Anna Noonan, R.N., Vice President, Quality, Jeffords Institute for Quality, University of Vermont Medical Center (Courtesy photo)

This Q&A with Anna Noonan, R.N., vice president of quality and operational effectiveness at the Jeffords Institute for Quality at the University of Vermont Medical Center, was originally published in the November 2016 issue of One.

Q: How would you describe the overall role of the Jeffords Institute for Quality?

A: The Jeffords Institute’s primary role is as an accelerator for clinical or operational improvement. Our team brings the skill set of their respective division to assist our organization to continuously improve the quality and safety of the care and services we provide. The Jeffords team brings expertise in the use of performance improvement tools and analytics and together with multidisciplinary team’s expertise, we improve the value of the services we provide our patients and their families.

The Jeffords is a resource not only for our organization and network but also for the communities we serve. One recent example was a partnership with the Howard Center. Our staff worked with their team to analyze their workflows and look for ways to do things more effectively, keeping the patient at the center of the experience. It was wonderful seeing this partnership between our two organizations as we worked together to improve their systems of care.

Q: Are there criteria that define an organization that performs well in quality?

A: Underscoring all our efforts are data and the desire for continuous improvement. We use data to understand how we are performing. If we have an opportunity to improve our performance we will bring a team together to design and implement a change in our system. We have been part of Vizient UHC, which gives us risk-adjusted benchmarking data from academic medical centers around the country and allows us to see how others are doing – and how we compare. Our relationships with academic medical centers across the country allows us to learn their best practices and adapt them here. When we have a best practice we share with them as well. A wonderful example of this was in our efforts to reduce infection rates. In 2015 we received a national award for our efforts and this year the UVM Children’s Hospital received an award for going an entire year without a single central line infection.

Vizient recently performed a study that looked at what makes a health care organization successful. These characteristics are reflected in our organization’s culture:

• Shared sense of purpose: The organization constantly reinforces the patient care mission as the primary mission.
• Leadership style: The CEO plays a critical role in gaining clarity on the shared purpose and in bringing it to life through words and deeds.
• Accountability system for service quality and safety: Clinical leaders accept responsibility for service, quality and safety; there is a sense of ownership for patient outcomes.
• A focus on results: Performance is evaluated against external standards and goals stretch the organization.
• Collaboration: Mutual respect and professionalism arise from being on a team with a singular commitment to the patient care mission.

In short, a high-performing, high reliability organization has a culture that encourages a collaborative approach to solving problems, addressing opportunities and defining new levels of excellence in service, quality and safety. We demonstrate all these characteristics. I’ve been involved in Quality for the past 18 years, and never once have I heard someone say to me, “we can’t improve.” Our physicians, our staff and the Jeffords team are all deeply committed to continuous improvement. This is in large part how we became a top performer among academic medical centers in the country.

Q: How has the work of the Jeffords Institute changed over the past decade?

A: Our focus is now on the populations we serve versus the patients we treat. Our improvement efforts are focused on our community in addition to improving the health of our patient and families. What’s been constant over the years is our commitment to continuous improvement. Over the years we’ve refined our improvement methodology to engineer errors out of the system and design systems of care that optimize outcomes. Building on this is our drive to standardize where possible through implementation of best practices. We’re constantly trying to improve and learn from each other with an ultimate goal of optimizing clinical and operational outcomes as well as optimizing the health of our population.

What’s also changed is how improvement has accelerated. Years ago, it was common for a project to take six months to a year to design and implement changes. Now most of our projects follow shorter cycles, with each phase building on the lessons of the previous test of change. This approach accelerates the whole process of improvement and promotes system changes that enhance clinical outcomes.

One of the improvement techniques that we have employed is the use of “Kaizens,” a Japanese term that means “change for the better.” This methodology is used to identify waste in a system and redesign systems that add value. It’s a grass roots, multidisciplinary, focused process that uses direct observation and measurement to redesign the system. We’re facilitating a number of these projects both inside the organization and in with our community partners.

Finally, we are sharing improvement practices by collaborating with our partners, sharing our practices so we can improve outcomes across our network.

Q: What’s up next for the Jeffords Institute?

A: We need to continue to educate staff, nurses, physicians and other providers on the use of process improvement methods and tools. We also want to engage more with the Larner College of Medicine and the College of Nursing and Health Sciences, focusing on the students so that improvement methodology becomes a part of their practice early in their careers. We will continue to focus on populations on the social determinants of health and supporting the shift to wellness, health maintenance, and improving care coordination. This means extending our reach and looking towards innovative strategies to optimize our mission. This is a very exciting time in health care and for the Jeffords Institute.

We will continue to focus on populations on the social determinants of health and supporting the shift to wellness, health maintenance, and improving care coordination. This means extending our reach and looking towards innovative strategies to optimize our mission. This is a very exciting time in health care and for the Jeffords Institute.