Leaders: Raising the Bar on Glycemic Control

Dr. Kendall M. Rogers, the division chief of hospital medicine at the University of New Mexico Health Sciences Center, helped dramatically improve glycemic control for patients at the Albuquerque hospital. In just 2 years, the glycemic control quality improvement project that Dr. Rogers launched helped to lower the hospital’s rate of hyperglycemia from 55% to 36%. And in the 2009 RALS (Remote Automated Laboratory System) report, the hospital was rated in the top 10 out of 575 hospitals for glycemic control. Since then, Dr. Rogers has been sharing what he learned as the Society of Hospital Medicine’s lead mentor in the Glycemic Control Mentored Implementation program.

In an interview with Hospitalist News, Dr. Rogers offered advice on how to succeed in a quality improvement initiative and how aspiring hospitalists can prepare for future leadership roles.

Hospitalist News: You launched a successful hospital-wide glycemic control initiative. What lessons did you learn about how to get a new program like this off the ground?

DR. ROGERS: Any quality improvement project is a continuous process. My initial thoughts were that our glycemic control project was something that was going to be accomplished in a finite amount of time. But I think anyone who gets involved with a large-scale quality improvement (QI) project like this very soon realizes that they it is an ongoing process.

I’ve also learned that quality isn’t just about coming up with good ideas, leadership skills are also necessary to be successful. It’s about managing people, managing attitudes, and having an understanding of change management. And the importance of data cannot be understated. Data are the foundation of any successful quality improvement project. Data are used to motivate, and without data, you have no idea where you’re starting from and if you’re having an impact.

HN: How do you sustain interest in the effort over time?

DR. ROGERS: I think it’s important to set achievable goals within a realistic time frame. To keep interest in a project you just continue to raise those targets. When we first started the glycemic control project, we set our goals with sample-level data. Then we raised the bar by using the same goals, but with day-weighted means. Then we went to stay-weighted means. Each of these changes raised the bar and maintained the sense of urgency necessary to keep team members and hospital staff motivated.

While you want to celebrate your successes, you do not want people to think that the problem is solved.

HN: Multidisciplinary teams are considered essential to QI efforts. How can the hospitalist ensure that all members of the team are equally valued and doing what they need to do?

DR. ROGERS: My recommendation for any QI project is to always have a physician and a nonphysician co-lead the project. Having co-leads really gives you a foot in each camp that you need to influence right off the bat. I also think it’s important that anyone who’s going to be affected by the changes that you’re making has a place at the table. It’s never us deciding first what changes we’re going to make and then trying to convince others; everyone needs to be involved in developing the solutions so you have buy-in from the beginning.

HN: You teach a 1-month elective for internal medicine residents on health policy and leadership. Why is this important?

DR. ROGERS: I think all physicians have leadership roles whether they realize it or not. They are leading teams. They are trying to motivate patients. They are leaders even if they’re not in physician management. This training can’t be started too early.

I think all physicians need to have an understanding of change management, teamwork, communication skills, and negotiation. With my elective, I teach 3 weeks of a fixed curriculum starting with health policy, health law, and quality. Quality is something that no physician can ignore. Then I spend a week on informatics, which is another tool that I think all physicians need to have a role in understanding and designing for it to reach its full potential.

I think it is never too early to start teaching these skills, from premed curriculums to medical school. But residency is really the first place where young physicians get to apply those skills, so it’s paramount to teach them there.

Take us to your leader. Nominate a hospitalist whose work inspires you. E-mail suggestions to m.schneider@elsevier.com and read previous columns at ehospitalistnews.com.

Dr. Kendall M. Rogers, the division chief of hospital medicine at the University of New Mexico Health Sciences Center, helped dramatically improve glycemic control for patients at the Albuquerque hospital. In just 2 years, the glycemic control quality improvement project that Dr. Rogers launched helped to lower the hospital’s rate of hyperglycemia from 55% to 36%. And in the 2009 RALS (Remote Automated Laboratory System) report, the hospital was rated in the top 10 out of 575 hospitals for glycemic control. Since then, Dr. Rogers has been sharing what he learned as the Society of Hospital Medicine’s lead mentor in the Glycemic Control Mentored Implementation program.

In an interview with Hospitalist News, Dr. Rogers offered advice on how to succeed in a quality improvement initiative and how aspiring hospitalists can prepare for future leadership roles.

Hospitalist News: You launched a successful hospital-wide glycemic control initiative. What lessons did you learn about how to get a new program like this off the ground?

DR. ROGERS: Any quality improvement project is a continuous process. My initial thoughts were that our glycemic control project was something that was going to be accomplished in a finite amount of time. But I think anyone who gets involved with a large-scale quality improvement (QI) project like this very soon realizes that they it is an ongoing process.

I’ve also learned that quality isn’t just about coming up with good ideas, leadership skills are also necessary to be successful. It’s about managing people, managing attitudes, and having an understanding of change management. And the importance of data cannot be understated. Data are the foundation of any successful quality improvement project. Data are used to motivate, and without data, you have no idea where you’re starting from and if you’re having an impact.

HN: How do you sustain interest in the effort over time?

