Hospitals have become ever-more important in the health care system. Just 200 hospital systems account for over half of all admissions in the United States. These systems increasingly employ physicians, own nursing homes, provide imaging and other diagnostic services and control a wide swath of other health care services. A new report examines what makes a high-performance hospital system, looking at objective measures to identify those systems and interviewing leaders from them. (Commonwealth Report) The best systems had excellent marks on patient satisfaction and readmission and mortality rates.
Across these high-performance systems, no one factor or characteristic was associated with quality. Large or small, geographically regional or multi-regional, for-profit or not-for-profit, teaching or not; all these systems could be high or low-performing. Similarly, across 50 factors, nothing seemed particularly correlated with better performance. The most notable difference was an extremely strong culture of high-quality, quality improvement and leadership devoted to the best possible performance. Practices associated with excellence were a clear system-wide strategic plan with measurable short and long-term goals; alignment of goals with incentive programs for managers and physicians; use of data to measure extensively against goals, with a target of perfect performance or strong stretch objectives; and standardization and training on best practices across the entire system.
This report provides very good insight into the mindset of organizations that really mean it when they talk about quality and improving quality. A level of leadership is needed from the board and senior managers that makes it clear that the organization will not accept anything less than perfection and that aligns rewards with meeting that goal. Good examples are given of specific steps taken by hospital systems to create this positive culture. Leaving aside issues of cost escalation, to which hospitals are the major contributor, more systems like those profiled in the report would go a long way to improving health outcomes.