Patient at the center: Pursuit of unparalleled safety, quality, service and innovation in healthcare

Houston Methodist Baytown CEO shares his organization’s journey in their targeted improvements — using Vizient’s Quality and Accountability Study as a North Star — to rise from No. 104 to No. 2 in the rankings as they improved patient safety and mortality outcomes.

Editor’s Note: Since publication of this story, David P. Bernard, has moved from Houston Methodist Baytown Hospital to a new role within the Houston Methodist System as CEO of The Woodlands Hospital.

Houston Methodist Baytown welcomed its first patients in 1948 with a vision to deliver modern healthcare and innovation to the community. As the first Houston Methodist community hospital, the organization takes deep pride in its 75 years of striving to provide quality patient care.

For the past several years, the hospital used Vizient's Quality and Accountability Study as a guiding star to implement changes that eliminate variation in care and improve outcomes. During their Power Huddle presentation "Journey to Improving on a National Quality Scorecard" with the University of Maryland at the 2023 Vizient's Connections Summit, Houston Methodist Baytown CEO David P. Bernard and his team shared the path they took to rise from No. 104 to No. 2 in the Vizient complex care medical center top performer rankings.

"Our vision is to provide our patients with unparalleled safety, quality, service and innovation," Bernard said. "Our impetus for improving has and will always be our patients — they are at the center of everything we do — and our staff and providers who care for our patients. We want to make sure our patients are receiving the best care and service possible, and our team is working in a psychologically safe and highly reliable environment."

Assessing with transparency

For the past 18 years, Vizient has evaluated the performance achievements of academic medical centers in Vizient's Quality and Accountability rankings and compared the practices of consistent top performers with those of peer institutions with less consistent success. The rankings measure annual performance across six domains: safety, mortality, effectiveness, efficiency, patient centeredness and equity.

Bernard said they studied the key drivers of Vizient's Q&A measurement tool very closely as they began their journey that included:

• Prioritizing their efforts based on the value to the patient, focusing primarily on patient safety and mortality outcomes, which would drive better overall performance.
• Creating an objective, non-threatening reporting structure that focused on transparent assessment, processes and outcomes to make it easy for everybody to see the gains, misses and gaps.
• Aligning medical staff and executive leadership — a must to drive changes to produce results.
• Setting clear expectations, defining roles and responsibilities, and giving everybody the tools, resources and more importantly the support that they needed to get things done.
• Fostering a culture shift to eliminate the ‘well, we've just kind of always done it this way' mentality while remembering that change to drive performance takes patience and resilience.
• Creating medical staff leaders and committee structures that would support a safe, high-quality environment and engage everyone along the journey. For example, the hospital's patient safety committee, chaired by members of the Board of Trustees, now also includes a lay member from the community.
• Implementing daily 15-minute staff/leadership huddles to allow everyone to view their area's quality and safety measures, along with other meaningful topics. The collaborative exercise empowers everyone to speak up and take the necessary steps to make improvements quickly.

Building a collaborative culture

Bernard emphasizes the importance of engaging the entire team in the effort and being fully transparent with the data and accountable for the results.

"We share unblinded data and openly discuss outcomes, near misses, adverse events and opportunities for improvement together. We believe in the concept of a Just Culture and that everyone comes to work to provide the best care possible to their patient. We created a culture of psychological safety and empowered everyone to speak up," he said. "When we experience an event, we unite to review how the process failed, not the person. This level of transparency and collaboration is critical to identifying thoughtful solutions and taking swift action to address concerns."

Collaboration is built around patient care first and foremost.

"We put the patient at the center of everything we do," he said. "Our improvements in patient safety and quality have been built around this principle."

Holding the team accountable also translates to celebrating wins along the way. Bernard said when they became a Vizient top performer and hit No. 2 in the rankings in 2022, Baytown leadership held a big celebration to recognize everyone's efforts.

"We involved everyone and as we made progress, we shared the success stories with our team, board and community," he said. "This created great pride and value for our leadership, physicians and staff that ignited a special energy across the organization. We used our successful work in mortality and patient safety to spark activity in the other domains — effectiveness, efficiency, patient centeredness and equity — and have realized positive gains in those areas as well."

Driving sustained quality and innovation

One of the biggest challenges in healthcare is not only to move the needle on quality, but to sustain those improvements over time.

Bernard said in addition to building trust, transparency and open communication with the medical staff, Houston Methodist Baytown's reporting and committee structure has provided a way to stay disciplined and hardwire accountability. To keep consistently aligned, the organization standardized reporting to its quality and patient safety committee includes priority focus areas with defined action plans, goals for improvement, target dates and measures of success.

"We host an annual medical staff leadership retreat and also present a transparency report to all members of the medical staff each year which includes activity from credentials, peer review and the medical executive committee," Bernard said. "This has been key in aligning the medical staff and keeping everyone on the same page along the journey."

Since arriving at Houston Methodist Baytown in 2015, Bernard and his team have been committed to carrying the organization's vision into the future, which includes continual improvement and a focus on innovation.

"The use of innovation and technology to improve outcomes is a part of our culture," he said. "We are always seeking ways to improve the care we deliver and the safety and efficiency of how our team works. While new technology plays a role, there is no substitute for focusing on teamwork, open communication and psychological safety fundamentals."