscious effort to model  these behaviors of courtesy in our daily lives.


On the Mend

Friday, September 3rd, 2010

The newest book that our McLeod leadership team is reading is written by John Toussaint, MD, and Roger Gerard, PhD.  The book is titled, On the Mend, Revolutionizing Healthcare to Save Lives and Transform the Industry. This year every leader at McLeod will read the book. 

We first met Dr. John Toussaint in the fall of 2005 at an Institute of Healthcare Improvement meeting in Boston.  After hearing a presentation by John on ‘Lean’ principles we shared a cab ride back to the airport.  John invited McLeod to visit ThedaCare in Appleton, Wisconsin.  So, in the spring of 2006, we sent a team to observe the use of rapid improvement events and ‘lean’ principles in action.  It was helpful to see a healthcare organization applying ‘lean’ principles of improvement that we had seen in Florence manufacturing organizations like ESAB and GE Medical.

We began ‘lean’ training in the fall of 2006 with our first rapid improvement events in January 2007.  Like ThedaCare, Simpler Consulting provided McLeod the education and support infrastructure.

As the McLeod team reads the pages of On the Mend, we will see ThedaCare’s Improvement System in the DNA of our work at McLeod Health.  We are grateful for John’s willingness to share ThedaCare’s work with us so that we might continue to improve the quality and safety of the care we provide to patients.

I hope you will enjoy the book.