The University of California, Los Angeles (UCLA) men's basketball team earned legendary status in the 1960s and 1970s when it won seven consecutive national championships and 10 in the span of 12 years. No men's program has ever won more than two straight titles since then.
John Wooden, the team's hall-of-fame coach known for a collection of inspirational quotes, succinctly summarized what it takes to continue being recognized as the best.
"Winning takes talent," Wooden once said. "To repeat takes character."
Jordan Raynor, MD, a neurologist at Reid Health in east-central Indiana, believes in a similar mantra.
"Programs that earn recognition once and then lose it typically treat the first award as a finish line," Dr. Raynor said. "The ones that sustain it year after year, they do so because they treat the metric as a floor, not a ceiling."
Reid Health does just that, Dr. Raynor said, and the results are clear. The regional independent health system recently earned American Heart Association (AHA) Get With The Guidelines® achievement awards for the sixth consecutive year. The honors were based on a continued commitment to providing quality stroke care.
Dr. Raynor credited the character of his colleagues throughout the health system as a driver for recognition.
"We've built a culture where stroke excellence is embedded into how the entire team operates, not just the neurology team," he said. "The recognition has become almost an expected outcome of the way the team works, and I think that's when you know the culture has truly taken hold."
Reid Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Making an impact on rural communities
Get with the Guidelines provides hospitals and health systems with research-based standards from the AHA and American Stroke Association. Those standards are particularly relevant in rural communities—like those treated by Reid Health—where, according to the AHA, people live an average of three fewer years than those in urban neighborhoods and have a 30% increased risk of stroke mortality.
Rural stroke care has a set of challenges that don't often show up in academic literature, Dr. Raynor said. Those challenges include patients waiting too long to call for help, longer transportation times for emergency medical services (EMS), and fewer options for things such as outpatient rehabilitation, specialist follow-up, and pharmacy access.
"Rural and underserved patients are disproportionately affected by stroke and disproportionately less likely to receive guideline-recommended care," Dr. Raynor said. "A community hospital has a unique re- responsibility and opportunity to close that gap for its patient population."
Reid Health does that in a variety of ways. The health system invested in community stroke education, collaborated with local EMS to implement stroke screening tools and pre-notification protocols, and expanded opportunities for outpatient recovery support.
"I can't say that we've solved all these problems," Dr. Raynor said, "but naming them explicitly and then tracking them is how you make progress in rural healthcare."
Building a system that continues to grow
Reid Health's focus on improved stroke care has evolved significantly in the past decade. In recent years, the health system expanded its use of telestroke—a form of telemedicine featuring healthcare professionals skilled in stroke care—technology, incorporated augmented intelligence software to help identify patients who could benefit from a mechanical thrombectomy, and introduced perfusion imaging.
"For each of those steps, first you have to build internal consensus," Dr. Raynor said. "That can be hard. Then you have to train staff, update protocols, and measure the impact. That cycle—identify the opportunity, build the system, measure the outcome, and then repeat—that’s really the engine of a sustained, high-performing stroke program."
A key component in stroke care is speed, specifically the amount of time between when an eligible patient arrives at a facility to when they receive thrombolytic therapy treatment.
"Speed in stroke care is almost entirely a systems problem," Dr. Raynor said. "Any individual clinician can make the right decision quickly. The challenge is building a system that removes every unnecessary step between the patient arriving and the treatment being given."
That is why Reid Health's stroke care model begins before a patient even arrives at the hospital. When EMS identifies a stroke in the field, they notify Reid Health while en route.
"That pre-hospital notification, it's one of the highest interventions in door-to-needle time reduction," Dr. Raynor said. "By the time the patient rolls through the door, they are viewed as the most important patient in the hospital."
Reid Health then conducts parallel processing as opposed to a sequential model. Labs are drawn while the patient is being registered. Imaging is ordered as the patient history is recorded.
"We don't wait for one step to be complete before initiating the next," Dr. Raynor said. "We also treat our time metrics as a team sport.
“The door-to-needle time is not a neurology number. It belongs to the emergency department nurse who triaged the patient, the CT tech who ran the CT scanner, the pharmacist, the physician who made the decision, the emergency room physician, the teleneurologist,” he added. “Framing it that way changes how every discipline sees their role in the outcome."
Advice for other health systems
Dr. Raynor credits Reid Health's multidisciplinary leaders for helping make the health system's stroke care so successful. Reid Health has a core stroke team that meets biweekly and a multidisciplinary stroke committee that meets monthly.
These teams feature representatives from neurology, emergency medicine, nursing, pharmacology and radiology. And the committee reviews performance data and takes ownership over process improvements.
"The critical thing is it's not just a neurology committee that other departments attend," Dr. Raynor said. "It's a shared governance structure where every discipline has standing and also has a voice."
That shared ownership is a key piece of advice Dr. Raynor shares with other health systems looking to replicate Reid Health's stroke care success. Beyond that, he offers three specific tips:
First, "you do not have to be an academic medical center to run an excellent stroke program," Dr. Raynor said. "The fundamentals of high-quality stroke care—rapid identification, streamlined workflows, team coordination, data-driven improvement—they're all achievable in a community and rural setting. What they require is commitment and structure, not necessarily resources that only large institutions have."
Next, “start with your data. You cannot improve what you don't measure,” he said. “Even if your metrics aren't where you want them to be, the act of collecting the data, reviewing the data transparently with the whole team creates the accountability structure that drives improvement.
Additionally, “invest in your EMS relationships. In a rural health system, the pre-hospital phase of stroke care is enormously consequential,” he said. “The paramedic who correctly identifies a stroke, activates notification, and delivers the patient to the right facility at the right time may have a greater impact on that patient's outcome than anything else that happens inside the hospital. So, treat your EMS partners as full members of the stroke team, give them feedback, train with them, and acknowledge their contributions.”
One obstacle Dr. Raynor said frequently gets in the way of rural hospitals finding success—either initial or sustained—is delaying starting a program or initiative because perfect systems are not in place.
His cautionary warning is not to let perfection be the enemy of good.
"Every rural hospital I've seen that is waiting until they have the perfect system, the perfect staffing, the perfect technology before pursuing stroke excellence is leaving patients behind in the meantime," he said. "Start where you are, build from there."
