SLIPPERY ROCK, Pa. - Tami Minnier, chief quality officer for the University of Pittsburgh Medical Center, told students to "speak up" when they know something is affecting the quality of the company they work.
Minnier, who also heads UPMC's Center for Quality Improvement and Innovation, spoke to a standing room only crowd. She was invited to lecture by Kurt Schimmel, dean of SRU's College of Business, Information and Social Sciences.
Her 35-minute address Tuesday in Eisenberg Classroom Building Auditorium, frequently linked quality control and patient safety to operations at UPMC.
Although she started her health career as a nurse, she said, "I want to talk about what is really my passion, and that is quality and safety in heath care."
Minnier did not start out to be a quality officer, "but I have taken a journey that has brought me where I am today. I just really think there is so much to do in the future of health care."
"At UPMC, I talk about our vision of 'the right patient getting the right care, at the right time, every time,' but what is happening in health care today is that 'hopefully the right patient gets some of the right care, some of the time, when we have time.' - And, that is not OK. It is not OK with me, probably not OK with you."
"There are times we hit it out of the park - we have that home run - and there are times we fail miserably. When we fail, I take it personal, because that is what it is, human lives we have been entrusted with. Health care is all about trust," she said.
"It was really only 10 years ago that we started to talk about that trust," she said, adding she spends a great deal of her time trying to determine how mistakes happen - then, working with others to devise plans and steps to help prevent mistakes in the future.
She said the culture of health care and the culture of safety are growing areas within health systems.
"When bad things happen, sometimes it isn't just because we made a mistake; it is because people knew we were going to make a mistake and they didn't say anything," she said. When asked by students what quality she is most seeking in hiring, she said, "Someone who would speak up; someone who in a professional, kind and thoughtful way, say, 'You know something just doesn't seem right.'"
Sometimes it will be intuition, "but you know it is not right, and you just have to be able to say, 'Jeese, something is not right' and that is what this safety culture discussion is all about," she said.
"When I started in this field, I never heard that phrase, that is how much this field has changed," she said.
Minnier said that understanding the culture applies to all fields - business, marketing and social - is critical.
She urged students to take surveys, then use the data gathered to make decisions and to also share the results of the surveys with those involved in the organization to make them feel involved.
She charged the audience to realize that the company's persona comes from the top down. She said once it is realized that top mangers care about safety, the whole organization will begin to think and care about safety.
"A positive safety culture today is one in which no one is hesitant to talk about it," she said.
She said, those who get up each morning and don't care about the safety of their patients, should find other jobs.
"I'm here to tell you that in every wrong-site surgery I have ever analyzed in my career, someone in the room knew - guaranteed, but they were afraid to speak up because of the social and hierarchical structure that exists in health care with the physician at the top of the food chain, everyone else perceives themselves to be beneath them. That is not OK," she said.
She said it was also true of nurses, pharmacists and physical therapists and other professions.
"We can exhibit 'horizontal violence' that makes it really hard to work with people. And there ain't no time for that when we are here to take care of patients. When that environment exists, where horizontal violence is tolerated, bad things happen - I guarantee it," she said.
Minnier urged students to review the literature related to how culture and safety can be linked and to use the information to better focus their work on improving safety in any profession they choose.
For her, using a team-based engagement model has proven successful, and she said that opening conversations with individuals has resulted in dramatic improvements in delivering better, safer health care.
UPMC is an integrated health care delivery system headquartered in Pittsburgh. It operates 19 hospitals, and the UPMC Health Plan with more than 1-million covered lives.
The primary mission of the Center for Quality Improvement and Innovation, which Minnier leads, is to partner with hospital leadership to change care delivery systems in support of the UPMC vision of creating the health system of the future.
Minnier has worked for UPMC and UPMC Shadyside Hospital for 15 years. Her most recent position was as vice president of patient care services/chief nursing officer at UPMC Shadyside, a 510-bed tertiary care hospital, including the NCI-designated comprehensive Hillman Cancer Center.
While at Shadyside, Minnier created the Clinical Design Initiative with a goal of providing clinicians more time with their patients, creating excellent care delivery systems and enhancing patient satisfaction.
The initiative resulted in millions of dollars being reinvested into patient care and, due, in part, to its success, the IHI and RWJ Foundation selected UPMC Shadyside as one of three pilot hospitals nationally to participate in the Transforming Care at the Bedside Initiative.
TCAB is being spread to all of the UPMC hospitals.
Minnier is also the UPMC Liaison to the Peter M. Winter Institute for Simulation Education and Research and president of Sim Medical, a UPMC subsidiary with expertise in the creation and management of integrated health care simulation training programs
She earned her bachelor of science in nursing and her master of science in nursing at the University of Pittsburgh. She is a fellow in the American College of Health Care Executives and has studied the Toyota Production System, Lean Manufacturing and other business improvement applications to health care.
Slippery Rock University is Pennsylvania's premier public residential university. Slippery Rock University provides students with a comprehensive learning experience that intentionally combines academic instruction with enhanced educational and learning opportunities that make a positive difference in their lives.