LibertyHealth CMO Dr. Kenneth Garay: Embedding Quality in Hospital Culture

A culture of patient safety and quality is more than a scorecard of measures and a written policy — it is a way of living. Embedding safety and quality in an organization requires strong leadership, teamwork and constant feedback, says Kenneth Garay, MD, CMO of Jersey City, N.J.-based LibertyHealth System, which operates Jersey City Medical Center. Dr. Garay shares how LibertyHealth System makes patient safety and quality part of the "core fabric" of the organization.

Dr. Kenneth Garay explains how LibertyHealth System makes quality part of its Culture as a way of living
The health system is based on four pillars: patient safety, clinical quality, engagement/satisfaction and economic health. These pillars inform how the system operates on a daily basis and how it strives to meet long-term goals. While these ideals make good business sense — high quality attracts patients and physicians — they represent much more to LibertyHealth, according to Dr. Garay. "We established from day one that it is not just a matter of getting a good scorecard for the importance of attracting physicians and patients, but that it should be a part of our inner being because it is the right thing to do," he says. Like studying for an exam, the goal is not necessarily to get all the answers right, but to really understand and live the answers every day, Dr. Garay says.

Under this philosophy, LibertyHealth/Jersey City Medical Center met 100 percent of the core measures (in heart failure, acute myocardial infarction, pneumonia, surgical care, etc.) last year. "The key is as we grow in volume, we don't want to be lackadaisical and let it become routine," Dr. Garay says. To continue to improve quality performance, LibertyHealth system maintains several teams to examine the core measures and identify areas for improvement within the health system.

Developing teams and leadership

LibertyHealth has teams for each core measure as well as teams for specific initiatives, such as projects to decrease blood stream infections or ventilator-associated pneumonia. The teams meet regularly to evaluate data and discuss ways to improve performance and address any problems. One of the keys to the success of these teams is that they work proactively to continue to enhance safety and quality rather than responding reactively.

These groups include people from every level in the hospital — from transporters to physicians to senior administrators. In fact, investment from senior leadership is one of the most important elements in embedding a quality culture in the organization, Dr. Garay says. "Our senior leadership lives [safety and quality] every day. Our president and CEO [Joseph F. Scott] has really instilled that leadership. He lives and breathes it," Dr. Garay says.

Constant feedback provides motivation
Besides setting the tone for the organization and inspiring others to act, one of the most important roles of hospital leaders in making safety and quality part of the fabric of the organization is providing feedback. LibertyHealth provides feedback through administrative conferences between senior leaders and managers, emails, print publications, fairs and roundings. The health system also hosts some fairs that feature members of the organization highlighting different teams' successes and progress. "When peers see [someone being recognized], it stirs them to succeed and maintain success," Dr. Garay says.

In addition, LibertyHealth's vice presidents do weekly safety rounds on units in which they speak with the unit's clinicians and staff to discuss any safety concerns. "It's great to listen, but you have to give feedback," Dr. Garay says. For example, he says if one unit says patients' food is arriving cold, the vice president should report the concern to the dietary department and follow-up with the unit to ensure the problem is fixed.

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