Balanced scorecards also help the staff at 260-bed Poudre Valley Hospital maintain focus on the hospitals patient safety strategic objective. The Fort Collins, Colo.-based teaching hospital has appeared on the Top 100 list for the last five consecutive years, and once before in 1994.
The scorecards, accessible through a Web portal, provide detailed information on a variety of performance measures Poudre Valley is working on in any given year, according to CMO William Neff. They reflect the work of a 12-month process that starts with the medical centers board. Executives review the current status of measures on the scorecard and determine where the medical center should focus efforts, Neff says. A committee takes those recommendations and develops a strategic action plan for staff to follow.
The quality committee is used a lot like the finance committee, Neff says. It meets quarterly and studies the various measures and standards supported by the Joint Commission, the NQF and Medicare, and it ensures the scorecard is showing improvement progress.
When the scorecard consistently was indicating there was a problem with patients falling, and no progress was made over several quarters in stopping the falls, the committee wanted to know why. The medical center dug through the scorecard down to individual patients and staff and discovered the majority of patients were falling in the bathroom, when no staff was present. After benchmarking to other facilities and seeing how they handled the problem, Poudre Valley added more employees so that at-risk patients had one-on-one assistance when leaving bed, Neff says. The fall rate has dropped so low since the implementation that now, if there is one, its a serious reportable event to the board, he says.
Employee satisfaction is as important as the scorecard, Neff adds. Poudre Valley focuses on maintaining its low turnover rate as another quality initiative. Instead of spending time and money retraining new staff, the hospital can work with a seasoned group that already understands processes, he says. With a combination of accountability, financial incentives and profit sharing, the staff remains engaged. Everyone knows they play a part, he says.
That open level of engagement also is at the heart of Chandler Hospitals quality programs. Thats how the whole thing is empowered, says Lofgren, the CMO at UK Healthcare.
About four years ago, a change in leadership at the hospital also brought about a change in focus. The faculty practice, hospital and college were brought together as one entity in an effort to end office politics and focus on quality programs, Lofgren says. Everyone has a place at the table.
Physicians are involved at every level of a quality initiative, and all staff members are encouraged to make small improvements when theyre in their departments, Lofgren says. The message has evolved: Before, people thought hospitals were either cost-effective or high-quality; now, everyone understands that they can be both and still be efficient, he says.
Timeliness became part of the mantra, too. The hospital created a center dedicated to quality, which conducts outcomes research and monitors benchmarking data from CMS core measures and the UHC database, but there were some growing pains. Initially, the hospital would implement changes then wait for CMS data to come in, anywhere from six to 12 months later, when they could find out whether those changes worked, Lofgren says. Now, the research center analyzes weekly data feeds, and rates are posted on the Internet. Reports are reviewed by the board on a monthly basis as well. We saw a much better movement in our performance, he says.
Employee engagement, executive leadership and physician involvement have another nameorganizational culture. When improvement is integrated into the culture of a hospital, things get done, says Thomas Herron, president and chief executive officer of 546-bed Centennial Medical Center, Nashville, a two-year designee on the top 100 list. Its part of our daily routine, he says.
Centennial, a facility within the TriStar Health System and the national HCA organization, attributes some of its quality success to HCAs dedication to improvement. The entire organization has invested $300 million in patient-safety technology, deploying an electronic medication-reconciliation system that has eliminated numerous potential medical errors within the system, Herron says. And HCA has turned to Centennial for a rapid-response team initiative that has worked so well in that hospital, it hopes to adapt the process in others.
The response teams are composed of nurses and respiratory therapists trained in critical care. The goal is to avoid code blue in patients, Herron says. In the past two years, Centennial has found the program not only reduced those codes, but also it could ensure patients were in the right care settings, he says. The response team data helps the hospitals bed-access management team determine patients severity of illness.
Centennial also took up two other popular initiatives for safety improvement. It expanded on HCAs medication reconciliation system with a computer system on wheels that nurses can use to check patient allergies, adverse drug reactions, dose accuracy and medication scheduling. The patient is given a wristband that is scanned to ensure everything matches, Herron says. In addition, the hospital adapted an infection screening process to combat the methicillin-resistant Staphylococcus aureus bacteria, commonly known as MRSA.
At-risk patientssuch as those coming from crowded conditions or other hospitalsare screened automatically and are not charged for the nasal swab test. The hospital has identified that about 18% of patients test positive for MRSA colonization, and Centennial is working on education for both patients and providers: Patients are told how to manage hand hygiene at home, and staff practices hand hygiene at work, Herron says.
Information makes all those programs possible. Centennial is aggressive in tracking quality data and benchmarking against other HCA facilities as well as similar hospitals outside the network, Herron says. The 21 quality directors for HCAs hospitals work together to share information and best practices: Its a combination of efforts, he says.