Dear Health Care Leader:

Sometimes you can just see improvement in action. Since the AHA-McKesson Questfor Quality Prize was established nine years ago, it has progressed from honoringhospitals that have created a culture of patient safety to recognizing hospitals that

exemplify the pursuit of excellence and commitment to an integrated approach to achievingall the Institute of Medicine’s six quality aims (safety, patient-centeredness, effectiveness, effi-ciency, timeliness and equity). State-of-the-art in health care quality has progressed along withthe award, and we hope that the examples set by the AHA-McKesson Quest for Quality Prizehonorees have helped spur hospitals on their quality journey.

This year’s honorees should also provide models and inspiration. The 2010 winner is

McLeod Regional Medical Center, Florence, S.C. The organization’s quality work was impres-

sive when it received a 2007 Citation of Merit for its work on clinical effectiveness and safe-

ty. Since then, it has applied its data-driven quality improvement process to all the aims, amaz-

ing the AHA-McKesson Quest for Quality Prize Committee with its rapid progress and the

lessons it took from its previous Quest for Quality experience.

The Finalist award was won by Henry Ford Hospital & Health Network, Detroit, in

recognition of its overall transparency and culture of safety, work on equity and strong lead-

ership and board engagement. Queens Hospital Center, New York, was awarded a Citation

of Merit for its focus on community health, community involvement, and outreach and over-

all commitment to cultural competency and equity.

Please notice the prize’s new tag line—Hospitals in Pursuit of Excellence. We believe that

these three honored hospitals are clearly pursuing excellence and that they provide ideas and

pathways for all hospitals and health care systems to follow.

On behalf of the AHA Board of Trustees, membership and staff, I am pleased to thank

McKesson for its support and funding for the AHA-McKesson Quest for Quality Prize and

its commitment to excellence.

Sincerely,

Rich Umbdenstock

President and CEO

American Hospital Association

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Publisher:Mary Grayson, Managing Editor:Bill Santamour, Writer: Lee Ann Jarousse, Copy Editor: Kendra A. Hopkins, Design: Cheri Kusek, Production:Heather Yang,

Cover Photographer: John Starkey. 2010 American Hospital Association-McKesson Quest for Quality Prize® is published by Health Forum, an American Hospital

Association company. The American Hospital Association and McKesson Corp. sponsor the Quest for Quality Prize program. © 2010 by Health Forum, 155 N. Wacker

Drive, Suite 400, Chicago, IL 60606, all rights reserved. All materials in this publication are provided for informational purposes only and should not be construed

as professional advice.

The American HospitalAssociation-McKessonQuest for Quality Prize©

The American HospitalAssociation–McKesson Quest forQuality Prize is presented annuallyto honor leadership and innovationin quality, safety and commitment inpatient care. The prize is supportedby a grant from McKesson Corp.The 2010 award recognizes organi-zations that have systematicallycommitted to achieving the Instituteof Medicine’s six quality aims—safety, patient-centeredness, effec-tiveness, efficiency, timeliness andequity. These organizations havedemonstrated progress in achievingmultiple aims and provide replicablemodels and systems for the hospitalfield.

Applications for the 2011 awardare due Oct. 10 and can be found atwww.aha.org/questforquality. Formore information, call 312-422-2700or e-mail questforquality@aha.org.

The winner will receive $75,000and two finalists will receive $12,500each. Citations of Merit may beawarded recognizing other note-worthy organizations.

The awards are presented inJuly at the Health Forum-AmericanHospital Association LeadershipSummit.

InsideWINNERMcLeod Regional Medical Center Florence, S.C.

Driven to Continuously ImproveEmployees at McLeod Regional Medical Center work ceaselessly toprovide safe, quality care. The hospital’s goal is to be better tomorrowthan it is today. The organization’s single-minded focus on qualityimprovement has been maintained and intensified over time.

FINALISTHenry Ford Hospital & Health NetworkDetroit

‘You can achieve dramatic results’Henry Ford Hospital & Health System sets aggressive goals for achieving clinical and service excellence. The organization strives tobecome a national leader in delivering safe, reliable, high-quality andhighly coordinated care.

