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Sepsis Success Proves the Power of the Team

By Dr. David C. Pate, News and Community
April 5, 2012

Qualis Health today announced St. Luke’s Health System as the winner of an Idaho Qualis Health Award of Excellence in Healthcare Quality for our work during 2011 to reduce sepsis mortality. I’ve asked Dr. Samantha Collier, St. Luke’s Health System Chief Quality Officer, to share her thoughts on what went into our success in fighting sepsis, an overwhelming and potentially fatal infection that can cause shock and organ dysfunction.

“Coming together is a beginning, staying together is progress, and working together is success,” said Henry Ford.

High-performing teams aren’t the result of a happy accident, research shows. They achieve superior levels of participation, cooperation, and collaboration because their members trust one another, share a strong sense of group identity, and have confidence in their effectiveness as a team. I’m so proud of how our St. Luke’s team has acquitted itself in improving the survival of patients admitted to St. Luke’s with sepsis. 

Teams and good performance are inseparable; you cannot have one without the other.  But people use the word “team” so loosely that it gets in the way of learning and applying the discipline that leads to good performance. We need to be more precise about what a team is and isn’t. 

According to research by Jon Katzenbach and Douglas Smith, a team’s essential discipline comprises five characteristics:

  • A compelling common purpose
  • Specific performance goals
  • The right mix of complementary skills
  • A strong commitment to getting the work done
  • Mutual accountability
Why is it so important to distinguish what a team is and isn’t?  

The ideal team merges individual talents and skills into one super-performing whole with capabilities that surpass those of even its most talented member. With a run-of-the-mill working group, performance is a function of what the members do as individuals. A team’s performance calls for both individual and mutual accountability.

The increasing complexity, challenges, and pace of change associated with delivering superior health care demands super-performance, which can only be achieved by teams. We are also now confronting new and bigger challenges, such as “super bugs.”  Our old ways of solving problems are becoming obsolete and inadequate for solving these complex challenges.

To meet the needs of our patients and society, we need to take a serious look at how we come together, stay together, and work together. I have been fortunate to be part of many true teams at St. Luke’s, among them the sepsis team. Here’s what I experienced with that group:

Coming together

For a team to come together, its members must share a common goal. The St. Luke’s Health System Sepsis Committee’s goal was simple and compelling: improve the survival of patients admitted to St. Luke’s with sepsis. 

While the management of sepsis is significantly better than it was 30 years ago, sepsis-associated death rates still remain too high, and it is projected that the incidence in the U.S. population will increase by 1.5 percent per year, more than 1 million cases, by 2025. Death from severe sepsis takes as many lives as heart attacks each year, and outnumbers death from breast cancer almost 5 to 1.

But national statistics, as frightening as they may be, are not a compelling enough reason for a team to come together purposefully. Assessing and acknowledging gaps in the care at St. Luke’s were. 

The committee’s first step in coming together purposefully was to face the “brutal facts,” as business consultant and author Jim Collins so memorably put it. In his classic business text, “Good to Great,” winning companies confront the brutal facts as a way of creating will and impetus for change. Doing so leaves the best companies stronger and more resilient, not weaker or dispirited. Or as Dr. Phil would say, “You can’t change what you don’t acknowledge.”

It takes real courage to acknowledge errors, gaps in care, and particularly avoidable deaths.  Coming together as a team provides the support and collaboration for doing so. The St. Luke’s sepsis committee was formed to do just this. It provided the framework and necessary data to inspire the organization to not focus on “good enough, “ but to aim higher.

Staying together:

The very essence of a team is that the right mix of complementary skills and perspectives that foster collaboration, strong commitment, and mutual accountability. Collaboration always happens between people, therefore good communication and understanding are vital for its success. An open-minded and respectful approach to the collaboration is critical. Having a facilitator who can channel the discussion towards what the team can do minimizes the team’s focus on what it can’t do

Once the St. Luke’s sepsis committee came together, members began to learn about each other’s skills and perspectives, and recognized the opportunity to leverage these for optimal improvement and collaboration across the system. 

The team accelerated the learning through frequent communication, regular and standardized feedback, and monthly working meetings to remove communication barriers. Team members from tertiary care facilities began to visit the smaller facilities, with all offering their experience and expertise. Team members reached out with new information and learning. We were making progress as a team!

Working together:

Coming together and staying together unfortunately isn’t enough to get results. Working together does, but it takes lots of practice. Teams need to persevere through bumps, conflict, wins, and losses. This practice results in optimizing the team, so that the whole is greater than the sum of its parts.  

With our sepsis initiative, there were many true teams. There was the St. Luke’s Health System Sepsis Committee, which created the initiative, goals, and expectations, and monitored performance of results to goals. 

There were the teams of ER and ICU nurses and physicians who held themselves and each other accountable to deliver perfect sepsis care as defined by the committee. There were the teams in the ER and the lab and supply and radiology and housekeeping and so many more, whose job it was to ensure that the ER and ICU clinicians could deliver their perfect care on time. 

Teams that come together, stay together, and work together get results. Here are some of ours:

For 2010 and 2011:

  • Approximately 50 additional patients who survived sepsis
  • A 48 percent reduction in risk-adjusted in-hospital death rates, and currently performing 20 percent better than the top 10 percent of hospitals
  • A 70 percent improvement in the rate of patients receiving perfect sepsis care, which correlated with the decline in risk-adjusted in-hospital death rates
My takeaway? The team’s process improvement focus on early detection and delivery of timely perfect care resulted in achieving the team’s goal of improving survival of patients admitted to St. Luke’s with sepsis. Delivery of perfect care across this large organization, involving a complex and deadly illness like sepsis, cannot occur through individuals, but only through collaboration and committed teams.

Great teams also celebrate together. Let’s congratulate each other on our effective teamwork and results. I offer my sincere gratitude for all the sepsis team members’ commitment and perseverance, and the results achieved that are my inspiration.

Remember upon the conduct of each depends the fate of all. Alexander the Great

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.