Be­liev­ing in care trans­parency

Com­mit­ment to per­for­mance mea­sure­ment earns Nor­ton an­nual NQF award

Modern Healthcare - - Front Page - El­iz­a­beth Gard­ner For a list of judges for this year’s award, please visit modern­health­care.com/nqf

Back in 2005, Nor­ton Health­care of Louisville, Ky., made a bold de­ci­sion to pub­lish its per­for­mance on ev­ery na­tion­ally ac­cepted qual­ity mea­sure from any source: the CMS, the Agency for Health­care Re­search and Qual­ity, the Joint Com­mis­sion, pro­fes­sional med­i­cal so­ci­eties, the National Qual­ity Fo­rum, the Leapfrog Group.

It didn’t mat­ter how the sys­tem was per­form­ing on the mea­sure, or even whether peo­ple in the or­ga­ni­za­tion agreed with what was be­ing mea­sured. It all went up on the sys­tem’s web­site for any­one to see.

“We de­cided we would mea­sure and re­port every­thing, and com­pare our­selves to national and state av­er­ages,” says Pres­i­dent and CEO Stephen Wil­liams, who’s been with the or­ga­ni­za­tion since 1977. Shortly af­ter ar­riv­ing, he be­came in­ter­ested in to­tal qual­ity man­age­ment as prac­ticed by man­u­fac­tur­ing and other in­dus­tries. By 1985, he had be­come in­volved in an ini­tia­tive to trans­late TQM prin­ci­ples to the care at Nor­ton. Over time, gath­er­ing qual­ity mea­sure­ment data be­came part of the in­sti­tu­tional cul­ture. But pub­lish­ing it was an­other story.

“It was a huge de­ci­sion, be­cause a few hos­pi­tals were reporting some of their in­di­ca­tors, but no one else was reporting every­thing they were mea­sur­ing,” Wil­liams says.

Charts with about 150 in­di­ca­tors were set up with red (worse than national av­er­age)/yel­low (av­er­age)/green (bet­ter than av­er­age) cod­ing to in­di­cate level of per­for­mance, and they had a dis­con­cert­ing amount of red to start with, says Dr. Henry Wal­ter, med­i­cal di­rec­tor of flag­ship Nor­ton Hos­pi­tal and vice chair­man of the Nor­ton Health­care qual­ity com­mit­tee.

Wal­ter was chief of the sys­tem med­i­cal staff at the time. He es­ti­mates the sys­tem had ad­e­quate per­for­mance on about 70% of the in­di­ca­tors, com­pared with a national av­er­age of 50%, but ev­ery­one felt things could be bet­ter.

“Some of the board said, ‘You’re go­ing to put this on a web­site?’ ” he re­calls. “Some oth­ers said, ‘If you can guar­an­tee me that this is go­ing to turn green, we’ll go along with it.’ ”

Wil­liams says that many of those red boxes moved to green within two years. Cur­rently, the pub­lic reporting ef­fort en­com­passes 376 in­di­vid­ual per­for­mance mea­sures from 11 spon­sor­ing or­ga­ni­za­tions in 15 do­mains of care.

For that com­mit­ment to trans­parency and the sys­tems it has cre­ated to turn those in­di­ca­tors from red to green—or at least to yel­low— Nor­ton Health­care won the 18th an­nual National Qual­ity Health­care Award, beat­ing 19 other ap­pli­cants, says Janet Cor­ri­gan, pres­i­dent and CEO of the National Qual­ity Fo­rum, which presents the award in part­ner­ship with Modern Health­care.

“Nor­ton Health­care has had a long­stand­ing com­mit­ment to mea­sure­ment, im­prove­ment and trans­parency through­out the sys­tem and at all lev­els,” Cor­ri­gan says. “They’ve been on this jour­ney a long time with a high level of per­sis­tence from one year to the next. The les­son we learn from Nor­ton is that if you work at mea­sur­ing and im­prov­ing, it doesn’t hap­pen in a year or two but it cer­tainly does in a decade.”

Nor­ton’s chief nurs­ing of­fi­cer, Tracy Wil­liams (no re­la­tion to the CEO), came to the or­ga­ni­za­tion in 2005, when the trans­parency ini­tia­tive was just get­ting started, and it was one of the things that at­tracted her to the job.

“I liked that they were say­ing, ‘This is where we are, and what are we go­ing to do to make it bet­ter?’“ she says. The or­ga­ni­za­tion makes sure each staff mem­ber, af­fil­i­ated physi­cian and ex­ec­u­tive sees data per­tain­ing to his or her area. “It’s cre­ated a com­mon lan­guage,” Wil­liams says. “We know what met­rics we’re us­ing, and what thresh­olds we’re aim­ing for.”

Dr. Steven Hester, Nor­ton Health­care’s se­nior vice pres­i­dent and chief med­i­cal of­fi­cer, who

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