Children's Hospital Of Orange County

Isabella Luz Garzón is a lucky baby. Born on April 17, 2008, weighing only 1 lb. 7 oz., she was admitted to the neonatal intensive care unit (NICU) at Children’s Hospital of Orange County (CHOC). Her parents, Elizabeth and Luís, couldn’t be more impressed with the care she is being given. “Our spirits are up. We are feeling a lot of emotions—she’s our first baby—but we feel that she is being given wonderful care.”

The NICU at CHOC recently implemented protocols to improve the clinical outcomes of extremely low-birth weight babies such as Isabella. While evidence supports early protein administration, a delicate balance must be struck in order to avoid feeding intolerance. To do this, a team of NICU staff reviewed best practices, collected data and agreed to protocols. As Dr. John Patrick Cleary, a specialist in Neonatal-Perinatal Medicine at CHOC’s NICU, explains, “There is a growing culture of quality improvement in the neonatal intensive care unit and, increasingly, we look outside ourselves for benchmarking and collecting pertinent data for monitoring outcomes and striving to optimize outcomes. There is also an institutional commitment to these issues that manifests itself in the very infrastructure of how we work and the way we work with one another.”

The implementation of a systemwide scorecard made CHOC’s commitment to collecting data and monitoring outcomes concrete. UniHealth Foundation’s grant to CHOC for the implementation of its Strategic Balanced Scorecard Initiative helped develop a system that made it possible to track progress towards meeting the mission, goals and strategies of its departments and management teams. By having a system in place that can track metrics and visually illustrate trends over time, hospital leaders in every department, as well as the CEO and the Board of Directors, have access to a timely, evidence-based view of organizational performance that assists their strategic and operational decision-making.

Currently, there are 89 scorecards that capture 4,875 different measures but, daily, new measures are added when identified as meaningful for the delivery of quality care or increasing efficiencies of on-the-ground operations. So, for example, in the NICU, where the newly implemented nutritional protocols have led to significant increases in discharge weight and head circumference of extremely low-birth weight infants, measures such as “hour of life protein feeding initiated” have been added to the scorecard. “We are taking scorecards to a new level by moving to a finer and more intelligent use of them—moving from a 10,000-foot aerial view to a 100-foot view. That way the data collected and our outcome goals are more meaningful to staff and, more importantly, to the wellbeing of our babies and families,” says Dr. Cleary.