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A staffwide sense of ownership.

As a public hospital in New York, Queens Hospital Center serves a culturally diverse population and is dedicated to eliminating disparities in care. Strong community ties are crucial to achieving the organization's vision of providing effective health care through a continuum of locally focused services that work as a catalyst for improving community health.

"Our community is well-informed in terms of what we are working on and we elicit their support in our efforts," says George Proctor, executive director. A community advisory board discusses disparity-related issues during monthly meetings that are attended by both clinical and administrative leaders.

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Efforts to eliminate disparities in care include the opening of a state-of-the-art cancer center in 2002. Data from the New York City Department of Health and Human Services showed an unusually high level of cancer being identified in late stages because many local residents lacked ongoing preventive care. A partnership with Memorial SloanKettering Cancer Center provides patients with access to the same clinical trials available at that renowned facility. A Center of Excellence in Diabetes was also opened to address the high incidence of diabetes in the community.

Queens Hospital Center is part of the New York City Health and Hospitals Corp., an 11-hospital system with a mission to provide all New Yorkers with comprehensive, high-quality services in an atmosphere of humane care, dignity and respect regardless of their ability to pay. The six Institute of Medicine aims drive quality assurance efforts across the system; each facility sets its own goals and develops improvement projects accordingly.

At Queens, quality and patient safety improvement initiatives are placed largely in the hands of front-line employees. Their feedback on safety concerns helps set the quality assurance agenda. "We keep our staff highly engaged," Proctor says. "Everyone has a sense of ownership for our quality improvement efforts."

A shared governance model gives nurses a voice in the process. "It's really brought decision-making down to the front-line staff,," says Jean Fleisch-man, M.D., associate director, department of medicine.

One improvement project identified by the organization was eliminating central-line infections. A multidisciplinary group developed a set of recommendations that are now in place across the HHC system. The recommendations include: Empower critical care nurses to stop physicians who deviate from standard procedures; create a checklist to monitor insertions; devise a safe catheter insertion kit; create a how-to video for catheter insertion; make the catheter maintenance bundle part of nurses' daily workflow reporting; and avoid catheter insertion in the femoral area.

Since implementation of the recommendations, central-line infections have dropped throughout the hospital. In the ICU step-down unit, for example, the median rate of infections dropped from 22.1 per 1,000 device days in 2002 to zero in 2007 and 2008.

Improving efficiencies throughout the hospital and health system remains a top priority. "We are challenged to improve efficiency and quality while also reducing costs," Proctor says. The organization has an electronic medical record system and 100 percent of medical orders are elecIronic. Yet changes in the care delivery system are needed if the system is to meet its mission of providing high-quality care regardless of ability to pay. Lean principles are used to identify efficiency gaps. In the OR, the majority of patients are ready for surgery 30 minutes prior to start time, representing a great increase since implementation of Lean principles.

"We've had a lot of advances and improvements, but we still have a lot to do," Fleischman says. She recommends that organizations undertake a thorough self-assessment as it relates to the IOM aims. Completing the Quest for Quality application has helped Queens structure how to move forward, says Fleischman. "With all that's going on with health care reform, that's crucial."
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Title Annotation:CITATION OF MERIT; Queens Hospital Center
Publication:H&HN Hospitals & Health Networks
Geographic Code:1U2NY
Date:Sep 1, 2010
Words:617
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