Morton Plant Hospital in Clearwater, Fla., is the only U.S. hospital that was named one of the 50 Top Cardiovascular Hospitals by Thomson Reuters for 13 consecutive years. Cardiovascular programs are evaluated by Thomson Reuters on clinical outcomes, clinical processes, extended (30-day) outcomes and efficiency. Kris Hoce, COO of Morton Plant Hospital, explains how the hospital has built and maintained a high-quality cardiology program for more than a decade.
Culture
Mr. Hoce says the strength of Morton Plant Hospital's cardiovascular program is due in large part to the culture of quality that the physicians and other care providers all buy into. "They let quality and outcomes drive their decision making. They didn't let economics or any one individual's success override the goals of the program. From a cultural perspective, that is really what allowed them to create clinical success." The cardiovascular team's shared goals enabled them to work together more efficiently and effectively to serve the patient. "[Our success is] a reflection of the collaboration among the physicians — a common vision of what we're trying to accomplish in terms of raising the bar in cardiac care," says Mr. Hoce.
The patient-centered culture is evident in the hospital's five-year-old Morgan Heart Hospital, which employs a universal bed concept. This concept allows heart patients to remain in one room during their recovery. "This may not sound significant in terms of culture, but by creating a separate physical environment, it really allows [physicians, nurses, hospital leaders and board members] to work with the same common purpose, with the intent of getting these patients treated and healed and back to their normal, healthy lifestyle as quickly as they can," Mr. Hoce says. He says this focus on the patient is one of the factors that sets the hospital's cardiovascular services apart from others.
Outcomes
Another way Morton Plant's cardiac program distinguishes itself from others is its positive outcomes. Its clinical quality is driven by patient volume, cautious use of new technologies and patient follow-up. A high volume of cardiac patients is key to maintaining good outcomes because it keeps physicians sharp, according to Mr. Hoce. The heart hospital gets sufficient volume by creating a reputation of quality in the community and implementing a referral strategy.
Referrals
After Morgan Heart Hospital built a reputation locally, it sought to broaden its patient base by reaching out to physicians and patients in the larger region. Morgan Heart cardiologists met with physicians in surrounding communities to explain the hospital's cardiovascular program and offer any support services the communities may need. "We looked to add value for [the other communities] and try to find a way to match their needs with our program in a complimentary fashion," Mr. Hoce says. "Our goal is to try to keep those patients in their community as much as we can. But, if they need a higher level of care, we will facilitate bringing them here and then work expediently to get them back to their home community." The hospital created a transfer center program in which a referring hospital or physician could transfer patients by making one call to Morgan Heart Hospital, which would coordinate transportation and resources for the patient and his or her family.
New technologies
New technologies and procedures are often a hallmark of top specialty programs. However, physicians need to be cautious when adopting these products or techniques to ensure patient safety and high quality. The cardiovascular team at Morgan Heart Hospital has developed a process for evaluating new tools to decide which ones have shown evidence of providing real benefits to patients and which ones "are more of a fad," Mr. Hoce says. "We try to take a very scientific and disciplined approach to make sure any new treatments or therapies really do result in added value to the program and to patients." The hospital studies empirical evidence to assess how new technologies or processes would affect patient outcomes, patient safety, cost to the patient and facility, length of stay and recovery. Based on their findings, the heart hospital has decided against adopting some new modalities and has had to turn some patients away who ask for the new technology, according to Mr. Hoce. "Patients come in asking for something they saw on TV or the Internet that does not necessarily have good science behind it."
For example, Morgan Heart has chosen not to pursue certain developments in valve surgery because the cardiovascular team was not convinced they would have better results. In contrast, physicians at the hospital have implemented new minimally invasive techniques because they believed the evidence more clearly showed improved outcomes. While sometimes the physicians have different opinions on the value of a new device or technique, Mr. Hoce says this difference in opinion is part of the culture of quality and teamwork. "We like the team to have some creative dissonance because we believe that's the way you come to the best decision and best planning," he says.
Follow-up
Morgan Heart Hospital's commitment to quality is also illustrated in its call-back program, in which nurses follow up with open-heart surgery patients within 30 days after the surgery. In the program, an RN meets one-on-one with patients and families before the surgery to educate them and prepare them for the procedure. After the surgery, the RN calls patients to assess their recovery and determine if the patients are adhering to their prescribed diet and medications. The hospital aims to reduce readmissions by tracking patients' health after the procedure in these follow-up calls.
