According to a recent report sponsored by the Commonwealth Fund and conducted by the Economic and Social Research Institute, hospitals with consistently good performance records have a number of things in common.
The report, Hospital Quality: Ingredients for Success-Overview and Lessons Learned, identifies four top facilities (chosen from 200 identified in a total pool of almost 2,700) that represent hospitals that deliver consistently high-quality care while managing to control costs: Beth Israel Deaconess Medical Center in Boston; El Camino Hospital in Mountain View, California; Jefferson Regional Medical Center in Pittsburgh; and Mission Hospitals in Asheville, North Carolina. The following factors were identified as essential to their success:
* instilling a supportive culture
* attracting and retaining the right people
* establishing an efficient quality improvement (QI) process
* investing in the right tools
Not only do the hospitals try to recruit the most qualified clinicians, they also work hard to retain them. Jefferson Regional, for example, has established a nurse-to-patient ratio that it will not violate, not even when faced with operating deficits and a negative cash flow-as it was a few years ago (the hospital managed by cutting administrative expenses).
Respect among employees is also emphasized at these hospitals: physicians view nurses as peers, and they not only welcome nurses' input, they expect it. At El Camino, for example, if physicians are disrespectful to nurses, they are given warnings; if the warnings are ignored, the physicians lose staff privileges.
The hospitals also have stringent QI processes that enable them to measure success, recognize pitfalls, and come up with ways to improve performance. External standards such as those imposed by the Joint Commission on Accreditation of Healthcare Organizations mean little at these hospitals because their own internal standards far surpass external ones. QI is part of everyday practice, and all members of the staffs-from CEOs and managers to nurses and physicians-take part in it. At Mission Hospitals, for example, the CEO emphasizes QI at every orientation for new employees. And Jefferson is willing to absorb the cost of "denied" days when necessary, meaning that no patient will be discharged until his clinicians believe that discharge is appropriate.
Abiding by the philosophy that even the most qualified people cannot perform optimally unless they have the right tools at their disposal, these hospitals regularly update their equipment. At El Camino, patient records can be instantaneously transferred from one department to another, so clinicians don't have to waste time tracking down test results. The hospitals also provide opportunities for the staff to network, attend conferences, and receive additional training and education. Jefferson offers a six-week mentoring program to nursing students, compensating them with $4,000 toward tuition in exchange for two-year commitments. It also funds nurses who wish to pursue specialties (half of the nurses on the oncology unit, for example, are certified in oncology).
The researchers provide a list of recommendations to help hospitals improve performance. The full report can be accessed at http://www.cmwf.org/programs/quality/761_Meyer_hospital_quality_overview.pdf. -Dalia Sofer