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Quality at Rush
The Bigger Picture of Quality at Rush

Raj Behal, senior patient safety officer and associate chief medical officer, Rush University Medical Center in Chicago

By Raj Behal, MD, MPH
Senior patient safety officer and associate chief medical officer

Publicly reported measures of quality are important for a variety of reasons. Every hospital should know and be willing to tell you its overall mortality rate and the mortality rates for each of its clinical programs. And every hospital should be able to measure performance on  patient safety indicators and examine its care when faced with high readmission rates or any other sign of possible quality problems. But these measures aren't the full picture of a hospital's quality of care  and they shouldn't be all patients are told about.

The information below is to give you a bigger picture of Rush's quality of care. We believe these characteristics are as important to our delivery of high quality care as the numbers we track.

Collaboration and teamwork
An academic medical center focused on patient care
Physicians and nurses who teach
Our new hospital building
Electronic medical records
Exceeding the standards
Continuous improvement
A vision for quality of care
Communicating about our quality

Collaboration and teamwork

The most common cause of medical errors in the hospital setting is problems with communication among the health care team members. In busy hospitals that take care of very sick patients, a number of staff with highly specialized skills may be involved in your care. This team of doctors, nurses, pharmacists and others must talk to each other about important aspects of your care. Not just that, they should talk to each other in very specific ways because people make assumptions, don't always speak up when something looks amiss, and sometimes just forget to tell others something important.

To address these human tendencies, some hospitals, including Rush, are using crew resource management training, or team training. Airline crew and pilots, like Captain C.B. Sully Sullenberger who landed a plane on the Hudson River in New York, go through this type of training. There are no assumptions, no hesitancy in speaking up and nothing left to memory. Even under stressful situations, the crew is expected to communicate in a certain way  a safe way.

Some hospitals, including Rush, are also using checklists to make sure communication during hand offs (i.e., when a transition in care occurs, such as during a shift change or a patient's move from inpatient to outpatient care) is done systematically, all required precautions are taken before placing a special catheter in the neck vein (central line), and for many other procedures where this is a substantial risk.

An academic medical center focused on patient care

Rush and the nation's other academic medical centers (approximately 125 in total) have three things in common. They all provide patient care, medical education and research. What varies among them is what drives each academic medical center's mission, or its purpose.

At Rush, it's patient care that drives our mission. This means the purpose of our research program and our medical college  in fact, all of Rush University  is to enhance patient care.

What's even more special about Rush is that our university and research are fully integrated with our patient care — meaning the physicians who treat patients at Rush University Medical Center are also faculty at Rush Medical College and investigators in our research program. And it's the same for many nurses and other clinicians.

Most of the research at Rush is translational, sometimes called "bench to bedside," which means our clinicians can bring discoveries and new therapies directly to the patients who can benefit most from them. And similarly, discoveries in clinics and other patient care settings can be taken back to the lab for further research. Investigators at Rush are involved in more than 1,600 projects, including hundreds of clinical studies that provide our patients options that are not widely available.

Rush cares for some of the sickest patients and takes on some of the most complicated cases. Because we have specialists with expertise in nearly every disease and condition, other hospitals send their patients whose cases are especially complicated to Rush. One example is a program at Rush that receives patients with severe strokes from more than 20 hospitals in the surrounding communities. The community hospitals trust their sickest patients to Rush because of the team of expert doctors and nurses who are available 24/7 to quickly apply the best science to prevent further damage to the patient's brain. We've recorded a video discussion with members of the stroke team to help patients and consumers understand more about what goes into quality of care.

Watch the video.
More about academic medical centers
More about Rush University

Physicians and nurses who teach

At Rush, the physicians who care for patients are the same physicians who teach at Rush Medical College. Many of our nurses and other clinicians also are on the faculty of Rush University. We call this the "teacher-practitioner model." This simple notion has big implications.

As I wrote in "Look Beyond the Numbers," some of the best physicians are attracted to the opportunity to teach while practicing medicine. Because they must stay current with the latest advancements in medicine, teaching keeps clinicians at the top of their game. Physicians at Rush are energized by the opportunity to teach in an academic program that is focused on enhancing the quality of care for its patients.

At Rush, not only are there more doctors in the house, but more physicians are involved in patient care, and more specialists collaborate in the care of more patients.

