Lindsay Municipal Hospital (LMH) is a 26-bed Level IV acute care hospital in rural Lindsay, Oklahoma. The facility first opened in the 1960s but closed in the mid-1990s due to financial hardship and its rural status. Local leaders partnered with state leaders to secure a partnership with the Department of Corrections, and in the spring of 2002, Lindsay Municipal Hospital reopened.
Today, 95% of Lindsay Municipal Hospital’s inpatient population is persons who are incarcerated. The agreement with the Department of Corrections allows for LMH to serve individuals in a work release program to those in maximum security. Their unique partnership with the Department of Corrections poses challenges that other facilities do not experience in day-to-day operations. The Hospital Quality Improvement Contractor (HQIC) network is collaborative by nature with frequent peer-to-peer sharing, but the exclusive patient population at LMH makes comparison difficult. Tandy Warren, RN, CIC, states, “It’s both unique and an honor to provide care and meet the medical needs of this population.”
Building Quality Improvement from the Ground Up
Director of Clinical Operations, Tandy Warren, along with Quality Manager Brittany Tice, LPN, reflected on their 14-year tenures at Lindsay Municipal Hospital. Each began as nurses on the floor and over time, grew into quality improvement (QI) positions. When she was in the infection preventionist role, Warren, alongside Portia England, RN, recalls building the quality department from the ground up. LMH had to develop a foundation for quality improvement and began incorporating these initiatives into their electronic health record (EHR) system. “We started acknowledging and documenting simple – yet profound – things for patient safety in the EHR, such as central lines, catheters and other indicators to eliminate risk to the patient.” These new processes helped LMH document patient needs, perform risk assessments in real time and move forward with best practices across multiple departments, ultimately creating a baseline for patient care and touching every area of the facility.
Tice shares that it is amazing to see the different ways teams approach their quality improvement goals. “Each department works as a team to find the best way to monitor things. We hear discussions on improving the patient experience and it’s neat to be at the beginning of new processes and see the entire life cycle.” Warren adds, “At the end of the day, quality improvement is about patient safety and the safety of our employees. Those processes put in place are for the betterment of care for everyone.”
Tandy Warren, RN, CIC
Brittany Tice, LPN
Telligen’s Enhanced Technical Assistance Support
As members of the quality department at Lindsay Municipal Hospital, Warren and Tice support their hospital and its departments, but praise Telligen for the quality improvement expertise that is provided through enhanced technical assistance. “Our staff wants help from experts in the field – they’re more inclined to receive the information and adopt it. Telligen is so good at providing feedback and information that helps us all get on the same page and gather buy-in.”
“The information is pertinent and it’s relevant. The help is coming in real time.”
– Tandy Warren
Tice notes that the Plan-Do-Study-Act (PDSA) process has been a driver for their QI efforts. She shares PDSA tools as an introduction to healthcare quality with LMH managers and has created a form to identify new indicators.
“Our departments look to us for information to support them. Everyone has so much on their plate, and knowing we have the support of Telligen is huge. The HQIC team reaches out to us a lot of times (before we even ask!) to let us know they were thinking about us and have something to share that is applicable to our situation. It’s the best support team,” praises Warren. “It feels like we’re at the forefront of their mind. They have nuggets of information that are golden for everyone.”
Data-Driven Improvements
Recognizing deficiencies is an important aspect of a strong quality program. Warren and Tice believe LMH has benefitted from Telligen’s data tracking tools which assist departments in reaching specific goals. From accounting to environmental services to patient care areas, departments can visualize progress by reviewing data and monitoring quality assurance indicators. Managers use monthly chart reviews to watch trend lines and discuss ways to improve. This data is then shared with medical staff and the LMH governing board.
Tice was proud to share recent successes in physical therapy. This department took on multiple indicators at once and over the past year, made significant improvements which positively impacted scheduling, patient communication and more. The entire program has benefited as a result and excelled in meeting milestones. In another area of the hospital, two departments are “competing” on their medication scan rates. Tice said how rewarding it is to see staff throughout the facility excited about improving patient care.
The Lindsay Municipal Hospital Difference
At Lindsay Municipal Hospital, over 95% of the population are individuals who are incarcerated. This unique situation may pose a “fear of the unknown” for new healthcare providers who come to work at LMH, but Warren explains that the heart of the healthcare provider always shines through.
“Regardless of the social disparity, regardless of a social status or identifier, these patients are treated and provided with the same quality care as any individual anywhere. To see past backgrounds and provide quality medical care – to me, this is the essence of what quality is.”
Security requirements at Lindsay Municipal Hospital add another layer to their healthcare quality improvement journey. When considering care for individuals who are incarcerated, the facility faces additional challenges to certain topics such as falls, since patients may be in restraints. Warren details the delicate balance of security with medical care and how Telligen has assisted in brainstorming and problem-solving issues that are not widely common. “We don’t want security to be our hard stop. We want to go beyond the need to meet our goals and Telligen has provided a wealth of ideas. There are not obvious answers to some of our challenges and Telligen helps us find the unique answers.”
In summarizing her relationship and experience with Telligen, Warren says, “Quality is not only their profession; quality embodies the people you’re working with.”
Quality Improvement Manager Joanna Haize-Clawson with Lindsay Municipal Hospital team members Portia England, Tandy Warren and Brittany Tice.
