Hospitals across the country are searching for ways to ensure patient safety and improve the quality of care. A new study identifies and describes the key factors contributing to the success of four high-performing hospitals across the country. The study finds that all four hospitals were able to develop a culture of safety, attract and retain key personnel, devise and continually update quality improvement processes, and give staff tools to excel. External influences, such as local market competition, and public or private health quality initiatives and standards also had an impact on their success. Through information gleaned from site visits and in-depth interviews with these high-performing hospitals, the researchers offer practical guidance to hospital administrators and providers.
Issue: Many hospitals around the country are searching for ways to ensure patient safety and improve quality. There are lessons to be learned from high-performing hospitals, which have been able to demonstrate good health outcomes while controlling costs.
Objective and Intervention: The Economic and Social Research Institute set out to define the factors leading to success of high-performing hospitals around the country.
Organizations: The Economic and Social Research Institute (ESRI) is a nonprofit organization that conducts research and policy analysis in health care and in the reform of social services. The four high-performing hospitals are Beth Israel Deaconess Medical Center (Boston), El Camino Hospital (Mountain View, CA), Mission Hospitals (Asheville, NC), and Jefferson Regional Medical Center (Pittsburgh, PA).
Key Measures: ESRI researchers used a combination of quantitative research on health outcomes and costs and in-depth case studies to identify the four hospitals. They considered external and internal factors affecting the hospitals and identified supportive tools and processes that contributed to their success.
P rocess: The study makes clear that, although the four hospitals had much in common, each followed their own path to improvement. Beth Israel Deaconess Medical Center has a long history of serving its community and has struggled through some difficult times due to a merger and financial troubles. This environment, according to the researchers, has fostered a staff committed to change and innovation. The hospital's success also is due to implementation of state-of-the-art information and decision-support systems that have been customized to meet the institution's culture and needs.
El Camino's success is primarily the result of two factors: an internal environment that constantly focuses on quality and a set of practical tools that promote good outcomes and quality improvement on a daily basis. Elements of these factors include strong leadership, high-quality nursing and physician staff, leading-edge technology and information systems, and sophisticated data analysis and performance monitoring systems. Key factors in Mission Hospitals' success include the integration of physicians into the leadership structure—with physicians leading the quality improvement process and being held accountable for effecting change—and the reliance on consultants who have a blend of clinical and analytical skills.
Jefferson's experience demonstrates that neither leading-edge technology nor external pressures are prerequisites for quality or quality improvement initiatives. Rather, quality at Jefferson is driven by strong leadership and a well-entrenched culture that emphasizes quality, along with productive cross-disciplinary relationships and a flexible, decentralized approach to problem-solving. The institution also employs nuts-and-bolts tools, including performance monitoring systems, permanent and ad hoc committee structures, and an aggressive case management program.
Lessons Learned: Many hospitals around the country are taking up the challenge of improving quality of care and patient safety. What distinguishes the leading hospitals from the others is that these hospitals take concrete actions and dig deeply beneath the surface to identify the root causes of problems, develop practical solutions, measure their impact, and hold themselves accountable for improvement. Willingness to invest and focus on long-term change and comprehensive quality integration (e.g., into all service lines and from the top of the institution to the bottom) are essential. The full case study reports, under Related Resources at right, provide more details about the quality improvement processes, results, and lessons learned at each of the hospitals. The researchers concluded that key elements of a successful strategy can be organized into the following categories:
- developing the right culture for quality to flourish;
- attracting and retaining the right people to promote quality;
- devising and updating the right in-house processes for quality improvement; and
- giving staff the right tools to do the job.
This study was based on publicly available information and self-reported data provided by the case study institution(s). The aim of Fund-sponsored case studies of this type is to identify institutions that have achieved results indicating high performance in a particular area, have undertaken innovations designed to reach higher performance, or exemplify attributes that can foster high performance. The studies are intended to enable other institutions to draw lessons from the studied organizations' experiences in ways that may aid their own efforts to become high performers. The Commonwealth Fund is not an accreditor of health care organizations or systems, and the inclusion of an institution in the Fund's case studies series is not an endorsement by the Fund for receipt of health care from the institution.