Reaching the top of your game takes hard work and ambition. Staying there? Hard work and ambition, says neurologist Dr Marcin Rogoziewicz, whose hospital in Poland is the only one in the world to reach diamond status in 13 consecutive editions of the ESO Angels Awards.
Two events decisively altered the course of stroke treatment at 107 Military Hospital in Wałcz in northwestern Poland. The most recent of these occurred in 2018 when after making the acquaintance of the Angels Initiative, the stroke unit at the hospital entered their treatment data into the stroke care quality registry RES-Q for the first time. The discovery that they qualified for an entry-level gold award, though an achievement in itself, stirred their competitive spirit. Quarter 2 of 2018 would be the last time 107 Military Hospital had to be satisfied with anything less than diamond status.
The earlier event occurred towards the end of 2015, when Dr Marcin Rogoziewicz became head of neurology at 107 Military Hospital.
If Dr Rogoziewicz was looking for a challenge, he had come to the right place. “The treatment of acute stroke as well as early post-stroke care existed very fragmentarily,” he says. “The recanalisation rate fluctuated at the level of a few percent and there was low awareness of the benefits of thrombolysis.”
Finding a shortage of, well, everything, the new head of neurology realised that almost everything would have to be changed, so he did.
Dr Rogoziewicz’s ambitions for transforming his department weren’t confined to stroke. Over the next few years they would develop the capacity to treat a wide spectrum of neurological disorders including multiple sclerosis, post-stroke spasticity, focal dystonia and hemifacial spasm, and in 2018 his department’s partnership with the Angels Initiative delivered a breakthrough.
Simplicity and trust
By 2018 Dr Rogoziewicz was already running a tight ship. As the youngest neurologist in his department, he had had plenty of reason to reflect on the nature of leadership, and his conclusion was that a leader should enjoy the respect and absolute trust of his team. He had to take care of his team, defend it and respect it, but also be demanding and vigilant when it came to performance.
Setting out to be this kind of leader, Dr Rogoziewicz created a stroke team that is based on teamwork, discipline and organisation.
“Acute stroke treatment involves a chain of people from different areas of the hospital and it all has to work well together,” he says. “It’s necessary to create a short and simple procedure that each staff member should have in mind. The simplicity is important. Each staff member has an assigned task and must know exactly what to do. Each person should trust the other. You have to do your job quickly and well, and then pass the patient to the next person in the chain.”
This standardised approach meant that when Dr Rogoziewicz’s path crossed with Angels there was instantly a marriage of minds. But what was about to be challenged was his belief that nothing more could be done to shorten the median door-to-needle time, which was then hovering just above 50 minutes.
To qualify for diamond status in the ESO Angels Awards, hospitals had to treat 50% of ischemic stroke patients in under 45 minutes.
“After entering our data into RES-Q, it turned out that our achievements were sufficient only for gold status,” Dr Rogoziewicz says. “We analysed the procedure, also comparing it to other centres. We found that initiating thombolysis in the CT laboratory decreased door-to- needle time significantly.”
In the next quarter 107 Military Hospital reached diamond status, an achievement that, as Dr Rogoziewicz puts it, has now become their permanent home.
The key to consistency
“A diamond is just a lump of coal that stuck to its job,” Leonardo da Vinci famously said – a metaphor that serves to describe Dr Rogoziewicz’s approach to excellence. His hospital has so far won 13 consecutive diamond awards, a feat of consistency that no other hospital has yet been able to replicate. However, the key to consistency doesn’t reside in the 13 certificates that adorn the walls of the neurology department, but in strict compliance with procedure and a commitment to continuous improvement.
“We are not doing any of this for awards, but to improve the quality of treatment,” Dr Rogoziewicz says. “Of course awards are important, but they are only added value. If your aim is receiving an award and showing it off in the local community, that’s
no guarantee you will maintain the highest level of performance. But if you want to improve the quality of treatment, you will do it consistently and the diamond awards will follow.”
The determination to do better today than they did yesterday, has lead to the stroke team at 107 Military Hospital outperforming several awards criteria. Three years after pocketing their first diamond, they report a median door-to-needle time of around 22 minutes, and their thrombolysis rate of around 45% is among the best in the world. “This is the effect of careful prenotification,” Dr Rogoziewicz asserts. “We need to know that a stroke patient is approaching to prepare for action.
“In addition, our team strongly believes that thrombolysis will reduce mortality and improve patient outcomes. Where the decision to administer a thrombolytic drug is not entirely straightforward, we always try to find the possibility of using this treatment. Of course, where there are absolute contra-indications, we withdraw, but in ambiguous situations, where neither administering the drug nor not administering it would be a mistake, we default to using the treatment.”
A bit of magic
For a doctor so strictly governed by procedure and responsibility, Dr Rogoziewicz sounds unexpectedly poetic when asked about his choice of career, citing a “fascination with the perfection of the human body as a set of wonderfully cooperating organs”.
“I studied at the Medical Academy in Bydgoszcz, and I always associated neurology with a bit of magic,” he says. But beneath the magic there is the demanding – and attractive – logic of neuroanatomy and neurophysiology. “I am a person created for specific tasks,” Dr Rogoziewicz says. “I analyse and predict various situations, then I try to perform the assigned task as best as possible, looking at it from different angles.” But no matter how cool-headed and courageous his decision- making needs to be, he never forgets that “behind every decision there may also be a human tragedy”.
