Big and small hospitals try benchmarking cooperative
Big and small hospitals try benchmarking cooperative
Clinical Advantage program brings them together
A group of 1,900 diverse hospitals, from small rural facilities to large academic institutions, is pushing the benchmarking envelope by cooperating in a multifaceted project designed to improve care in seven areas in the course of a year.
Not all hospitals are participating in all projects, but according to Pat Houghton, RN, BSN, MHA, senior director of performance consulting at VHA Inc., the Irving, TX-based alliance of hospitals involved, all are bringing something important to the table and assisting their peers in providing better care.
Houghton says some rural facilities don’t have all the technological "bells and whistles" that academic institutions have, which makes the program a real benefit for them. But small hospitals aren’t the only ones to reap rewards.
"Maybe community hospitals keep it to the basics, but they can be very adept at tailoring programs to their community, to doing what is needed in their area," Houghton says. "Rural, community, academic — throw them all together and you find you can learn a lot from a diverse group."
Being part of a large network allows all the hospitals to compare themselves to a variety of groups: hospitals in their region, hospitals of their size, rural hospitals, urban facilities, and community or academic institutions. "We have a Web approach, which combined with the phone, allows the hospitals to communicate and compare with each other easily."
Smaller hospitals are heard
There are certainly attitudinal adjustments that some of the members of the alliance have to make. Houghton recalls a big academic facility on the East Coast that was in a group with a small 60-bed institution. "The bigger one was used to doing things its own way and wielding its power. But I just reminded them that there are a lot of similarities, and if the big hospital had it all right, they wouldn’t be involved in the Clinical Advantage program."
Clinicians at more than 20 hospitals in the Midwest and Northeast are midway through the part of the project dedicated to improving clinical assessment, management, and discharge planning for heart attack patients.
Although there is ample evidence supporting the most effective and efficient ways for hospitals to treat patients who have had heart attacks, processes and standards of care vary widely. Several research studies have shown a wide divergence of patient care in different geographic regions. For instance, some patients in the South are only half as likely as patients in the East to get beta-blockers after heart attacks.
So far, the impact of the project has been positive, says Houghton. At Reid Hospital, a 359-bed facility in Richmond, IN, door-to-cardiac monitoring dropped from 14 to nine minutes in a four-month period.
Eighty-five hospitals are working on the stroke program, she notes. Fort Sanders Regional Medi-cal Center/Covenant Health, in Knoxville, TN, has reduced door-to-tPA (tissue plasminogen activator) time by 30% — from 93 minutes to 60 minutes — over a six-month period. Another improvement occurred in the use of anticoagulants and antiplatelets therapy, with 93% of patients who get these drugs receiving appropriate patient education.
Another group that improved stroke care was MedCentral Health System in Mansfield, OH, which reported a reduction of 20 minutes in door-to-CT time.
The remaining programs slated for this year are medication-error reduction, breast cancer, congestive heart failure, end-of-life care, and patient safety.
In each case, Houghton says VHA has looked outside of the group for the best in evidence-based medicine. The institutions participating in each of the seven programs then compare themselves to that standard of care and see where they are lacking.
Each of the topics is narrowed down to domains and key aspects of care. (To see key aspects of care for stroke, acute myocardial infarction, and breast cancer, see list, p. 66.) The domains cover the major areas of focus, and key aspects of care reflect the evidence-based practices that have to be addressed for an organization to achieve clinical excellence, says Houghton.
The key aspects of care come from literature and research reviews. VHA contacts the leading people in a particular area and sets up a meeting between them and members of the alliance. "They have a planning meeting, and the research staff will look for what are considered key aspects of care," she explains.
The national experts are brought in to talk to hospital staff during accelerated learning workshops. "They teach them rapid improvement methods, give them appropriate tools to implement change, and we end by telling them we expect change by next Tuesday," Houghton says.
During a recent stroke meeting, VHA even had a patient come and talk about his experience of care from a different perspective than most hospital administrators are used to hearing. "It gave a real 360 degree view," she says.
For the next three months, VHA’s regional staff works with the hospitals at a local level. "We do site visits, telephone conferences, and interactive television meetings," she says. "We use listservs and e-mail."
There are three follow-up meetings during which the group is expected to show implementation, collaboration, and benchmarking progress, she says.
VHA looks at performance on the key aspects, such as door-to-tPA time for stroke patients. "Some might be at four or six hours at first, but by the second and third meetings, we expect to see a story board of their implementation and charts that show where they are compared to before," Houghton says.
It is certainly a rough-and-tumble process that demands and delivers results. But Houghton has proof that it works and says the VHA model of getting diverse groups to work together can and should be mimicked.
"Yes, this is something you can do, but you should start small," she warns. "Don’t try to fix everything about stroke or acute myocardial infarction at once. Take one evidence-based thing that your institution can buy into and do. Then do it."
It might not be the common door-to-tPA measure that many facilities look at, Houghton adds. "It could be a process that you need to fix. Just start with a small bite of the elephant. Don’t try to eat it all at once."
Houghton also believes that facilities or groups shouldn’t make any of their projects dependent on some new computer system or software program. "Get some data — good data, maybe every fifth patient that comes in with stroke. Once you have that, get involved through a web-based group or some organization you are already linked to."
Offer up your data to other facilities to share, Houghton advises. "Ask if they have numbers, offer to show yours and see if they respond. With all the regulatory and external pressures, I find that organizations are a lot more willing to share, and more trusting. And there’s your chance for improvement."
[For more information, contact:
• Pat Houghton, RN, BSN, MHA, Senior Director of Performance Consulting, VHA Inc., Irving, TX. Telephone: (972) 830-0000.]
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