A common response among healthcare leaders when asked about the impact of the Patient Protection and Affordable Care Act on their organization isn't too surprising given the growing costs of healthcare: Major changes in healthcare delivery were and are coming, regardless of the Supreme Court's decision.
"With the aging population and more people needing healthcare, the need to provide more efficient and effective care would be an issue we'd have to address with or without the ACA," says Quint Studer, founder of the Studer Group. "Healthcare providers have to figure out to improve clinical quality of care at a less costly price."
Nearly every hospital has recognized this to some degree or another and has begun process improvement and other efforts to address efficiency and quality. However, hospitals differ in the degree and urgency of these efforts, and many have a long path of improvement ahead of them, especially in terms of working with physicians around improving clinical quality.
A recent Studer Group survey of more than 17,000 healthcare leaders in 44 states examined how healthcare leaders rated the care provided at their organization and cross referenced this information with the organization's performance on the HCAHPS survey and CMS' process of care measures. The survey found that leaders' perceptions didn't always match the data, and many hospital leaders overrated the performance of their organization.
This is concerning because, "If you overrate performance, you're not going to improve it," says Mr. Studer. Or rather, if you don't know something is broken, you won't be empowered to fix it.
For example, at hospitals where 75 to 100 percent of leaders reported "quality of care" was something their hospital "did well," patients responding to the HCAHPS survey didn't always agree. These hospitals scored in the 43rd percentile, on average, for the measure "Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)." These same hospitals had an average score of 88.2 on CMS' clinical process of care measures. Hospitals with slightly less confident leadership — 50 to 74 percent of leaders reported "doing well" — performed better on core measures (94.0 average score).
"For years, healthcare providers were so worried about what gets out in public, what people may think and litigation that they sometimes held tight clinical outcomes and patient safety data," says Mr. Studer. "As this data is released and more available to the public, leaders must be willing to own that data and get aggressive about putting in place practices to improve efficiency and quality."
So what are some of those practices that can move a hospital toward transparency and high performance? Mr. Studer says it's not about the specific program but rather the level of accountability in an organization's culture.
"Healthcare providers tend to grab programs or buzzwords; They're good programs but they don't know how to effectively execute them," he says. "Take Lean or process improvement — we're a huge believer in both at Studer. But, unless the organization changes certain core things, such as its leadership training and an evaluation system to hold people accountable, the organization won't maintain high performance."
According to the Studer survey, six specific characteristics of healthcare organizations were correlated with a positive affect on HCAHPS results.
1. Doesn't tolerate low performers. Organizations with leaders who reported a high percentage of low performers had lower HCAHPS results. Accordingly, hospital leadership must put into place hiring and performance evaluation tactics that rid the organization of low performers who "sabotage excellence," says to Mr. Studer.
2. Alignment among senior leaders. A lack of alignment at the senior leadership level negatively affects HCAHPS results. For example, the survey found that even senior leaders within an organization varied in terms of the level of concern they had for their organization's future and the urgency in which their hospital should adapt.
"If senior leaders don't see the environment the same way, you don't get the execution you need to see results," says Mr. Studer.
3. Effective leadership training. Positive perception of leadership training was positively correlated with HCAHPS scores. That is, hospitals where leaders felt they were well prepared for their roles had higher HCAHPS results, on average, than organizations where leaders gave their training lower marks.
4. Effective leadership evaluation systems. Hospitals where leaders reported effective evaluation systems had higher HCAHPS scores, on average, than those that lacked strong leadership accountability systems.
"Hospitals with an evaluation tool that holds people accountable for performance provide better patient care," says Mr. Studer.
5. Consistent leadership. High ratings on consistency of leadership positively affected HCAHPS results. Consistency requires alignment among leaders as well as low turnover amongst these leaders, according to Mr. Studer.
6. Standardization of best practices. Hospitals that received high ratings by their leaders for implementing and standardizing best practices also had higher HCAHPS results, on average.
According to the survey report, "Identifying best practices really does not seem to be the problem. The problem is moving best practices. When they move best practices, they have positive outcomes."
Leaders looking to prepare their organizations for a future of reform and pay-for-performance should worry less about the next process improvement "buzzword" and instead focus on cultivating a culture of accountability that demonstrates these six characteristics.
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"With the aging population and more people needing healthcare, the need to provide more efficient and effective care would be an issue we'd have to address with or without the ACA," says Quint Studer, founder of the Studer Group. "Healthcare providers have to figure out to improve clinical quality of care at a less costly price."
