Believing in care transparency
Commitment to performance measurement earns Norton annual NQF award
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