Making their mark

In 2010, overwhelmed by a deluge of performance data coming from both internal and external sources, officials at the University of Michigan Health System formed a 25-member clinical quality committee charged with gathering all the information in one place and parsing out top priorities for the 919-bed medical center.

Made up of physicians, nurses and administrators who meet monthly, the committee collects and analyzes quality data from the CMS' Hospital Compare, the state's hospital association, various collaborative initiatives with Blue Cross and Blue Shield of Michigan and other sources.

“It's a huge amount of data, and it can sometimes feel like you're drinking from a fire hose,” says Dr. Darrell Campbell, a professor of surgery and chief medical officer at UMHS.

“Before we formed the committee, we had well-meaning but redundant efforts in some areas and we were missing things in others. This gave us a way to centralize the data and become much more effective and organized.”

With the committee in place, the health system was able to more efficiently target a number of quality and safety problems, including high rates of ventilator-associated pneumonia on a particular unit or foreign bodies retained after surgery. The committee formed teams tasked with analyzing data, identifying evidence-based strategies and evaluating whether hospital staff employs best practices in the problem-plagued areas.

A year later, the health system instituted medical team training in its operating rooms, protocols that include the use of checklists, verification and improved communication. Medical team training, currently in use by many hospitals across the country, was shown in 2010 to have reduced surgical mortality by 18% in a group of 108 Veterans Health Administration hospitals.

It's those changes, among others, that Campbell credits with helping the health system secure a place for the eighth time on Truven Health Analytics' 100 Top Hospitals: National Benchmarks for Success.

Now in its 20th year, the list recognizes 100 high-scoring hospitals from a field of 2,922, based on performance across mortality measures, 30-day readmission rates, average length of stay and a number of other measures.

Formerly known as the health business of Thomson Reuters, Truven Health Analytics was formed in June 2012 when Thomson Reuters sold its health division to Veritas Capital, a New York private equity firm, for $1.25 billion.

Truven released its 100 Top Hospitals list for 2013 exclusively to Modern Healthcare.

Among this year's honorees are several hospitals that have made the list repeatedly, such as 659-bed Baystate Medical Center, Springfield, Mass., which has appeared 16 times; 395-bed St. Thomas Hospital, Nashville, which made the list 12 time; and 199-bed Licking Memorial Hospital, Newark, Ohio, which has made the list 11 times.

This year's list also features 18 first-timers, including 409-bed Presbyterian Intercommunity Hospital, Whittier, Calif., and 80-bed Lovelace Westside Hospital, Albuquerque.

Truven identifies each year's 100 Top Hospitals by analyzing publicly available claims data from the Medicare Provider Analysis and Review (MedPAR) dataset, the CMS' Hospital Compare database and Medicare cost reports. Eligible hospitals are divided by size into five categories: major teaching hospitals, teaching hospitals, and large, medium and small community hospitals.

Within each of those five categories, hospitals are evaluated against their peers on 14 measures, such as 30-day mortality for heart failure, inpatient expense per discharge, complications and patient experience. To make the 100 Top list, hospitals must rank above their peers on a composite score of all 14 measures and must also score above the median for each measure.

Any hospital that lost money during the preceding year, based on Truven's analysis of cost reports, is out of the running, says Jean Chenoweth, Truven's senior vice president of performance improvement.

According to Truven's national comparison data, the 100 Top outperformed peer hospitals across all 14 measures. They had 7% fewer patient deaths and 6% fewer complications than expected, considering the severity of their patients. On the other hand, peer hospitals not on the list, in the aggregate, had expected rates of mortality and only 1% fewer complications than expected.

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.”