What makes a top hospital?
And why aren’t there any from some states?
For the last three years, McKay-Dee Hospital — a 325-licensed-bed teaching hospital in Ogden, UT — has made the cut for Modern Healthcare’s 100 Top Hospitals. This year, they were named an Everest Award Winner, too, which is a status reserved for hospitals that have not only topped the metrics used for the list, but have had the fastest improvement. Seventeen of the hospitals were named Everest winners.
The 100 Top Hospitals list relies on metrics including mortality, 30-day readmission rates, complications, average length of stay, average cost per stay, and profit margins.
So what is it that makes a hospital that makes the list? Part of it is exceptional leadership, says Scott Saxton, the facility’s continuous improvement director. “I’ve been here for just under a year and have worked for many different industries, including mining and engineering. What I know is that companies that have the best leadership, who are passionate about driving the right things, are the ones that make these lists.” At McKay-Dee, and its parent Intermountain Healthcare, those drivers are patient-centered everything. “From the first day anyone is hired, what you hear about is how everything we do is for the benefit of the patient.”
Employees are schooled on the six dimensions of care: clinical excellence, service excellence, physician engagement, operational effectiveness, employee engagement, and community stewardship. And the excellent care? Well, the focus is on evidence-based practices, with a demand that everyone implements them the same way throughout the organization.
There is also a sense that every team member, from the custodial staff to the loftiest physician, has the potential to contribute a great idea that makes a difference to the patients and the organization. There are idea cards they can fill out, and last year, more than 4,000 were filled out. But more than just submitting an idea, employees know that the ideas will be considered. Each one is followed up on, and in a timely manner, Saxton says. “If you don’t respond to ideas, why would anyone submit one?”
There are also team huddles every day. McKay-Dee uses these to give staff performance information that many hospitals opt not to share. But giving that data gives them a sense of ownership, Saxton says, which feeds the idea machine as they strive to do better. “Front-line staff always have the best ideas. And if they don’t know where they are, continuously and in real time if possible, how do they know what they should be thinking about to improve?”
Not every hospital has the kind of high-level support for every-level inclusion, he says. In that case, start at the unit level where you have a charismatic champion who can inspire staff. Find a project that can prove this kind of engaged leadership can work. “Word travels and people get excited about success.”
Next up at McKay-Dee is leadership training designed to improve employee engagement even further. Based on Lean management theory, Saxton says they are providing managers, directors, and other leaders with new tools to help them problem solve, determine bottlenecks and obstacles, and then how to clear them. The training talks a lot about the natural flows of a hospital — like patient flow, provider flow, medication and information flow. Each of them is independent, but also dependent on each other. Showing leaders how to figure out where there are blockages should improve efficiency, work environment, and quality of care alike. “We want to figure out where the waste is — motion, over-processing, over-inspection — and get rid of it.”
Winning the Everest Award for rapid improvement this year was great, but Saxton says they still have more to do, and they don’t do it to make a list, but rather to take better care of patients.
Why not your hospital?
There are some who criticize lists like the 100 Top Hospitals because they don’t include some metrics and do include others. For example, looking for a profitable hospital might exclude one that has taken some write down for some obscure tax reason. The lack of profitable status keeps them from the list regardless of how well they do on metrics related to patient care.
There wasn’t a single hospital from the Pacific Northwest on the list, despite the region having some pioneers of quality improvement like Virginia Mason in Seattle, which pioneered the Toyota Management model in healthcare. In Portland, Oregon Health Sciences University Hospital also didn’t make the cut. But it’s not something that bothers chief medical officer Charles Kilo, MD.
“The desire for transparency in healthcare is important,” he says. “Consumers have the right to make informed choices and having access to reliable data is necessary to help them — we are very supportive of this with public reporting being an important component.”
But there are problems with this kind of public reporting, he says. Several studies show that the data used for some of these lists can be unreliable or inaccurate. That’s not to say that the data used for the 100 Top Hospitals list is inaccurate, but some data used for some reporting is. “There are no standards for the data that is publicly reported, and some of the reporting agencies won’t reveal their methods.”
That’s why you sometimes get one organization touting a hospital that another organization ignores and why really great facilities with stellar programs don’t get this or that award.
Kilo continues: “In addition, the data used in many of the ratings is quite old, sometimes several years old and therefore may well not reflect the current performance of a physician, clinic or health system. While individuals deserve information for decision making, inaccurate data simply doesn’t help — in fact, it can understandably build resistance among well-intended healthcare providers.”
He wants data available, but he’d like to see some basis for understanding the age, provenance, and validity of the data. Right now, his organization is working with the American Academy of Medical Colleges (AAMC) on the standards for publicly reported data. “Our goal is to make healthcare more transparent while making sure the public receives data it can rely on. Building trust with both the public and with healthcare providers is essential as we move in this direction.”
Modern Healthcare did not respond to a request for an interview about this year’s list and its creation.
For more information on this topic, contact:
- Scott Saxton, Continuous Improvement Director, McKay-Dee Hospital Center, Ogden, UT. Telephone: (801) 387-3705.
- Charles Kilo, MD, Chief Medical Officer, Oregon Health Sciences University Hospital, Portland, OR. Telephone: (503) 494-8311.
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