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Hospitals Seeing Gains in Quality and Efficiency

In the past several years, hospitals have made great strides in measuring the quality of care they provide and instituting necessary improvements. Still, little is known about the dynamics of hospital performance—the degree to which hospital quality is improving or deteriorating over time, and how hospitals are achieving and sustaining that improvement.

Two new reports from The Commonwealth Fund examine trends in hospitals' performance and their strategies for change. In Hospital Performance Improvement: Trends in Quality and Efficiency, analysts Eugene Kroch and Michael Duan of CareScience, Inc., and Sharon Silow-Carroll and Jack A. Meyer of Health Management Associates note significant improvements across hospitals in reducing mortality and increasing efficiency, with mixed results in reducing complications and morbidity.

Lower mortality, the authors say, is likely due to better diagnostic techniques and treatments, earlier interventions, and reduction in errors, as well as more conscientious record "coding" and improved discharge practices.

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The characteristics of hospitals that have improved the most indicate that quality improvement is occurring "at least as much among small, non-teaching institutions as among their larger, more prominent counterparts," the report finds.

Commenting on the study, Harvard University's Ashish Jha, M.D., and Arnold Epstein, M.D., two noted experts in the quality improvement field, said that the study "provides enough credible data to suggest that real, broad-based improvements in hospital care are likely taking place."

In the companion Fund report, Hospital Quality Improvement: Strategies and Lessons from U.S. Hospitals, Silow-Carroll, Meyer, and Tanya Alteras take an in-depth look at how four hospitals achieved and sustained improvements over time. The authors describe the hospitals' impetus for focusing on quality, the structural and organizational changes that were implemented to create a "culture of quality," and reforms in protocol and practice.

Some of the key organizational changes made by the hospitals studies were:

  • elevating the role of the quality improvement and performance departments and providing them with sufficient budgets and resources
  • instituting policies that encourage staff to express concerns, identify deficiencies, and challenge the status quo—such as nurse empowerment programs and anonymous reporting systems
  • creating multidisciplinary teams to provide patient care and address deficiencies—and holding them accountable for success.

Notably, the researchers found that leadership at the top is essential to realizing sustained improvement in quality. Often one of the triggers for change at hospitals that have achieved rapid improvement is the arrival of a new CEO with a strong interest in patient service and quality, as well as a commitment to invest resources in these areas. Boards of directors that set and closely monitor quality-related goals are no less important.

Dale Bratzler, D.O., the medical director for the Hospital Interventions Quality Improvement Organization Support Center at the Oklahoma Foundation for Medical Quality, says that although the importance of leadership and governance has by now been amply demonstrated in studies such as this one, the "commitment to quality has not been widely embraced by all hospital executives and boards."

"Hospital executives and board members must take as much responsibility for the quality of care in their institution as they take for the fiscal health of the organization," he said.

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