Among the fundamental underpinnings of health care reform is transparency. Patients, families, and the employers who purchase health care on their behalf, are demanding publicly available information that allows them to compare and select various providers and networks by quality outcomes, patient satisfaction, and cost. In fact, under health care reform, reimbursement rates are closely tied to performance. Now, ensuring that patients have the best possible experience is not only the right thing to do, it’s integral to a health system’s survival. Good quality, safety, and satisfaction scores are crucial to both our competitive reputation and our bottom line.
For those reasons, the URMC board and leadership has continued to make quality and safety improvement its top priority. Each month, quality discussions top each board meeting’s agenda. Faculty members are invited to present their efforts to improve outcomes and address any problem areas. As representatives of the community, board members expect URMC leaders to track and share information to make our services ever better.
As a member of the University HealthSystem Consortium (UHC), the Medical Center has access to a robust, real-time database that compares its performance on safety and quality outcomes with those of 107 other peer academic medical centers. URMC leaders and board members carefully track UHC’s Mortality Index as a definitive measure of how well we are delivering quality care. UHC measures complement those published by the Center for Medicare and Medicaid Services (CMS) which score both mortality and core process measures.
While the ultimate measure of quality and safety is mortality, URMC – like most health care institutions – tracks a host of factors that together provides a birds-eye view of how well it cares for patients, including mortalities, readmissions, CMS core measures, patient satisfaction, and more. In 2010, URMC developed a new monthly report card that allows viewers to recognize performance on multiple weighted measures at a glance. In addition to the weekly “harm” report that chronicles avoidable complications by unit, the new report card is shared with board members and clinical leaders as an up-to-date snapshot of our progress.
URMC stepped up its quality and safety initiatives in 2010 by announcing three areas in which it will endeavor to drive infection rates down to zero: central line associated blood stream infections (CLABSI) in all Intensive Care Units and all adult non-ICU units; surgical site infections (SSI) among heart bypass and colon surgery patients; and ventilator associated pneumonias (VAP) in all adult ICUs. The effort represents a change in traditional thinking in which modest rates of infection were considered inevitable. In fact, Strong Memorial Hospital was among the first hospitals in the nation to demonstrate the ability to virtually eradicate VAP in ICUs. Teams throughout Strong Memorial and Highland are now working to eliminate these three types of infections through consistently practiced bundles of preventive measures. Zero may be an audacious goal, but already units throughout the hospitals are seeing real improvement. For instance, Highland Hospital’s ICU has had zero VAPs since April of 2009.
Now more than ever, health care providers like URMC must make the patient experience their top priority. Under the leadership of acute-care CEO Steve Goldstein, URMC has commissioned a series of interdisciplinary teams at each affiliate to begin creating our unique brand of patient- and family-centered care (PFCC). These teams have revised each entity’s mission statement to reflect our shared commitment. They’ve articulated common organizational values and fundamental behaviors that will transform our culture into one that pays greater attention to the human side of medicine. As a patient- and family-centered organization, URMC will see patients and their families as integral members of the care team itself. Involving them in decisions, focusing on what they tell us is important to them, putting their needs first.
In 2011, URMC will officially launch its new patient- and family-centered care effort throughout its health system. But, across the system, efforts are already under way to strengthen the human aspect of our care.
Creative Care Neighborhood
The Living Center at The Highlands at Pittsford is having a dramatic impact on residents’ quality of life and family satisfaction with resident care. The Center’s Creative Care Neighborhood (CCN) rekindles residents’ past interests and familiar environments, awakening brain functions and sparking meaningful and fulfilling interactions. As a result, staff are conversing with once-silent residents, preventing agitation with activities like music or watercolor painting, and documenting dramatic improvements. Success of the CCN has been measured since its inception. This includes a reduction in falls by 66 percent, resident to resident incidents by 25 percent, elopements by 100 percent and annual cost savings of $12,000 by reducing antipsychotic medication use by 11 percent, anxiolytics by 10 percent, and sedative-hypnotics by 5 percent. A survey noted families found the CCN more peaceful and nurturing with increased staff expertise and job satisfaction making it easier to leave their loved ones.
A Strong Start
Leaders at Strong Memorial Hospital are preparing to share quality and satisfaction data with each unit and clinician so that individuals can gauge their own performance against peers. In 2010, URMC designated Jean Joseph, M.D., as its PFCC medical staff advisor, to spearhead the involvement of physicians in creating patient- and family-centered care. Already, a host of clinical leaders has begun designing ways to support individuals who need help improving their scores – by tapping into internal experts as well as national resources. In addition, multidisclipinary teams are scrutinizing everything from visiting hours to family access in the operating room, to family participation in daily patient care rounds.
The Highlands at Brighton embraced the patient- and family-centered care initiative by establishing a steering committee that’s focusing on improvements to first impressions and service recovery for residents and families. The effort is already reenergizing pre-existing teams such as Quality of Care, Safety and Health and the Resident Council.
Highland Taps Teamwork
Highland Hospital has mobilized 12 multidisclipinary teams to drive improvement in patient- and family-centeredness across all aspects of the organization. The hospital is recruiting patients and family members to join an advisory council that will partner with staff to share their feedback and propose improvements. First-line employees as well as managers and physicians are represented on all of the improvement teams; their direct experience with patients and families and their understanding of barriers to patient- and family-centered are will be crucial as the hospital seeks to transform its approach to care.