Our new hospital building

Every aspect of the new hospital was planned to provide the best patient care possible. Even the facility's unique butterfly shape is a result of designing from the inside out: It allows for clear sight lines to every room from one of the nurses' stations on each floor, enabling caregivers to see and respond to patient needs more quickly.

Three floors in the new building house an "interventional platform" where all diagnostic testing, treatment and recovery happen within short distances of each other to make collaboration easy among our specialists, patients and their families. The Tower also has one of the most advanced centers for imaging (e.g., CT and MRI scanners) in the country for diagnosis and treatment of everything from cancer to heart disease. And a new and expanded neonatal intensive care unit will be adjacent to labor and delivery so babies in medical distress can go right into the hands of intensive care specialists. Learn more.

Electronic medical records

The new hospital building is part of what we call the Rush Transformation, a 10-year campus-wide project that includes new construction, renovation and technology. As part of the transformation, an electronic medical record system was implemented throughout the hospital over the last two years. This kind of system, also called "electronic health records," is in the news lately because the health care reform package that was passed by Congress encourages hospitals to adopt this technology to improve efficiency and patients' safety and quality of care. Learn more.

Exceeding the standards

At Rush, our aim is to exceed national standards for care rather than just meet them. This requires a focus on quality of care and continuous improvement that suits our culture, which is collaborative. We're pleased that our focus on quality has been recognized by the organizations that specialize in health care quality and who use rigorous evaluation processes in their recognition programs.

These achievements include Magnet nursing status by the American Nurses Credentialing Center, a subsidiary of the American Nurses' Association; Top Hospital Award for Quality and Safety by the Leapfrog Group, a national organization that promotes quality of health care; Premier Award for Quality from Premier, a health care alliance promoting high quality, cost-effective health care; ranking among the top 10 academic medical centers in the country in the University HealthSystem Consortium annual study on quality of care.

In addition, Rush has achieved certification and several special accreditations, beyond the required hospital accreditation, from the Joint Commission. Learn more.

Continuous improvement

A continual focus on improvement and learning is a key component of excellent teaching hospitals. As an academic medical center, research and education go hand in hand. So we are not only asking important clinical questions, we are researching answers we can then use to improve our patient care.

At Rush, our philosophy on continuous quality improvement allows all staff to discuss problems openly and without blame. As I mentioned in "Look Beyond the Numbers," thanks to research in safety we know that simply re-educating staff and modifying policies often leads to problems recurring. Because of this, at Rush we are developing a safety treatment plan  based on the science of safety and years of experience in studying medical errors  that forces a definitive treatment that has a much better chance of protecting the next patient than simply changing policies.

We believe engagement of front line staff  like doctors, nurses, pharmacists and others  in continuous quality improvement is very important. Do the staff report problems when they occur? Do they report near misses or just really bad things? Are the staff engaged in improvement activities? Rush has 22 patient safety officers  at least one doctor in each clinical department who takes responsibility for quality and safety. Doctors don't work alone  at Rush, each improvement effort involves a multi-disciplinary team.

At Rush our Board of Trustees is equally committed to our continuous quality improvements. At Rush, we have a dedicated quality committee of the Board that oversees hospital performance and holds our senior leaders accountable.

A vision for quality of care

Finally, let's take a leap and ask whether the hospital understands what patients really want. Yes, we need to have the best possible performance on core measures, patient satisfaction, readmissions, infections, falls, pressure ulcers, mortality, surgical complications, but this is not enough. Not developing an infection after a knee replacement is important, but shouldn't that be a minimum standard? If what the patient really wants is to be able to ride her bike in Ireland on a family trip  recovery of function  isn't that what the health care system should strive for? At Rush, we are beginning to ask these important questions. And our researchers are helping design measurements of functional outcomes so we can figure out how to deliver the quality patients want.

Communicating about our quality

This website represents our commitment to share information about our quality of care with our patients, health care consumers, referring physicians and anyone else who is interested. We also hope to help you understand quality of care and know how to compare hospitals whether you are considering Rush or any other hospital.

We are working to expand the information we have on these Web pages. We'll have more videos, more quality data and other educational information.

Our promise to you when communicating about our quality of care is that we will be transparent. When we post a set of quality data, we promise that along with our good results, we will also tell you where we need to improve.

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