We are often asked which organisations are achieving excellence. Across health systems there are consistent themes emerging for hospitals and healthcare systems that indicate the common methods used by leading healthcare organisations.
The problems that contribute to high costs and low quality in the UK NHS are complex and intertwined with the organization and financing of health services. There are, however, changes under way within leading organisations that suggest significant improvements in quality and value can be achieved. A study by the Commonwealth Fund into high performing hospitals in the US health system indicated commonalities emerging and highlighted some valuable lessons for UK NHS leaders.
All successful hospital leaders set clear goals for their organizations and align daily practice with those objectives. They employed widely used quality improvement strategies such as monitoring and reporting quality indicators against benchmarks to motivate providers and focus improvement resources. Each hospital also used technology to test improvement tools and provide staff with longitudinal patient information that they might use to monitor their progress.
Many successful hospitals had begun to shift a larger portion of patient care responsibility from community physicians toward a smaller team of hospitalists who are accessible full-time and can be more easily trained to adhere to best-practice guidelines. Each hospital had also recently reorganized at least a portion of its staffing assignments and roles to align provider skills and staffing levels more effectively with patient needs.
In addition, all hospitals had worked on improving provider communication during handoffs between hospital departments and transitions between inpatient and outpatient care. While technology was a part of the revised processes, more complete communication, including frequent face-to-face contact, was also deemed integral to its success.
In both clinical and support services, staff of these institutions standardized and simplified processes to eliminate redundancy, slowdowns in patient flow, and errors. At least one of the hospitals went outside the health care sector for models of managing workforce costs, standardizing and tracking supplies, and purchasing in bulk orders.
Each hospital was part of an integrated system with certain features that support efficiency, including access to patient information across settings and over time, economies of scale, opportunities to share best practices, and greater potential for aligning inpatient and outpatient goals. In integrated systems, reduced hospital admissions and readmissions do not hurt the bottom line to the extent they do in freestanding hospitals.
So their checklist went something like :
- Pursue quality and access, and efficiency will improve. Cost reduction is the consequence, not the primary goal, of their efforts.
- Reinforce goals by addressing organizational culture through communication, clinical leadership, alignment of purpose, and celebration of success.
- Implement quality improvement strategies such as close monitoring of performance indicators against benchmarks to motivate physicians and frontline staff and promote a culture of continuous quality improvement.
- Use technology including electronic medical records that are customized to the hospital’s configuration and needs as tools to improve quality and efficiency.
- Manage staffing and adjust roles to reduce or improve handoffs and promote teamwork to meet patient needs, including reassessing traditional boundaries that contribute to faulty handoffs between personnel. Use full-time, on-site physicians such as hospitalists, as well as team leaders, to coordinate services and enhance continuity.
- Emphasize communication among providers and with families to clarify expectations and improve patient transitions throughout sites of care.
- Standardize processes and supplies to reduce the opportunity for errors and increase purchasing power.
- Integrate care, systems, and providers, either explicitly in an integrated health system or by adopting the characteristics of an integrated care system within a community (for instance, by sharing a common information system).
We will provide regular tips and hints against each of these categories for improving your Hospital’s performance and ranking…