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Culture
Mr. Hoce says the strength of Morton Plant Hospital's cardiovascular program is due in large part to the culture of quality that the physicians and other care providers all buy into. "They let quality and outcomes drive their decision making. They didn't let economics or any one individual's success override the goals of the program. From a cultural perspective, that is really what allowed them to create clinical success." The cardiovascular team's shared goals enabled them to work together more efficiently and effectively to serve the patient. "[Our success is] a reflection of the collaboration among the physicians — a common vision of what we're trying to accomplish in terms of raising the bar in cardiac care," says Mr. Hoce.
The patient-centered culture is evident in the hospital's five-year-old Morgan Heart Hospital, which employs a universal bed concept. This concept allows heart patients to remain in one room during their recovery. "This may not sound significant in terms of culture, but by creating a separate physical environment, it really allows [physicians, nurses, hospital leaders and board members] to work with the same common purpose, with the intent of getting these patients treated and healed and back to their normal, healthy lifestyle as quickly as they can," Mr. Hoce says. He says this focus on the patient is one of the factors that sets the hospital's cardiovascular services apart from others.
Outcomes
Another way Morton Plant's cardiac program distinguishes itself from others is its positive outcomes. Its clinical quality is driven by patient volume, cautious use of new technologies and patient follow-up. A high volume of cardiac patients is key to maintaining good outcomes because it keeps physicians sharp, according to Mr. Hoce. The heart hospital gets sufficient volume by creating a reputation of quality in the community and implementing a referral strategy.
Referrals
After Morgan Heart Hospital built a reputation locally, it sought to broaden its patient base by reaching out to physicians and patients in the larger region. Morgan Heart cardiologists met with physicians in surrounding communities to explain the hospital's cardiovascular program and offer any support services the communities may need. "We looked to add value for [the other communities] and try to find a way to match their needs with our program in a complimentary fashion," Mr. Hoce says. "Our goal is to try to keep those patients in their community as much as we can. But, if they need a higher level of care, we will facilitate bringing them here and then work expediently to get them back to their home community." The hospital created a transfer center program in which a referring hospital or physician could transfer patients by making one call to Morgan Heart Hospital, which would coordinate transportation and resources for the patient and his or her family.
New technologies
New technologies and procedures are often a hallmark of top specialty programs. However, physicians need to be cautious when adopting these products or techniques to ensure patient safety and high quality. The cardiovascular team at Morgan Heart Hospital has developed a process for evaluating new tools to decide which ones have shown evidence of providing real benefits to patients and which ones "are more of a fad," Mr. Hoce says. "We try to take a very scientific and disciplined approach to make sure any new treatments or therapies really do result in added value to the program and to patients." The hospital studies empirical evidence to assess how new technologies or processes would affect patient outcomes, patient safety, cost to the patient and facility, length of stay and recovery. Based on their findings, the heart hospital has decided against adopting some new modalities and has had to turn some patients away who ask for the new technology, according to Mr. Hoce. "Patients come in asking for something they saw on TV or the Internet that does not necessarily have good science behind it."
For example, Morgan Heart has chosen not to pursue certain developments in valve surgery because the cardiovascular team was not convinced they would have better results. In contrast, physicians at the hospital have implemented new minimally invasive techniques because they believed the evidence more clearly showed improved outcomes. While sometimes the physicians have different opinions on the value of a new device or technique, Mr. Hoce says this difference in opinion is part of the culture of quality and teamwork. "We like the team to have some creative dissonance because we believe that's the way you come to the best decision and best planning," he says.
Follow-up
Morgan Heart Hospital's commitment to quality is also illustrated in its call-back program, in which nurses follow up with open-heart surgery patients within 30 days after the surgery. In the program, an RN meets one-on-one with patients and families before the surgery to educate them and prepare them for the procedure. After the surgery, the RN calls patients to assess their recovery and determine if the patients are adhering to their prescribed diet and medications. The hospital aims to reduce readmissions by tracking patients' health after the procedure in these follow-up calls.
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