For the 100 Top, average length of stay was less than 4 1/2 days, compared with nearly five days among peers not on the list. Their inpatient expense per discharge totaled $5,548, 10% lower than the peer group's average of $6,172. Hospitals on this year's list also outperformed on profits, with an average operating profit margin of 14.2%, compared with 3.7% for hospitals not on the list.
In addition to its 100 Top roster, Truven also compiles an annual list of Everest Award winners, a subset of hospitals that are included in the 100 Top and have also met a national target for rate of improvement over five consecutive years. “These hospitals have managed to reach benchmarks for achievement and for sustained improvement,” Chenoweth says. “That's not easy to do.”
This year's list of Everest Award winners features 17 hospitals, ranging in size from large teaching hospitals such as 919-bed University of Michigan Helth System to small community hospitals such as 55-bed Mercy Hospital Grayling (Mich.).
Advocate Lutheran General Hospital, Park Ridge, Ill., also an Everest Award winner, makes its 14th appearance on the 100 Top list this year. Anthony Armada, president of the 624-bed hospital, attributes Advocate Lutheran's success to a number of factors, including high scores on patient experience—as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey, or HCAHPS—physician engagement, efficiency and financial performance.
For instance, the hospital's costs per adjusted discharge have fallen for four years running, a trend that Armada says aligns Advocate Lutheran with one of the main drivers of the healthcare reform law.
“No one in our hospital would say that we're doing what we do to cut costs,” Armada says. “But what we have found that improving quality is cost effective, and at the end of the day, we've also been able to increase our market share.”
Advocate Lutheran's emphasis on care coordination has also helped the hospital to achieve a 30-day readmission rate of 8.2%, far below the national average of roughly 19%. The hospital has implemented a number of strategies to improve transitions of care, such as the use of health coaches for tough-to-treat patients with multiple chronic illnesses.
The hospital recently took its quality-improvement efforts to the next step when it chose to participate in the Malcolm Baldrige Performance Excellence Program, which relies on set criteria to spur innovation and improve organizational performance.
“We don't get comfortable—we're performing well on several fronts but we want to be a high-reliability organization,” Armada says.
Woodwinds Health Campus, an 86-bed hospital in Woodbury, Minn., made the 100 Top list for the third time this year.
Scott North, senior vice president and president of acute-care hospitals for four-hospital HealthEast Care System, Woodwinds' parent organization, says much of the credit for the hospital's high scores can be traced to a dominant culture of continuous improvement and patient-centeredness. The hospital opened its doors in 2000, affording hospital leaders the opportunity to plan out each detail of the new facility and seek out a staff that had a similar vision.
“There are not a lot of chances to build a brand new hospital and define the culture and philosophy you want from day one,” North says. “For us, it started with connecting with the community and finding out what they wanted. That happened before any shovels were put in the ground.”
The result is a facility on 32 acres of wetlands “that doesn't look like a hospital,” North says. Appearance isn't the only difference, he says, adding that Woodwinds emphasizes health and wellness as much as treating acute conditions.
“HealthEast has traditionally been a hospital-centered organization and now we're becoming more of a continuity-of-care provider,” North says. “It goes hand-in-hand with health reform, but it's also the right thing to do.”
Woodwinds also appears for the first time on Truven's list of Everest Award winners, a designation that North credits to rapid improvement in overall financial performance and efficiency, among other areas.
This year also marked the first time that Mercy Hospital Grayling made the 100 Top roster. The 55-bed hospital, located in a rural Michigan town of just over 1,800 people, has balanced thin margins common to such hospitals with a series of ambitious improvement projects.
For instance, the hospital created unit-based councils that focus on patient engagement and improved care coordination. Stephanie Riemer-Matuzak, the hospital's CEO, says the councils' work has led to more multidisciplinary rounding and has ensured that every patient receives a visit from a care manager before discharge.
The hospital has also experienced marked progress in obstetrics quality after participating in a perinatal safety initiative in 2012. Those improved outcomes are especially important, Riemer-Matuzak says, because the hospital's number of annual deliveries spiked from 300 to 400 in recent years, after the closure of a nearby hospital.
Mercy Hospital Grayling was also recognized as an Everest Award winner for its five-year rate of improvement. Riemer-Matuzak says she was surprised to learn that the hospital would appear on both lists for 2013, but she saw the news as hard-won recognition after years of sustained effort. She also attributed much of the hospital's success to the guiding efforts of its parent system, 35-hospital Trinity Health, Livonia, Mich.
“I think for a small, rural hospital like ours, one problem is managing the number of initiatives, because there are always new ones,” she says. “But if you have a great process in place for managing those initiatives, if you're measuring those metrics and if associates understand the goals, it becomes much easier to achieve.”