Reform Sharpens Focus on Quality Outcomes

Joe Cantlupe, for HealthLeaders Media , March 16, 2011
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Hospital leaders who are achieving quality outcomes are doing so by forming leadership teams to evaluate initiatives on a daily basis and improve data collection. For the University of Maryland Medical Center in Baltimore, the process evolved over time and was cemented in certain beliefs among the leadership. “It was a true belief among the entire leadership team [that] if we did a good job measuring our quality, we would be successful,” Rivest says. “When you share data, it just resonates and the culture builds over time. It’s a holistic
way of thinking.”

As a hospital recruits and retains leadership, it must be clear about that philosophy and culture, Rivest says. “Everything we do is about striving to be in the top 10% of quality.”

Rivest and other hospital leaders say it is necessary to continually raise the bar as other hospitals achieve standout positions, noting it gets “harder and harder to stay ahead.”

 What’s more, they add, is the importance of establishing a team of clinical leaders, including physicians, nurses, pharmacists, and therapists, to work together to improve everything from hand hygiene to medical reconciliation to communication of critical information to patients, and to have the leadership structure to ensure that such work is accomplished.

Some accomplishments are vivid, simply in the reflection of the numbers. The approximately 850-licensed bed NorthShore University HealthSystem, with four hospitals in the Chicago region, for instance, reduced mortality rates in the ICU within the past five years, exceeding the Leapfrog Group’s criteria for staffing levels that have been shown to achieve mortality rate reductions of 40% or more. The hospital was able to attain those measures through integrated changes in its system, according to Kenneth Anderson, DO, chief medical quality officer of NorthShore University HealthSystem. It has been a matter of bringing together “people, processes, and technology to focus on creating the best outcome, delivered with the highest efficiency,” says Anderson.

For many systems, a lengthy journey of change has resulted in quality improvements. Efforts to reduce medical errors have increased over the years since an Institute of Medicine report that noted between 44,000 and 98,000 Americans die each year in U.S. hospitals due to preventable errors.

Stephen T. Smith, MS, FASHP, director of pharmacy services for the Karmanos Cancer Center in Detroit, says that a multifaceted approach carried out over the years directed at system change has been a major element for reducing medical errors. Using electronic medication verification systems that require specific physician orders, testing, and other patient records to be collected and processed has resulted in a reduction of medical errors by 5% over the past five years, Smith says.

The 405-licensed-bed Bronson Methodist Hospital, based in Kalamazoo, MI, rethought its quality initiatives around the time it built a new system facility in 2000.

“Around that time, we challenged ourselves to begin thinking about how we assess ourselves as an organization,” says William J. Mayer, MD, MPH, vice president and chief quality officer at the Bronson Healthcare Group. “We began to work with our board to create a new vision for the organization to be a national leader in healthcare quality.

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