Integrating Care Through Collaboration, Assessment and Communication

By Dr. Kenneth Aldridge, M.D., FACS
Vice President for Medical Affairs, DCH Health System

Dr. Aldridge, a practicing urologist from Tuscaloosa, Ala., has served in leadership positions on the medical staff of DCH Regional Medical Center and Northport Medical Center. He was chairman of surgery at both hospitals, and he held leadership positions in the Tuscaloosa County Medical Society and with the Medical Association of the State of Alabama. In addition, he serves on the board of directors for the Alabama Quality Assurance Foundation (AQAF), the Quality Improvement Organization (QIO) for the state of Alabama.

When the DCH Regional Medical Center was first contacted by AQAF, the Alabama QIO, about working to improve care transitions, we were excited because we saw it as an opportunity to continue to improve upon the work that we had already initiated. Our hospital’s board of directors is always interested in quality initiatives and became directly involved from the start by providing budget support and actively following up on our quality scores and improvement.

Starting the process was somewhat daunting. We struggled with how many staff to dedicate to the project and where they should be placed. Our first step among many was to address the greatest area of need—diabetes patients who had the highest readmission rates.

Our case management director made sure I was thoroughly engaged in the initiative, as he believed that it was critical for morale and communication between the hospital’s administration and clinical leadership. He was right. I attended weekly meetings to hear about patient cases and brainstormed along with staff on how to get patients better and faster care. I also periodically reviewed assignment duties, coaching efforts and metrics with the case manager and AQAF representative in a constant effort for us to improve. This continuous introspection and reassessment was key to our success.

Our collaborative partnerships with the community were another cornerstone of our success. AQAF worked with community centers and attended community events to promote our program and helped us set up a monthly meeting between all nursing home administrators, home health centers and other end users to discuss how to prevent avoidable patient readmissions. We partnered with a dialysis provider to work with hospitals and the public health clinic to help educate frequently readmitted patients on how they could take better care of themselves.

We also implemented a “time-out” process for medication reconciliation upon discharge, where our mantra was, “The right patient, the right medication, the right prescription.” As trite as that may sound, it is not something that is easily accomplished. Due to a lot of hard work by our nursing leadership and case managers, we went from a 46% success rate in June 2009 to 100% in May 2010.

The final thought I want to convey is that the culture of our hospital and health care organization is not unique. Providers are being asked to do more and more in the same amount of time. For quality improvement initiatives like this to work, it’s important that executives are personally involved and help staff to problem solve. It’s good for the “boots on the ground“ to know that the front office is working closely with them to improve results and that their progress is being reported to the board, and appreciated by them. This entire process has shown me the value and synergy of collaboration.

It all boils down to communication. If you communicate well—to patients, staff, the board, the community, and to other health care stakeholders—everything else is more likely to fall in line.