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America’s Poorest City (Detroit) Leads The US In Healthcare Quality Reform

Photo of Nancy Schlichting

Nancy Schlichting

“Detroit is the poorest city in America. But we’re not going to be victims of circumstance. We’re going to rise up and lead the country in healthcare quality and become part of the economic solution for our community. The Henry Ford hospital name must mean something when people drive up to it.”
– Nancy Schlichting, President and CEO, The Henry Ford Health System, Detroit, Michigan
I sheepishly admit to being surprised that a hospital system in Detroit was singled out for a national award for hospital quality and safety. Who would think that the poorest city in America could be a beacon of light in these dark times in healthcare? The story of Henry Ford Health System, and its female president and CEO, Nancy Schlichting, is both inspirational and motivational. I had the chance to interview Nancy at a recent award ceremony at the National Press Club where she received the 2008 National Health System Patient Safety Leadership Award.

You may enjoy our conversation via podcast, but please forgive the “tinny” sound quality. I recorded our conversation with a little hand-held digital device instead of my usual recorded phone line.

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Dr. Val: Congratulations on winning the National Health System Patient Safety Leadership Award. Has improving patient safety at your hospital been a challenge?

Schlichting: On a given day, a patient may encounter up to 50 different hospital employees. Coordinating our efforts so that the patient’s experience is consistently positive and error-free is certainly challenging.

We have 7 pillars of performance at Henry Ford, and the first is “people.” We like to say that we “have to take care of the people who are taking care of people.” We need to make sure that they have the resources they need, that the processes are in place so they can do their jobs well, and that they get their individual needs met. For example, everyone knows my email address and they can contact me at any time if they’re not getting their problems resolved. I respond to every single email. This creates a culture of openness and responsibility. They know that the person at the top cares about them.

Dr. Val: A prominent community member experienced an unfortunate lapse in communication during his hospital stay, which resulted in compromise of his care, and he eventually died in the hospital. You personally met with his wife and promised her that you’d take the necessary steps to ensure that this never happened again. Tell me more about that.

Schlichting: If you imagine each patient experience as something that happens to yourself or your family, it makes it very personal. Our vision at Henry Ford is to provide the same level of care for others that we want for ourselves and our families. This means that everyone from housekeepers to surgeons can relate to illness and the way they’d like to be treated in those circumstances. If you treat others the way you’d like to be treated, the steps you need to take to make that happen become quite clear.

After the incident you described we created a video called “Through The Patient’s Eyes” and we told the story of what had happened to them at our hospital from their perspective. We hired screen writers to create the script, and both actors and our own staff participate in it. We’ve broadly disseminated it to all our staff and we want them to talk about it and learn from the experience. The case essentially boiled down to staff not listening to the patient, and that’s unacceptable.

Dr. Val: You’ve said that although Detroit is the poorest city in the United States, Henry Ford has resolved not to be a victim, but to rise to the challenge and be a leader in healthcare quality. What inspired you to take that stance?

Schlichting: I’ve always been an optimist, and I can’t stand people who whine or play the victim. Frankly, lack of personal responsibility is a real problem in this country in a lot of areas, especially in clinical quality measures. For a long time people just didn’t acknowledge that there was a problem. When I became CEO of Henry Ford I decided that we were going to change our attitude. We created a new tagline, “We’re Henry Ford – We can” and it was designed to build confidence in our own potential.

It’s very easy in Detroit to be a victim – it’s a victim kind of environment. But when I go out to speak to members of the community I tell them: “I didn’t grow up here. I moved here. I want to live here. I think this is a great place to live and we need to move on from feeling like victims and see what we can do to improve our community.” It’s amazing what you can do just by changing your attitude.

Dr. Val: You mentioned an interesting observation: that it’s harder to meet incremental goals than large goals. What’s that about?

Schlichting: This has been a learning process for me. I was raised with the business mindset that progress occurs in clearly delineated, yearly increments. But what I discovered is that in the area of clinical quality and safety that really doesn’t work. People need to be inspired by big ideas in order to push themselves.

When you say you don’t want ANYTHING bad to happen to a patient – or zero defects in patient care – it drives a very different agenda than a one or two percent improvement. For example, we set a goal of “perfect depression care.” What does that mean? That means a zero suicide rate – because suicide is failed depression care. We had to get very creative in our treatment protocols, but our passion in achieving our goal resulted in lower rates of suicide among the depressed patients we treated than in the general adult population at large. I don’t think we could have achieved that without setting the bar at perfect care.

Dr. Val: So what do you think of CMS’s “never events” policy? I’m guessing you think it’s a good thing. But doctors are left scratching their heads wondering how we prevent patients from ever falling in the hospital. We’d have to tie them down, and that’s not nice.

Schlichting: Well, the CMS “never events” policy is a good thing, but it will need to be refined over time. Paying for complications of care doesn’t drive the right results. If we buy a TV that’s defective, we shouldn’t have to pay for it. If untoward things happen in the hospital, why should the patient (or payer) have to pay for that?

If we say that we don’t want any patient to fall, then we really have to be innovative to think of ways to make sure that they won’t fall. That includes having the patients help us – many times they don’t want to bother the nurse and try to do things on their own. We have to put programs in place where we have enough nursing staff to handle our patient needs and teach patients to use those services for their own safety.

Dr. Val: What would you tell other hospitals who’d like to emulate your quality programs and results? What’s your secret sauce?

Schlichting: I don’t think that we’re inherently any “better” than other healthcare organizations, but we set ambitious goals that are motivating and engage the leadership. We focus on the fundamentals of why we each got into healthcare in the first place: we wanted to make a difference and we’re committed to “doing no harm.”

Dr. Val: So the solution to reforming health quality is in Detroit?

Schlichting: We certainly hope so. I think Henry Ford is a pretty good laboratory for quality improvement.

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