“If you get the culture at the organization right, eventually everything else falls into place.”
There’s a simplicity to the way Dr. Mark Jarrett, Chief Quality Officer at Northwell Health, says those words. But ensuring the highest quality care across Northwell’s 23 hospitals, nearly 700 ambulatory sites, joint ventures, and medical and nursing schools is anything but simple.
At Northwell, it takes education and a strong focus on communities and programs that drive innovation, including a Shark Tank-like competition in which the health system invests more than $1 million a year to support promising commercialization ideas.
Students visiting one of Northwell’s facilities as part of their SPARK Challenge, an initiative involving dozens of schools throughout the NY area in which they expose hundreds of young people to potential careers in health care.
Northwell Health’s Quest for Quality
Northwell Health is the winner of the 2018 American Hospital Association Quest for Quality Prize.
When Northwell began the process of applying for the prize, it was easy for the team to access data on the quality measures that they watch and publicly report. The bigger challenge was consolidating information on everything the system does to engage its communities and outpatients.
“I think that as a very important aspect for us because while we knew we were conducted a lot of programs, I think some of us were shocked by all the things we didn’t know were happening,” says Jarrett. “We had the chance to look at certain things that normally wouldn’t be in the spotlight.”
Part of Northwell’s “Food as Health” initiative is serving fresh, nutritious food at their hospitals instead of frozen or processed meals.
Some of those initiatives include work with a variety of community organizations, programs for veterans, and collaborations with local police departments and district attorneys to address the opioid epidemic.
“A lot of the work that we’re doing is trying to develop metrics that include social determinants of health and vulnerability” says Jarrett.
According to Jarrett, a lot of this involves digging deeper into quality measures. He uses the example of mammography. “As a system we might be doing 87 percent, but we know that’s an average. Which means that in some areas we might be doing 95 percent and others we might only be doing 60 percent because people don’t have access to care,” he says.
A System-Wide Pursuit of Quality
As a large health system, Northwell stretches across metropolitan New York and the communities it serves are diverse and complex – and so are its staff. In the communities served by Northwell’s Forest Hill hospital in Queens, New York, over 160 languages are spoken.
“We really want to reflect our communities because it’s the right thing and because it helps us gather that essential input,” says Jarrett. To champion this, Northwell created the position of Chief Diversity and Inclusion Officer, who is responsible for organizing community outreach and participation across the system.
“Often we look at quality as either a provider failing to do something or, classically, the patient being non-compliant,” says Jarrett. However, much of Northwell’s success has come from looking beyond what’s on the surface. “It’s hard for [a patient] to be compliant with their medications, if they can’t afford them,” he says, providing one example.
In another, he shares that the system noticed an influx of pregnant women who were arriving at the hospital in the late stages of labor, which was contributing to poor outcomes. A team dug a little deeper and realized that a good percentage of the women in these cases were undocumented, and, as a result, were afraid to call 911 or to order an ambulance. Instead, they waited until their spouses or a family member could take them to the hospital.
In practice, this involves partnering with a lot of organizations in the community – from supermarkets to religious groups – to address the diverse needs of the people in these communities and meet them where they live.
“A lot of large health systems in the United States are doing similar things; I really think this is where we’re all going, and I think it’s an absolute necessity,” says Jarett. “It’s recognition that if you don’t take care of the whole patient, so to speak, we’re not going to be successful.”
Programs to Give Quality Improvement Bite
Maintaining momentum for quality takes creativity. At Northwell, one strategy is an annual competition called the Innovation Challenge where staff submit ideas that are reviewed by outside business advisors.
The approach helps spark creativity and innovation. For example, this year’s winner won $500,000 to continue their research for a proposed better methodology for endometriosis screening.
As for whether the competition mirrors the intensity of the TV show, “It’s much more diplomatic, but the finals are very much a Shark Tank- like on TV – the advisors ask hard questions,” says Jarrett.
But the annual Innovation Challenge is only one element of how Northwell engages staff in the pursuit of quality.
There is a system-wide dedication to ensuring that data and information on quality improvement initiatives are delivered down to the unit level wherever possible. They also use collaborative councils to help pick projects that are aligned with system-wide initiatives, to avoid overlap and create efficiencies.
“We’re very big on sharing,” says Jarrett, “The one thing we don’t do is fix something in one place and then not see that through everywhere else.
Hospital incentives are tied to this commitment to sharing. Eighty percent of incentives are tied to local performance, but 20 percent are tied to performance system-wide. “It really speaks to everybody helping everybody,” says Jarrett, “We’re all in it together.”
Jarrett describes the Quest for Quality Prize as an award that “represents every one of Northwell’s 67,000 employees” and says that applying – and eventually winning – the award as a health system, has been meaningful and unifying to staff across all Northwell’s sites.
Quality at Northwell is a system-wide pursuit that everyone has a role in. Although, says Jarrett, “There was cheering in my quality department when they found out we won.”
“I think it’s important that these awards exist, because an award like this reflects culture, not just performance and measurement,” says Jarrett, taking the conversation full circle. “And this just reinforces how important culture is.”