Awards tap the best and the brightest
How to be a winner: Try using strategic plans
Two hospitals were awarded prestigious Mercury Awards toward the end of last year, and quality professionals closely associated with each facility’s efforts agreed to share with Hospital Peer Review how they did it. All agree that whatever strides their facilities have made over the year were aimed at improved patient care, not at jockeying for the award, but they say getting the recognition doesn’t hurt. The common denominator of their advice: Have strategic plans, and follow through on them.
The University of California at Los Angeles (UCLA) Medical Center received a 100.0 rank in the Mercury Award’s "overall facility" category. (See chart at right showing UCLA’s other awards.) Lee Hilborne, MD, MPH, director of quality management services at the medical center, says that for several years his facility has had a major strategic plan to identify key areas where the facility needs to concentrate its quality improvement efforts. "The three service lines that the Mercury Award committee focused on — cardiovascular services, orthopedics, and oncology — were areas that we had identified for improvement," he says. "For example, we had just improved length of stay in our cardiovascular services when the group looked at those numbers." Many of the surrounding hospitals refer their most difficult cardiac patients to UCLA, so the center’s cardiovascular service is an area of continual focus.
"We’re an internally driven organization," he explains. "We didn’t gear our efforts to this award, but it’s gratifying to see that when external benchmarking data are analyzed, they show that we do well."
"Any facility’s challenge today is to attract and retain well-trained professionals," says Heidi Crooks, RN, assistant director of patient care services at UCLA. "Our people have to be competent to face the dual challenges of the increasing acuity of patients and shortened lengths of stay. Any award UCLA receives makes it more attractive to professionals to join a highly rated institution."
A number of years back, UCLA participated in a study — called the Quality Measurement Management Initiative — that worked with academic medical center consortia. The initiative looked at quality and other variables related to cardiovascular surgery and identified areas of opportunity for improvement. When the team looked at UCLA’s myocardial infarction mortality rates and realized they were somewhat high (12% to 15%), one of UCLA’s cardiologists assembled a team to work with the emergency department physicians. They brought the rate down to 4% — well under the national average.
"The improvements we made as a result of the efforts of that initiative continue today," says Hilborne. "We integrated the improvements we made into practice. That study showed us that process improvement efforts can really pay off. They pay off in terms of patient outcomes, and patients who are treated more efficiently leave the hospital sooner, their care costs are less, long-term morbidity is decreased, and so on." Improving quality also has proven beneficial in terms of expanding UCLA’s market share. "When the managed care plans see that we can take care of patients better and cheaper, they send cases to us," says Hilborne.
UCLA’s kidney transplant program also has had success in shortening LOS and improving outcomes, both immediate and long-term. "We looked at our time between taking the kidney and transplant and set out to cut that down considerably from 28 to 17 hours," says Hilborne. "At the same time, graft rejection was cut from 30% to 15%. And graft survival — avoiding the need for re-transplant — went up by 2% to 3%. All that meant cost savings of $750,000."
A serendipitous visit by JCAHO didn’t hurt’
Does the Joint Commission give consideration to hospitals’ achievement awards? No — well, maybe a little. Crooks at UCLA says, "I doubt that the Joint Commission analyzes any outside agencies’ review of quality."
But Elizabeth Evins, RN, JD, says, "It was serendipitous that we received the Mercury award on the week before the Joint Commission came for its survey." She is vice president of quality improvement services at Anne Arundel Medical Center (AAMC), a 291-bed acute care facility in Annapolis, MD, and another Mercury winner. "In both our leadership interview and our performance improvement interview, we were able to talk about the award, and they did indicate they were quite impressed that we had achieved it. They asked a lot of questions about it." Those two interviews are the point in any survey when the Joint Commission learns basic information about an organization and how it sets its priorities.
"I don’t think the fact that we got an award made our surveyors look specifically at our cardiology, orthopedic, or oncology programs, however," Evins says, "nor did they avoid those programs. The fact that we got high rankings on those programs from Mercury did not mean that we were not surveyed on them." Instead, she indicated, the surveyors looked at those services the same way they looked at all the other services at AAMC.
"It did not affect the way the surveyor looked at our institution. But it didn’t hurt," she says. "It was a way for them to see that we are a quality organization and that others beside them are interested in our performance." Even so, the Joint Commission gave Anne Arundel a score of 93 with a few "Type 1 recommendations," that is, significant issues or deficiencies that will need to be corrected before accreditation can be issued.
How can you help your facility get an award like these quality pros did? Evins’ advice: "Have strategic goals, and measure your progress toward those goals."
"Take advantage of opportunities as they arrive in support of your goals," she continues. "As an example, when we have an opportunity to credential a physician with a particular type of expertise that brings value to one of our organization’s goals for improving access to services and patient care, we do it. It isn’t always planned, but when we have an opportunity to link new technology, exper tise, and other performance measures with a pre-existing strategic goal, we try to take advantage of it."
Each of the 23 hospitals in the Baltimore market was rated by the Mercury committee on the basis of eight statistical measures that evaluated various aspects of quality and care. (See article on p. 77 describing those eight indexes.)
AAMC was recognized as best in the area for overall quality and care, No. 1 in cardiology, No. 2 in oncology, and No. 4 in orthopedics. (See chart above listing Baltimore-area awards.)
"With respect to cardiology," says Evins, "we set out a number of years ago to have a future-oriented cardiovascular program." The medical center does no cardiac surgery, but takes care of hundreds of chest pain patients each year. For those patients, a team developed a four-stage triage and treatment protocol for the quick identification of heart attack. The facility’s catheterization and electrophysiology labs came about as a result of performance goals set by Evins’ team.
In addition to gaining attention for the Mercury award, AAMC’s cancer program has won approval by the Commission on Cancer of the American College of Surgeons, an honor only one-fifth of American hospitals has received. The program includes inpatient and outpatient centers for radiation therapy, a breast center, and an active community education program. AAMC’s orthopedic program offers services from minimally invasive arthroscopy to joint replacement.
"We have an ongoing long-term and short-term performance improvement philosophy," Evins says, "and that is driven by our strategic plan. We set goals each year, one of which is to provide superior patient care." Under that goal umbrella are several smaller objectives that are "as measurable as possible," Evins says.
Clinical initiatives aspire to meet the facility’s internal benchmarks as well as external ones such as those put forth by the Maryland Quality Indicator Project and the IMSystem quality project of the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL. "The benchmarks give us a concept of our own ongoing performance," she says. "In addition, we use them as guidance for goals to set for next year."