"Nobody knows. There is no tight connection between known specific behaviors that tie well or any study has ever shown are connected with a reduction in mortality," he said.
But he has some good clues: Years ago, Hackensack's leadership started working with the Institute for Healthcare Improvement, the Robert Wood Johnson Foundation and joined a Centers for Medicare & Medicaid Services demonstration project to adopt emerging best practices, he explained.
"We got good at making people comply with what we saw as the science, and we rode that to glory," he said. "We became a well-versed choir of people imbued with a sense that we can make things better."
Okay, but what did you do? I asked again. Why are you so much better at keeping your patients alive?
Riccobono says the most probable underlying reason for lower mortality is the effort his teams spend on reducing infection rates through the use of central line-associated bloodstream infection bundles and checklists. "Our internal data shows that we've reduced mortality through our infection rates," he said.
Beyond that, he offered three initiatives that influence Hackensack's low scores.
1. Rapid response teams rush to the bedside of a patient who unexpectedly and suddenly crashes. "We've increased the numbers of calls to bring expert people to the bedside to prevent this thing called 'failure to rescue,' and the result has been a reduction in codes outside the intensive care unit," he said.
2. Pharmacists are involved in the process of medication reconciliation and how medication gets to patients.
3. Post-discharge planning alone is important, but now Hackensack staff physicians are much more involved as team members in the patient's care. "We bring them in more so we can get them to more reliably share the care of a patient and create real team behavior."
Teamwork is key, Riccobono says. He thinks most healthcare providers, the public or physicians incorrectly think of hospitals as one entity when they are actually numerous units, which have historically functioned very differently. "You can find big differences in the way the various units function," he said. "You can walk down the hallway and find enormously different safety profiles." That needs to change, he says.