All Entries in the "Hospital rankings" Category
Transparency… are we there yet?
Apparently not. Public reporting of surgical site infections is required in only eight states. That fact was brought to light by a new Johns Hopkins University report, which calls for more reporting. Lead author of the report, Martin Makary, MD, notes that patients still have little information when choosing hospitals.
Personally, I think the bigger issue is that public reporting gives hospitals, from the top down, a real push to do better. I think Makary does too:
“Nothing motivates hospitals to improve quality and listen to their front line staff like public reporting,” he says. “In order for the consumer to interpret publicly reported SSI rates, it is imperative that the data be collected and reported in a standardized manner,” he and his co-authors wrote.
I would have to agree. Surgical site infections not only result in 8,000 deaths a year in the U.S., they occur in 4% to 25% of patients who undergo major surgical procedures, and their cost to the healthcare system is about $10 billion annually (these stats are mentioned in the report and come from other studies).
Makary calls out state hospital associations for not supporting public reporting. What do you think? Is public reporting the way to change hospital culture?
Is it time to stop duplicating reporting efforts?
Interesting turn of events this week. The Cleveland Clinic, Henry Ford Hospital in Detroit, and Parkview Health in Fort Wayne, IN, have all ceased to report hospital-acquired infections to the Leapfrog Group, a nonprofit organization in Washington, D.C.
According to Consumer Reports, the three health systems fall in different spots for bloodstream infections—something Consumer Reports previously analyzed. One did better than average, one about average, on under average.
The hospitals’ reason for the end to Leapfrog reporting was that they now report to CMS on the same or similar measures, and must end duplicate efforts to reduce waste of resources.
What do you think? Do you think the private nonprofit reporting group will soon be a thing of the past?
Learning from the Ritz
Yet another company outside the field of healthcare has offered its services to teach hospitals something about customer service and excellence. Of course, the customers in healthcare are patients, and taking care of them is different than taking care of customers.
Still, we’ve seen Disney offering lessons to healthcare institutions, and now the Ritz-Carlton. Erlanger Health System in Chattanooga, Tenn. signed a $388,000 contract with the Ritz to help the hospital change its culture to service excellence.
What do you think? Is this a passing fad? Or is this the beginning to really focusing on patient satisfaction and service excellence in healthcare?
Money can’t buy you love
It turns out the elusive patient satisfaction craved by most hospitals can’t be bought, or at least, not by throwing money toward environmental services. (Questions regarding environment are specifically asked on the HCAHPS survey, including whether patient bathrooms and rooms were kept clean and how quiet the room is, and of course a patient may consider such factors when answering questions regarding overall experience.)
Patients, like hotel guests, often sleep in the same room for quite some time and it would be rational to tie cleanliness and maintenance costs to patient satisfaction. But Penn State researchers say it ain’t so—well, not exactly. Like most things, it depends how the money is spent.
The amount of money spent matters less than efficient operational processes and the service provided behind them, according the press release.
I might have to put this in the obvious column. If leaders don’t ensure higher costs lead to a thoroughly and quickly cleaned, scores won’t be any higher. But it was curious to see environmental services studied for HCAHPS. Does your hospital focus on this aspect of patient satisfaction? Should they?
Post thoughts below.
How does your hospital’s patient safety culture compare?
The Agency for Healthcare Research and Quality (AHRQ) has released Hospital Survey on Patient Safety Culture: 2011 User Comparative Database Report. You can compare your hospital’s culture to 1,032 others in the U.S.
The survey was developed in 2004 to help hospitals assess their patient safety culture in 2004. The first benchmarking database was released in 2007 and included data from 382 hospitals.
Out of 472,397 staff working in these hospitals, teamwork within units had the most positive response (80%). Most also rated their hospital well in regard to managers listening to input from staff about patient safety and praising staff for following patient safety protocol (75%).
Staff did not rate their hospitals as well when it came to creating a nonpunitive response to error (44%), or implementing safe handoffs and transitions (45%).
Interestingly, 54% of respondents, on average, reported no adverse events in their hospital over the past year, an indication of possible underreporting.
The survey results urge me to do a bit of promoting of two books I truly think readers might have interest in:
First is Creating a Just Culture: A Nurse Leader’s Guide. The authors go into detail about what it actually takes to create a nonpunitive culture (hint: it’s not easy, but in time it can be done!). It’s an easy read that provides sample incident reporting policies, a sample just culture principles document, case scenarios, advice on disclosure, and more.
Second is Occurrence Reporting: Building a Robust Problem Identification and Resolution Process. What’s to love about this book? It takes the overwhelming process of event reporting and whittles it down, giving advice on which events to collect, which events to focus on, how to implement a system that staff actually use, how to make sure actual, quality improvement actions come out of all the work, etc.
Okay, I’ve said my piece. Now say yours: Does this report surprise you? Does your hospital leadership let you know where you stand, comparatively? What’s holding up nonpunitive culture and event reporting? Share your thoughts below.
Is Disney aiming to make your hospital the happiest place on earth?
The Disney Institute, which helps apply universal Disney best practices to other organizations, has announced a professional development program to help hospitals increase their patient satisfaction, called “Building a Culture of Healthcare Excellence.” The program focuses on helping managers create methods to ensure the entire patient experience–not just clinical outcomes–is a positive one.