Nearly every hospital has recognized this to some degree or another and has begun process improvement and other efforts to address efficiency and quality. However, hospitals differ in the degree and urgency of these efforts, and many have a long path of improvement ahead of them, especially in terms of working with physicians around improving clinical quality. When perception doesn't match reality
A significant obstacle for many hospitals and health systems is that their view of their organization's preparation for reform doesn't necessarily align with reality, as indicated by objective measures.A recent Studer Group survey of more than 17,000 healthcare leaders in 44 states examined how healthcare leaders rated the care provided at their organization and cross referenced this information with the organization's performance on the HCAHPS survey and CMS' process of care measures. The survey found that leaders' perceptions didn't always match the data, and many hospital leaders overrated the performance of their organization.
This is concerning because, "If you overrate performance, you're not going to improve it," says Mr. Studer. Or rather, if you don't know something is broken, you won't be empowered to fix it.
For example, at hospitals where 75 to 100 percent of leaders reported "quality of care" was something their hospital "did well," patients responding to the HCAHPS survey didn't always agree. These hospitals scored in the 43rd percentile, on average, for the measure "Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)." These same hospitals had an average score of 88.2 on CMS' clinical process of care measures. Hospitals with slightly less confident leadership — 50 to 74 percent of leaders reported "doing well" — performed better on core measures (94.0 average score).
Transparency may require cultural change
This disconnect highlights the importance of using objective data to drive and monitor performance improvement, rather than relying on perception. This may require a culture change within organizations as, historically, hospitals have been slow to embrace transparency."For years, healthcare providers were so worried about what gets out in public, what people may think and litigation that they sometimes held tight clinical outcomes and patient safety data," says Mr. Studer. "As this data is released and more available to the public, leaders must be willing to own that data and get aggressive about putting in place practices to improve efficiency and quality."
So what are some of those practices that can move a hospital toward transparency and high performance? Mr. Studer says it's not about the specific program but rather the level of accountability in an organization's culture.
"Healthcare providers tend to grab programs or buzzwords; They're good programs but they don't know how to effectively execute them," he says. "Take Lean or process improvement — we're a huge believer in both at Studer. But, unless the organization changes certain core things, such as its leadership training and an evaluation system to hold people accountable, the organization won't maintain high performance."
According to the Studer survey, six specific characteristics of healthcare organizations were correlated with a positive affect on HCAHPS results.
1. Doesn't tolerate low performers. Organizations with leaders who reported a high percentage of low performers had lower HCAHPS results. Accordingly, hospital leadership must put into place hiring and performance evaluation tactics that rid the organization of low performers who "sabotage excellence," says to Mr. Studer.
2. Alignment among senior leaders. A lack of alignment at the senior leadership level negatively affects HCAHPS results. For example, the survey found that even senior leaders within an organization varied in terms of the level of concern they had for their organization's future and the urgency in which their hospital should adapt.
"If senior leaders don't see the environment the same way, you don't get the execution you need to see results," says Mr. Studer.
3. Effective leadership training. Positive perception of leadership training was positively correlated with HCAHPS scores. That is, hospitals where leaders felt they were well prepared for their roles had higher HCAHPS results, on average, than organizations where leaders gave their training lower marks.
4. Effective leadership evaluation systems. Hospitals where leaders reported effective evaluation systems had higher HCAHPS scores, on average, than those that lacked strong leadership accountability systems.
"Hospitals with an evaluation tool that holds people accountable for performance provide better patient care," says Mr. Studer.
5. Consistent leadership. High ratings on consistency of leadership positively affected HCAHPS results. Consistency requires alignment among leaders as well as low turnover amongst these leaders, according to Mr. Studer.
6. Standardization of best practices. Hospitals that received high ratings by their leaders for implementing and standardizing best practices also had higher HCAHPS results, on average.
According to the survey report, "Identifying best practices really does not seem to be the problem. The problem is moving best practices. When they move best practices, they have positive outcomes."
Leaders looking to prepare their organizations for a future of reform and pay-for-performance should worry less about the next process improvement "buzzword" and instead focus on cultivating a culture of accountability that demonstrates these six characteristics.
More Articles Featuring Quint Studer:
Quint Studer: Community Hospitals Must Lead With Experience, Close With CompassionThe Next Iteration of Hospital-Physician Alignment: Making Medicare Profitable
The Ladder of Employee Engagement: 5 Can't-Miss Steps for Hospital Leaders