January 12, 2016

When Every Minute Counts, Even Minor Details Matter to Patient Care

Kim Miyauchi, Chief Nursing Officer
Kingman Regional Medical Center, AZ 

Saving the lives of heart attack patients is one of the biggest challenges for hospitals. When every minute counts, we all need to be looking at the same clock…that is one of the key messages our hospital learned when we examined mortality rates of patients with acute myocardial infarction (AMI). 

Kingman Regional Medical Center (KRMC) discovered that sometimes the simplest solutions can be the keys to saving lives. As part of the Leadership Saves Lives program, KRMC partnered with the Yale Global Health Leadership Institute and we were challenged to examine our hospital culture and treatment methods for patients with AMIs. We were part of 10 U.S. hospitals involved in the two-year program to determine causes of high AMI mortality rates.  

To reduce the AMI mortality rate at KRMC, we examined several possible determinants and honed in on three: 1) timeliness of EKGS; 2) protocols, pathways and guidelines; and 3) discharge process. We first addressed the causes by encouraging more teamwork. We created committees to examine each of the three causes contributing to our high AMI mortality rate. As teams engaged with each other and with other hospital staff they were better able to understand how and why goals weren’t being met and how to improve the results.

For example, a large number KRMC patients arrive at the hospital by private vehicle – delaying the electrocardiogram (EKG) process that normally would take place in an emergency vehicle. Kingman Regional Medical Center strives to complete EKGs within 10 minutes of an AMI patient’s arrival. However, when we reviewed patient charts, we discovered our EKG completion times were inconsistent and recorded times depended on which clock a staff member was using. We had eight clocks in the ER and they were not synchronized. This had to be addressed to improve patient care.

Our hospital replaced all of the ER clocks and synchronized them with our computer system.  This simple, inexpensive solution, along with its other efforts ended up significantly improving timeliness of care. Although all of KRMC’s process changes were not as simple as replacing clocks, we have already seen the efforts paying off with a decrease in AMI mortality rates.

December 21, 2015

Hospital Change -- How to Make it Stick

Amanda Brewster, Ph.D., GHLI research and education associate 

Health care professionals constantly invest time, effort and expense trying new methods to improve care only to see promising innovations evaporate rather than become part of everyday work habits. When this happens, hospitals miss potential performance improvements, waste money and time, and feed quality improvement fatigue among staff.

New evidence published in Implementation Science from the Yale Global Leadership Health Institute shows that there are predictable patterns in what it takes to make change “stick.” Reviewing data from hospitals that participated in the State Action on Avoidable Rehospitalizations (STAAR) initiative, GHLI researchers examined different strategies hospitals tried to reduce readmissions.

The research showed that getting new practices integrated depended on how the integration process was executed. When hospitals appointed staff to oversee that a new practice was performed regularly for several months up to a year, more permanent integrating mechanisms had time to start working. Staff had a chance to feel direct benefits from the new practice – like greater job satisfaction or less stress – which motivated them to keep doing it even without close oversight. Or failing that, job expectations had a chance to catch up with the new practice, making it a non-negotiable part of work.

What should hospital leaders make of these results? Truly integrating a new practice takes patience and extended effort over time. And, staff members’ own desires to improve patient outcomes can give a powerful boost to quality improvement. Ensuring that staff responsible for implementing a new practice have the opportunity to see the positive impacts – through data feedback as well as personal interactions – can enlist them as partners in integrating the innovation into the permanent fabric of the organization.  Finally, the work does not ever go on auto-pilot, but incorporating the effort into ongoing management oversight efforts allow champions to move onto the next burning platform.  

October 15, 2015

Why We Do What We Do: Netsanet Fetene

GHLI research associate, Dr. Netsanet Fetene was inspired to pursue a career in medicine to help the ill people, especially children, he observed in Ethiopia. “Many of deaths in Ethiopia were caused by treatable, even curable diseases,” explains Dr. Fetene, “this was something I just could not overlook.” Motivated by his strong will to make a difference in his community, Dr. Fetene went on to study medicine at Addis Ababa University.

Dr. Fetene’s commitment to improve the lives of those around him has been evident since the beginning of his career. As a practicing medical doctor in Ethiopia hospitals, he quickly realized his work could have an even greater impact if he focused on the field of public health. This led him to become involved in with some of the world’s preeminent public health organizations such as the World Health Organization. Dr. Fetene believes that research, management and leadership programs are the key to strengthening a nation’s health system – and in turn, strengthening a nation’s overall health.

Prior to working at GHLI, Dr. Fetene worked on capacity building projects for the reproductive and primary health care teams in South Sudan, Pakistan and Sudan. There he established protocols and systems for drug management, developed reporting tools, and implemented case management based on Ministry of Health and World Health Organization protocols.

