Managers at Intermountain Health Care go through a three-day "boot camp" for basic training to lead their staffs toward better care.
It's the first stop in a training continuum that seeks to continuously improve employees' capacity to improve quality.
A second course certifies employees in quality-improvement processes, and a 160-hour training program gets even deeper into clinical practice improvement. Refresher courses are offered annually for all graduates of the in-house courses. And employed physicians are required to attend a 16-hour course in clinical improvement. Other physicians are invited.
Assisted by a quality integration council made up of representatives from each IHC division, employees have been charged with chipping away at inefficiency and improving measurable outcomes of care.
The degree to which that process has caught on, and the resulting track record, earned IHC the 1996 National Quality Health Care Award from the Washington-based National Committee for Quality Health Care, to be presented Jan. 30.
The award aims to "recognize the innovation and revolution that's been going on" in quality-improvement methods and achievements, said Joan Simmons, executive director of the NCQHC. The progress made by the more forward-looking healthcare institutions across the country had been "largely unheralded" at the time the award was established three years ago, she said.
The quality-improvement effort at Salt Lake City-based IHC involves coordinating operations in a three-state area comprising 23 hospitals, 44 clinics, 19 home-care agencies, and health plans that cover 570,000 enrollees.
IHC developed its own financial and administrative information systems in the early 1980s and has combined those with clinical reporting systems for the past 10 years for utilization analysis. Recent advances permit employees to get current data on costs, length of stay, service and clinical satisfaction, and other feedback for quality improvement.
The NCQHC looked not only for a well-oiled system for improving quality but also for "the ability to demonstrate outcomes" that showed the system was producing results, Simmons said.
IHC listed three dozen projects it completed just in 1994 for a total savings of $3.8 million. They ranged from a systemwide decrease in the cost of total hip replacements, which saved $280,000, to higher productivity in answering the phone, at a savings of $4,000 in salaries (See chart).
Long-term efforts to improve clinical care include:
A 50% decrease in adverse drug events since 1991, with much of that improvement coming in the first year. A computerized alert system was a key factor in avoiding prescriptions that could pose a risk to patients, said Ann Ward, assistant vice president for quality management. Compliance with the concerns and suggestions raised by the alert system now runs about 98%, she said.
An 80% decrease in post-operative wound infection rates, reducing an incidence of nearly 2% in 1990 to a fraction of a percent in 1994, Ward said.
IHC said the effect of these and other process improvements is lower annual price increases compared with the National Hospital Price Index. In 1994, for example, the system's average increase was 4.1%, compared with 6.9% for the national benchmark.
Financial accountability is an established component of evaluation for managers, and IHC is planning to add clinical goals soon. Its report to the NCQHC said it "has researched and is developing a system to hold administrators and clinicians accountable for excellent clinical outcomes as part of monthly operational reviews."
Quality-improvement steps at Intermountain Health Care
Samples of projects large and small that reduced operating costs in 1994 System project Expense reduction
Standardizing hematology procedures $259,000 in supplies, $58,000 in equipment
Standardizing chemistry reagents $209,000 in supplies
Decrease in costs of coronary artery $245,400 (since 1993)
Facility-specific project Expense reduction
Emergency room lab turnaround time $18,800 in salary and
Fast-track extubation $575,500 in shorter length of stay
Decreased retake rate for X-rays $11,200 in film costs
Source: Intermountain Health Care application for the National Quality Health Care Award