Focus on quality

When Marcia (pronounced “Mar-see-a”) Nelson first started in her role as chief medical officer at Enloe Medical Center back in 2005, the hospital was at a crossroads. It had a great staff, she recalled, but somehow had lost its way. In the years since then, she’s seen the organization through a recession, through shifts in policies and technology, and, most recently, through a natural disaster.

One thing, Nelson said, has remained the same: a focus on quality care. It took some time to nail down exactly what that meant to the people working at Enloe, but the goal evolved into one clearly dedicated to treating the whole patient, not just for the diagnosis. It’s had tangible results, Nelson told the CN&R. An accreditation team noted during a recent visit that the “feel” of being at the hospital was warm and friendly, a difficult feat that tends to translate to other successes in an organization.

After 15 years in her post—and 30 working in Chico—Nelson, who continues to run her private practice at Mission Ranch Primary Care, was chosen as the first female recipient of Enloe’s Physician Legacy Award. Nominations come in from patients as well as colleagues and then are vetted by an executive committee.

“Dr. Nelson is a gifted leader who supports physicians and encourages quality care at Enloe and in Chico,” cardiologist Peter Magnusson said in an Enloe press release. He presented the award to Nelson earlier this month. Last week, Nelson sat down with the CN&R to discuss her legacy thus far.

What does it mean to be the first woman to receive the legacy award?

It’s been exciting for me. I was the second female chief of staff here at the hospital. That’s the doctor that the medical staff elects to run the executive committee and oversee the workings of the medical staff. I have been the first and only chief medical officer here, because we didn’t have one before. It’s exciting to be the first, and I’m hoping to see a lot more women follow and get the legacy award also. There’s a lot of talent across the medical staff, and I have no doubt there will continue to be great women and men who get the award.

What have been some of your biggest challenges?

The biggest challenge was all of the upheaval that was going on in the 2008-2009 timeframe. That was a period when we had to decide who we were, who we wanted to be, and for me it was the hardest time of my tenure as chief medical officer but in some ways it was also my best time. I had known the people who were my colleagues … since 1989, so I’d known them 17 years already. I knew we were really good doctors, really good nurses, a really good hospital. But everything went off track. We were the same people, but something changed. It was an opportunity to bring people back together and bring out the best in them again. Part of that challenge was helping to create a culture where improving quality is just part of the work we do. I’ve been involved in this annual quality summit that we have had since we started that in 2009. It’s really a way we show our commitment to being transparent. In order to show that you’ve had success with a quality improvement project, you have to start somewhere that wasn’t as good. It’s about being transparent, it’s about saying we want to keep getting better, that every year we’ll show a measurable improvement over the previous year.

Can you think of an example?

This was a really small thing, but a number of years ago, one of our staff in home medical equipment noticed that when we drop a bed off, a hospital bed, for a patient, it was great that they got the bed, but nobody has sheets that fit a hospital bed. So, they started bringing sheets. And it was like, “Oh, my gosh, what a gift.” They were giving somebody something, but they couldn’t use it. So now they’ve brought something so that this necessary piece of equipment can be used and bring comfort to a patient. So, [quality improvement] runs the gamut from high physical impact [like reducing sepsis rates] to little things that touch the heart of the patients that we’re helping. That has been one of the most gratifying projects that I’ve worked on.

In addition to implementing the quality improvement project, Enloe also partnered with Planetree early on in your tenure—and you’re gold-certified. Can you tell me more about that?

With Planetree, we found our heart again. We learned to rebuild around quality. So we were able to start recruiting and get new, young doctors. We’re really person-centered, more even than patient-centered. We knew who we wanted to be, what quality looked like, we knew how we wanted to treat patients—and each other, really—and that’s why we became Planetree-affiliated back in 2006. Planetree made it very explicit that good health care focused on what’s best for the patient. They coined this term “patient-centered care,” which evolved into “person-centered care.”

How do you address the physician shortage in Chico?

We take very, very seriously the role we play here. The board of trustees understands that the physician shortage, particularly with primary care, makes it so hard to raise the health of a community when you can’t even tend to basic needs. They’ll be working throughout this year to address that.

What are your goals for the coming year?

A big part of my focus right now is on physician wellness and finding ways to help physicians continue to thrive in a job that is, particularly in our area, even more demanding than it was [before the Camp Fire]. When the Camp Fire happened, all the OBs [obstetricians] from up the hill left. I understand that—they started their lives elsewhere. But there were still pregnant women and a population that was now bigger down here in Chico. So, our OB staff didn’t swell automatically. We had over 200 deliveries in a month, where normally we’d be in the mid-100s. We deeply held that responsibility of being here for our community. Now we need to make sure our caregivers are taken care of, too.