This is the fourth in a series of 12 PBN articles focusing on the backgrounds, challenges and successes of some of the area’s most influential and interesting business women. The series began Sept. 12.
Laura Adams was a nurse before she ever learned about policy and business, and her experience with patients always has fueled her passion and clarified her vision.
Her first job was at Memorial Hospital in Greeley, Colo., a small rural facility that provided medical and surgical care to patients of all ages. Nurses had to learn to do everything, from bedside care to surgery.
Adams advanced quickly, rising to vice president of patient care services within less than a year, though she still worked as a nurse as well. And as conscientious as she was, one time she still made a terrible mistake, giving a 7-year-old girl a tenfold overdose of her medication.
Looking back now, she recognizes how easy it was to make that mistake: At the hospital, doctors’ orders would be taken on the fly, scribbled on paper, then transcribed multiple times.
“By the time you’ve transcribed something four or five times by hand, where a decimal point means somebody’s life, you have a system perfectly designed to kill someone,” Adams said.
The overdose she administered involved scapolomine, which in excessive doses can cause seizures, coma and death. Within hours, the girl couldn’t breathe and was in grave danger.
“Fortunately,” Adams said, “that 7-year-old survived my care that night.” And for someone who had dreamed of nothing but being a nurse since she was small, it was devastating. Did she have a right, she asked herself, to still do this work?
Today, as president and CEO of the Rhode Island Quality Institute, a collaboration by providers, insurers, policymakers and consumer advocates to improve health care in the state, Adams spends much of her time both highlighting the dangers of medical errors – and their frequency – and explaining why those errors are mostly due to systems, not individuals.
“We rely a lot on vigilance in the profession because we believe people should be … personally responsible,” she said. But people are fallible, she noted, especially in hectic situations and when they go on “autopilot” to get through the many tasks of the day. So true responsibility, as she sees it, means eliminating the risk of mistakes.
“Reliance on vigilance is one of the most impotent theories of quality improvement,” she said.
Adams’ authority in this field comes from having been a pioneer. As vice president for patient services at Parkview Episcopal Medical Center in Pueblo, Colo., a mid-sized HCA hospital, from 1987 to 1990, she helped implement one of the first hospital quality improvement systems.
Soon Adams was going out to other hospitals, teaching their leaders about quality improvement. And in 1990, a week into a new job as a consultant, she met the master of quality improvement himself, W. Edwards Deming, the statistician and business expert credited with teaching Japanese manufacturers how to compete in the global economy through improved design, quality controls and testing.
At a book signing, she recalled, “I handed him my business card and I said, ‘I’m from health care and we need help.’ It just so happened that he had been hospitalized the week before, and he couldn’t have agreed more. He called me the next day and said, ‘If you’re serious, meet me in New York tomorrow and we’ll get started.’ ”
Adams trained with Deming periodically for about two years, and she applied his theories and methods to her work in health care – which, in turn, was taking her across the nation, from the HCA hospitals to Memorial Sloan-Kettering Cancer Center.
Over time, Adams not only became a nationally recognized expert, but she made her mark overseas as well, teaching quality management in Egypt and Israel.
She came to Rhode Island in 2001, when a group led by now-U.S. Sen. Sheldon Whitehouse came together looking to collaborate on health care quality improvement efforts. They called Dr. Donald M. Berwick, president and CEO of the Institute for Healthcare Improvement in Cambridge – and Adams’ partner in the Egypt and Israel project – for a referral.
The institute was formally established the following year, and Adams was hired to run it. Until last year, she was the institute’s sole staff member (though board members and their staffs contribute considerably to the institute’s work as well).
From the start, the Quality Institute has focused on ways to improve systems to provide higher quality health care and reduce the risk of errors.
Because, as Adams and institute board members see it, electronic medical records and health care IT in general are crucial in that effort, much of the work has involved technology. But the institute also has led an effort to improve quality in intensive-care units, and most recently, it connected Rhode Island to a national initiative to provide Web access to a wide range of behavioral-care resources.
Asked how she keeps erstwhile business rivals at the table, she replied: “You have to make sure that you are focusing on the opportunity [to improve]. … The only currency we have through the institute is a vision of the future that’s far better than the one we’re going to face if we work independently.”
Asked about her experience as a woman in this role in a world dominated by men – and in an industry where nurses still often struggle for respect – Adams acknowledged that she does encounter stereotypes and low expectations. Until she opens her mouth.
“One friend described it as, with expectations that low, you can’t help but exceed them,” she joked. “It’s overcome almost immediately when you know what you’re doing, you know what you’re talking about. And I have such experience that I think if there are any biases in the beginning … I think it’s quickly forgotten once we start on this important work of reducing errors and improving quality.” •
