In 2009, the Premier healthcare alliance launched QUEST: High Performing Hospitals, an initiative to improve quality and lower costs. The program's 157 participant hospitals tracked and shared performance data with a goal of matching or exceeding the top 25 percent of hospitals in quality metrics and the top 50 percent in cost. Over three years, the hospitals saved an estimated 24,820 lives and reduced healthcare spending by nearly $4.5 billion. Donna Isgett, senior vice president of corporate quality and safety at Florence, S.C.-based McLeod Health, one of the participating hospitals, shares how the program helped the health system reduce mortality by 28 percent and costs by 22 percent.
Transparency sheds light on best practices
The key to Quest's success was transparency of data between all hospitals. Sharing outcomes allowed hospitals to benchmark themselves against each other and identify high-performing hospitals that could teach best practices to lower-performing hospitals. For example, McLeod looked at surgical cost data for different procedures in an effort to reduce costs. If a procedure, such as a total hip replacement, cost less in one hospital, McLeod would study that hospital to learn best practices. The differences in cost were often due to the supply chain, which led McLeod to reevaluate its medical devices and supplies, according to Ms. Isgett. This reevaluation, along with other initiatives, enabled the health system to reduce costs by 22 percent.
"Total transparency allowed us to come together and migrate to who was doing it the best," Ms. Isgett says. Those that succeeded in certain areas, such as mortality, analyzed practices to "tease out the common denominator," she says. Quest hosted two on-site meetings each year for hospitals to share successes and failures with each other. While participating in Quest, McLeod developed a program that reduced mortality. Its success allowed the system to lead sessions at the meetings to teach the program to other participants.
Rovers reduce mortality
Comparing data with other hospitals in Quest motivated McLeod to target mortality as an area where they could improve, although McLeod's mortality rate was as expected. The health system's physicians formed a mortality committee that analyzed the organization's mortalities to identify common factors that could suggest weak processes. They found six types of patients who were at high risk of dying in the hospital:
• Patients who transitioned from the intensive care unit within the last 24 hours
• Adult patients on pediatric floors
• Patients who controlled their own pain pump
• Patients under restraints
• Patients who had an abnormal heart rhythm in the last 24 hours
• Patients the telemetry unit had concerns about
Once these patients were identified, McLeod assigned an ICU nurse to be a "rover" — a nurse who visits and monitors the high-risk patients. The rover visits the patient with the patient's staff nurse and provides a fresh perspective on the patient's health and risk factors, such as over-sedation for patients with their own pain pump. This system allows rovers to detect problems early and reverse them to prevent harm and reduce costs. In combination with other programs, the rover system helped McLeod reduce mortality by 28 percent.
Engaged physicians champion initiatives
Engaging physicians in quality initiatives is crucial to the success of the initiatives and to creating a culture that is focused on improving quality and reducing costs. "[One] challenge was helping many of our professional staff understand that lower cost oftentimes is reflective of better quality," Ms. Isgett says. For example, McLeod's antibiotic stewardship program ensured that patients were taking the appropriate antibiotics, which reduced costs and prevented the development of multi-drug resistant organisms. "Lower cost really does go hand in hand with better quality," she says. To engage physicians in a conversation about quality and cost, McLeod simply presented the data and provided transparency. "Physicians respond so much better if you do it with them rather than to them."
McLeod is now participating in Quest 2.0, a continuation of Quest with added metrics that measure patient experience, readmissions and patient harm. McLeod will work to reduce length of stay and improve care for renal failure, among other initiatives.
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Transparency sheds light on best practices
The key to Quest's success was transparency of data between all hospitals. Sharing outcomes allowed hospitals to benchmark themselves against each other and identify high-performing hospitals that could teach best practices to lower-performing hospitals. For example, McLeod looked at surgical cost data for different procedures in an effort to reduce costs. If a procedure, such as a total hip replacement, cost less in one hospital, McLeod would study that hospital to learn best practices. The differences in cost were often due to the supply chain, which led McLeod to reevaluate its medical devices and supplies, according to Ms. Isgett. This reevaluation, along with other initiatives, enabled the health system to reduce costs by 22 percent.
"Total transparency allowed us to come together and migrate to who was doing it the best," Ms. Isgett says. Those that succeeded in certain areas, such as mortality, analyzed practices to "tease out the common denominator," she says. Quest hosted two on-site meetings each year for hospitals to share successes and failures with each other. While participating in Quest, McLeod developed a program that reduced mortality. Its success allowed the system to lead sessions at the meetings to teach the program to other participants.
Rovers reduce mortality
Comparing data with other hospitals in Quest motivated McLeod to target mortality as an area where they could improve, although McLeod's mortality rate was as expected. The health system's physicians formed a mortality committee that analyzed the organization's mortalities to identify common factors that could suggest weak processes. They found six types of patients who were at high risk of dying in the hospital:
• Patients who transitioned from the intensive care unit within the last 24 hours
• Adult patients on pediatric floors
• Patients who controlled their own pain pump
• Patients under restraints
• Patients who had an abnormal heart rhythm in the last 24 hours
• Patients the telemetry unit had concerns about
Once these patients were identified, McLeod assigned an ICU nurse to be a "rover" — a nurse who visits and monitors the high-risk patients. The rover visits the patient with the patient's staff nurse and provides a fresh perspective on the patient's health and risk factors, such as over-sedation for patients with their own pain pump. This system allows rovers to detect problems early and reverse them to prevent harm and reduce costs. In combination with other programs, the rover system helped McLeod reduce mortality by 28 percent.
Engaged physicians champion initiatives
Engaging physicians in quality initiatives is crucial to the success of the initiatives and to creating a culture that is focused on improving quality and reducing costs. "[One] challenge was helping many of our professional staff understand that lower cost oftentimes is reflective of better quality," Ms. Isgett says. For example, McLeod's antibiotic stewardship program ensured that patients were taking the appropriate antibiotics, which reduced costs and prevented the development of multi-drug resistant organisms. "Lower cost really does go hand in hand with better quality," she says. To engage physicians in a conversation about quality and cost, McLeod simply presented the data and provided transparency. "Physicians respond so much better if you do it with them rather than to them."
McLeod is now participating in Quest 2.0, a continuation of Quest with added metrics that measure patient experience, readmissions and patient harm. McLeod will work to reduce length of stay and improve care for renal failure, among other initiatives.
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