As part of GHLI, Dr. Fetene enjoys translating research into actionable results that help solve health problems in his community. While Dr. Fetene and the GHLI team have achieved great success in Ethiopia, he believes that there is still much more work to be done. A slow response to change in disease patterns related to population growth and urbanization is just one of the many challenges he and the team in Ethiopia face. Additionally, making health care facilities ready to provide quality health care services and allow the community access to standardized and equitable health care remains one of the biggest global health problems today. Still, Dr. Fetene remains optimistic that the work GHLI does is an integral part of overcoming these challenges and looks forward to continuing to serve his community in the field of public health.

September 14, 2015

Addressing Alcohol Use through Policy Implementation

Gerneiva Parkinson, 2015 GHLI Fellow 
History, culture, tradition and income. When I was growing up in this beautiful twin- island, Trinidad and Tobago, these were some of the associations used when talking about rum and other alcoholic beverages. Being a former sugarcane colony, alcohol is integrated into the rich heritage of this country. As a result, alcohol consumption is very popular within the country – with that brings alcohol-related health issues. 
Islanders are prone to high rates of binge drinking, and there is an alarmingly high alcohol usage among the adolescent population. Despite these issues, there is little in place to restrict or control alcohol use and subsequent abuse. As a GHLI Fellow, this summer I worked with with members from the Ministry of Health and a university to develop a national policy and action plan to control alcohol use and decrease its harmful effects on society. Daily, we pooled together research on past alcohol studies to create evidence for our policy draft. We also reached out to other government, regional and non-profit groups to spread awareness and ultimately create an alliance towards alcohol control.

Alcohol will always be a part of T&T's heritage, but we can find ways to make its use safer and more responsible. I look forward to working with this fantastic delegation for the next year, as we usher in a new policy for alcohol regulations. It has been wonderful to see the various delegates with different backgrounds and skill sets collaborating for one cause; forged from a unifying love to see our country flourish safely. With my career interests surrounding NCDs in the Caribbean region, this opportunity as a GHLI Fellow has been a unique and absolutely magnificent experience here at Yale. 

August 18, 2015

Safety’s Impact on Physical Activity in Brazil

Yaphet Getachew and Jennifer Mandelbaum,
2015 GHLI Fellows

We often hear parents complain that their kids spend too much time on the internet or they are too lazy to play outside. But, in Brazil, it’s not lack of desire among kids to be active, there is a far more serious reason why physical activity is a challenge – safety.  

As part of our GHLI fellowship this summer, we spend time in Brazil observing the Agita São Paulo program – designed to prevent childhood obesity through physical activity. During our first week in Brazil, we visited the island of Ilhabela to learn about efforts in both elementary and middle schools to help kids be more active. 

We met with representatives from the Secretary of Education and learned about the very real barriers to physical activity facing children on the island. For example, even though they’re surrounded by water, the majority of children and their parents on the island do not know how to swim. Parents worry about violent crime, causing them to keep their children indoors most hours that they are not in school. And, so the only real safe space students have to exercise is within the schools. This leads many children to spend their free time playing video games or watching television and being sedentary instead of playing sports outside with their peers. Students are typically only in school for half of the day, leaving many hours of unscheduled time, which is why the development of active after-school programs is crucial.

Given these barriers to physical activity, Ilhabela has made strides to provide outlets for physical activity in schools. For instance, the schools we visited had recently built an athletic facility, which included a basketball court and a pool. Our visit to the schools gave us a much clearer picture of the physical activity environment theses kids can access and helped us develop recommendations for Agita’s future programs. Maybe more importantly, we observed how a community bands together to tackle a major problem for its children.

August 12, 2015

UK and US Health Systems: Can we Learn From Each Other?

Brittany Stollar, 2015 GHLI Fellow

Before this summer, I had almost no knowledge of the structure, the effectiveness, or the political implications of the National Health Services -- the United Kingdom’s health care system. When I joined GHLI as an intern, that quickly changed. My first project involved researching the impact of NHS reform on the recent elections in the UK. What really made this experience special was not just that I was learning about the NHS in greater depth, but I got to hear about certain details first-hand when our UK colleagues visited the Yale campus this summer. 

During the week-long Forum, I was surprised to realize how little I really knew about health care systems outside of the U.S. I knew our health care expenditure per capita was much higher than most other countries, but never truly understand to what degree and that we spend more than $2000 beyond that of our closest competitor while still having health outcomes consistently below the average of our peers. I was also shocked by how partisan the Affordable Care Act has been. Unlike in the UK, there is no agreement between the parties on any of the issues raised within the ACA.

Coming from a country that has practiced universal health care coverage since 1948, the UK delegates struggled to understand our political conflict over the ACA. I found myself struggling to understand as well. I hadn’t realized that I’d grown accustomed to debates over the basic human right of available, accessible, affordable, and acceptable health care. While the delegates learned about how to improve the NHS by looking at our system, I learned how we could improve our system by looking at the NHS. During this week, the concept of national agreement on universal health care became less of a myth and more of a feasible possibility.