Norton Healthcare report will cover 200+ indicators

New publication to be most extensive of its kind

Norton Healthcare, a Louisville, KY-based organization that comprises four adult hospitals, a children’s hospital, and a number of physician groups, soon will start publishing what is said to be the most extensive self-published report card of its kind, posting on its web site about 200 indicators of clinical quality.

Sources of the indicators include:

  • from the National Quality Forum (NQF), all indicators and practices on hospital care, cardiac surgery, nursing-sensitive care, and safe practices;
  • hospital quality measures from the Joint Com- mission on the Accreditation of Healthcare Organizations (JCAHO) and the Centers for Medicare & Medicaid Services (CMS) indicators;
  • JCAHO’s National Patient Safety Goals;
  • from the Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators and Inpatient Quality Indicators.

"We plan to display our performance compared to a national average whenever available," says Ben Yandell, PhD, CQE, division director of clinical information analysis for Norton Healthcare. "Where we can, we will also show the Kentucky average."

Yandell directs a group of analysts that set up and maintain data on clinical issues and then analyze results.

Ongoing quality dialogue

Yandell says he has been working with Norton’s quality department for a number of years, "and in the late 1980s, we started to talk about how to help hospitals be more transparent about what they do and inform the public about our quality."

This latest initiative logically follows from those discussions. "As for this current step, one of the reasons is the amount of attention being given nationally on indicators and the onset of public reporting," he notes. "This gave us a starting group of nationally designed indicators."

Norton started paying close attention to the NQF and the work it has been doing endorsing measures about a year ago, Yandell continues.

"They check out other people’s indicators and endorse them, so we said, Let’s start there,’" he recalls. "Everything they’ve endorsed, if it applies to us, we used it. Then we added JCAHO and CMS measures, which is not unusual, and responded to the National Patient Safety goals. And to liven things up, we included all the AHRQ patient safety indicators and inpatient quality indicators."

In determining which indicators were to be used, some rules were laid down. "It has to be a national set; we don’t want any homegrown indicators, because we want to be transparent — no black-box methodologies," Yandell explains.

"With all of these, you know what the rules are. We can run comparisons about our competitors in Kentucky, and they can run them on us. We think that’s important — in fact, we like it. Also, choosing national sets means it’s evidence-based," he says.

Quality check continues

The Norton quality professionals remain key players in the process, Yandell says. "They’ve been involved in all the work we’ve done with JCAHO and CMS, which was our first plunge into public reporting; we were the first large system in Kentucky to voluntarily report," he notes. "As we’ve done our homework on different pieces — such as AHRQ — we’ve sent them those, and they gave us feedback."

Not surprisingly, the quality staff agreed with some of the indicators, but not with others.

"However, we do not have to agree exactly with a definition; we will use an indicator even if we think the definition is not exactly right," adds Yandell.

He says he expects many future changes and believes the list of indicators will grow rapidly. "Look at the history of the AHRQ indicators. They put out things that seem to work, then people complain and they refine them. But this only happens if people measure themselves on it — and care."

In terms of future changes, Norton has joined NQF "so that we can be one of the voices at the table to say what we like and don’t like, and we hope other hospitals will do that, too," he says.

One of the main reasons Norton is doing this, he says, is "it makes us pay even more attention to quality. But it also turns the heat way up on us to measure it right, to put resources to it, to improve if we’re not where we ought to be."

That pressure will begin this month, at which point the information should be posted on the Norton web site. "We are doing this in the spirit of accountability, not marketing," Yandell stresses.

It will not require great clinical sophistication on the part of the public, because rankings will be color-coded. "The public can tell red from green, so if your area is highlighted, it will get your attention," he notes.

Will this cause any consternation among staff? "Staff may question if we are using the right indicator or the right data, but to their credit, that phase does not last as long as it did at one time," Yandell says.

"The quality managers are getting used to the idea that we are measured in quantified ways that are not perfect but are at least correlated with the truth, and they will respond." The dominant effect, he says, will be that staff will try to raise their quality scores.

Yandell says he doesn’t know of any other organization that is doing what Norton is doing. "We’ve been in contact with the NQF, and they said they are not aware of anyone doing this as extensively as we are," he reports.

Yandell says he is not entirely happy with his role of being a pioneer.

"It’s fun, and it’s scary; but we hope we are not at the front of the line for long," he adds. "It’s just like having a fax machine; it’s only useful when other people have it, too. We do not want to be Lone Rangers’ for very long."

Need More Information?

For more information, contact:

• Ben Yandell, PhD, CQE, Division Director, Clinical Information Analysis 24-4, Norton Healthcare, Louisville, KY. Phone: (502) 629-8639. Fax: (502) 629-5760. E-mail: