Creating culture emphasizing perfection aids Aurora improvement
Established in 1984, Aurora Health Care, a not-for-profit system with headquarters in Milwaukee, serves eastern Wisconsin. A nationally recognized leader in efforts to improve healthcare quality, it has sites in more than 90 communities, including 13 hospitals, more than 140 clinics and 80-plus community pharmacies. There are more than 3,400 affiliated physicians including 900-plus in the Aurora Medical Group and the 250 physicians of Aurora Advanced Healthcare. With 29,000 employees, Aurora is one of Wisconsin's largest private-sector employers. www.aurorahealthcare.org.
Challenge:
Are economic incentives to hospitals – also known as pay-for-performance or value-based purchasing – an effective way to improve the quality of inpatient care?
Solution:
In 2003, The Centers for Medicare & Medicaid Services (CMS) and the Premier healthcare alliance teamed up to launch the Hospital Quality Incentive Demonstration™ (HQID) – the first national project of its kind designed to answer that question. More than 250 hospitals from across the nation joined the project initially. A long-time Premier Healthcare Informatics products user, Aurora Health Care chose to participate in HQID
Results1
As politicians and policymakers search for models of healthcare payment and reform, fourth-year results reveal the HQID project is helping patients live longer and receive recommended treatments more frequently.
- Participating hospitals have raised overall quality an average of 17.2 percent over four years based on delivery of 30-plus nationally standardized and widely accepted care measures to patients in five clinical areas.
- The improvements have saved the lives of an estimated 4,700 heart attack patients, according to a Premier analysis of mortality rates at participants.
- During the same time, the more than 1.5 million patients treated in five clinical areas at the 230 hospitals also received about 500,000 additional recommended evidence-based clinical quality measures, such as smoking cessation, discharge instructions and pneumococcal vaccination.
- In addition to significant incentive payments, Aurora Health Care’s 10 participating hospitals won 68 out of 86 possible awards, including 23 “Top Performer” awards, in the fourth year of the HQID project.
1From an article by Susan D. DeVore, President and CEO, Premier healthcare alliance, "Results from the First 4 Years of Pay for Performance" in the January 2010 edition of HFM magazine.
“Prior to joining the HQID, Aurora had in place protocols that had helped to
drive quality improvement successes; ironically, this was both an advantage and
a disadvantage as a participant in the HQID project.
“As a system, we ranked in the middle of the pack at the beginning of the
demonstration – some facilities were top performers while others had room for
improvement. As mentioned, we were already well-rounded in quality improvement,
but we found through HQID that our approach was not going to be as effective as
needed if we wanted to be a top performer. For instance, if we were at 85
percent compliance with a bundled measure, we were geared to improve
incrementally.
“So we made a number of adjustments that created an
overall cultural shift and a drive toward perfection. The discussions
quickly turned from how do we improve from 85 percent to how do we impact
the 15 percent not in compliance with a bundled measure.”
“Key
changes included the standardization of quality approaches across the entire
system. Upon joining HQID, we realized that we had close to 50 approaches to
quality across our facilities. In response, we decided upon an “Aurora
Approach to Quality,” which is based on lean processes and plan-do-study-act
approaches. This shift allowed for improvements in efficiencies – time and
money saved – as well as enhancements in quality.
“Also, our
president and CEO at that time made a structural change, requesting that the
accountability for the HQID results be transitioned from the quality
departments to the administrator at our individual facilities. This
increased the opportunities to accomplish quality improvement with each
other versus to each other. This shift of accountability to leadership has
played a major role in the successes that we see as a part of this project.
“Working together the health system focused on HQID. Results were
posted quarterly and available to all caregivers. A lessons-learned database
was created so successes and pitfalls could be quickly shared. The open
approach to both performance and improvement activities allowed everyone to
be engaged in the effort. Our results reflect this impact.1”
Patrick D. Falvey, PhD
Senior VP/Chief Integration Officer
Aurora Health Care, Milwaukee, WI
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