Driving Superior Clinical Outcomes: What is the Secret Sauce?

I was in Washington, DC last month at the DaVita Board of Director’s meeting. My presentation to the Clinical Performance Committee of the Board was very upbeat—2010 was another great year for our patients with improvements in most intermediate outcomes, and continued improvement in survival rates.  Some of the clinical outcomes were truly spectacular; day 90+ catheter rate has fallen 27% since 2007 and influenza vaccinations reached 90% in the first quarter of 2011. I was very proud that our DaVita teams, caregiver teammates, Medical Directors, attending physicians, and all of the great support people in the field and at corporate, not only collaborated to make this happen, but were able to celebrate these remarkable achievements.

I was then able to present some of the data from our Seabiscuit’s program, the systematic approach to identifying chronically underperforming facilities based on clinical scores on the DaVita Quality Index (DQI)- these are facilities in the lowest 20% of DQI scores for at least 6 months.  As we presented at ASN last year, DQI a composite quality score, is a powerful predictor of facility level mortality and hospitalizations. Remarkably, the vast majority of the Seabiscuit’s facilities significantly improved their scores by intensely focusing on the underlying cause of their poor performance, usually the lack of facility leadership, such as a weak Facility Administrator or Medical Director, or both. I somewhat glibly stated to the Board that the key to improving these facilities had generally been bringing in new leadership; then one of the Board members, someone without any clinical background, asked a marvelous question. “What do these new people say they have done to improve the quality of care in the facility?”  Of course this is exactly what we should be asking so that we can share these pearls of information with all of our facilities.  I couldn’t answer the question, however, since we hadn’t asked it.

What is the “secret sauce” that makes a dialysis facility great? Is it clinically knowledgeable teammates, low staff turnover, a true team mentality and work ethic focused on the patient and the patient experience?  We intend to find out by going back to the facilities that were improved by focused, corrective action and asking them those questions. However, in the meantime, are anxious to hear from others about their sense of what it takes to be the best.

I look forward to your comments, until next time.

Striving to bring quality to life,

Allen R. Nissenson, MD