Going back to school is not the kind of thing most people do when they’re pushing 70. But Aline Holmes, 67, a nurse leader in the field of health care quality and safety, is no slave to convention. “It was on my bucket list,” she says. “It’s one of the things I wanted to do before I die.”
Holmes is senior vice president for clinical affairs at the New Jersey Hospital Association (NJHA) and director of the NJHA Institute for Quality & Safety—positions she has no intention of leaving any time soon. Indeed, she upped her workload at age 64—the traditional age of retirement—when she enrolled in a doctor of nursing practice (DNP) program at Rutgers, the State University of New Jersey.
Holmes’ educational aspirations took on more urgency last year, when, at 66, she became co-director of the New Jersey Nursing Initiative (NJNI), a multi-year, $30 million project of the Robert Wood Johnson Foundation (RWJF) and the NJHA Hospital Association/Health Research and Educational Trust that is working to transform nursing education in the state. “At NJNI, we encourage nurses to further their education and, as one of its leaders, I felt it was important to walk the walk,” she says.
And walk the graduation walk she did, earning her DNP in May—the capstone to an academic journey that began some five decades ago at the University of Massachusetts. Holmes had planned to become a doctor but switched gears when her parents told her they could no longer afford medical school. Unfazed, Holmes enrolled in a baccalaureate nursing program, and joined the U.S. Navy Reserves Nurse Corps to cover the cost of her education.
After graduation, Holmes moved to Florida, where she spent four years caring for soldiers who had been wounded in the Vietnam War. The work was demanding, but Holmes, the daughter of U.S. Marines, thrived, honing skills in leadership and management. “I went from working in a community hospital where I was taking care of one little old lady with a hip replacement at a time to a big military hospital taking care of guys blown up in Vietnam. I loved [the work] ... and I learned a lot.”
But even caring for wounded vets didn’t prepare her for her next shock: the desperate need for higher quality and safer care in the civilian health care system. It was a lesson she learned early in her civilian career when she witnessed a botched medical procedure that led to a young man’s death. Outraged, Holmes challenged her superiors, and quit the following day. Ever since, she has focused on improving quality and safety in health care.
“That was when I realized we could do much better,” she recalls. The Institute of Medicine agreed. In 1999, it released To Err Is Human: Building a Safer Health System, a groundbreaking report that found that nearly 100,000 people die in U.S. hospitals every year as a result of preventable medical errors—more than the number of deaths attributable to such feared threats as motor-vehicle accidents, breast cancer, and AIDS.
Eye Toward Quality, Safety
A few years later, Holmes earned a master’s degree in nursing and then worked as a clinician, a nurse educator, and a leader in nursing administration, patient care services, and operations in New Jersey, Chicago, and Washington, D.C.
Along the way, she never took her eye off improving quality and safety. In 2002, she got the opportunity to focus on that issue exclusively when she was asked to serve as director of NJHA’s Institute for Quality & Safety. At the time, most hospital administrators strove to keep hospital infection rates below the national average put forward by the Centers for Disease Control and Prevention, Holmes says. But she and her colleagues started to believe that average was not good enough. Their goal, they realized, should be as close to perfection as possible.
With that in mind, Holmes and her team created a statewide collaborative designed to reduce hospital acquired infections and preventable errors. They identified evidence-based best practices, developed tools to help hospital administrators to implement best practices, and worked with the staffs at 40 hospitals to implement interventions and measure outcomes.
The effort was “tremendously successful,” Holmes says. Central line bloodstream infections dropped by 70 percent, the rate of hospital-induced pneumonia fell by about 55 percent, and communication and cooperation improved—even among competing hospitals. “One thing I learned is that nobody is going to compete on quality,” Holmes says. “If one hospital finds something that works, they’re more than willing to share that with others to improve care.”
Holmes also led the New Jersey Transforming Care at the Bedside (TCAB) program, a quality improvement initiative funded by RWJF that encouraged nurses to suggest, implement, and evaluate safety-related changes in their units. She served as principal investigator and project director for several patient safety improvement initiatives funded by RWJF and the Healthcare Foundation of New Jersey, and directed NJHA’s efforts to serve as a Hospital Engagement Network in the Partnership for Patients national initiative.
As senior vice president for clinical affairs at NJHA, Holmes is working toward a number of professional goals: improving end-of-life care, reducing health care disparities, bridging the divide between nurse education and clinical practice, and promoting interprofessional education.
But that’s not all she has on her bucket list. She hopes to travel, study Spanish, spend time with her granddaughters, learn to play a musical instrument, and maybe even learn to ride a motorcycle. That may sound like a lot to some people, but not to Holmes. School, after all, just got out, and there’s more time than ever to make all of her dreams come true.