Laura Adams was a nurse before she ever learned about policy and business, and her experience with patients 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. And as conscientious as she was, 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 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.
“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.
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 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.
“Reliance on vigilance is one of the most impotent theories of quality improvement,” she said.
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. 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 was taking her across the nation.
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.
The institute was formally established the following year, and Adams was hired to run it.
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.
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.” ••