CITATION OF MERITQueens Hospital CenterNew York

A Staffwide Sense of OwnershipQueens Hospital Center is dedicated to eliminating disparities in care.Strong community ties are crucial to achieving the organization’svision of providing effective, high-quality care.

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Achieving quality perfection.That’s the underlying pursuitat McLeod Regional Medical

Center. The hospital’s goal is to be bet-ter tomorrow than it is today.

The goal fosters an environmentwhere employees work ceaselessly toprovide safe, high-quality care. “Wehave a desire to continuously improveeverything that relates to the care ofthe patient,” says Donna Isgett, R.N.,senior vice president of quality andsafety. McLeod was awarded theAmerican Hospital Association-McKesson Quest for Quality Citationof Merit in 2007. Since that time, theorganization has not only sustained,but also intensified its commitment toclinical, operational and service excel-lence.

Leadership involvement is a keyto the 453-bed organization’s success.

The Quest for Quality is ongoing. McLeod Health leaders are pictured in the McLeod Hospice Garden standing amongflourishing greenery along the Infinity Walkway. From right: Ronnie Ward, McLeod Health chairman of the board oftrustees; Donna Isgett, R.N., senior vice president of quality and safety; Rob Colones, McLeod Health president andCEO; William Boulware M.D., McLeod Regional Medical Center chief of staff; Marie Segars, R.N., administrator ofMcLeod Regional Medical Center.Photograph Courte

sy of M

cLeod He

alth

WINNERMcLeod Regional Medical CenterFlorence, S.C.

Driven to Continuously ImproveIsgett credits President and CEO RobColones for inspiring employees torelentlessly pursue perfection. “Heknows our efforts and performance aswell as I do,” she says. “That’s a differ-entiator.”

Colones and other members ofthe leadership team make time eachday to visit with patients to discusstheir care and perceptions of quality.Quality is also the focus of a weeklysenior executive meeting that exam-ines progress in performanceimprovement initiatives, challengesand potential solutions.

“Carving out time in the seniorexecutive calendar is important from alearning, resource and messaging stand-point,” Colones says. “My role is to beengaged and involved in our qualitywork.” Colones also writes a weekly blogupdating employees and the communi-

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ty on the organization’s efforts. The board, too, plays a visible role.

Board members participate in patientrounds and quality is at the top of theagenda for each board meeting. “Wehave good, meaningful discussions,”says Board Chairman Ronnie Ward.“We know we are never going to beperfect, but we can’t be content withbeing better than average.”

McLeod prides itself as being ded-icated to continuous learning. Sharedlearning is viewed as an opportunityfor organizational growth. Senior exec-utives, along with medical staff offi-cers, participate in a book review todiscuss management, safety and relat-ed topics. And Colones makes month-ly visits to a different employer in thecommunity to discuss their qualityand safety initiatives. The meetingsalso address, among other things,workers’ compensation issues, ser-vices the employer would like McLeodto offer, and health care cost concerns.

“It’s helpful to see the workforcein its setting,” Colones says. “It’s agreat place for us to learn.” A visit toGE Medical Systems in Florence, forexample, resulted in McLeod’s adop-tion of the Six Step Problem SolvingProcess, a forerunner to Six Sigma.The process is used as the standardapproach to the organization’s clinicalexcellence initiatives.

Clinical, service and operationalimprovement initiatives are designedaround the six IOM aims. Improve-ment processes are data-driven andfocus on system-level improvements,rather than disease, department orunit-level changes. Rapid Improve-ment Event teams are deployed tooversee operational effectiveness pro-jects. The teams include three sets of“fresh eyes,” team members who

work in areas unrelated to theimprovement initiative to provide newperspective to the process.

Physicians have played a centralrole in clinical excellence since theprogram began in 1998. The majorityof physicians have participated onimprovement teams. “The success wehad in the early years created enthusi-asm,” says William Boulware, M.D.,chief of staff. “We’ve created a cultureof excellence and quality and that hasattracted better physicians to the orga-nization.”

