Tru­ven’s 15 Top sys­tems: Con­sis­tency boosts qual­ity

Modern Healthcare - - NEWS - By Sabriya Rice

Be­ing “in a rut” has a neg­a­tive con­no­ta­tion for most people. But some hospi­tal sys­tems work­ing to im­prove per­for­mance have turned that phrase into a con­struc­tive con­cept as they in­sti­tute sys­temwide pro­to­cols to im­prove the con­sis­tency and ef­fi­ciency of health­care for pa­tients.

OhioHealth, a net­work of not-for­profit hos­pi­tals and health­care or­ga­ni­za­tions in cen­tral Ohio, has es­tab­lished pro­to­cols—which lead­ers there call “good ruts”— so that no mat­ter which of its 12 hos­pi­tals a pa­tient walks into, he will get the same stan­dard of care. “The ‘rut’ lib­er­ates the physi­cian and al­lows them to fo­cus their ex­per­tise where it is most needed,” said Dr. Bruce Van­der­hoff, OhioHealth’s chief med­i­cal of­fi­cer.

The sys­tem’s ef­forts have paid off. This year marks the fifth time OhioHealth is be­ing rec­og­nized as one of Tru­ven Health An­a­lyt­ics’ 15 Top Health Sys­tems. The recog­ni­tion is given for high achieve­ment in clin­i­cal per­for­mance, ef­fi­ciency and pa­tient sat­is­fac­tion.

“Con­sis­tency across sites of care is ter­ri­bly im­por­tant as trans­parency in­creases un­der the Af­ford­able Care Act,” said Jean Chenoweth, se­nior vice pres­i­dent of per­for­mance im­prove­ment for Tru­ven. “It’s a ma­jor goal of these very high-per­form­ing sys­tems.”

This year’s list of the 15 Top Health Sys­tems, Tru­ven’s sixth an­nual, is again based on ag­gre­gat­ing data for all of a sys­tem’s hos­pi­tals. The 15 sys­tems in­clude the top five each from large, medium and small health sys­tems across the na­tion. Sys­tem size is based on to­tal op­er­at­ing ex­penses.

Each sys­tem was eval­u­ated based on pub­licly avail­able govern­ment data look­ing at eight per­for­mance mea­sures, in­clud­ing death rates, com­pli­ca­tions, 30-day read­mis­sions, lengths of stay, a pa­tient-safety in­dex and Hospi­tal Con­sumer As­sess­ment of Health­care Providers and Sys­tems score. The data are ad­justed for the ill­ness sever­ity of pa­tient pop­u­la­tions.

On aver­age, the length of time pa­tients stayed in hos­pi­tals run by the win­ning sys­tems was 10% shorter than their peers. Small sys­tems saw an even larger dif­fer­ence—a 16% dif­fer­ence in length of stay com­pared with the bench­mark. The top 15 hospi­tal sys­tems also out­per­formed their peers by 8% on the pa­tient-safety in­dex, mean­ing they had fewer ad­verse pa­tient-safety events. Safety per­for­mance was higher among small and medium-sized sys­tems, which per­formed 14% and 11% bet­ter, re­spec­tively.

Those dif­fer­ences are “about lead­er­ship,” Chenoweth said. “These or­ga­ni­za­tions were able to de­velop a cul­ture of per­for­mance im­prove­ment across their sys­tem. It means that the man­age­ment of these or­ga­ni­za­tions is be­com­ing more fo­cused on the con­sis­tency of qual­ity, on ef­fi­ciency and on the cus­tomers.”

Eight health sys­tems were on the list for the sec­ond con­sec­u­tive year: Advo- cate Health Care, OhioHealth and Scripps Health, for the large health sys­tems; Ale­gent Creighton Health, Mercy Health South­west Ohio Re­gion and Mis­sion Health, for the medium sys­tems; and Asante and Roper St. Fran­cis Health­care, for the small sys­tems.

Lead­ers from sev­eral of the win­ning health sys­tems said the recog­ni­tion val­i­dates their ef­forts to im­prove qual­ity and safety. “I like to set goals that re­ally push us and are not easy,” said Dr. David Pate, CEO of St. Luke’s Health Sys­tem, a Boise, Idaho-based sys­tem with six hos­pi­tals.

This is the first year his sys­tem made the top 15. Pate said that when he be­came CEO nearly five years ago, he set the bar high by an­nounc­ing he wanted St. Luke’s to be a leader in qual­ity and safety by 2015.

