Access to data was critical for the orthopedic surgeons at St. Luke's Health System in Boise, Idaho, when they launched a project to eliminate hospital-acquired infections in 2011.
It enabled them to routinely monitor the system's infection rate after knee and hip replacement surgeries, laminectomy procedures and spinal fusion surgeries. The team used data to reduce foot traffic in operating rooms and change how patients' skin was prepped.
Data availability encouraged them to launch their Project Zero campaign. And in the past two years they've reduced the hospital's infection rate from 1.08 per 100 procedures to 0.57 per 100 procedures.
Dr. David Pate, CEO of St. Luke's Health, said the Project Zero program was an initiative the orthopedic surgeons began themselves. By allowing physicians to access data easily at any time, the culture shifted to one that motivated staff to develop their own goals.
“Real progress is done at the service level,” Pate said. “They look at their specific data, and they set goals for themselves. It really moves the dial more broadly toward organizational goal-setting.”
Fostering a culture of transparency on performance measures is one of the key strategies used by St. Luke's and the other health systems that made this year's list of Truven Health Analytics' 15 Top Health Systems. But implementing changes to improve quality in an evolving healthcare reimbursement landscape is a challenge for the health systems, their leaders acknowledged.
Truven's best performing systems include the top five from three categories based on operating expenses: large systems generating expenses of more than $1.75 billion; medium-size systems generating between $750 million and $1.75 billion; and small systems with less than $750 million in operating expenses.
The 15 were selected from 338 health systems across the U.S. Each was evaluated based on publicly available government data looking at nine performance measures, including death rates, complications, 30-day readmissions and lengths of stay.
Complication rates at the top-performing systems were 15.1% lower than their peers. Mortality rates were 14.7% lower among the top-ranked hospitals.
In a new measure for this year, emergency department wait times were 12.3% shorter at the hospitals that were among the top-performing systems, according to Truven. “The emergency department is important because it's the source of the majority of admissions to the hospital,” said Jean Chenoweth, senior vice president of performance and improvement for Truven Health Analytics. “Emergency department wait time is an important metric because this is often the first contact the patient has with the organization.”
Wait times affect patient-experience scores on the Hospital Consumer Assessment of Healthcare Providers and Systems survey, Chenoweth said. Truven includes HCAHPS scores in its analysis. Top-performing systems reported 2.7% better patient-experience scores than their peers, according to the report.
For the second year, Truven included Medicare spending per beneficiary in its rankings. The percentage difference between the top health systems and their peers on Medicare spending decreased from 5.2% in last year's analysis to 4.9% this year. This likely reflects an effort by health systems nationwide to address the continuum of care, Chenoweth said.
Among the systems recognized by Truven this year, Sutter Health Valley Area in Sacramento, Calif., was recognized for the first time in the large-system category. A subsystem of Sutter Health, which also made the list, Sutter Health Valley Area operates 11 of Sutter's 23 hospitals.
To make changes, Sutter initially implements a program at one facility. After monitoring its success, the program is adopted systemwide, said James Conforti, president of Sutter Health Valley Area.
Sutter appoints physician leaders and holds staff forums on what changes are coming and why. “We work very closely with our physician leaders and nurse leaders to make sure we're taking a collaborative approach,” Conforti said.
Converting all the hospitals in the system to a single electronic health record vendor also helped the system integrate its approach.