Advocate Christ Improves ICU Care by Engaging Physician Leaders

by HCE Exchange on February 8, 2016

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Passionate, committed leadership is at the heart of any transformation project. As models of care change, hospitals need focused leaders who are excited about innovation and willing to lead the charge into new, uncharted territories.

About nine years ago, Kenneth W. Lukhard joined Advocate Christ Medical Center, located in Oak Lawn, Ill., as president and took the organization from a large community hospital with some tertiary services to a tertiary, quaternary medical center.

Building committed physician leaders

Lukhard’s passion for the organization is obvious when he speaks of the medical center as though he’s a proud father, and this excitement has carried over to the rest of his executives and physicians.

In addition to expanding services, Lukhard wanted the hospital to rank in the top 10 percentile in the nation for measurable outcomes.

To achieve this, he built teams of physician leaders and nurses to oversee their service areas. He created the position of vice president of clinical transformation to develop the playbook for these teams and to engage with them.

Christ Medical Center, which is part of the larger Advocate Health Care system, employed the dyad leadership model, which combines a physician and a nurse to lead the outcomes and quality initiatives for their service line.

“As an organization, we require a high level of engagement and accountability from physicians on a daily basis,” Lukhard said.

The organization also developed a two-year training program for physicians to assist them in understanding the dyad leadership model and how to put it into practice. Lukhard estimates 90 physicians have been through the training and are now leading clinical teams.

Putting the model into practice

Recently, Christ Medical Center rigorously applied the dyad leadership model to reduce ICU ventilator days.

The hospital has four ICUs with a total of 90 beds and is building a new patient tower that will house another 72 ICU beds. The emergency department handles about 100,000 visits per year, and the ICU sees one of the most severe populations in the country.

In 2012, using a ventilator-day index that divides the number of observed days by the number of expected days, the average was 1.27. Lukhard said his goal was to get that number at or below 1.0, meaning the observed days on a vent would be the same as the expected days. Expected days are determined using the APACHE II scoring system.

By 2013, Lukhard was still not seeing the results he wanted. Facing the reduced clinical outcomes associated with patients spending more time on a ventilator, he called a meeting with the vice president of clinical transformation, the chair of medicine, and the medical director of the ICU.

“We talked about how to change the paradigm and asked the medical director of the ICU to take on a high level of accountability and lead this change,” Lukhard said.

With 200 employed physicians and 1,000 independent physicians, achieving the desired outcomes required a complete reformation of culture. Where physicians once came in and rounded whenever they wanted, they were now being asked to discuss cases together and to communicate about the patients as a cohesive group.

“Initially, the medical director and I met with intensivists to talk about why this new model is important in terms of quality of care,” Lukhard said. “I personally asked them to commit to me that they would participate.”

The medical director and his dyad partner led the paradigm overhaul among clinical staff and intensivists. The department also had a steering committing working in the background to analyze data to establish leading indicators. Within four months, the ICU saw dramatic changes with ventilator days dropping from 1.27 to 1.0.

Recently, the index has been as low as 0.93.

As a result of this ICU success story, Lukhard has begun to promote the outcomes across the organization, emphasizing the lessons he and his leaders have learned through the dyad leadership model.

“We have told the story dozens of times, showed them the data and the success,” Lukhard said. “It was a hard journey for our leaders, but they are proud of the work they’ve done, and our patients are getting better care.”

Expanding throughout the organization

Lukhard believes not only in Christ Medical Center, but also in Advocate as a system and strives to hold the organization to the high standards set by Advocate.

“At Christ we have passionate people, chasing world-class care,” he said. “Advocate is doing it well at the system level, and Jim [Skogsbergh], Lee [Sacks, MD], and their team are pushing us to see how good we can get. We are a 100 Top Hospital according to Truven; the third-best hospital in Chicago according to U.S. News & World Report; and we are meeting our system targets for health outcomes.”

Lukhard credits the organization’s success to the exemplary leadership shown by the dyad teams.

“All our physician leaders and presidents of system hospitals are expected to perform at a high level,” he said. “We have come a long way in embracing these leadership principles, and we have a lot farther to go in our pursuit of excellence.”

-by Patricia Chaney

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