Indun (Whetsell) Patrick has spent four decades working to improve the quality of care at Regional Medical Center in Orangeburg, SC.
Over the course of her career, the role and scope of quality and patient safety work in hospitals have expanded dramatically, and Patrick was at the forefront of many of those trends on a hospital and state level. She chaired the first statewide quality measurement committee, a group which developed the first comparative metrics and benchmarks for SC hospitals long before the Centers of Medicare and Medicaid and The Joint Commission required them. Throughout her career, Patrick has been a huge advocate for making quality and patient safety central to hospital culture and mindset and is a leader and mentor to others in the field. As she prepares for a well-deserved retirement, SCHA asked her a few questions about her career and the evolution of quality and patient safety.
Why did you want to be a nurse?
I was a senior in high school. I was 16 years old. You have to make such big decisions at a young age! I really wanted to go into psychiatry and when you're that young, you're really kind of foolish. In retrospect, I probably should have gone to medical school, but I thought I didn't want to go to school that long, right? And if I went in to psychiatry, I would have had to get a PhD to make a living. So, I decided to go into nursing. And I really thrived there. I like people, I like taking care of people. I like making a difference.
Tell me how you got into doing quality work.
I went to MUSC for nursing school and graduated with a BSN at the age of 20, so I was a baby nurse. I had worked in the summer as a student, as a nursing assistant at RMC, and I liked the people. knew I didn't want to come back home. I was really nervous about doing that because I knew at Orangeburg, they wanted you to start IVs and [immediately] use all of these technical skills and I didn't have [much] experience with that. I remember talking to one of my instructors about it. She looked at me and she said “anybody can learn the technical skill. We are training leaders here.” I didn't really appreciate that when I was 20 years old. But the older you get, the more you appreciate your training. So, I came back.
I was one of three nurses with a BSN at that time in Orangeburg, so I quickly went up the chain. I love education. At my inner core, that's my favorite thing. I love teaching. I started getting involved with staff education and that just grew. Plus, we were doing all kinds of other things as far as administration, like policies and procedures. We were be-all, do-all type of workers at that point in time.
I felt a real need for patient education, so I kind of grew that program. We were doing wellness [education] and having fun every day. When the quality position came open, I was friends with the COO and we were just having this feet-up-on-the-table conversation. I said, “you just need to make sure you hire the right person.” And he said, “well, when do you want the job?” I said, “you must have lost your mind. I'm happy every day. I love what I'm doing.” He put some pressure on me.
I felt that it was a good move. I had always loved quality. I was doing the nursing quality at that time already. I love making things better. So, I seized the moment and took on that responsibility and I’ve been doing it ever since. I'd have to look at my resume to tell you when that really occurred, but a long, long time ago. I love working with the medical staff, that's probably my strength, and engaging them and making a difference. I love numbers. I love strategy. So, it fits my personality type.
There have been so many changes in quality work, both in the nature of its role and the perspective hospitals have taken towards quality and patient safety over the years. Can you reflect on how that's changed over your career?
Well, it's changed tremendously. The two biggest changes in my tenure are with the federal government, number one, with all their mandates. When that became critical to getting paid, it became more important in the administrative mind, and now it has a huge dollar sign attached to it. Once they attached the dollar sign to it, it was much easier to leverage things. Whereas before it was all pulling and pushing and tugging, you can leverage some things now, it's a little bit easier. It's unfortunate that it took that to get that type of attention. But now quality is at the forefront. It drives the finance [department]. It's a nice change.
You were part of one of the first quality measurement committees for SCHA. Can you tell me a little bit about that?
Back in the day, there were some of us who said, “we need to be able to compare some of this data.” And there were absolutely no comparisons out there, no databases to work with. So, a core of us got together and said, “okay, we're going to do our own thing, we're going to develop these metrics.” At that time, we had a group that was going to crunch the numbers from the statistical portion and make sure they were significant and that we were doing everything right. So we developed certain metrics, and we did manual abstraction. We submitted them and then they would turn them back around with graphics, and it was great. We loved it. It was fabulous.
But after we'd been doing this for a while, we said, “this is a labor intensive. We can't keep up. We're not staffed to keep this pace up and surely the federal government is going to be using the DRG system, they're going to pay us by what we document in the chart, right? They're going to pull out from the data that's submitted for billing to develop this scorecard, right? Because they will never ask for individual metric and manual extraction.”
So, we started looking at what the Georgia Hospital Association was doing. We decided to go with the database that they were using. We were very shortsighted. Years later, here comes the federal government giving us manually abstracted metrics for submission. So we laugh to this day about it. We were so shortsighted, we could have made some money! We were actually before our time and ahead of the curve, we just didn't know it. So it was a learning experience for sure.
I think one of the things that was very interesting that we learned was there was a core of us and we thought alike. We were constantly meeting about the metrics and then about six to nine months into the program we were talking about one of the metrics and we realized that we weren't using the same definition! It was a real learning experience and taught me how important it is to clearly define what you're measuring and how you measure it. Because here we were thinking we were all on the same page and we were not. That's one of the challenges with quality – getting everybody on the same page. I'm defining One must define things exactly the same way so that you really get good comparison data.
What are the other big lessons of your career in quality and patient safety?
I always tell people [who ask] that if I could fix one thing, if I could wave a magic wand, I would fix still think communication – it is the biggest challenge to quality. When you think you're on the same page, and then you find out that you're not or you assume people understand and they don't.
Sustainability is also really hard. You have to do due diligence, and you have to stick with it. And once you think you've fixed it, you need a way to continue to monitor it in some way, shape or fashion, because you may lose your gains.
Seeing the big picture is hard sometimes. Another learning experience for me was when I was ready to go for my doctorate, I was ready to submit for it. At the last minute, I decided to do the Baldridge Performance Excellence Program instead. So I did that for a couple of years and it was really transformational for me. I finally put all the pieces of the puzzle together from a big picture perspective. I had always loved strategy, but prioritizing projects is always hard. But if you put all the pieces together, it works. It's a very complex thing. People are always a challenge, whether it's a patient, their family, ancillary or medical staff or the Board.
I tend to be pretty [enthusiastic]. I was a cheerleader in my high school days and I'm still a cheerleader, you know, it's about motivating and keeping them focused. Even when things are not going the way you want, the metrics may not be what you want, you need to keep people motivated to make a difference.
One of my other mantras is to always make it easier and safer to do the right thing at the bedside. I think that we have to listen to the people doing the work. You can't stay in the office and create policies and procedures and dictate practices when you don't know what the day-to-day operations are. So, you really have to get down in the weeds sometimes to find out how you can make it easier and safer to do the right thing at the bedside or wherever that might be.
Where do you see quality work going forward? Do you feel like you can tell how it's evolving?
Well you can't ignore quality anymore. I mean you can't just give it lip service. You've really got to invest in it and put your resources there.
I've been very fortunate with the medical staff and finance area that they understand all that. Sometimes with nonclinical people, you really have to engage them and do a return on investment [argument]. Sometimes those complications are really costing you in the long game. The biggest change that I'm seeing right now is in care transitions. I think the whole payment methodology is going to change. I think that the days of wanting inpatients in a bed are going to go away. You're going to see people being taken care of in the field, or at home, or in a different environment.
Population health, I think, is so important. I think prevention is finally going to raise its head, which is what I was doing early in my career with the whole wellness program. I think that the public is forcing us to be more patient-centered, more oriented to meeting their needs. They are more informed [now]. I think telemedicine has a huge future. We’re expanding into that role, going to the patient instead of patients coming to us.