Excellence is one of our core values

Proverbs often carry deep truths, like the Nigerian one that says, “Until the lion has a historian, the hunter will always be the hero.” It’s just another way of saying that history belongs to the storyteller. As national politics heat up before November, and we all remain subject to the self-justifications of human nature, we can expect many versions of “truth,” attempts to spin a set of facts a certain way, or explanations of an event to our advantage.

This also applies to the care of patients, as we seek to explain and justify every outcome, good or bad, even while we know improvements can be made! Peter Pronovost, MD, PhD, chief quality and transformation officer at University Hospitals Cleveland Medical Center, has championed the cause of patient safety over the last several decades in this country. He has helped spawn a whole movement around safety and the quality of healthcare. At our LLUH board meetings, our quality report is sprinkled with acronyms like CLABSI and CAUTI. These two conditions — Central Line Associated Blood Stream Infections, and Catheter Associated Urinary Tract Infections — have been a contributing cause to prolonged illness and even death among hospitalized patients across the country. Along with several other events like Surgical Site Infections, Ventilator Acquired Pneumonias, and Readmission Rates, their avoidance has become the standard to measure patient safety in America’s hospitals today. 

These safety issues are at the forefront of how we practice medicine today. Patients and their families expect positive outcomes from the magic of modern medicine, regardless of the underlying conditions. One of the real challenges for physicians and staff is how far to go when trying to save a life. New medicines and procedures are both expensive and sometimes risky, with only marginal benefit, but how much is a life worth?

Excellent care does not always mean walking out of the hospital in good health. Teaching hospitals, in particular, are expected to accept the most difficult cases, use the newest strategies, and give each patient their best chance at success. And we pledge to do that even as we recognize the right answer may be letting go, protecting dignity, and offering some remaining quality of life for each patient.

It is in this context that one of our core values — Excellence — becomes so pertinent. What is excellent care? Who makes the decision to try once more, to add a new drug or try a new procedure? Is it a doctor’s decision, the patient’s, the insurance payor, the family, or who? Hospitals and doctors work hard to balance all these inputs as they seek the best path forward. But these requests don’t agree all the time, and judgments get questioned, people get accused, doctors and payors get blamed, and we all tell our version of reality. 

I am proud of the record Loma Linda University Health has achieved on these safety standards. Our quality team, led by Dr. Ihab Dorotta and Brenda Bruneau, meticulously administer detailed protocols designed to avoid errors and maximize favorable outcomes. They conduct time-consuming root cause analyses when complications arise to carefully determine what happened and how we can improve. They continue to move our culture, day by day, to even higher standards.

This has resulted in Loma Linda University Health receiving, over multiple years, some of the best quality ratings in the country, according to the Leapfrog Group. This industry watchdog focuses on patient safety, using multiple metrics, comparing the 3,000 hospitals in this country who voluntarily participate. Their evaluation system constantly monitors a variety of practice metrics and scores each hospital quarterly. Striving for this external validation of excellence permeates our culture and is taught to our residents and students as well. Good healthcare is certainly a team sport, requiring all members to complement each other.

I applaud our quality team and the impact they are having. Excellence continues to be our goal in every encounter.

Sincerely,

Richard Hart, MD, DrPH
President
Loma Linda University Health