Readers talk back on hospital innovation

My last column--in which I offered some comments on hospital innovations by physician-author Dr. Richard Reece--spurred some interesting feedback from readers. So this time around, I thought share some of the detailed and thoughtful commentaries with you in a series of columns. Here's a physician's great story of how one hospital rethought its total joint replacement approach, to great success:

In 1999, as a result of continued frustration over making changes in our TJR pathway at my old hospital, I moved my practice to (Missoula, MT-based) Community Medical Center (CMC), a 100 bed hospital which had a supportive administration for innovation and wished to start a TJR program. At that time they were performing 60 TJRs annually.

With the hospitals staff's involvement (we had extensively trained everyone over the preceding three months in our patient-focused approach to TJR care) and senior administration support, we developed a TJR pathway that generated the following outcomes the first week we worked together:

• 98 percent of all patients went directly home without any intermediate stays in rehab or nursing homes (vs. US averages where only 40 to 65 percent were discharged directly home).
• Only 2 percent of all patients who went directly home required any outside assistance from home health physical therapy or nursing
• The average length of hospital stay was reduced to 2 days (vs. US averages of 4 to 5 days).
• Patients on average returned to independent walking and activities of daily living 30 days faster than traditional TJR.
• Over 90 percent of our patients claimed their care was the best or better than average when compared to previous admissions.
• Nursing and physiotherapy productivity increased by over 100 percent.
• My own personal productivity increased 300 percent.
• For the first time, the hospital was profitable doing TJR cases for even Medicare and Medicaid patients that pay on average 92 percent of costs.

Over the next three years CMC became the preferred hospital for TJR in Missoula. We won national awards for quality improvement from JCAHO, USA Today and the Rochester Institute of Technology. Within five years, the hospital had increased its TJR procedure volumes six fold to over 420 cases a year.

No doubt, there are several lessons to be learned from this tale, not the least of which being that when processes work better, clinicians are not just more productive, they're actually happier. It also makes the point--which always bears repeating--that the effort worked because the hospital's senior management were supportive and involved. All told, the final result seems like a win for everyone involved.

In upcoming weeks, look for more stories and comments on the hospital innovation process, plus the strengths and weaknesses of various approaches. And please feel free to keep things moving with more stories of your own! - Anne

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