Understanding Performance Improvement Programs in Safety-Net Hospitals

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An increasing number of safety-net hospital systems are exploring systemwide performance improvement efforts to achieve their goals for quality and equity in the provision of health care to their low-income and vulnerable patients. By transforming care delivery and management at the organizational level, these health systems seek better clinical outcomes, shorter visit times, and improved patient experiences. Safety-net systems, however, face challenges when engaging in such redesign efforts, including a lack of financial stability, effective leadership, and capacity to implement and sustain culture change. What is needed is a fuller understanding of best practices for performance improvement in the safety net, including the factors that motivate, enable, and hinder safety-net systems in this endeavor. This study aims to identify and describe safety-net hospital performance-improvement efforts. The primary goals are to: 1) inform efforts to scale up performance improvement efforts; 2) increase awareness of models for delivering high-quality, equitable care to vulnerable populations; 3) identify gaps in current research; and 4) guide the development of policy recommendations for advancing population health. The project team will begin with an environmental scan to identify safety-net hospital systems engaging in performance improvement. Next, the team will analyze data from the American Hospital Association (AHA) Annual Survey and the AHA's National Survey of Lean/Transformational Performance Improvement to describe the general characteristics of those hospitals. Phone interviews conducted with safety-net hospital leaders will help identify common attributes that facilitate or hinder successful adoption of performance improvement efforts. Site selection will be based on survey data and expert advisory group recommendations. This research will provide guidance to safety-net hospital systems as they implement formal performance-improvement programs. Findings will also help state hospital associations and policymakers provide the types of support these systems will require to succeed in their improvement efforts. Finally, the results will inform questions to be added to future AHA national surveys.

Grant Details

Grantee Organization:
Health Research & Educational Trust (in partnership with the American Hospital Association)
Principal Investigator:
Marie Cleary-Fishman, M.S., M.B.A., B.S.N., and Jay Bhatt, D.O., M.P.H., M.P.A., F.A.C.P.
Award Amount:
$320,200.00
Approval Date:
November 14, 2017

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