Even in healthcare, quality is free

As the healthcare industry prepares for the implementation of the Patient Protection and Affordable Care Act, known affectionately or derisively as “Obamacare,” the issues that preoccupy top hospital and system managers range from cost-cutting to increased paperwork and perhaps most importantly, maintaining patient satisfaction and excellent care during an era of diminishing resources.

In our zeal to look for efficiencies, we can't compromise safety and quality. The American public already has some preconceived notions about what the future may hold, and there's an anxiety that pervades the industry.

A recent Rasmussen Reports poll showed that 47% of those surveyed believe the U.S. healthcare system will get worse over the next two years even though 78% rate “the overall quality of the healthcare they receive as good or excellent.”

In the popular mind, cost-cutting is associated with only one thing—less quality. But it doesn't have to be. In fact, to borrow a phrase from a popular management book published 35 years ago, “quality is free.”

That may sound preposterous, but it's not. Management consultant Philip Crosby dedicated his career to proving the success of the adage, and in the process, he changed the way U.S. companies did business.

The concept that quality is free applies to healthcare just as much as it applies to the manufacturing sector. Quite simply, when you focus on the patient and never change your focus, patient satisfaction goes up, employee satisfaction goes up, physician satisfaction goes up, errors go down, rework goes down, efficiency improves and income improves beyond that which you spent on the journey.

Bridgeport Hospital has proof of its success, and has metrics to back up that assertion.

In Washington, a commonly used term is “bending the cost curve,” and Bridgeport did that last year by reducing its cost per unit of service by .5%, from $11,780 in 2011 to $11,714 in 2012. The volume increased 5% year over year and was the highest volume increase in recent history at the hospital.

When you really improve service, the economics will follow. Patient satisfaction at Bridgeport increased 20 percentile points, physician satisfaction increased from the 53rd percentile to the 86th percentile, and employee satisfaction increased from the 75th percentile to the 86th percentile. These three service measures all improved at the same time the hospital “bent the cost curve.”

Of course, Bridgeport is not in the business just to provide service; its mission is the business of improving healthcare. Key clinical measures have improved as costs decreased.

The obvious question is “How could this happen?” The explanation is a simple one. Hospital management engaged the team thoroughly in the measures and was completely transparent about what it wanted to accomplish.

As a key part of the effort, managers emphasized accountability. Every department developed seven measures of quality that were publicized on posters not just in their break room, but also in public areas.

The departments picked quality measures that were chosen by their staff members. How well they performed was also made public.

Even at the board of directors level, Bridgeport emphasized the importance of transparency, with a program developed by the vice president of quality. I told him that if the staff was required to measure its performance, the administration should be required, too.

As a result, he produced a one-page balanced quality score card of clinical metrics with such measures as “emergency room turnaround times,” “mortality rates” and “bloodstream infections.” The quality score card, which is never more than a page long, is read at every board meeting, every staff meeting, every medical forum and every management meeting. We review the results and compare our performance in these areas with national or state benchmarks, whichever is more applicable.

In addition, as part of our quality initiative, we hold a daily safety huddle at 8:15 a.m. Every leader in the hospital, some 100 people, gather in the medical library for 15 minutes, and they remain standing while we ask ourselves crucial questions.

How many days since a serious safety event? How many days since the last employee injury? Have there been any patient safety concerns in the last 24 hours, and are any expected in the next 24 hours? Was there a great catch that prevented an error from occurring?

This safety huddle has raised the visibility of patient safety and contributed to the positive trend at the hospital. The practice is something we stole straight out of the manufacturing world.

So Crosby was right, quality is free—even in healthcare. We have proof.

William M. Jennings is president & chief executive officer of Bridgeport Hospital in Connecticut and executive vice president of Yale New Haven Health System.