The sys­tem saw a “pre­cip­i­tous drop” in sep­sis mor­tal­ity when it in­sti­tuted best prac­tices, he said. Sys­tem lead­ers

en­cour­aged each hospi­tal to ap­proach sep­sis in a uni­form man­ner. In their ru­ral hos­pi­tals, they also es­tab­lished elec­tronic in­ten­sive-care units, giv­ing those fa­cil­i­ties the abil­ity to con­nect vir­tu­ally with spe­cial­ists at larger in­sti­tu­tions. “Know­ing that we’ve al­ready achieved this level of per­for­mance, it’s ex­cit­ing to see where we can go next,” Pate said. “I see much more that we can do and are poised to do.”

Roper St. Fran­cis, a three-hospi­tal sys­tem based in Charleston, S.C., was rec­og­nized for the sec­ond time as one of the top sys­tems in the small cat­e­gory. Its em­pha­sis has been on ex­tend­ing care be­yond the walls of the hospi­tal. For ex­am­ple, when the sys­tem no­ticed that many HIV pa­tients were be­ing ad­mit­ted, Roper St. Fran­cis started pro­vid­ing free trans­porta­tion to well­ness vis­its, free med­i­ca­tions de­liv­ered to pa­tients’ homes, and ac­cess to den­tal and men­tal health ser­vices at a well­ness cen­ter.

Qual­ity ex­perts at Roper St. Fran­cis say their sys­tem has seen in­pa­tient death rates fall by about 10% each year since a pal­lia­tive-care pro­gram was in­sti­tuted to im­prove care for the seri- ously ill. Now, many of those pa­tients re­ceive the care they need at home.

The Tru­ven recog­ni­tion, they say, means the Roper St. Fran­cis hos­pi­tals are on the right track. “It tells you that not only are you run­ning in the right di­rec­tion, but you’re run­ning at the right speed,” said Dr. Todd Shu­man, vice pres­i­dent and chief qual­ity of­fi­cer for the sys­tem.

Ad­vo­cate Health Care, a sys­tem of 11 hos­pi­tals in Illi­nois, made the Tru­ven list for the fifth time in the large health sys­tem cat­e­gory. When lead­ers there no­ticed that the in­ten­sive-care unit at Ad­vo­cate BroMenn Med­i­cal Cen­ter in Nor­mal, Ill., had gone more than six years with­out hav­ing a sin­gle cen­tral line-as­so­ci­ated blood stream in­fec­tion, the sys­tem ap­plied the best prac­tice from that hospi­tal to oth­ers in the sys­tem.

By the end of 2013, six Ad­vo­cate hos­pi­tals re­ported hav­ing no cen­tral line-as­so­ci­ated in­fec­tions for the en­tire year.

“We proved to our­selves that we could get to zero,” said Dr. Lee Sacks, ex­ec­u­tive vice pres­i­dent and chief med­i­cal of­fi­cer for Ad­vo­cate. “It is about de­creas­ing vari­a­tion, adopt­ing ev­i­dence-based prac­tices and con­tin­u­ing to re­fine them.”

Chenoweth said the con­cept of “sys-tem­ness”— co­or­di­nated ef­forts across or­ga­ni­za­tions that el­e­vate qual­ity and pro­vide max­i­mum value for the con­sumer—has spread since Tru­ven first be­gan pub­lish­ing its 15 Top Health Sys­tems list. She was sur­prised by how dif­fer­ent the re­sults are to­day com­pared with six years ago. “When we first pub­lished in 2009, we didn’t see very much con­sis­tency across (a sys­tem’s hos­pi­tals in) the met­rics we were mea­sur­ing, but to­day these par­tic­u­lar sys­tems are show­ing a great deal of con­sis­tency and high per­for­mance,” she said. “That is good news.”

As early as next year, Tru­ven may add new mea­sures on cost and fi­nan­cial per­for­mance, in­clud­ing per­pa­tient spend­ing on Medi­care ben­e­fi­cia­ries and sys­tem op­er­at­ing mar­gins. Pre­lim­i­nary analy­ses show a lot of vari­a­tion among hos­pi­tals in a sys­tem on these mea­sures, Chenoweth said.

Sys­tems on this year’s list say a key les­son they have learned is the im­por­tance of find­ing col­lab­o­ra­tive ways to work with doc­tors and nurses to iden­tify ar­eas that need im­prove­ment. Sev­eral sys­tems said they iden­ti­fied staff mem­bers who were trusted by other staff and were seen as clin­i­cal prac­tice lead­ers. These in­di­vid­u­als, they say, not only helped iden­tify best prac­tices, but also led the way in im­ple­ment­ing them. Lead­er­ship “can­not do this alone,” Pate said.

It’s also im­por­tant to es­tab­lish a way to gauge suc­cess. “What gets mea­sured gets done,” said James Skogs­bergh, pres­i­dent and CEO of Ad­vo­cate Health Care. “You can’t im­prove on what you don’t mea­sure.”

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