DR. ROGERS: I think it’s important to set achievable goals within a realistic time frame. To keep interest in a project you just continue to raise those targets. When we first started the glycemic control project, we set our goals with sample-level data. Then we raised the bar by using the same goals, but with day-weighted means. Then we went to stay-weighted means. Each of these changes raised the bar and maintained the sense of urgency necessary to keep team members and hospital staff motivated.

While you want to celebrate your successes, you do not want people to think that the problem is solved.

HN: Multidisciplinary teams are considered essential to QI efforts. How can the hospitalist ensure that all members of the team are equally valued and doing what they need to do?

DR. ROGERS: My recommendation for any QI project is to always have a physician and a nonphysician co-lead the project. Having co-leads really gives you a foot in each camp that you need to influence right off the bat. I also think it’s important that anyone who’s going to be affected by the changes that you’re making has a place at the table. It’s never us deciding first what changes we’re going to make and then trying to convince others; everyone needs to be involved in developing the solutions so you have buy-in from the beginning.

HN: You teach a 1-month elective for internal medicine residents on health policy and leadership. Why is this important?

DR. ROGERS: I think all physicians have leadership roles whether they realize it or not. They are leading teams. They are trying to motivate patients. They are leaders even if they’re not in physician management. This training can’t be started too early.

I think all physicians need to have an understanding of change management, teamwork, communication skills, and negotiation. With my elective, I teach 3 weeks of a fixed curriculum starting with health policy, health law, and quality. Quality is something that no physician can ignore. Then I spend a week on informatics, which is another tool that I think all physicians need to have a role in understanding and designing for it to reach its full potential.

I think it is never too early to start teaching these skills, from premed curriculums to medical school. But residency is really the first place where young physicians get to apply those skills, so it’s paramount to teach them there.

Take us to your leader. Nominate a hospitalist whose work inspires you. E-mail suggestions to m.schneider@elsevier.com and read previous columns at ehospitalistnews.com.

Dr. Kendall M. Rogers, the division chief of hospital medicine at the University of New Mexico Health Sciences Center, helped dramatically improve glycemic control for patients at the Albuquerque hospital. In just 2 years, the glycemic control quality improvement project that Dr. Rogers launched helped to lower the hospital’s rate of hyperglycemia from 55% to 36%. And in the 2009 RALS (Remote Automated Laboratory System) report, the hospital was rated in the top 10 out of 575 hospitals for glycemic control. Since then, Dr. Rogers has been sharing what he learned as the Society of Hospital Medicine’s lead mentor in the Glycemic Control Mentored Implementation program.

In an interview with Hospitalist News, Dr. Rogers offered advice on how to succeed in a quality improvement initiative and how aspiring hospitalists can prepare for future leadership roles.

Hospitalist News: You launched a successful hospital-wide glycemic control initiative. What lessons did you learn about how to get a new program like this off the ground?

DR. ROGERS: Any quality improvement project is a continuous process. My initial thoughts were that our glycemic control project was something that was going to be accomplished in a finite amount of time. But I think anyone who gets involved with a large-scale quality improvement (QI) project like this very soon realizes that they it is an ongoing process.

I’ve also learned that quality isn’t just about coming up with good ideas, leadership skills are also necessary to be successful. It’s about managing people, managing attitudes, and having an understanding of change management. And the importance of data cannot be understated. Data are the foundation of any successful quality improvement project. Data are used to motivate, and without data, you have no idea where you’re starting from and if you’re having an impact.

HN: How do you sustain interest in the effort over time?

DR. ROGERS: I think it’s important to set achievable goals within a realistic time frame. To keep interest in a project you just continue to raise those targets. When we first started the glycemic control project, we set our goals with sample-level data. Then we raised the bar by using the same goals, but with day-weighted means. Then we went to stay-weighted means. Each of these changes raised the bar and maintained the sense of urgency necessary to keep team members and hospital staff motivated.

While you want to celebrate your successes, you do not want people to think that the problem is solved.

HN: Multidisciplinary teams are considered essential to QI efforts. How can the hospitalist ensure that all members of the team are equally valued and doing what they need to do?

DR. ROGERS: My recommendation for any QI project is to always have a physician and a nonphysician co-lead the project. Having co-leads really gives you a foot in each camp that you need to influence right off the bat. I also think it’s important that anyone who’s going to be affected by the changes that you’re making has a place at the table. It’s never us deciding first what changes we’re going to make and then trying to convince others; everyone needs to be involved in developing the solutions so you have buy-in from the beginning.

HN: You teach a 1-month elective for internal medicine residents on health policy and leadership. Why is this important?

DR. ROGERS: I think all physicians have leadership roles whether they realize it or not. They are leading teams. They are trying to motivate patients. They are leaders even if they’re not in physician management. This training can’t be started too early.

I think all physicians need to have an understanding of change management, teamwork, communication skills, and negotiation. With my elective, I teach 3 weeks of a fixed curriculum starting with health policy, health law, and quality. Quality is something that no physician can ignore. Then I spend a week on informatics, which is another tool that I think all physicians need to have a role in understanding and designing for it to reach its full potential.

I think it is never too early to start teaching these skills, from premed curriculums to medical school. But residency is really the first place where young physicians get to apply those skills, so it’s paramount to teach them there.

Take us to your leader. Nominate a hospitalist whose work inspires you. E-mail suggestions to m.schneider@elsevier.com and read previous columns at ehospitalistnews.com.