BY MATT HONGOLTZ-HETLING
Staff Writer
Two small hospitals 25 miles from each made a list of the 13 best rural hospitals in the nation and adminstrators said it has a lot to do with workplace culture and computers.
Infections and other preventable errors are becoming less common at Inland Hospital of Waterville and Sebasticook Valley Health of Pittsfield, two of the top 13 rural hospitals in the nation, according to an independent nonprofit group dedicated to improving health care.
The group, Leapfrog, released the list after an analysis of public data on more than 200 hospitals showed that Inland and Sebasticook minimize hospital errors that hurt patients and increased health care costs.
Statistics from the national Centers for Disease Control show that hospitals give infections to 1.7 million patients a year, costing more than $30 billion.
Inland President John Dalton and Sebasticook President Victoria Alexander-Lane said workplace culture and computers are behind their success.
Workplace culture
âThe fact that we continue to reduce errors, the fact that weâre essentially driving hospital-acquired infections out of this hospital, thatâs the culture,â Dalton said.
Part of that is making peer interviews a big part of the hiring process.
âOur folks know right away, does this person care,â Dalton said. âAre they going to be part of our culture? Are they going to buy into this obsessive attention to trying to find out how to do better?â
Rick Barry, Inlandâs vice president of patient care services, said staff members help screen out inferior candidates.
âIf the staff tells the manager this person isnât the right fit, the manager takes that seriously and we donât bring that person in,â Barry said.
At Sebasticook, Alexander-Lane said job candidates are held to the hospitalâs core values, even when it is difficult to fill a position.
âWe have found ourselves in a position where we really needed somebody, and weâve said âwe havenât found the person who meets the values,â and we have gone without,â she said.
The values, including open communication, are applied equally to each employee, from the housekeepers to the board of directors, Alexander-Lane said.
Because of this, the days of close-minded doctors intimidating nurses and ignoring advice are over.
âWe have zero tolerance for doctors who feel they donât need to listen,â she said. âItâs important to have a good relationship between doctors and nurses which will result in nurses feeling empowered to speak up when they see something wrong.â
This is helped by a training program in which nurses receive specific instructions on what to say when calling a doctor about, for example, unexpected post-operative pain.
âIâve see this happen and itâs frustrating,â Alexander-Lane said. âThe nurse calls with inadequate information, the doctor becomes frustrated and is very busy and says, âgo back and get that informationâ or makes the decision without all the information. It doesnât lead to a good relationship.â
Sebasticook workers also adhere to a set of principles originally developed at Toyota, according to Mike Peterson, chief administrative officer.
âThe whole idea is, turning a staff into an army of people looking for problems to solve inevitably leads to solving a lot of problems,â he said.
Alexander-Lane said that projects suggested by employees at the hospital have led to reduced costs and higher efficiencies.
Projects have reduced the cost of printing employee paycheck stubs, made it easier for employees to purchase food from the cafeteria, among other cost reductions.
Barry said a demand for accountability at Inland also reduced the number of cases in which labor was induced in women before 39 weeks of pregnancy, one measure used by Leapfrog.
âThereâs a lot of evidence that suggests that, for a standard, normal delivery, if you induce a patient before 39 weeks, thereâs a greater choice of poor outcomes for the babies,â Barry said. âWe had zero cases over the past year of inducing before 39 weeks.â
Dalton said the practice of inducing labor early is often done as a convenience, either for the patient or the provider.
âWe just donât believe in it,â he said. âWe wonât do it.â
They did make one exception, a year and a half ago, because the babyâs father was about to be deployed to Afghanistan. The hospital induced labor 38 weeks and six days into the pregnancy â one day early.
âEven for that, we had significant discussion,â said Barry.
Computers
Because both Sebasticook and Inland are part of the Eastern Maine Healthcare System, they use similar advances.
A registration kiosk in Sebasticookâs lobby, for example, allows patients to check themselves in by inputting a unique code, Alexander-Lane said. When they do, the person they are there to see, like a blood lab technician, is automatically notified of the patientâs arrival, making for quicker contact between patient and provider.
At Inland, automated systems are becoming the norm, said Dalton.
âWe actually have more computers here than we have employees,â he said.
Barry said the net effect is better patient outcomes.
âYouâve probably heard a lot of jokes about physiciansâ handwriting not being the best,â said Barry. âFor some people, trying to interpret physician handwriting is like trying to read hieroglyphics.â
Doctors and other providers at Inland now enter orders into a computer system, leaving no room for interpretation, Barry said. He said the same system walks the doctor through a checklist that ensures the best practices are considered for each patient.
âIt helps to prevent working solely off of memory. Humans make mistakes,â Barry said. âThey never do it on purpose, but sometimes youâre processing five or six things and you miss something.â
About a month ago, both hospitals started a new system that uses bar code technology to scan patient wristbands as medication is dispensed.
âIt has caught errors,â Barry said. âThis has caught things where maybe the pharmacy tech who was loading the machine put medication A into the slot for medication B. Then the nurse took it out of slot B to give the patient, and the machine caught the error.â
While advanced systems can help reduce human error, sometimes the solutions are decidedly low-tech.
Barry said that there is a set of errors called never events, or things that should never happen in a hospital. One never event is performing surgery on the wrong patient, or the wrong part of a patientâs body.
âIf you come in for knee surgery on your right knee and we do it on your left knee, thatâs a problem,â Barry said. âUnfortunately, that happens elsewhere in the country. That happens more than you might think.â
This doesnât happen at Inland or Sebasticook, though, because of a simple solution. Before each surgery, a time out is called before the patient is put under anesthesia. During the time out, patient and physician each physically mark the site of the operation on the patientâs body.
Matt Hongoltz-Hetling â 861-9287
mhhetling@centralmaine.com
Send questions/comments to the editors.
Success. Please wait for the page to reload. If the page does not reload within 5 seconds, please refresh the page.
Enter your email and password to access comments.
Hi, to comment on stories you must . This profile is in addition to your subscription and website login.
Already have a commenting profile? .
Invalid username/password.
Please check your email to confirm and complete your registration.
Only subscribers are eligible to post comments. Please subscribe or login first for digital access. Hereâs why.
Use the form below to reset your password. When you've submitted your account email, we will send an email with a reset code.