Multi-hospital health systems: Best practices for high-quality care

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What makes a high-performing healthcare system tick? More than half of all U.S. hospital admissions occur in the 200 largest hospital systems (a system has two or more general acute-care hospitals), so the answer to this question can have a considerable impact on the quality of care nationwide.

Success isn't tied to the specific practices that system leaders employ to improve care. Rather, high-quality care is directly linked to "the execution of those practices and the creation of a culture that supports performance improvement," says the Chicago-based Health Research & Educational Trust (HRET) in a new study. With the support of The Commonwealth Fund, the HRET analyzed publicly available quality data and interviewed leaders of 45 multi-hospital health systems to identify three themes, four best practice categories and 17 specific best practices associated with high performance.

The first identified theme is that no single type of system has a stranglehold on high performance, says the HRET. In fact, multiple system types achieve high quality scores, including large and small systems, regional or multi-regional systems, systems anywhere in the United States and systems with different levels of teaching components. Second, no single factor leads to high performance. The HRET examined 50 system factors, and no factor "clearly separated" high-performing systems from lower-performing ones. Finally, creating "a culture of performance excellence, accountability for results, and leadership execution are the keys to success," says the HRET.

The following excerpt identifies the best practices established by the HRET:

1. Establish a system-wide strategic plan with measurable goals:
  
a. Set both measurable short and long-term goals.
  
b. Set goals for quality and safety based on the pursuit of perfection rather than improvement. 
  
c. Link the system's quality goals with its operational and financial goals.

2. Create alignment across the health system with goals and incentives:
   a.
Establish system-level quality steering/oversight committees to provide direction to system leaders in setting system-wide goals and aligning them with all hospitals. 
   b.
Embed health system goals into individual hospital leaders' goals.
   c.
Link annual bonuses for system and hospital leaders to performance targets in the system's key strategic areas.
   d.
Align incentive pay and/or accountability for achieving system-level quality and patient safety targets into contracts with physicians.
   e.
Align emphasis on culture with efforts to understand and improve it.

3. Leverage data and measurement across the organization:
   a.
 Use an "all or none" or "perfect care" approach to set targets for all performance measures.
   b.
Consider setting targets based upon event counts (numerator) as well as rates.
   c.
Share dashboards with hospital leaders and staff frequently to identify areas in need of improvement and then take immediate actions to get back on track.
   d.
Post dashboard information on the system's intranet.
   e.
Engage in national benchmarking initiatives to achieve greater transparency as well as foster healthy competition between hospitals.
   f.
Utilize corporate support through data mining of existing information systems, frequent analyses, and reporting of measures for hospital-level performance improvement. 

4. Standardize and spread best practices across the health system:
   a.
Establish a process to identify and select practices for standardization.
   b.
Use ongoing education and skills development to spread best practices. 
   c.
Effectively disseminate best practices across the system.

To learn more about the HRET's findings:
- read "A Guide to Achieving High Performance in Multi-Hospital Health Systems"