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As the improvement leader for Gift of Life Michigan's donation service area (DSA) and senior leader for the Donation Collaborative, Kathleen Smith, director of hospital development, has evolved her department and exceeded standards. From implementing measurable goals to modifying hospital development plans, the hospital development department is a model for others. "HRSA gave us clear, standardized definitions to judge a hospital's performance, thus we modified all hospital development plans, educational offerings and created a standardized data template system to reflect these measurable goals," said Smith.

Along with standardizing all of its educational offerings, hospital development instituted a real-time customer service system. Real-time customer service means on-site collaboration between the OPO and hospital staff and using real time education to build relationships during the donor event.

"When we first started, hospital development didn't feel comfortable on the units when a donor event was occurring," said Smith. "With the implementation of real-time customer service, the hospital development staff takes the initiative to look at the referral database (Stat line) to see if there's a donor event occurring and respond on-site to assist their clinical colleagues with the communication process and team huddles." Smith also states that real-time customer service gives her staff an opportunity to meet the physicians and nurses they normally wouldn't interact with on a regular basis. This on-site response also allows real time follow up, education and after action reviews. "We can refine the huddle process if needed, find out any challenges to the process and troubleshoot at the time of the event. This early intervention is a proactive response that has alleviated many issues before they could become larger communications problems," says Smith.

The hospital development staff has increased from four to 18 with the recent addition of in-house coordinators. Gift of Life Michigan bases its in-house coordinators at the largest potential donor hospitals. From real-time customer service to initial responding after normal business hours, the department has become the key liaison to staff in the donor process. They have helped facilitate the passage of donation after cardiac death (DCD) policies and protocols, aided in the retrieval of lab results and arranged for various ancillary services such as cardiac procedures and chaplain services. "They are on-site as an added resource to help ensure a smooth donation process," said Smith.

Along with facilitating the donor process, Smith and her staff educate clinicians in many areas, including the policy implementation of DCD. The department recently developed a process guideline sheet,  checklist and flow sheet, plus a comprehensive brochure outlining DCD donation for hospitals.

As improvement leader for Gift of Life's DSA, Smith helped initiate and develop a relationship with the Michigan Hospital Association-Keystone Patient Quality and Safety division, which has proven to be a winning partnership. Through this partnership, mini Collaborative sessions have taken place with over 75 Michigan hospitals in attendance. In addition, they have teamed up to host monthly conference calls; the first nine months focused on "First Things First," and had hospitals present success stories from the Donation Collaborative. This highly successful spread initiative under the auspices of Gift of Life Michigan is now focusing on the Transplant Collaborative and continues its monthly conference calls covering a wide variety of topics. For instance this month's call was on APRV (lung recruitment).

"We had a physician from one of our transplant hospitals present on lung recruitment protocol, a recovery using different ventilator settings. For this particular one, we offered it to the HRSA listserv and had about thirty national teams participate in the call," Smith said. Approximately 40 Michigan hospitals participate each month. "We're at the point now of working with the Michigan Hospital Association to launch a Web site to publish OPTN data on how the hospitals are doing in our DSA area," said Smith.

The Association of Organ Procurement Organizations (AOPO) recognized Gift of Life Michigan's achievements by granting the hospital development department for an AOPO "Best Practice" last year for its integration of standardized definitions, educational offerings and data throughout the DSA and with its hospital partners. This recognition was awarded during their AOPO accreditation survey process.

Smith continues to venture into new areas as she was named the educational director for Gift of Life Michigan's minority grant from the National Institute of Health (NIH). NIH awarded Gift of Life Michigan the five-year grant to conduct an educational research study on physicians participating in continuing medical education (CME) programs on the Best Practices for organ donation. "It has been presented in twenty five different venues with over 600 participants and 100 physicians enrolled in the program; so far the data indicates it has had a significant outcome on consent and conversion rates," says Smith.

"I've been blessed to have learned so much throughout the HRSA Collaborative and from my colleagues in the industry. It has allowed me to institute many of these changes in our DSA. I guess we have really taken the HRSA 'all teach all learn' concept to heart here in Michigan," Smith concludes.