At St. V, small miracles and big changes
10/2/2010The baby was so tiny, I had to look twice to spot him amid the wires and monitors and blue lights of the ventilator he was hooked up to. I wondered how he would survive.
Not to worry, Dr. John Schaeufele assured me: “A year from now, he'll be running the halls someplace, throwing peas against the wall.”
Dr. Schaeufele is president of Mercy Children's Hospital, part of Mercy St. Vincent Medical Center. I was visiting the hospital campus on Cherry Street to check out the little miracles and big changes at “St. V,” a downtown Toledo institution since 1855.
Elsewhere in the newborn intensive-care unit, a middle-aged woman held another baby, rocking it gently. She is one of the hospital's “cuddlers,” a volunteer position for which there's a one-year waiting list.
She seemed to personify Mercy's mission statement: to extend “the healing ministry of Jesus by improving the health of our communities, with emphasis on people who are poor and underserved.”
As it strives to fulfill the faith-based mission of its parent company, Catholic Healthcare Partners, St. Vincent is also a major Toledo employer (more than 3,500 workers, including nearly 900 staff doctors), a regional teaching hospital, and a cutting-edge medical provider that operates a top-level trauma center, an acclaimed chest pain center, a key critical-care unit for treating high-risk infants and their mothers, and five air ambulances.
Managing all those roles, especially during a bad economy, has required St. Vincent to get a lot more efficient, said Dr. Imran Andrabi, the hospital's president for the past two years.
“Our system wasn't working,” he said. “We asked ourselves, what if we could design a system that would get to the right outcome for patients? What should it look like?
“We looked at best practices. We talked to industrial engineers, people in global logistics and technology design. Sometimes they would ask us: ‘Why do you even do this?' ”
St. Vincent adopted the motto “Patients First — Journey to Zero.” And it's working, Dr. Andrabi said: “By focusing on doing what's best for our patients, we've made a 50 percent reduction in errors.”
The hospital has cut the length of time to get an emergency patient into a hospital bed from four to six hours to 50 minutes, he added. He estimates the efficiencies the hospital has carried out have saved $100 million.
The children's hospital has undergone a similar transformation, Dr. Schaeufele said.
“We were the Jetsons operating with the infrastructure of the Flintstones.” he said. “We introduced systems that force people to do the right thing. We've cut down the cost of management and improved quality. We've cut the length of stay and dropped our readmission rate.”
Approvals from insurance companies that used to average 28 hours “on a good day” now are achieved in two hours, he said.
Activities at St. Vincent revolve around its “hub,” the hospital's equivalent of an air traffic control center or Mission Control at NASA. “If Houston can do it, why can't we?” Dr. Andrabi quipped.
Hospital coordinators sit at computer terminals, keeping track of the 300-plus patients St. Vincent sees on a typical day — admissions, outpatient care, emergency treatment. They monitor the locations of doctors and nurses.
Large wall-mounted screens show the status of each patient and each hospital bed. A bulletin board displays pie charts that convey standardized data about patients. A system that will make the information available on handheld devices is in the works.
St. Vincent's designed and developed the program from scratch, Dr. Andrabi said, to provide statistical measures of quality of care that would replace previous “anecdotal conversations.”
“Everything around here was ‘stat',” Dr. Andrabi said, using hospital slang for a demand for immediate action. “Now we can anticipate where patients will need to go in the next four hours. We can plan instead of reacting.”
The hospital's heart center performed 375 open-heart surgeries last year. St. Vincent is stepping up its use of robots in surgery, to enhance quality and reduce complications such as infection.
In a temporarily empty patient room in the 80-bed heart center, Dr. Andrabi showed me a dinner menu that would have distinguished a good restaurant. He noted that patient satisfaction scores for the food at St. Vincent exceed 99 percent — a long way from the days of Jell-O and mystery meat.
Another mission of the hospital is community development. Throughout this decade, St. Vincent's Legacy Project has worked with community groups, the Toledo Police Department, and other public and private agencies to spruce up the Cherry Street corridor, reduce crime and drug activity, and replace blighted homes with green space. The project includes a $90 million investment in the St. Vincent campus.
“We're committed to this neighborhood,” Dr. Schaeufele said. “This hospital hasn't moved ten blocks since 1855.”
Part of that effort, Dr. Andrabi acknowledged, is aimed at retaining hospital employees. A decade ago, St. Vincent's set a goal of keeping 30 percent of its graduating residents in northwest Ohio and southeast Michigan. Today, Dr. Andrabi noted, the retention rate is “upwards of 50 percent.”
He said the region must do more to diversify its economy and improve its public schools if it is to entice people to live and work here. But he and Dr. Schaeufele offered themselves as examples of professionals with options who have chosen to remain because of the area's quality of life.
“I never intended to stay in Toledo,” Dr. Schaeufele said. “Now I'll probably die here.”
Said Dr. Andrabi, a native of Pakistan: “I moved 10,000 miles to come to Toledo. I came for one year, and I'm in my 19th year. I wouldn't change a thing, for me or my family. It's been a great journey.”
David Kushma is editor of The Blade.
Contact him at: dkushma@theblade.com