Mediocre outcomes are no longer tolerable. That's the message that 11 executive leaders from hospitals and health systems, including Cleveland Clinic and Geisinger Health System, had for their peers.
In an Institute of Medicine discussion paper released yesterday, the health leaders shared their top 10 strategies for system-wide transformation that revolve around the organization's foundation, infrastructure, care delivery priorities and feedback:
1. Governance priority
2. Culture of continuous improvement, in which the organization is committed to ongoing, real-time learning
3. IT best practices, in which the organization uses automated, reliable information to and from the point of care
4. Evidence-based protocols
5. Resource utilization to optimize personnel and physical space
6. Integrated care, in which patients receive the right care in the right setting by the right providers who have the right teamwork
7. Shared decision-making, in which the patient and clinician collaborate on care plans together
8. Targeted services, in which patients who use the most resources receive clinic or community interventions
9. Embedded safeguards to cut down on injuries and infections
10. Internal transparency, in which the organization shares progress on performance, outcomes and costs
The health executives said they found these strategies to be most effective in improving quality and reducing costs but noted that it's more of a "credo of commitment than a simple checklist."
For example, in its commitment to shared decision-making, Cleveland Clinic improves patient and family engagement. Caregivers and patients have daily "huddles" about the patient's progress and a care plan, which Cleveland Clinic attributes to a 1.5-day drop in the average length of stay, a 3 percent improvement in 30-day survival and a 6 percent reduction in the total cost of care, according to the paper. Even more, patient satisfaction with clinician communication went up by 28 percent.
In another example of teamwork, Partners HealthCarein Boston works with multiple departments to ensure that patients are getting the right medication. At Brigham and Women's Hospital, Partners implemented a barcoding system in which pharmacists scan all medications before dispensing to make sure they match the physicians' orders. The nurses at the bedside then scan the medications prior to administering them. Partners said the barcoding system has cut down on serious medication-administration errors by 31 percent and saved $3.3 million in cumulative five-year savings.
The health leaders noted that the checklist strategies aren't "one-and-done." They wrote, "Rather, the items we present here are elements that must become core components of an organization's DNA."
They see the strategies as opportunities--rather, obligation--to cut costs and improve care.
"Ultimately, the transition to high-value care will be led and championed by executives who recognize high quality and lower cost as institutional aims, and will be sustained by a system-wide culture of continuous improvement," they wrote.
For more information:
- here's the IOM summary
- check out the discussion paper (.pdf)
Fierce Q&A: Cleveland Clinic CEO dishes on his expansion goals
Hospital checklists cut readmissions, Medicare costs
Checklist cuts surgical infections in half