McLeod has made significantprogress in the efficiency and timeli-ness of care. Lean principles areapplied to streamline services andenhance care. In the emergencydepartment, door-to-provider time wasreduced from two hours and 20 min-utes in February 2008 to 60 minutesin August 2009. And the number ofpatients leaving without being seendropped from 8.6 percent in February2008 to 4.7 percent in August 2009.

One lesson McLeod has learnedis the value of taking time to salute theorganization’s accomplishments. “Weare so driven to continuously improve,that we often don’t stop to celebratewhere we are,” says Marie Segars,R.N., administrator. “That’s a futurefocus for us. We have many peoplewho need to be recognized andrewarded.”

McLeod tries to take a deeper diveinto quality improvement each year.The organization continues to seek outchange methodologies that are reliableand effective. “It’s important for us torecognize when an improvement hasmaxed out so that we can change ourapproach,” Colones says. “We havecome to understand that the quest forquality is part of our daily work.” •

“We have a desire to continuouslyimprove

everything thatrelates to the

care of the patient,” says DonnaIsgett, R.N.,senior vice president of quality and safety.

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The American Hospital Association-McKesson Quest for Quality Prize Committee

Eugene NelsonProfessor of Community and FamilyMedicineDartmouth Medical SchoolHanover, N.H.

Jeffrey Selberg, ChairmanLakewood, Colo.

Gerald WagesExecutive Vice PresidentNorth Mississippi Health ServicesTupelo, Miss.

Nancy Wilson, M.D. Senior Adviser to the DirectorAgency for Healthcare Research andQuality Rockville, Md.

Gary Yates, M.D. Chief Medical OfficerSentara HealthcareNorfolk, Va.

Stephanie AlexanderHealthcare AdviserPremierJacksonville Beach, Fla.

James Bagian, M.D.DirectorNational Center for Patient SafetyAnn Arbor, Mich.

Kathleen Jennison Goonan, M.D.Executive DirectorCenter for Performance ExcellenceMassachusetts General Hospital/PartnersBoston

Paul HofmannPresidentHofmann Healthcare GroupMoraga, Calif.

Beverley JohnsonPresident and CEOInstitute for Family-Centered CareBethesda, Md.

Peggy Naas, M.D.Vice PresidentPhysician StrategiesVHA Inc.Irving, Texas

Mary Beth Navarra-Sirio, R.N.Vice President and Patient Safety OfficerMcKesson CorporationCranberry, Pa.

www.aha.org/questforquality

StaffGail Lovinger GoldblattVice President, Association GovernanceAmerican Hospital AssociationChicago

Kathy PooleDirector, Governance ProjectsAmerican Hospital AssociationChicago

Erin HennessyProject CoordinatorAmerican Hospital AssociationChicago

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‘You can achieve dramatic results’

FINALISTHenry Ford Hospital & Health NetworkDetroit

Quality and safety drive success atHenry Ford Hospital & HealthNetwork. The 802-bed hospital,

in Detroit, sets aggressive goals forachieving clinical and service excellence,seeking to become a national leader indelivering safe, reliable, high-quality andhighly coordinated care.

The six IOM aims are embedded inall safety and process improvementefforts. The belief is that the aims willhelp the organization achieve its visionto provide the level and manner of carethat employees would want for them-selves and their families.

Quality and safety initiatives supportthe organization’s core values: a socialconscience, respect for people, high per-formance, learning and continuousimprovement. Goals are updated annu-ally and receive regular oversight fromthe board of trustees’ quality committee.Results are disseminated across the orga-nization through various modalities,including meetings, the intranet, Inter-net and a quarterly performance report,which details results on a business unitand organizationwide level. “We workhard at openly sharing results about allunits across the hospital,” says WilliamConway, M.D., senior vice president andchief quality officer of Henry Ford HealthSystem and chief medical officer of Hen-ry Ford Hospital & Health Network.“Internal competition is very healthy andtransparency helps drive that.”