With HCAHPS scores now publicly posted (and reimbursement tied to doing so), I expect we might see more of these programs in the future. But only the test of time will tell whether consumers actually use Hospital Compare, the public website that offers such data, to lead their decision-making when choosing hospitals. I imagine if they do visit the site, HCAHPS scores might the easier to understand than other publicly posted measures that are focused on clinical outcomes, and as a result, gain more attention.
I should note, however, that the site is certainly easier to navigate and understand than when first launched a few years ago. It’s now easier on the eyes, includes easier navigation, and offers patient help tools like maps to hospitals, an option to make hospitals “favorites,” and short descriptions of measures and what results might indicate.
Also, as mentioned in an earlier post, local news outlets have begun in earnest to inform the public that these data and resources are available to them.
Still, I suppose time will tell how this public reporting affects the way hospitals operate. Have you noticed patient satisfaction become a more highly prioritized goal in your organization? Where is it compared to five years ago? Where do you think it will be in five years from now? Share your thoughts below.
New CMS final and proposed rules address HACs, transparency
Last week, The Centers for Medicare & Medicaid Services (CMS) issued the final rule on reducing or prohibiting payments to providers for hospital-acquired conditions (HAC). The new rule will better align Medicare and Medicaid payment policy and give states flexibility to add to the federal list of HACs. This rule specifically prohibits states from making payments to providers under the Medicaid program for HACs, using the current list of HACs under the no-payment Medicare rule already in place.
The final rule is effective July 1, 2011 and gives states the option to implement its effective date July 1, 2012.
View the press release and the list of reduce or no-pay HACs.
In other CMS news, a new proposed rule would allow Medicare and private sector claims data to be used to produce public reports that evaluate the performance of physicians, other healthcare providers, and suppliers. Organizations seeking such Medicare information would have to undergo an application process and be continually monitored by CMS.
To prevent mistakes, the proposed rule requires that any reports generated from the Medicare data be shared confidentially with providers and suppliers before being released to the public. Publicly released reports would contain aggregated information only, meaning that no individual patient/beneficiary data.
“Performance reports that include Medicare data will result in higher quality and more cost effective care,” CMS administrator Donald M. Berwick, MD, said in a statement.
For more analysis, visit HealthLeaders Media.
The proposed rule will be published in the Federal Register on June 8, and the CMS will accept public comments for 60 days. Until June 8 the proposed rule is available here.
Engaged leadership = lower mortality rates among heart attack patients?
Yale University researchers decided to investigate why some hospitals had vastly different mortality rates among heart attack patients, even after figures are adjusted for severity. Through site visits to 11 hospitals, which included both the best and the worst rates according to the Centers for Medicare & Medicaid Services (CMS), researchers found the hospitals differed in five major areas:
- Organizational values and goals
- Senior management involvement
- Broad staff presence and expertise in AMI care
- Communication and coordination
- Problem solving
Strong communication across departments and maintained leadership involvement were displayed in the high-performing hospitals, according to the Yale University press release. The lead author of the study, Elizabeth Bradley, PhD, noted that these “essential ingredients are not expensive.”
What do you think? Is this the mix to successful clinical outcomes?
Team-building program decreases surgical deaths
Hospitals are learning about team building programs in the OR from the aviation industry and NASA to avoid surgical deaths.
A new study showed surgical death rates could decrease if operating room staff used team-building exercises similar to the ones used by airlines and NASA, reports Health Day. The Medical Team Training program enlists operating room staff to talk about potential problems before surgery, administer important checklists, and then evaluate the positive and negatives occurrences after surgery.
There were 182,000 patients who underwent surgery in one of the 108 Department of Veterans Affairs (VA) hospitals that were researched in the study from 2006 and 2008. Of those hospitals, 74 were executing the Medical Team Training program, according to Health Day.
The study showed that after one year, surgical deaths at hospitals using the program decreased 18%, whereas hospitals that were not using the program decreased 7%.
Surgical errors are caused by lack of effective communication, according to James Bagian, MD, chief patient safety and systems innovation officer for the University of Michigan Health System, in Ann Arbor, MI. Bagian is the senior study author and a former astronaut.
Bagian also noted that the physicians in charge of the operating room tend to think of themselves as good communicators, although the rest of the OR staff doesn’t always agree. The Medical Team Training program allows OR staff to get together before and after the surgery to discuss what went wrong to avoid future errors, Bagian told Health Day.
Data sharing project boosts patient safety and decreases spending
Hospitals throughout Michigan have helped decrease complications from surgery by compiling a data sharing project that helps 16 Michigan hospitals share information on keeping surgical patients safe.
The University of Michigan Health System collected date from more than 35,000 Michigan patients that went through some sort of vascular surgery from 2005-2007, reports iHealthBeat. The complications patients went through were then compared. The study found that since the data sharing project started, complications from surgery dropped from 10.7% to 9.7%.
According to iHealthBeat, the data sharing project helped reduce post-surgery rates of:
- Blood infections;
- Cardiac arrest;
- Prolonged ventilator use; and
- Septic shock.
Other than improving surgical related complications, the study also found a decrease of 1$3 million in spending.
Read the rest of the article on iHealthBeat.
Does your healthcare facility have a similar project that increases patient safety? Let us know in our comment section!
