An Organizational Culture of Quality
My thinking about Fletcher Allen’s culture of quality was spurred by the Tenth Annual Quality Forum in early April, which highlighted the quality of the work we do and how we strive every day to improve. An essential element of our organizational culture is that most of us come to work every day with the goal, the desire, to do better today what we did very, very well yesterday—to continuously improve the quality of our services and strive for high reliability in everything we do.
Back in the late 1970s at what was then called the Medical Center Hospital of Vermont (MCHV), quality was relegated to the “Quality Assurance Department” and was the purview of a very few individuals, led by Dean Lea, who was dedicated to improving how health care was delivered. The quality group expanded in 1982 when one of my mentors, Dr. Phil Mead, was named Hospital Epidemiologist and began the quest to reduce hospital infections. Shortly thereafter, another dedicated and skilled individual came into the mix, Carol Haraden, who brought significant expertise with a PhD in systems and the evolving field of continuous process improvement (CPI). I became acquainted with the group in those years of my early residency through Dr. Mead and was always impressed with their dedication to improvement and their accomplishments, despite being very isolated from the mainstream of clinical activities.
In the mid- to late 1980s, two very important national organizations were formed—University HealthSystem Consortium (UHC) and the Institute for Healthcare Improvement (IHI). MCHV and our quality staff were instrumental in the early work of both organizations. When IHI was formally launched by Dr. Don Berwick and incorporated in 1991, we were among the initial charter members. Subsequently, Carol Haraden left MCHV and spent the remainder of her career as a senior leader of that organization.
Through the intervening years, our focus and dedication to quality continued to develop. In 2004, with the insightful leadership of Dr. Steve Shackford, Dr. Mindy Estes as well as Anna Noonan, the Quality Institute was formed. This brought resources from throughout the organization dedicated to quality assurance and process improvement into one structure. The position of Chief Quality Officer (CQO) was established at the most senior level, and we were among the very first health care organizations to have such a position. I was honored to be named Fletcher Allen’s second CQO. In 2006, the Quality Institute was formally named for retiring Vermont Senator James Jeffords, who had dedicated much of his career to legislation to improve health care access, quality and safety.
Over the course of this history, an amazing transformation happened. Quality was no longer the job of a dedicated few in a cluttered office in the basement of the Adams Building. Providing the highest quality health care to every patient every time became the ORGANIZATION’s responsibility, an institutional priority. Today, every one of us at Fletcher Allen feels this accountability. The focus on quality, process improvement and the drive for high reliability has become an essential element of our culture.