The hospital uses a variety of processimprovement efforts to achieve its safetyand quality goals, including Six Sigma,Lean and root-cause analysis. All processimprovements follow the Plan-Do-Check-Act cycle. “We’re not committed to a sin-gle improvement tool, but we are com-mitted to a consistent approach,” saysSusan Hawkins, vice president of plan-ning and performance improvement. Theorganization stays actively involved inlocal and national organizations andimprovement initiatives to keep abreastof quality and safety developments.

Leaders throughout the hospital useweekly huddles with safety messages toshare what’s going on throughout theorganization, says Veronica Hall, chiefoperating officer and chief nursing offi-cer. In addition, an annual Quality Expofeatures about 75 improvement projectsaround the six IOM aims. The expoallows staff to learn about quality initia-tives throughout the organization andshare best practices among teams. Exter-nal judges, who have included DonBerwick, M.D., president and CEO of theInstitute for Healthcare Improvement,and former U.S. Surgeon General DavidSatcher, M.D., hear presentations fromthe top 12 project teams and select up toeight to receive special expo awards, pro-viding an opportunity to publicly recog-nize staff for their efforts.

As a member of the Henry FordHealth System, the hospital’s quality and

Photograph by Sa

nta Fabio

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safety initiatives are part of a broadereffort to develop a cohesive strategy toeliminate harm from the health careexperience. The system adopted a NoHarm campaign in 2007 that seeks tocombine harm-reduction initiatives intoa single systemwide effort. The cam-paign focuses on enhancing the cultureof safety, improving the quality and clar-ity of clinical communications, identify-ing the top causes of harm as a systemand at the individual points on the con-

bundle, among other things, has con-tributed to the decline.

Henry Ford Hospital is committedto providing care in a culturally support-ive environment. The hospital strives toprovide care that does not vary becauseof personal characteristics, such as gen-der, race or socioeconomic status. AHealth Equity Campaign, launched lastyear, seeks to increase knowledge, aware-ness and opportunities for ensuringhealth care equity. The three-year cam-paign also strives to establish equity as akey, measurable aspect of clinical equity.

“Given the extent of diversity in ourcommunity, we are committed to makingprogress in this area,” Conway says. Toaddress the needs of the large Arab-Amer-ican population in the Detroit-area, forexample, the hospital has partnered witha community services organization toestablish the Arab Community CenterObstetrics Clinic and the organizationhired Arabic-speaking female staff toencourage women to seek care. Thehealth system’s website is also translatedinto Arabic. The African-American MaleHealth Initiative promotes prevention andearly disease intervention by reaching outto the community—such as throughchurches, barbershops and communitycenters—to provide health screenings andeducation.

Resource allocation remains a chal-lenge, given the breadth of quality andsafety initiatives under way at HenryFord Hospital. Like most hospitals, theorganization struggles not to overwhelmfront-line staff with new concepts andtraining. Education and training is bun-dled over a half- or full-day per quarterto limit disruptions to work schedules.

Still, Conway says that hospitalsshould set aggressive goals for qualityand performance improvement. “Don’tbe afraid,” he says. “You can achieve dra-matic results.” •

tinuum of care, and redesigning care toeliminate common causes of harm.

The No Harm campaign focuses onhigh-impact harm areas such as sepsismortality. Sepsis represents about 30 per-cent of all deaths at Henry Ford Hospital.Since the creation of an evidenced-basedsepsis identification program at HenryFord Hospital in January 2004, the sep-sis mortality rate has dropped from over15 percent to less than 11 percent in May2009. The implementation of a sepsis

Front row seated: William A. Conway, M.D., senior vice president and chief quality officer, Henry Ford HealthSystem, chief medical officer of Henry Ford Hospital; Susan Hawkins, vice president, planning and performanceimprovement, Henry Ford Health System. Standing (left to right): Gwen Gnam, R.N., administrator, surgical ser-vices, Henry Ford Hospital; Veronica M. Hall, R.N., chief operating officer and chief nursing officer, Henry FordHospital; J.H. (Pat) Patton, M.D., director, trauma services, Henry Ford Hospital; Peter Y. Watson, M.D., divisionhead, hospitalist medicine, Henry Ford Hospital; Kimberlydawn Wisdom, M.D., vice president, community health,education and wellness, Henry Ford Health System.

