Collaborating to Achieve Highly-Reliable Care

A group of Premier member hospitals are participating in Premier's most recently launched quality improvement collaborative, QUEST® 2020, a program where shared data, insights and best practices enable members to learn from each other and implement quality, efficiency and safety improvements across their organizations. The first iteration of QUEST (from 2008-2016) enabled approximately 350 hospitals to

save nearly $18 billion and more than 200,000 lives.

MB: In today's value-based payment environment, it's more important than ever to identify gaps in care and be able to implement and accelerate change quickly. That's the beauty of collaboration across healthcare providers, and not just with providers in the same system but with peers that are experiencing the same challenges.

For example, Premier gathered a group of 350 hospitals to form QUEST, a Premier collaborative launched in 2008 aimed at improving quality, safety and costs to achieve highly-reliable care. At the start of the collaborative, members transparently shared clinical outcomes data on

critical quality, safety and cost measures. In doing so, they identified opportunity areas and pinpointed exactly who the outlying top performers were. This started a discussion around areas the collaborative needed to prioritize, placing sepsis at the top of the list for patient mortality drivers. To tackle the problem, QUEST members set up specific initiatives around sepsis, starting with implementing practices that top performing organizations already had in place. As a result of these interventions, member absolute sepsis mortality rates were reduced overall by 18 percent by the end of 2016.

These improvements represent the power of hospitals coming together to measure and compare their performance, and use data and proven best practices to solve significant problems. It's about building bridges of knowledge across the healthcare industry.

MB: The ability to share and compare clinical outcomes data with other providers is so important because we believe that there's no better way to measure how a healthcare institution is performing than to benchmark its performance against other similar institutions. Armed with this information, institutions can identify opportunities to enhance care, and if they're involved in a collaborative like QUEST, they can get best practices from those identified as top performers.

Take a group of 13 hospitals in Hawaii, for instance, that participate in a statewide initiative with the Hawaii Medical Service Association (HMSA) and Premier to improve care delivery. Through this initiative, these hospitals not only share outcomes with each other but they're also able to tap into data from QUEST hospitals across the U.S. They're working with Premier and its members to learn best practices and benchmark outcomes against top performers. This work, which takes mutual trust and transparency, has enabled these hospitals to improve patient safety by 20 percent and reduce readmission rates by 18 percent.

The more providers share data and collaborate with peers as part of their day-to-day work, the closer they get to achieving highly-reliable care.

MB: Improvements are only impactful if they can be maintained effectively overtime. At QUEST member Baptist Memorial Healthcare in Memphis, they've been able to reduce central line-associated bloodstream infections (CLABSI) rates by 90 percent over the past three years. Without a process to sustain the improvements they made in 2014, this wouldn't have been possible. This is why systemizing a sustainability plan is essential.

At Premier, we work directly with hospitals to ensure there are structured processes and communication forums built into a health system's core business so that changes and improvements are tied into the organization's culture. Keys to becoming a highly-reliable organization are to identify and empower stakeholders with clear roles and responsibilities to instill accountability; create standardized communications and review processes; and ensure that when positive outcomes are achieved there is heightened organizational awareness of the new care delivery models that have been developed, enabling organizations to connect the dots between quality improvement and cost reduction.