Truven's 15 Top systems: Consistency boosts quality

Being “in a rut” has a negative connotation for most people. But some hospital systems working to improve performance have turned that phrase into a constructive concept as they institute systemwide protocols to improve the consistency and efficiency of healthcare for patients.

OhioHealth, a network of not-for-profit hospitals and healthcare organizations in central Ohio, has established protocols—which leaders there call “good ruts”—so that no matter which of its 12 hospitals a patient walks into, he will get the same standard of care. “The 'rut' liberates the physician and allows them to focus their expertise where it is most needed,” said Dr. Bruce Vanderhoff, OhioHealth's chief medical officer.

The system's efforts have paid off. This year marks the fifth time OhioHealth is being recognized as one of Truven Health Analytics' 15 Top Health Systems. The recognition is given for high achievement in clinical performance, efficiency and patient satisfaction.

“Consistency across sites of care is terribly important as transparency increases under the Affordable Care Act,” said Jean Chenoweth, senior vice president of performance improvement for Truven. “It's a major goal of these very high-performing systems.”

This year's list of the 15 Top Health Systems, Truven's sixth annual, is again based on aggregating data for all of a system's hospitals. The 15 systems include the top five each from large, medium and small health systems across the nation. System size is based on total operating expenses.

Each system was evaluated based on publicly available government data looking at eight performance measures, including death rates, complications, 30-day readmissions, lengths of stay, a patient-safety index and Hospital Consumer Assessment of Healthcare Providers and Systems score. The data are adjusted for the illness severity of patient populations.

On average, the length of time patients stayed in hospitals run by the winning systems was 10% shorter than their peers. Small systems saw an even larger difference—a 16% difference in length of stay compared with the benchmark. The top 15 hospital systems also outperformed their peers by 8% on the patient-safety index, meaning they had fewer adverse patient-safety events. Safety performance was higher among small and medium-sized systems, which performed 14% and 11% better, respectively.

Those differences are “about leadership,” Chenoweth said. “These organizations were able to develop a culture of performance improvement across their system. It means that the management of these organizations is becoming more focused on the consistency of quality, on efficiency and on the customers.”

Eight health systems were on the list for the second consecutive year: Advocate Health Care, OhioHealth and Scripps Health, for the large health systems; Alegent Creighton Health, Mercy Health Southwest Ohio Region and Mission Health, for the medium systems; and Asante and Roper St. Francis Healthcare, for the small systems.

Leaders from several of the winning health systems said the recognition validates their efforts to improve quality and safety. “I like to set goals that really push us and are not easy,” said Dr. David Pate, CEO of St. Luke's Health System, a Boise, Idaho-based system with six hospitals.

This is the first year his system made the top 15. Pate said that when he became CEO nearly five years ago, he set the bar high by announcing he wanted St. Luke's to be a leader in quality and safety by 2015.

The system saw a “precipitous drop” in sepsis mortality when it instituted best practices, he said. System leaders encouraged each hospital to approach sepsis in a uniform manner. In their rural hospitals, they also established electronic intensive-care units, giving those facilities the ability to connect virtually with specialists at larger institutions. “Knowing that we've already achieved this level of performance, it's exciting to see where we can go next,” Pate said. “I see much more that we can do and are poised to do.”

Roper St. Francis, a three-hospital system based in Charleston, S.C., was recognized for the second time as one of the top systems in the small category. Its emphasis has been on extending care beyond the walls of the hospital. For example, when the system noticed that many HIV patients were being admitted, Roper St. Francis started providing free transportation to wellness visits, free medications delivered to patients' homes, and access to dental and mental health services at a wellness center.

Quality experts at Roper St. Francis say their system has seen inpatient death rates fall by about 10% each year since a palliative-care program was instituted to improve care for the seriously ill. Now, many of those patients receive the care they need at home.

The Truven recognition, they say, means the Roper St. Francis hospitals are on the right track. “It tells you that not only are you running in the right direction, but you're running at the right speed,” said Dr. Todd Shuman, vice president and chief quality officer for the system.

Advocate Health Care, a system of 11 hospitals in Illinois, made the Truven list for the fifth time in the large health system category. When leaders there noticed that the intensive-care unit at Advocate BroMenn Medical Center in Normal, Ill., had gone more than six years without having a single central line-associated blood stream infection, the system applied the best practice from that hospital to others in the system.

By the end of 2013, six Advocate hospitals reported having no central line-associated infections for the entire year.

“We proved to ourselves that we could get to zero,” said Dr. Lee Sacks, executive vice president and chief medical officer for Advocate. “It is about decreasing variation, adopting evidence-based practices and continuing to refine them.”

Chenoweth said the concept of “systemness”—coordinated efforts across organizations that elevate quality and provide maximum value for the consumer—has spread since Truven first began publishing its 15 Top Health Systems list. She was surprised by how different the results are today compared with six years ago. “When we first published in 2009, we didn't see very much consistency across (a system's hospitals in) the metrics we were measuring, but today these particular systems are showing a great deal of consistency and high performance,” she said. “That is good news.”

As early as next year, Truven may add new measures on cost and financial performance, including per-patient spending on Medicare beneficiaries and system operating margins. Preliminary analyses show a lot of variation among hospitals in a system on these measures, Chenoweth said.

Systems on this year's list say a key lesson they have learned is the importance of finding collaborative ways to work with doctors and nurses to identify areas that need improvement. Several systems said they identified staff members who were trusted by other staff and were seen as clinical practice leaders. These individuals, they say, not only helped identify best practices, but also led the way in implementing them. Leadership “cannot do this alone,” Pate said.

It's also important to establish a way to gauge success. “What gets measured gets done,” said Jim Skogsbergh, president and CEO of Advocate Health Care. “You can't improve on what you don't measure.”

Follow Sabriya Rice on Twitter: @MHsrice