Children's hospitals know they'll need to improve operations to thrive if reform imposes a managed-care-like system on them. At least 12 of them are working together to do just that.
Those facilities, participating in a consulting firm's program to better their performances, are joining to find which hospitals are doing the best in 18 key areas, with the goal of emulating the practices of the top facilities.
This benchmarking approach focuses on concerns that are important for children's hospitals because they involve cost and quality issues particularly related to their young clients, many of whom receive care paid for by Medicaid programs, executives said.
Improvements in these areas can result in cost savings and more satisfied customers, two areas of hospital operation that will be important under a reformed healthcare system.
Until lately, children's hospitals haven't fully felt rising cost-containment pressures because Medicare didn't pay them under prospective pricing and because it was assumed they couldn't avoid the high costs related to treating chronically ill young patients with complicated cases.
Children's hospitals now are sharing information to improve their performance. Two children's hospital associations-the National Association of Children's Hospitals and Related Institutions, and the Child Health Corporation of America-have started groups where children's hospitals can talk about improvement concerns.
But the 12-hospital group, started in April 1992 by Steve Cohn, president of Medical Management Planning, involves hospitals that have a shorter list of issues to study and a more direct approach to bring group members up to the level of "benchmark" facilities. The hospitals are splitting the cost of the program by MMP, a Calabasas, Calif.-based consulting firm.
The 18 issues picked by the facilities were selected as those having the most impact on the children's hospitals. They include waiting times for emergency care and in clinics as well as admission and discharge process times; departmental productivity; supply costs, laboratory tests and paid hours per adjusted discharge; resident/fellow costs per adjusted patient day; lengths of delay until first clinic appointment; medication error rates; lengths of stay by DRG; unplanned returns to operating, emergency or specialty units; and operating room turnaround times.
Comparing the hospitals' performances in these areas revealed those with the best records, and they became the models the others could copy.
"Because there is nothing sacred in the way we do business, this type of networking has allowed us to identify the best practices and how to adapt re-engineering techniques to improve quality and delivery of care," said Barry Weinstein, chief operating officer at Children's Hospital Medical Center in Cincinnati.
The potential benefits of improvement are made more evident by the data, said Janet Porter, COO at 309-bed Children's Hospital in Columbus, Ohio. As its first response to the benchmarking information, her facility wants physicians to weigh the cost of additional tests and medications against the likelihood of worthwhile benefits.
Children's Hospital in Cincinnati is using information from the program to target emergency department improvements. It has implemented a new fast-track triage system to streamline and shorten the admission process. The 361-bed facility, which has 90,000 emergency visits annually, also is considering a bedside admission process, used by the benchmark facility, that employs lap-top computers.
In Memphis, Tenn., 208-bed Le Bonheur Children's Medical Center is seeking to speed emergency department treatment for the 150 to 200 children who come to its facility every day. Establishing an urgent-care track and an effective triage system allowed the facility to decrease waiting times for patients while relieving staff pressure and increasing patient satisfaction, said its COO, Jim Schmerling.
Participants aren't just looking for cost savings; they want to improve patient outcomes as well. But most say it's still too early in the program to see measurable improvement in outcomes.
However, the benchmarking process already has increased communication with hospital boards and developed a better means to gauge successes and failures in each facility.