BusinessTN

The observation that "one goes to a hospital to get sick"—an opinion once associated more with uninformed, provincial suspicions of technology and a dislike for the antiseptic confines of a hospital—has too often of late a disturbing ring of truth. Every year, some 98,000 deaths occur in America's 5,000 hospitals due to medical errors. Simply put, too many people are dying in hospitals from ailments and injuries they did not bring with them.

Like the majority of his colleagues—not to mention medical insurers and, most of all, the patients themselves—Dr. Richard Salluzzo considers this trend unacceptable. (Even the mere perception is dangerous, as it can prevent the sick from seeking the help they need.) Salluzzo, an able emergency room doctor who is now the CEO of Wellmont Health System, decided to change things the only way he knew how: from the bottom up. But he's not achieving this through an invention or some high-tech gadgetry—after all, most hospitals in America have plenty of those already. No, Salluzzo is relying more on communication and a common sense-fueled attention to detail. To prevent patients from falling at hospitals, Salluzzo hands out non-slippery slippers and puts bed alarms near patients' beds. To improve the chances for survival of patients who arrive suffering from chest pains, Salluzzo makes sure they reach a cath lab in less than 40 minutes (not the nationally required 90 minutes).

This attention to detail, and the results such attention yields to the health of both patient and bottomline, have helped Salluzzo make a name for himself. Having started his medical career as an attending emergency room physician, Salluzzo rose to the rank of emergency department chairman, then chief medical officer, then CEO, one of only 500 physician-executives in the nation in charge of a health care organization. When the board of Wellmont Health System of Kingsport retained him as chief in 2004, Salluzzo's keen eye for mistakes and the details that prevent them found that nearly everything was broken within the four-hospital system. Even though the system had good clinical outcomes, "the fiscal process, the patient service, everything—we were heading for more disaster," he says.

Disaster averted. In two years, the not-for-profit organization went from losing $10.8 million on $436.5 million in net patient service revenue to an operating profit of $15 million on net patient service revenue of $547.9 million. In that same time, Wellmont expanded from four hospitals to 11. Today, as the organization embarks on a $200 million Holston Valley Project Platinum expansion plan, Salluzzo has set his sights on reaching $1 billion cash flow by 2011.

Still, as thrilling as improved patient outcomes and robust cash flow are to most health care CEOs, Salluzzo is determined to do more than change the way one hospital or even one system approaches safety. With so much of his day filled with the usual administrative challenges of running a tight ship, Salluzzo likes to come in at 5:30 am to sign papers and plot strategy for the Safest Hospitals Initiative.

Though there are what Salluzzo calls an "alphabet soup" of some 20 hospital-safety organizations that compete with each other as they market their know-how to hospital CEOs, he considers their overall effectiveness lacking. For instance, "AHRQ says: don't have post-operative infections, don't leave sponges in bellies, don't have transfusion reactions, but they don't tell you how to do it," he laments. "Right now, it's chaotic and disorganized, and people don't know where to start. CEOs feel they are taking a sip of water from a fire hose when they get those 175 things thrown at them. They don't know what to do."

In an effort to make the transmission of safer practices less general data dump and more practical instruction, Wellmont Health System has joined with Adventist Health System and Novant Health to build a patient safety model that can become an industry-wide guideline. The systems, which represent 1.5% of the nation's hospital admissions, plan to take the model to the National Press Club this coming January, convinced that its adoption can rid the nation of medical errors and their estimated annual $37.6 billion price tag.

At its core, the model addresses a lack so basic that many people are probably unaware it exists—the lack of industry-wide standards for ensuring patient safety.

Airlines have clear, agreed-upon parameters—20 metrics or so—of how not to lose baggage, deliver passengers to their destination on time, etc. Though how well airlines meet those metrics may be up for debate, the fact that hospitals lack similar, industry-arching metrics should be a cause for concern for all. Currently, all patient outcomes—such as falls and medical errors—are self-reported, and everyone defines them differently. It's not difficult to see how such a system would hardly encourage best practices and, indeed, would be particularly susceptible to "creative accounting," where a preventable fall becomes "unavoidable."

The Safest Hospitals Initiative would remove much of the gray from these situations. Instead of giving hospitals a laundry list of things not to do, Salluzzo and his partners are teaching them how to do it. Take falls, for example. Many hospitals have 100 patient falls per quarter, which often result in hip fractures and bleeding around the brain. "So they try to fix it backwards, after it's occurred," Salluzzo says. "That's traditional performance improvement, and it works somewhat. I've used it," he adds. Instead of merely directing hospitals to "limit falls," the guidelines Salluzzo and his partners are proposing present six error-free steps to keep patients from falling. Every patient must get a fall assessment (something a third of the hospitals in the country don't do, and another third do badly); high fall-risk patients are issued a bed alarm, and are rounded hourly by staff nurses; and a giant "At Risk For Fall" sign is put up on the door. If a patient is demented, they get a sitter, and janitors are instructed to dry-mop the floor and not to create obstacles. Hardly rocket science, steam locomotive or even sliced bread—it's just common sense. But it's exactly this type of attention to detail that, applied industry-wide, could merit the term "revolutionary."

In 2003, before Salluzzo's arrival, a patient at Holston Valley Medical Center with kidney stones called 911 from the emergency room because he couldn't get anyone to attend to him. While it's an anecdote that would make any hospital administrator wince, it serves as a measure of how far the type of guidelines Salluzzo and his partners are proposing can take a health organization.

Since his arrival, Salluzzo and his team have managed to lessen by 150 hours the daily load of patient care in the emergency department by channeling work to more appropriate stations. The move not only cut costs, but it also improved hospital admissions, which shot up from 50,000 to 80,000 in one year. Patients voted with their feet. One only need look at such figures, not to mention Wellmont's revenue, to see what's to be gained by a little attention to detail.