July 1, 2004
Todd Kutyla, Jack Meyer, Sharon Silow-Carroll
Hospital Quality: Ingredients for Success A Case Study of Jefferson Regional Medical Center, Jack A. Meyer, Ph.D., Sharon Silow-Carroll, M.B.A., M.S.W., Todd Kutyla, M.L.A., et al., The Commonwealth Fund, July 2004
This related report summarizes four case studies of hospital quality, HOSPITAL QUALITY: INGREDIENTS FOR SUCCESS—OVERVIEW AND LESSONS LEARNED
High quality at Jefferson Regional Medical Center appears to be the result of a variety of institutional factors that collectively have created an internal environment constantly focused on delivering excellent medical care. It is largely not, however, the result of a push from external stakeholders, including employers, health plans, and regulators. Rather, because of strong leadership and a well-entrenched culture that emphasizes quality, along with productive cross-disciplinary relationships and a flexible, decentralized approach to problem-solving, Jefferson has created the type of learning environment that produces good outcomes and continuous improvement. This success has been facilitated by a set of nuts-and-bolts tools that leads to quality care on a daily basis. Key factors responsible for the creation of a learning environment within Jefferson include the following:
- A rich history and culture that supports quality.
- Leadership at all levels committed to quality, as evidenced by a consistent willingness to commit resources and absorb financial losses, if necessary, to ensure that quality is not compromised.
- Mutual respect and strong relations across disciplines, including between the administration and clinical care staff (both doctors and nurses) and between physicians and non-physician care staff.
- A highly skilled nursing and medical staff.
- Local (i.e., clinical department or unit-based) ownership and accountability for quality and quality improvement (QI).
With this learning environment in place, Jefferson has invested in a variety of nuts-and-bolts factors that keep quality at the forefront on a daily basis. Sophisticated information technology (IT), however, is not one of these tools, as IT has not played an important role in Jefferson's historical success. It is, however, a central component of future plans. Rather, this daily attention to quality and QI are the result of the following:
- Selected performance monitoring and reporting.
- A broad set of existing structures to identify and address quality and service issues, along with the ability to create ad hoc structures to tackle specific problems identified through data analysis.
- Aggressive case managers who ensure that patients receive appropriate and timely care and services, leading to the earliest possible rehabilitation and discharge.
Key challenges faced by Jefferson relate primarily to getting physicians to accept IT and standardized medicine (e.g., use of protocols). The hospital has achieved its strong performance without having made much progress to date in addressing these challenges.
Lessons learned from the Jefferson case study include the following:
- Leading-edge IT is not necessarily a prerequisite to quality nor is strong external pressure for quality or QI.
- There is no substitute for creating the type of organization where talented individuals want to work and for instilling a culture that values mutual respect and peer-type relations between administrators and clinicians and between physicians and non-physician caregivers.
- Physicians and other caregivers can and should be liberated to take local ownership and accountability for QI.
- An aggressive case management program can play a critical role in facilitating a team-based approach that gets patients appropriate care in a timely manner.