Jim Anderson was CEO of Cincinnati Children’s Hospital Medical Center from 1996 to 2009. In all measures, the hospital’s success and growth under Jim’s visionary leadership was extraordinary.
THE EXTRAORDINARY COMMITMENT OF PATIENT AND FAMILY-CENTERED CARE
Q: In the well-known report on “Pursuing Perfection: Improving Family-Centered Care for Cystic Fibrosis Patients,” you directly confronted CCHMC’s fairly average record of treating this disease and then did some extraordinary things to fix the problem. This was a wonderful example of how you were improving care by encouraging a culture of transparent openness. Being a corporate lawyer and CEO for 24 years prior to coming to CCHMC, did you have reservations about this openness, this possible risk? Can you share the inside story behind this transformation?
Jim Anderson (JA): When you try anything new, there are always risks. Always worries. The experience could end badly—but it could also end wonderfully. Innovation and transformation require risk—and not just risk-oriented thinking, but also well planned action and execution. I came to the conclusion that transparency was truly an
essential aspect of patient and family-centered care—a new ideal to strive for. That the cystic fibrosis (CF) project by the way, was not painless. There was pushback. But we plunged forward with the belief that we were doing the right thing.
First, we exposed the situation and the data at a meeting of patients and patient family members. Our team revealed that we were not one of the top hospitals for the treatment of CF. At the time we did this, sharing data that suggested under-performance was not common at most hospitals. There was too large a threat for legal action. But because we were encouraging a culture that honored transparency, we got the families and patients involved in fixing the problem, even asking the patients and families how they perceived our level of care.
Once we put the issue on the table, our team came up with a set of promises to the patients and their family members:
• We will preserve your child’s lung function better than any other organization.
• We will get the care you need regardless of race, age, gender, education or ability to pay.
• We will protect your child from harm related to our care.
• We will allow you, as parents, to be involved in the care as much as you desire.
• We will respect and value your time.
• We will optimize your child’s nutritional status.
This type of commitment and transparency is extraordinary— some might even say risky. But the results were spectacular:
• The percentage of cystic Fibrosis (CF) patients under the 10th percentile for weight dropped from more than 40 percent to less than 25 percent.
• More than 95 percent of patients received flu vaccines that first winter, compared to an estimated 40 percent prior to the new program.
• Compared with less than 50 percent in the three years prior, 85 percent of the patients now receive a quarterly respiratory culture.
Q: A conflict arose with one of your most experienced CF doctors. He thought his method of treatment was the best, but the results didn’t support that. How do you handle it? when one of your very best and most experienced doctors tells you he’s doing the best they can, and it can’t be done any better?
JA: You handle it with compassion—and persistence. Our doctor had been practicing for 30 years and truly believed his methodology was the best. He stuck by this belief until the fourth or fifth data set from that project validated a different approach. While he was convinced that he was producing good outcomes, the metrics convinced him that the outcomes could be better. At first, the doctor believed the metrics were wrong. It’s a matter of professional respect to get the metrics right. The numbers have to support the actions—the treatments and the results. Eventually, we all have to follow what the numbers indicate; at the end of the day costs count.
If we are going to be data-driven, our organization must be supremely capable of generating good data. We have PhD statisticians who compile, analyze and review the data so that when they sit down with the doctors, the conversation moves very quickly to the quality of the data. You need credible data when you have difficult conversations about medical protocols. The data must be at a level that is appropriate and acceptable. Providing good data is one of the ways CCHMC supports our medical staff, our patients and their families.
The CF doctor was almost in tears when he finally realized that what he had been doing for decades was really only putting us in the 20th percentile. And, you know, it was crushing. I mean it would have been to me, it would have been to you or all of us. After confronting the story the data told, he said, “Well, I need to do things differently.”
And the results changed dramatically.
Now CCHMC is in the top 10% of all CF hospitals. And despite this improvement, we’re still not happy. We want perfection. Getting better relies on having solid, data-driven process improvement that ultimately impacts our medical protocols.