Hospital achieves consistent success
How it made the Top 100 list five times
Out of the 5,800 hospitals in the country, which is the best? Your answer probably depends on the criteria you use to measure the hospital and the peer group against which you measure it. But for nearly two decades, Thomson Reuters has put out a list of the 100 Top Hospitals, and while none is named "best," the list is certainly the cream of the crop.
Scripps Clinic and Green Hospital in San Diego has made the list five times, including in each of the last three years, says Maida V. Soghikian, MD, FACP, FCCP, medical director, performance improvement and associate program director, internal medicine residency program at the 173-bed teaching hospital in La Jolla, CA. It was one of just a handful of California hospitals named to the list.
Soghikian thinks the culture of the hospital is part of what sets it apart. While all hospitals aim to provide patients with the best possible care, "we have learned how to effectively and efficiently design teams that are able to use scientific data to develop excellent processes," she says. "We work hard to identify champions amongst our staff and medical staff who not only help motivate, but are also critical to defining sustainable work flow." With that kind of "high-level engagement" and performance oversight, they are able to identify breakdowns and opportunities to improve.
The hospital uses standard performance improvement methodology — emphasizing the Plan, Do, Check, Act process, and reviews metrics every year to determine if the facility leadership needs to modify its focus, she says. "These reviews are critical not only to ensure that we remain in line with our own facilities' needs, but also that we are aligned with Scripps Health and current healthcare requirements." Once they determine the metrics for the year, they focus on achieving 100%, rather than just exceeding state or national norms. They set high goals and assign responsibility and ownership for specific indicators and processes to ensure that someone is accountable for meeting the goals.
Being named one of the 100 top hospitals validates that the facility's commitment to the provision of high-quality patient care, and its methodology is on track with national benchmarks and the performance of other leading facilities, says Soghikian. "In other words, we can see that our efforts are working, particularly after receiving this award in consecutive years. In these challenging economic times, it also reflects our ability to do more with less. This is truly a motivator for our staff and medical staff, particularly when we reflect on the impact our performance has on mortality, morbidity and patient safety."
It is different winning it the fifth time than the first, she says. Initially, the entire staff celebrated because they had been working to evolve quality metrics and performance improvement. It was something that encouraged them to keep moving forward. But being repeatedly awarded — especially the last three consecutive placements on the list — is "more powerful," says Soghikian. "Our care was consistently and reliably outstanding; therefore our message of commitment and clinical excellence had really sunk in to all of our providers."
Scripps Green Hospital meets or exceeds national norms and even the rates of peer hospitals for many of the data points used to create the top 100 list. Some of the areas are still things that give Soghikian and her colleagues pause — like reducing heart failure readmission rates. "That work continues," she says. "We certainly want to improve on all of the readmission measures and focus on identifying any potentially preventable reasons for patient readmissions. As we drill down on the readmission data, we hope to develop additional processes to keep our patients and their primary caregivers well informed of their medications, their next appointments and what to do if they are not improving."
Strategic objectives
Making the list is not on her mind every year, but the data the list makers use is something that should be at the forefront of any quality improvement and patient safety goal list. "We do not try to reinvent the wheel each year. We know that many national awards and report cards focus on evidence-based guidelines." So every year, they review the patient population, any new procedures, any new high-risk, high-volume, or problem-prone conditions, and determine if there should be additional review. The leadership team looks at Scripps Health's strategic objectives so that their goals align with the hospital's, and they evaluate any new or changed regulatory or reporting requirements. They also look at the issues that quality, safety, and regulatory agencies and organizations are looking at to see if they missed something. Only after all that is done do they develop the plans and priorities for the hospital.
This fiscal year, they have focused on a long list of issues:
- Joint Commission core measures;
- readmission rates;
- hospital-acquired infections;
- venous thromboembolism (VTE) prophylaxis;
- turn-around time for imaging studies;
- glycemic control;
- operating room safety;
- patient satisfaction.
"We also routinely look at our registry and national databases including NSQIP, ACC, STS, UNOS, and FACT, which provide outstanding benchmarked data to demonstrate our performance," she says.
She is particularly happy with the progress made on VTE prevention. "We have been working with the nurse managers on the units to get them involved in the process of evaluating patients for VTE prevention," Soghikian says. "Our goal is that all patients with a length of stay over 24 hours will be evaluated by a physician and a nurse for preventive measures. If not indicated or contraindicated, we request that the physician document this."
When Scripps Green started the process, the performance on this was just 68%. Now, there is 100% compliance on the telemetry floor, as well as the surgical and medical units. "The next steps are to implement the process in other units and to evaluate if there is an associated outcome benefit."
With results like that, being named a top hospital is just icing on the cake.
For more information on this topic, contact Maida V. Soghikian, MD, FACP, FCCP, Division of Pulmonary and Critical Care Medicine, Medical Director, Performance Improvement and Associate Program Director, Internal Medicine Residency Program. Scripps Clinic & Green Hospital, La Jolla, CA. Telephone: (858) 554-9100.
How do they pick the 100 Top Hospitals? There are some 3,000 hospitals whose data are checked and measured to come up with the 100 Top Hospitals list each year. If every hospital performed as well as those on the list, there could be 186,000 lives saved, 56,000 more complication-free patients, half a day less in the average length of stay and some $4.3 billion saved, according to Thomson Reuters. This year, it helped to be from Texas, California, or Florida, which had a disproportionate number of winners. Many states had none at all. The winners all do better in mortality rates — by about 8% in small hospitals and 3% in large teaching facilities — complication rates (5% less than expected, while non-winners had 1% more than expected), and better 30-day mortality and readmission rates. Winners follow evidence-based protocols better and more often than non-winners. They have some 18% fewer adverse events than those who do not make the list, and in small hospitals, the difference is even greater, with winners having nearly a third fewer adverse events than the small hospitals who did not make the cut. From a consumer perspective, being at a better hospital does not appear to mean you'll pay more. Indeed, the better performing hospitals charge $464 less than non-winners, and large community hospitals have the lowest expenses among the winners. Patients had the best experiences at the winning hospitals, too, with small community hospitals doing the best on their Hospital Consumer Assessment of Healthcare Providers and Systesms (HCAHPS) scores. The metrics used by Thomson Reuters to compile the list for 2012 were:
The report overview can be viewed at 100tophospitals.com/assets/100TopHospitals_National2012.pdf. |
Out of the 5,800 hospitals in the country, which is the best? Your answer probably depends on the criteria you use to measure the hospital and the peer group against which you measure it.
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