Susan Vitolins
Director of Performance Improvement
Northeast Health
“The nature of my job is to bring principles of performance improvement to the front-line staff.” (0:49)
I’m Susan Vitolins. I’m the Director of Performance Improvement at Northeast Health in Albany and Troy, New York. I’m a registered nurse. I’ve been a registered nurse for thirty years, and my background is in med/surg and critical care nursing. We have two small acute care hospitals. We have critical care units at both hospitals and have been involved in the critical care IMPACT Community here for about three years. It’s an integrated system with four or five nursing homes, medical home care service, a visiting nurse association, and two rehab hospitals.
The nature of my job is to oversee improvement throughout the hospital, specific improvement projects, and also for some regulatory compliance core measures, but really it’s to bring the principles of performance improvement and the goals of the organization to the front-line staff.
“When you’re missing something, someone else is usually having a problem, too.” (0:37)
You would see the same mistake over and over and over again. When you were working, you’d have the same problem — not to pick on pharmacy — but you’d be missing medications and you’d have to call the pharmacy; and after awhile, you started saying to yourself, “What’s wrong with the system?” You know, it’s not working the way it should; and as a staff nurse, I was involved years ago on a pharmacy nursing committee and I think that probably piqued my interest to see how things worked behind the scenes. There are always two sides to every story. So when you’re missing something, someone else is usually having a problem, too. So it was good to get the big picture and be involved as a front-line staff in some of the improvement committees.
“The board of directors and the senior leaders have had a change in attitude over ten years.” (0:58)
I think for me it’s when I see front-line staff get it. They really latch onto the excitement of wanting to test something, wanting to change something, and they see that they have the power. And being in the critical care [IMPACT] Community and bringing front-line staff to meetings and having them be involved, I can see when the lightbulb goes off in their head and they really want to do it. It’s very exciting. The other thing for me is to see that the board of directors and the senior leaders have had a change in attitude over ten years. There was not much discussion of quality initiatives or agendas, or planning by the senior team or the board about the quality agenda. And over the last three or four years, I’ve seen a big change in that.
Our CEO has been a tireless champion of this since he’s been involved with IHI, and our other senior leaders have really bought into it. So, I think there’s the buy-in from the top, and we’ve gotten the “board on board” now, you know, to use the phrase, and it’s really become an exciting time.
“We’re really trying to get the patient into the middle of the picture.” (1:04)
I think there have been really three big priorities that I’ve seen over the last few years. One is customer satisfaction — patient-centeredness. We’re really trying to get the patient into the middle of the picture, and it takes a long time to change that culture so to speak, but I hear people talking about it all the time, which I didn’t hear them talking about [previously]. The other thing is to be a high-quality organization. They’re talking about how do we measure the quality of the organization, spending more time really dissecting our quality measures, our outcome measures, our process measures, but then deciding where we need to focus our efforts.
The two areas within the hospital I think that are getting the biggest clinical focus are the critical care areas, instituting all the bundles, working on glucose control, involving patients and families, and the other area is infection. The senior leadership has decided to really make decreasing hospital-acquired infections the banner goal for the year. So if you can have one “big dot” or one priority, that is going to be our big, big dot for the year.
“To change the way people do things, to change a mindset, will take more than a week.” (1:08)
I think you need to be patient. You want it to happen right away, but I find it doesn’t happen right away. It takes a long time, which sometimes is harder to understand. But to change the way people do things, to change a mindset, will take more than a week, or a month, or maybe more than six months. And especially if you’re going to change physician practice patterns, it takes longer.
The faculty in the critical care [IMPACT] Community has been outstanding. Having physicians who actually practice in critical care units talking about evidence-based medicine really appeals to the physicians in my institution. After listening to us talk about this for a few years, they finally decided to come to a meeting and were very impressed with the faculty that were there. So I think having actual physicians who are practicing in the setting in which they’re teaching us has also been very beneficial.
Physicians like evidence. And even if something isn’t approved or isn’t in the literature, if they hear another physician who is obviously knowledgeable about it say, “I’ve done this, it works for me” — it’s really been helpful for us.
08/18/2008
