Creating a Culture of Ownership to Improve Care

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Jeffrey A. Flaks is Chief Operating Officer (COO) of Hartford HealthCare (HHC), a more than $2 billion health care system based in Connecticut’s state capital. Flaks previously served as President and Chief Executive Officer (CEO) of Hartford Hospital, HHC’s flagship tertiary care center. Before being named CEO, Flaks served as Hartford Hospital’s COO and implemented the How Hartford HealthCare Works” (H3W) campaign to create a culture of ownership and accountability. Flaks has received numerous honors over his career, including being named one of the top 12 industry leaders in the nation byModern Healthcare and receiving the American College of Healthcare Executives’ Regents Award for outstanding leadership.

I began my career with Hartford HealthCare (HHC) as COO of MidState Medical Center in Meriden, Connecticut. While at MidState I experienced something special that would eventually lead to the development of How Hartford HealthCare Works” (H3W).

In 1991, Meriden-Wallingford Hospital was merging with Memorial Hospital to become a single institution – MidState. Leaders spent significant time and effort to develop a new operating model called Continuous Quality Improvement” (CQI). This process aimed to establish a culture of ownership among staff, a culture that would be driven by the patient experience. Hospital staff delivering care would become accountable owners,” creating a strategy-driven workplace based on recognition.

I learned that CQI was different from any hospital process model I had ever seen. I became a devotee of the idea of inverting the organizational hierarchy, having day-to-day staff at the top of the pyramid, and receiving credit for their individual actions.

Fast forward to 2007 when Hartford Hospital was put on probation for failing quality initiatives. This public acknowledgement of quality problems was beyond comprehension as COO and for everyone associated with our renowned teaching hospital. I came up with the idea to take the CQI process from MidState and apply it to Hartford Hospital; thus, H3W was born.

Today, every person who works at HHC is a member of a Work Group,” the team closest to the workflow in every department and patient care unit. Each Work Group meets monthly with an assigned leader to create clear and specific goals with a strong patient focus, to ensure consistent, system-wide communication. Each meeting celebrates data-driven improvement and recognizes successes.

Our staff feels empowered and informed to treat patients and improve care because of this restructured management system. Last year, one of our Work Groups learned that intensive care unit (ICU) patients at Johns Hopkins University Hospital were walking around while still on a respirator, which improved recovery times and rates. Observation of this best practice inspired our team and resulted in the creation of a single mobile carrier for a patient’s equipment. Early Ambulation Rehabilitates Lives,” or EARL, a specialized cart that gives patients more mobility, is part of our ICU process and is a leading national approach to promoting mobility in the ICU.

EARL was a staff-driven innovation developed by hospital engineer, Earl Morrison. The cart supports a cardiac monitor, portable mechanical ventilator, oxygen tanks, an IV pole, an IV pump, and a Foley catheter. The weight of the cart’s contents is strategically distributed making it easy to move. This innovation is something that could only have arisen from a culture of empowerment and ownership.

In the past couple of years, we have experienced dramatic improvements in the quality of patient care. Since implementing H3W, Hartford Hospital has jumped from the 15th to the 65th percentile in patient satisfaction, increased its hand-hygiene best practices and reduced bloodstream infections, among other achievements. I credit our top marks to the bottom-up, top-down communication structure that the Work Group model established. 

Hartford Hospital recently achieved the highest-ever patient experience score in the state of Connecticut, which is something I credit to our dedication to keeping the patient at the center of care. Our Work Group process includes soliciting input from patient and family advisory boards, which discuss patient concerns and desires.

Today, HHC is applying the H3W model in all five of its hospitals, as well as throughout all subdivisions. We’re creating an organizational dynamic in which values and behaviors are acknowledged, and maximizing the importance of each individual role.

Our success has provided an unprecedented opportunity for other organizations facing challenging circumstances. There is tremendous potential to create a nationwide culture of ownership and accountability to deliver better health care services at lower costs. I’m hopeful that across the country, leadership will embrace this opportunity.