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PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY June 2016 | Archived Issues

Romanoff Maintained Relentless Focus on Patient Safety

In most large workplaces, stepping onto an elevator means riding a few floors with social awkwardness. Avoiding eye contact. Staring down at a mobile device. Silence.

Few of the compartments are known for their practical content, much less advancing the art of healing — unless they are at Cedars-Sinai. For the past decade, medical center elevator doors have been plastered with colorful floor-to-ceiling messages exhorting passengers, as in one memorable campaign, to save lives by cleaning their hands.

Romanoff Neil

Neil Romanoff, MD

You can thank Neil Romanoff, MD, vice president for Medical Affairs and associate chief medical officer, for making a short trip with strangers educational. After 25 years at Cedars-Sinai, the longtime health care executive is retiring June 30.

"People were always willing to try new things here," said Romanoff, who was inspired by seeing movie ads on elevator doors at a local mall. "You can come back with an idea and you could easily work in a place where someone might say, 'That's ridiculous. That's a shopping center.' But people here said, 'Wow, that's an opportunity to get people to wash their hands.'"

The elevator messaging, an inventive approach soon copied by other hospitals, stands as one of myriad contributions Romanoff has made during a career marked by precision, dedication and vision. In addition to being a calm and steady leader during a time of great change in healthcare, the Cedars-Sinai executive is perhaps best known for spearheading a major cultural shift in attitude and practice toward quality and safety.

"Neil really developed a corporate awareness, passion and accountability for our work in the clinical sphere," said Michael Langberg, MD, chief medical officer at Cedars-Sinai. "His legacy will forever be the organization's commitment to the highest possible safety and quality for our patients. He embodies that."

Before Romanoff arrived in the early 1990s, like much of the healthcare industry, Cedars-Sinai had no quality council, no safety officer and no widely accepted methodology for measuring quality and safety. That all changed under Romanoff, who helped lead a drive to treat improvement as a science.

"People didn't really like the concept that this could be seen as making widgets," said Romanoff, who led the way in creating the Cedars-Sinai Resource and Outcomes Management Department. "But by the same token, there are a series of inputs that go through a process and something comes out of that.

"You had to design a process for that to happen," he added. "It wasn't just going to happen because people tried harder."

His knowledge and expertise were sought after far beyond Cedars-Sinai. A couple of examples: In April 2012, he presented at the International Forum on Quality and Safety in Healthcare in Paris. His talk on "What Will Go Wrong Next?" highlighted a defect-analysis methodology developed at Cedars-Sinai along with Institute for Healthcare Improvement faculty. In December 2014, he presented at the Institute for Healthcare Improvement's national forum on "It Takes a Village: Lessons Learned Along the Journey Toward Reducing 30-Day Readmissions."

Colleagues describe him as collegial, hard working, open-minded, but a stickler for detail and follow-up. He's the kind of executive who can emerge from a 90-minute meeting and describe it as "fun" — and mean it.

"He could always be relied upon to be the one person in any conversation at any level to remind everyone why we are all here," said Rekha Murthy, MD, who has worked with Romanoff for more than two decades and will become vice president for Medical Affairs and associate chief medical officer on July 1. "That is, to do the best for our patients and not to be satisfied with the status quo."

Those qualities have come into play in a couple of noteworthy safety campaigns. A prevailing view in healthcare was that a certain number of hospital acquired infections was unavoidable. But Romanoff argued there shouldn't be any — and "zero is the greatest number" soon became a common phrase around the medical center.

"The old mentality was that 95 percent was an A and a great score," said Romanoff. "But here if you get a 95, that means five patients didn't get something right done to them and that had to change."

Another effort Romanoff championed was identifying seemingly innocuous daily tasks that could sometimes build into a critical mass and derail a safety process. The idea was called normalized deviation, in which workers unwittingly tolerate as acceptable what should be regarded as a problem.

The trick is spotting the potentially corrosive activity. To do so, Romanoff dispatched teams across dozens of units in the medical center to uncover these trends and suggest ways to eliminate them.

"Neil himself would go to floor after floor, unit after unit, having conversations, and it was amazing to watch," recalled Langberg. "There would often be this 'a-ha' moment when people would suddenly realize that some annoying problem was keeping them from their work."

Retirement is never an easy decision, but Romanoff felt it was just time for him.

"Change is good for an organization," he said. "Rekha is wonderful, and she's going to be bring a new perspective."

What will he miss about the job?

"The people," he said. "This is my second family."

He did identify a couple of things he won't miss. One is waking up at 5:30 a.m. The other is a state of perpetual readiness.

He compared it to a selling point for older television sets, which were marketed for their "instant on" ability. Hit the switch and the viewer didn't have to wait for the gradual appearance of a picture, but received a bright, clear one in seconds.

"That's what we expect from physicians and that is the job," he said. "But I won't miss being on 'instant on' mode constantly."

He has largely relied on methodology, hard data and the scientific process to light his way, but he'll soon be heading for a territory where those tools are less in demand. One place he'll be spending more time will be the kitchen — Romanoff is accomplished chef.

He's been written about in Bon Appetit magazine and studied at the Culinary Institute of America in New York and with a host of European and American master chefs. He plans to take more classes and teach as well. (His favorite style of food? Comfort food.)

Even after he steps down from his current post, Romanoff will continue to work at Cedars-Sinai devoting his time to special projects. He estimates those will wrap up in six months.

What then?

"I don't know what I'm going to do after that," he smiled. "The best advice I heard about all this is: 'You shouldn't try to figure it out, while you're still doing what you're doing.'"