As Mary Washington Healthcare has made a commitment to becoming a High Reliability Organization that focuses on consistency and patient safety, deliberate processes have been put in place at all levels to establish a culture that embraces these ideals. Using safety huddles and Verge reports, all employees, leaders and staff review “near misses” and celebrate “good catches”. By encouraging this mindset and fostering the so-called “preoccupation with failure”, always considering what could go wrong, the health system aims to drive our preventable medical errors down to zero.

Within the Quality Committee of the Mary Washington Health Alliance, we hope to push our integrated network to become a High Quality Organization by building a shared culture of premier customer service among our many independent members. We would encourage each practice to establish deliberate processes designed to reward outstanding service by reviewing “missed opportunities” and celebrating “home runs”. As an organization with a collective calling to serve our community, we would promote a “preoccupation with success”, always considering how best to make things go right. We are working in three broad areas to achieve this goal: customer service aimed at optimizing CAHPS survey results, integration and communication among our providers and staff, and clinical decision support.

Good old-fashioned customer service is what sets many businesses apart. Who among us does not believe it really gives a Chik-fil-A employee great pleasure to clear our table or refill our drink? And who does not think that each employee at Disney World considers you his or her guest? Healthcare experiences should be no different, and we should all strive for the mindset that each patient is one of our own family. In order to facilitate our focus on customer service, we are distributing flyers to all practices under the heading “Patient Experience Matters” with statements highlighting the CAHPS survey items by which our services are judged and which we all should hold as our values. These should be copied and posted in staff areas, provider offices, exam rooms, and waiting rooms in order to promote this part of our culture and celebrate good customer service. Also, we are evaluating emerging care delivery models that are geared more towards meeting evolving patient demands, such as virtual health office visits using telemedicine and home care visits using advanced practice providers.

A second key component of a High Quality Organization that we are working to support in the Quality Committee is excellence in integration and communication. How much does it undermine a patient’s confidence in our system when the primary doctor does not have the results of a test she ordered at the last visit, or a specialist expresses no idea as to why a patient was sent to him? As an organization, we must become more seamless in our exchange of information and coordination of care, and that is why we fully support efforts to extend Epic Connect to as many of our members as possible. Furthermore, we are working to promote better communication among providers by extension of TigerConnect texting services to all providers and evaluating best practices for processes such as specialty referrals and results reporting.

Finally, we believe a third key component to a High Quality Organization is excellence in clinical care and decision-support. Ultimately, a perception of cutting edge, evidence-based diagnostic and therapeutic expertise is what takes patients out of our area to Hopkins, Mayo, and Cleveland Clinic and there is no reason we cannot strive for this same reputation. We have already worked to establish a library of clinical care guidelines for various conditions, and links to external sources such as the University of Michigan clinical care guidelines and UpToDate. However, we are also exploring ways to bring our specialists together with our primary care providers to share their knowledge and support our diagnostic efforts on the front lines.

All of these concepts can help us to create a culture of a High Quality Organization. But the absolutely most vital lever for our success as a network is that we all continue to think less and less as individuals competing against each other in our local area and think more as members of a growing team that is maturing and thriving in a rapidly evolving healthcare market.

Daniel Woodford, MD