Captain of the Ship


About a year ago, Ira Horowitz, MD, chief medical officer at Emory University Hospital in Atlanta, went to his COO and said, “Something is happening.”

While this would usually be cause for concern, Dr. Horowitz was referring to the landmark changes occurring in the Emory Healthcare System as a result of quality initiatives like the venous thromboembolism (VTE) dashboard, a computerized system that allows hospital staff, in real time, to identify patients on prophylaxis at any of Emory’s three hospitals.

Because VTE is one of the most preventable causes of death in hospitals, the dashboard allows nurses to “take the lead” and build monitoring into their workflow, Dr. Horowitz says. Nurses can begin their shifts by identifying which patients are on prophylaxis. The dashboard also gives them the opportunity, when the physicians are rounding, to discuss whether prophylaxis is appropriate.

Emory hospitalist Jason Stein, MD, SFHM, spearheaded the VTE dashboard team, which included 24 other hospitalists, nurses, pharmacists, and IT personnel. The new system was initiated during Dr. Stein’s research in HM process improvement, at the time Dr. Horowitz and others were doing parallel work in VTE prevention.

“What’s really exciting is having the troops on the ground, so to speak—having the physicians intimately involved with the patients, and the nurses really taking the lead. That’s what this study or this process improvement really illustrates,” says Dr. Horowitz, who cosponsored the research that won SHM’s 2010 Award of Excellence in Teamwork in Quality Improvement. The award was given for both the creation of the dashboard and the monumental changes the new system inspired in Emory’s approach to QI.

Sharlene Toney, RN, PhD, associate chief nursing officer for research and executive director for Emory’s professional nursing practice, says that while the dashboard concept focused on how to prepare physicians and nurses to make a difference in patience outcomes, the QI movement has spread to all parts of the Emory system.

“We actually have housekeeping staff who have had a discussion with patients about the importance of wearing [sequential compression devices],” she says. “This is really about an organizational culture. … You’re in this as a team, and this research is about the synergistic relationship of every employee. You can’t see it as hierarchal; it’s truly partnerships.”

While the dashboard is a start, Drs. Horowitz and Toney say that the positive shift happening at Emory can only be reproduced by first establishing a level of respect among and for all hospital employees, and by breaking down silos.

“I think in medicine, in order for us to provide the best and the safest care for our patients, the physicians have to start realizing they’re not captain of a ship, they’re captain of a team,” Dr. Horowitz says, “and with that comes very different behaviors.”

For more information about SHM's Awards of Excellence winners, visit our website.

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