Sustaining Change: Maureen Bisognano

The CEO Blog will feature posts from guests while Geraint is away, including the APAC keynote speakers and Deputy CEO, Ron Pearson. Today we’re joined by President and CEO of the Institute for Healthcare Improvement (IHI), Maureen Bisognano. One of the world’s most powerful women in healthcare, Maureen’s visit for the APAC Forum was her third to CM Health and Ko Awatea. Here she talks about her impressions of the work we’re doing and where it might take us next.

Maureen Bisognano,  President and CEO, Institute for Healthcare Improvement
Maureen Bisognano,
President and CEO, Institute for Healthcare Improvement

Sustaining change is equally as challenging as making it. But over the course of my last three visits to CM Health and Ko Awatea, I’ve been so impressed by the progress being made here, particularly with regards to patient safety. It’s never easy to learn within your own system but despite that, clinicians here are truly interested in making improvements to the quality of care they provide and finding ways to overcome traditional barriers.

One of the stellar examples I discovered was during a recent visit to Ward 9 at Middlemore Hospital. The visit started when I joined the nurses and other frontline staff in front of a board, on which the number of days the ward has been free of CLAB (Central Line Associated Bacteraemia) infections is recorded. It’s now up to more than 900 days – among some of the best results achieved worldwide and a truly inspiring result.

The pride of the staff was incredible but there were several other things I noticed too. One was teamwork. Nobody stood up and said this was a nursing project or this was my project. The sense of team was palpable and truly a critical ingredient to this kind of success.

Second was the intensity and rigour with which the team pursues success. The staff showed me everything from education and supply management to training and engagement of patients. They also do deep analysis whenever they have a patient they can learn from. There was simply no let up in the tempo of improvement, even though this change has been sustained for a long period. You might think that staff assume the practise is embedded and let things slip over time. On the contrary, the team doesn’t take it for granted and is committed to improving every single day. This motivation was true elsewhere too. When I asked them what else they had improved, they showed me work they’re doing around hand hygiene, reducing patient falls and their safety agenda. They really are equally excited about these other areas.

Finally, I asked them how they spread this change to other units, both within Middlemore and beyond. Again, they described a structure with monthly meetings where people come together and share what they’ve learned.

I think Ward 9’s achievement is a wonderful example of an organisation-wide commitment to safety, from CEO Geraint Martin right down to the team doing the work with the patients. Everybody’s aligned on this one mission.

There’s no doubt that this kind of alignment is critical to success. During an APAC workshop I was teaching on leadership, I asked everybody in the room to close their eyes and point north. You can imagine what it looked like when they opened their eyes – there was no alignment. They all laughed as they realised they were all pointing in completely different directions, despite all being sure they were right! I asked someone with a cellphone to figure it out and within a minute, three people had the right answer, pointed due north and everyone followed on. Direction is important.

It’s a fun exercise to illustrate a point in a workshop, but in a very busy environment like a hospital, ensuring that everybody is aligned north really is important. Without senior leaders’ attention, people often move on to the next big thing. If people aren’t holding each other accountable, they drift onto something else and you end up reverting to prior bad performance. I remember speaking to a Vice-President for Nursing in another country who said, “We’re excellent at improving. We improve the same things every year.”

The work you’re doing here at CM Health is very promising. There’s a real sense of curiosity, albeit a shy curiosity! Everybody is open to learning and fostering a sense of community improvement where people come together and work on collaboratives or projects to build improvement momentum. Coupled with that, you have the leadership momentum to keep your change sustainable.

I’d say that the next step for you is to continue to build innovation capacity and improvement capability. We’re going to need new models. You already have some wonderful ones, like the Manukau SuperClinic, but we’re going to need to be even more innovative. We also need to better partner with patients. I think patients can help but the health system still tends to treat them in a paternalistic way. The big shift I think we need to make is from “I’m taking care of you” to “I’m taking care with you”. We need to encourage patients to say what they want and what matters to them, and then sit down and talk with them about the best way to achieve those goals.

Maureen Bisognano, President and CEO, Institute for Healthcare Improvement

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Author: Geraint Martin

Geraint Martin was appointed Chief Executive Officer of Counties Manukau DHB in December 2006. It is one of the largest District Health Boards in New Zealand and services a population of half a million. He has significant experience over 30 years in national policy & in managing both primary and secondary care . Previously, he was Director of Health and Social Care Strategy at the Welsh Government .He authored a radical 10 year strategy of reform, including the successful “Saving 1000 lives” Campaign.Until 2004, he was CEO at Kettering General Hospital & had held senior positions in London & Birmingham.He has worked closely with clinicians in improving clinical standards,patient safety,chronic disease management & managing acute care to reduce hospital demand.In NZ, He has promoted clinical quality and leadership as central to improving patientcare. This has led to a significant increases in productivity and access, whilst maintaining financial balance. CMH has completed in 2014 a $500 m capital redevelopment programme, the largest in New Zealand. A central part of this is the establishment of Ko Awatea,the Centre for Innovation and Research which will underpin CMH as one of the the leading health systems in Australasia.In 2008, he chaired the Ministerial Review of Emergency Care in New Zealand, and in 2013 was an member of the Expert Advisory Panel on Health Sector Performance. Geraint has an MSc in Health Policy from Birmingham University .His post-graduate work has focused on health economics and Corporate Strategy . He is adjunct Professor of Healthcare Management at AUT and Victoria University, Wellington Elected in 2006 as a Companion of the Institute of Healthcare Management, previously he was an Associate Fellow at Birmingham University.He is is Chair of the Auckland Philharmonia Orchestra, a member of the Institute of Directors, on the Board of the NZ Institute of Health Management & previously the Board of The NZ Health Quality and Safety Commission.

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