How The Effects Of Hahnemann’s Closure Rippled Into Philadelphia’s Suburbs
This is one commentary in a series of occasional first-person accounts of the effects of Hahnemann University Hospital’s closure in Philadelphia. To view other commentaries, click here.
Since Abington Hospital first opened its doors in 1914, it has built and maintained an outstanding reputation in the Philadelphia area, with education as an essential element of our founding purpose.
Each year more than 120 Abington Hospital residents in family medicine, internal medicine, obstetrics and gynecology, surgery and dentistry serve Abington patients. Residents rotating from university centers in anesthesia, cardiology, infectious disease, internal medicine, orthopedic surgery, physical medicine and rehabilitation, plastic surgery, psychiatry, radiation oncology, rheumatology, urology and neurosurgery add to the robust teaching environment. As part of our program, Drexel University School of Medicine medical students, residents and fellows participated in rotations from their home hospital, Hahnemann University Hospital.
Upon learning that the Drexel-Hahnemann residents and their supervising faculty members would resign on Monday, August 5, Abington Hospital’s leaders had two weeks to develop a plan for the transition of nine medical services and one intensive care service involving 120 patients at Abington. We decided to fast-forward the implementation of a new medical model, which was scheduled for later this fall. We utilized the guiding principles of crisis management and assembled a team of talented individuals representing nearly every department throughout the hospital. A project manager was appointed to keep our work on track and mandatory 7 a.m. meetings began.
Excellent, dedicated clinicians stepped up to help and take on the new work previously done by Drexel residents and faculty members. They included our dedicated hospitalist and network physicians as well as a bevy of healthcare professionals, from physician assistants to nurse practitioners to community physicians who would fill in the gaps. We had full support of our Nursing Department and many ancillary departments. Thankfully.
Some of the biggest challenges were in the details.
- How would we communicate the changes in provider responsibility for patients?
- How would we support clinicians in pharmacy and informatics as they began entering orders for the first time in decades?
- Who would do the new employee physicals on short notice to make our new hires employment ready?
- Should phones be assigned to the individual clinician or the role they were fulfilling?
- Who needed training on the clinical systems? How quickly could we safely and adequately train them?
- How quickly can we get the new providers credentialed?
As the go-live date quickly approached, leaders stood up a Command Center in the Board Room with a simple, dedicated phone line for clinicians to call when they needed additional resources. We had everyone involved meet in the Command Center on Day 1 to rally together before heading out to the nursing units to care for patients. This way, the healthcare providers saw firsthand there was a team behind them to help in any way they could.
Leaders “rounded” on nursing units to identify issues and provide help or arrange help “at the elbow” for clinicians who were new in their roles of covering hospital patients without residents. More than 80 specific action items were addressed involving a variety of departments in the span of one week.
High Reliability Organization
The situation presented all the challenges of an acute transition. It drove us to improve our operations and allowed us to fix chronic issues with rapid cycle improvement. There could be an issue at 8 a.m. and the SWOT team would have it fixed by 3 p.m. In this scenario, we quickly operationalized the solutions.
Our organization modeled all the attributes of an HRO (High Reliability Organization).
- Sensitivity to operations—Developed systems to allow us to understand our performance on a continual basis, i.e., Command Center, multiple structured check-ins, meeting daily with the advance practice professionals and physicians, etc.
- Preoccupation with failure—Reported all issues, even the minor ones, attempted to understand them, and developed new routines to mitigate future failure points.
- Reluctance to simplify—Performed a multidisciplinary review and analysis of event reports and occurrences to fully understand each problem and its degree of complexity.
- Deference to expertise—Ensured all staff created solutions appropriate for each issue.
- Commitment to resilience—Kept our communications structures intact, which include a variety of patient safety communications initiatives already in place. Provided immediate IT and clinical informative support for physicians and advance practice professionals.
Teamwork and collaboration
On August 5, we said goodbye to the 30 Drexel residents and hello to a new medical model with physicians and teams working on specified units to care for their patients. As a learning organization, we always look to improve, and this work is still not complete. We are continually refining our processes.
As we reflect on the challenges of this transition, we are struck by the teamwork and collaboration that was exhibited by our friends and colleagues. Our collective efforts predictably far outpaced our individual efforts, though there are many individual efforts that should be acknowledged and celebrated. Together, the staff all put patients first during this critical time and once again brought to life our mission, We Improve Lives.
Gerard M. Cleary, DO, is Chief of Staff, Chief Medical Officer and Senior Vice President at Abington-Jefferson Health.