Of the five small system winners, Maury Regional Healthcare System in Columbia, Tenn., made the list last year. The four others are first-time winners. Besides Tanner Health System, they are Baptist Health in Montgomery, Ala., Poudre Valley Health System in Fort Collins, Colo., and St. Joseph Regional Health System in South Bend, Ind.
The 15 Top Health Systems were not ranked.
Thomson Reuters chose the winners from a total of 321 systems with 2,194 member hospitals and about 8 million patient discharges.
Also this year, the firm included both parent systems and their qualifying subsystems. So, for instance, HCA's Central and West Texas Division was named among the winners.
“This expanded the number of systems we could include,” says Julie Shook, product director at Thomson Reuters' Center for Healthcare Analytics.
Systems were compared using eight performance measures. The benchmark health systems did better than the peer group on all measures.
Among the key findings:
- Better survival rates. The 15 Top systems had nearly 17% fewer deaths than expected, while non-winners had 4% more deaths than expected.
- Fewer patient complications. Patients at the 15 Top systems had patient complication rates 19% lower than non-winning system hospitals.
- Better long-term outcomes. The large winning systems had the lowest 30-day mortality rates. Small and medium-size winning systems had the lowest readmission rates.
- Better adherence to accepted care protocols and patient-safety standards. The winning systems had 23% fewer adverse patient-safety events than expected, while their peers had just 2% fewer adverse events than expected.
- Patients returned home sooner. Winning systems had a median average length of state of 4.7 days, compared with their peers' median of 5.1 days. Small systems in the 15 Top had the shortest average length of stay, at 4.4 days.
- Better hospital experience. The 15 Top systems had a higher median Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, score than their peers. The top small systems had the highest HCAHPS scores.
Jean Chenoweth, senior vice president of performance improvement and 100 Top Hospitals programs at Thomson Reuters, says what distinguishes the 15 winners is they are “making a commitment across the full health system to drive key goals that are the highest priority.”
“Those goals cannot be ignored at the individual hospital level,” she adds. “These systems have a very strong commitment to provide a uniformly consistent level of quality to the communities they serve and it is higher than their peers.”
The 15 Top Health Systems also showed better alignment between administration and medical staff, Chenoweth says.
Tanner Health, serving suburban and rural parts of Georgia and Alabama, has reoriented its staff toward patient safety and a better care experience. The system employs 14 hospitalists and is hiring three more to work as team members with other employees, leading to a decrease in average length of patient stay.
In addition, case-management functions have evolved into care-management teams that provide more personalized service. The system has invested heavily in home health and telemedicine, and continues to grow that arm of care. Other investments include the hiring of three certified infection prevention professionals, who are led by the medical director of infection prevention.
Tanner eliminated catheter-related bloodstream infections through a coordinated approach involving every team member. This includes using checklists, following best practices, and making sure everyone is gowned and gloved before catheters are inserted or removed. The system switched to the use of kits instead of piecemeal supplies, costing about $67,000 more a year, but saving much more in terms of patient health, said Dr. Bill Waters, Tanner's chief medical officer.
One infection “costs thousands and thousands and thousands of dollars,” Waters says.
Being a small system can sometime have its advantages, Howard says. “The whole medical community is focused on one thing, and that is the patient,” he adds. “In most markets we serve, we are the only hospital and the only care provider—it's kind of a burden and an opportunity.”
Officials at large system Banner Health—another of the 15 Top Health Systems—also say clinical leadership is critical to its success.
Each year, Banner's board of directors approves areas of strategic innovations to focus energy and dollars. These areas maximize the use of Banner Health's technology investments, says Dr. John Hensing, Banner's chief medical officer.
For instance, the system tackled the deadly problem of sepsis two years ago by starting to flag at-risk patients through its electronic health-record system. An early alert system was created to identify patients most likely to develop the serious bloodstream infection. As a result, Banner Health has seen a substantial improvement. Out of all identified patients at risk of sepsis, 92% leave the hospital alive, Hensing says.
“It's a combination of having clinicians respond promptly, creating a protocol of early intervention and using EHR technology to reduce overall mortality and improve outcomes,” Hensing says.
Once Banner identifies an area to improve patient care, it can rapidly deploy it throughout its 26 hospitals. “Implementation is not optional,” Hensing says. An example is preventing unnecessary radiation exposure by limiting CT scans in patients complaining of headache but with absence of trauma. Clinicians can override this rule and still order the scan, but the new policy has resulted in significantly fewer scans. Since March, more than 1,300 CT scans have been reconsidered and canceled throughout the Banner Health system.
“It's doing a very good service to patients and taken a load off our radiology department as well,” Hensing says.
