At the Becker's Hospital Review Annual Meeting in Chicago on May 10, 2013, CEO of Cottage Hospital Maria Ryan, PhD, gave a presentation titled "Key Steps to Improve and Measure Clinical Outcomes." "A few years ago, all hospital CEOs in New Hampshire got together and decided we were going to eliminate harm in hospitals," said Dr. Ryan. "We decided we could eliminate harm if evidence-based guidelines were followed. After coming together with these initiatives, we have been ranked number one in providing evidence-based care."
The six domains for improving quality Dr. Ryan discussed were:
• Safety — avoiding injury if unintended;
• Timeliness — minimizing unnecessary delays that can hurt the patient;
• Effectiveness — providing care on evidence-based practice;
• Efficiency — looking at production time versus cost and whether there is evidence to implement lean practices;
• Equity — providing the same care to everyone regardless of their ability to pay;
• Partnerships — partnering with people in the community to communicate about care.
"Now the data we can collect is much more scientific," said Dr. Ryan. "We can look at the issue and create measures with all the stakeholders. It's very time-consuming and costly, but leads to better patient care and ultimately better revenue."
The keys to success, said Dr. Ryan, are for the senior leadership to be involved and to understand that each level of change will require different motivators and incentives. There must be accountability and follow-through as well as follow-up to the process. Assess your local market place to find the biggest health risks and tackle those issues first.
"No matter where you live, you know what impacts your patients more than anything," said Dr. Ryan. "Find the issues. In New Hampshire, it's diabetes. We struggle to make a big difference in diabetes prevention and care in our population. We started with our employees because we had their health data, so I could do initiatives with them and see the impact. Then we can take our campaigns out into the community."
Clinical quality, safety and infection control also has a big impact on the hospital's bottom line, especially as pay-for-performance takes over.
"Bridge the quality and finance silos," said Dr. Ryan. "By improving your quality, your financial health will be better. We are in the transition for paying for outcomes, and when I improved the quality at the hospital we had better financial returns. There is a business case for doing quality improvements, and they are not cheap. Not only are these initiatives the right thing to do for your patients, but it also boosts your reputation and brings more patients into the hospital."