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CITATION OF MERITQueens Hospital CenterNew York

A Staffwide Sense of Ownership

As a public hospital in New York,Queens Hospital Center servesa culturally diverse population

and is dedicated to eliminating dispar-ities in care. Strong community ties arecrucial to achieving the organization’svision of providing effective health carethrough a continuum of locally focusedservices that work as a catalyst forimproving community health.

“Our community is well-informedin terms of what we are working onand we elicit their support in ourefforts,” says George Proctor, executivedirector. A community advisory boarddiscusses disparity-related issues dur-ing monthly meetings that are attend-ed by both clinical and administrativeleaders.

Efforts to eliminate disparities incare include the opening of a state-of-the-art cancer center in 2002. Data fromthe New York City Department ofHealth and Human Services showedan unusually high level of cancer beingidentified in late stages because manylocal residents lacked on-going preven-

tive care. A partnership with Memori-al Sloan-Kettering Cancer Center pro-vides patients with access to the sameclinical trials available at that renownedfacility. A Center of Excellence in Dia-betes was also opened to address thehigh incidence of diabetes in the com-munity.

Queens Hospital Center is part ofthe New York City Health and Hospi-tals Corp., an 11-hospital system with amission to provide all New Yorkerswith comprehensive, high-quality ser-vices in an atmosphere of humanecare, dignity and respect regardless oftheir ability to pay. The six Institute ofMedicine aims drive quality assuranceefforts across the system; each facilitysets its own goals and developsimprovement projects accordingly.

At Queens, quality and patientsafety improvement initiatives areplaced largely in the hands of front-lineemployees. Their feedback on safetyconcerns helps set the quality assur-ance agenda. “We keep our staff highlyengaged,” Proctor says. “Everyone has

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tion; make the catheter maintenancebundle part of nurses’ daily workflowreporting; and avoid of catheter inser-tion in the femoral area.

Since implementation of the rec-ommendations, central-line infectionshave dropped throughout the hospital.In the ICU step-down unit, for exam-ple, the median rate of infectionsdropped from 22.1 per 1,000 devicedays in 2002 to zero in 2007 and 2008.

Improving efficiencies throughoutthe hospital and health system remainsa top priority. “We are challenged toimprove efficiency and quality whilealso reducing costs,” Proctor says. Theorganization has an electronic medicalrecord system and 100 percent of med-ical orders are electronic. Yet changesin the care delivery system are needed

if the system is to meet its mission ofproviding high-quality care regardlessof ability to pay. Lean principles areused to identify efficiency gaps. In theOR, the majority of patients are readyfor surgery 30 minutes prior to starttime, representing a great increasesince implementation of Lean princi-ples.

“We’ve had a lot of advances andimprovements, but we still have a lot todo,” Fleischman says. She recom-mends that organizations undertake athorough self-assessment as it relatesto the IOM aims. Completing theQuest for Quality application hashelped Queens structure how to moveforward, says Fleischman. “With allthat’s going on with health care reform,that’s crucial,” she says. •

a sense of ownership for our qualityimprovement efforts.”

A shared governance model givesnurses a voice in the process. “It’s real-ly brought decision-making down tothe front-line staff,” says Jean Fleisch-man, M.D., associate director, depart-ment of medicine.

One improvement project identi-fied by the organization was eliminat-ing central-line infections. A multidisci-plinary group developed a set ofrecommendations that are now in placeacross the HHC system. The recom-mendations include: Empower criticalcare nurses to stop physicians whodeviate from standard procedures; cre-ate a checklist to monitor insertions;devise a safe catheter insertion kit; cre-ate a “how to” video for catheter inser-

Photograph co

urtesy of Q

ueens H

ospital C

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The American Hospital Association-McKesson Quest forQuality Prize® is a program administered by the HealthResearch & Educational Trust.

The American Hospital Association-McKesson Quest forQuality Prize® is supported by the McKesson Corp.