Process measures cut expenses by $4.5 million

Patient-focused care redesign aids efficiency

Is your hospital performing better today than five years ago?

When the board of Bellin Health System in Green Bay, WI, asked this simple question a few years ago, system leaders were faced with a glaring hole in their understanding of organizational performance. Even though they had worked diligently over the preceding years to improve processes, they simply couldn’t answer this question, says Carole Davis, RN, BSN, MS, team leader of the system’s Quality Resource Center. The issue: System leaders lacked a systematic set of measures with which to establish a baseline and track progress over time.

To fill in this hole, Bellin leaders have designed and implemented an organizational model to establish a baseline and measure the system’s progress. As a result, the past two years have produced significant changes, one of which has been a reduction in expenses by more than $4.5 million while maintaining patient satisfaction at benchmark levels.

A little history

Since the late 1980s, Bellin has embraced the concepts of continuous quality improvement (CQI), tackling large-scale issues such as medication errors and providing intensive training to employees. "The problem was, it was hard to sustain the gains; everything had to cross departmental boundaries, and that took a lot of effort and was very resource intensive," Davis explains.

Still committed to CQI, hospital leaders decided to change the internal structure of the hospital to make it more CQI-friendly, she continues. Using a quality improvement process called systems thinking, to which the old departmental structure was an anathema, they reconfigured the organization into five clinical and two nonclinical centers:

• cardiac;

• medical/surgical;

• family;

• outpatient diagnostics;

• surgery;

• support services;

• business services.

Each center was designed using a patient-focused care approach targeting efficiencies and redeploying activities, Davis says. "All this work led up to an opportunity to understand ourselves a lot better."

Are the changes effective?

Back to the $25,000 question. The Quality Council decided that rather than acting as a bureaucratic organization giving the nod to QI projects, they should work on answering the question "have our changes had any effect?"

"We got together all the QA stuff that had gone on in the whole hospital, and it filled boxes, and we looked at all this minutia and said, ‘we have no way of telling if we made any change.’ We had no way to sum up in a valid, consistent, aggregate way, the impact of those changes," Davis explains. "That’s what led us to the notion of developing performance measures for the organization."

The Council and the Quality Resource Center staff put together an organizational model that encompasses several performance measures. (See list of measures, p. 38.) "What we’ve done is developed a way to score them, to measure them. If we say we want to have the most competitive price on our acute care services, for example, how do we know that? We developed ‘market baskets,’ like the Dow Jones average, of our inpatient DRGs — a local one and a regional one because we are a regional cardiac center, and we have to compete for patients on a regional level."

Information on competitors’ prices is available through the Wisconsin Office of Health Care Information, a clearinghouse of hospital inpatient and outpatient charges. "The market basket enables us to identify our position within a competitive group of hospitals for an identified set of services," Davis says.

The team quantified how each performance factor would be measured, identified Bellin’s current position, and establishes targets in 18-month planning cycles. Davis uses a spider diagram to illustrate Bellin’s current and target position in each performance factor. (See spider diagram, p. 39.)

The next step was to develop an integrated system of measures to bring each of the seven clinical and nonclinical centers into the fold. "Each center must commit to doing something to budge those overall performance factors," Davis explains. "Each has accountability. And you can’t manage what you can’t measure." Thus, each center has its own process measures, such as surgical wound infection rates, time waiting for consults, cost of surgical supplies, and objectives. "All those measures pulled together should eventually contribute toward the organizational performance measures," Davis says.

Every 90 days, each center’s management is responsible for meeting with the system CEO or CFO and updating its Strategic Alignment/ Deployment Worksheet. (See copy of worksheet, p. 40.) The worksheet is a way for system and center leaders to track measurements and improvement opportunities, and even includes a list of 90-day action items.

"This whole process and the worksheet provides everyone in the centers with a focus. It helps center leaders establish vision and helps [staff] participate in that vision," Davis explains. "I’m not saying it’s easy. It’s far from effortless. It takes energy for center leaders to keep people on the same track. But we have seen dramatic results."

Bellin has been using this goal setting and tracking system for two years. In that time, it has seen a reduction in expenses by more than $4.5 million. The health care system has reduced its charges compared to the local market from the 50th percentile to the lowest percentile. In addition, the readmission rate has dramatically dropped, and patient satisfaction has remained at benchmark levels, Davis says.

[Editor’s note: For more information, contact Carole Davis, Team Leader, Quality Resource Center, Bellin Health System, 744 S. Webster St., Green Bay, WI 54301. Telephone: (414) 433-7511.]