Approaching Quality the Sanford Way: A Coordinated Improvement Strategy
In 2009, Fargo, N.D.-based MeritCare merged with Sioux Falls, S.D.-based Sanford Health to create an integrated health system that now includes more than 34 hospitals, 116 clinics, 30 long-term care facilities and 1,000 physicians. The system — the largest rural non-profit healthcare system in the United States, operates in seven states. The wide breadth of the organization geographically requires coordinated efforts to reach quality goals. Bruce G. Pitts, MD, CMO of Sanford Health, discusses how leadership, physician alignment and electronic medical records are critical to successfully adopting a single quality strategy.
The Sanford Way paves the path to quality
The Sanford Way is Sanford Health's common performance improvement methodology that is being developed from tools from both former MeritCare and pre-merger Sanford Health (the two merged in 2009). For example, Dr. Pitts designated a chief quality officer for each of the system's three geographic regions to oversee quality, safety and service at a regional level, an idea he borrowed from pre-merger Sanford Health. The health system also uses clinical decision support to encourage best practices, a practice that was more fully developed at MeritCare.
"Both systems had robust approaches. My job is to develop a consistent enterprise-wide approach to quality, safety and performance," Dr. Pitts says. "It's a way to have a common language and a common approach to performance improvement — solving problems, reducing waste and engaging the human spirit."
One tenet of this approach is continuous improvement. While the health system already performs well in readmission rates, risk-adjusted mortality and other quality metrics, Sanford Health is "never satisfied," Dr. Pitts says. The system looks at comparative reports and data from its electronic medical records to identify target areas for continued improvement.
Coordinating care over distance
Sanford Health's ability to adopt strategies and ideas from different areas is one of the benefits of its large geographic reach. "We have an opportunity to try a lot of different approaches to performance improvement across the enterprise and identify what works best for us and our culture," Dr. Pitts says. However, the physical area Sanford Health encompasses creates a challenge in coordinating performance initiatives. To better align practices, Dr. Pitts centralized key performance improvement resources. Sanford Health employees also stay connected over distance through the EMR. "We cover a huge geography that is relatively sparsely populated; our approach has to be different than if we were located in one city. The network approach allows us to communicate improvements across the enterprise in a transparent way and share methodology of how to get there," Dr. Pitts says.
Leading the Sanford Way
Deploying a universal set of tools across a system relies on strong leadership at every level. "Perhaps the most unique aspect of the Sanford Way is its very explicit understanding about the role of leadership," Dr. Pitts says. "So often when people talk about methods [of performance improvement], they focus on tools and data. We're very focused on the role of leadership. Of all the ingredients, that's the most important one."
Sanford Health promotes leadership by offering leadership education, giving future leaders progressively more responsibility and mentoring. In addition to supporting people in formal roles of leadership, Sanford Health encourages informal leaders who may not be in positions of power but are still very influential in the organization. Sanford Health mentors these 'informal" leaders and exposes them to situations in which they can exercise their leadership skills.
Physician alignment drives coordinated care
Integration is key to succeeding with a single performance improvement methodology, says Dr. Pitts. He attributes Sanford Health's current success in quality in part to the system's close alignment with its physicians. This alignment will also help the entire system adopt the Sanford Way. "One of the reasons we do well is because we are an integrated health system. Our affinity and common purpose have driven improvement over the years," Dr. Pitts says.
Sanford Health's physicians are all employed and are members of one practice. They retain close ties to the organization regardless of distance through the EMR, which provides patients' information, and sophisticated video connectivity, which enables physicians to communicate with other clinicians and patients. Sanford Health also established a local and enterprise-wide leadership structure that connects physician to the system. "We are so good at keeping people out of the hospital because our primary care physicians are so well connected to the whole enterprise," Dr. Pitts says.
In addition to helping physicians align with the overall system, EMRs help improve patient safety across Sanford Health by ensuring clinicians' access to a patient's file in any part of the system. Dr. Pitts says this capability is important because patients often go to different areas for care: their primary care physician may be located in a different area than their specialist, which may be in a different location than an emergency department they enter, for instance.
To enhance this capability, Sanford Health is currently transitioning its Fargo region facilities from GE Centricity EMRs to Epic EMRs, which facilities in the Sioux Falls region already use. While this transition will be a challenge, having compatible EMRs across the enterprise is critical to deploying a single quality approach, according to Dr. Pitts.
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