Is Center of Excellence Investment the Silver Bullet Healthcare Has Been Looking For?

Healthcare leaders generally recognize that there is no "silver bullet" to any of the challenges the industry presents today — aligning with physicians, improving quality while lowering costs and differentiating oneself in an increasingly competitive market. However, there are some strategies that resemble the proverbial silver bullet more than others — strategies that, while not solving every problem in one go, make significant progress on a wide range of issues. One such strategy (a silver-plated bullet, if you will) that plays a central role in many healthcare organizations' strategic plans is investment in centers of excellence.

Developing centers of excellence can provide a platform for hospitals and health systems to align physicians in quality improvement, reduce costs through greater efficiencies and create market differentiation through clinical excellence and high patient satisfaction.

Faye Deich is senior vice president of division operations and COO of Sacred Heart Hospital.
Faye Deich

Target 1: Enhanced quality

As the name suggests, centers of excellence are primarily designed to deliver high-quality care consistently. Developing standardized, evidence-based care processes that ensure high-quality outcomes not only sets the foundation of a center of excellence, but also helps hospitals reach quality standards that are included in federal reimbursement models such as value-based purchasing and bundled payments. Thus, investing in a center of excellence enables hospitals to differentiate themselves through top-tier care and gain cost savings under new payment models.

"Right now, there is so much pressure on the cost side that sometimes quality takes a backseat," says Steve Moreau, president and CEO of St. Joseph Hospital in Orange, Calif. "But that is not going to be sustaining. That's why focusing on excellence is such an important effort. We can't take our eye off quality by focusing exclusively on cost reduction." Mr. Moreau says a key aspect of centers of excellence is their consistency, reliability and minimal variation. Reducing variation can improve outcomes as well as patient satisfaction, another aspect of healthcare quality.

Patient satisfaction
"The more we become responsible in every aspect of care, the better patients seem to feel about [the hospital]," says Marc Sakwa, MD, chief of cardiovascular surgery at Beaumont Hospital, Royal Oak (Mich.) and chair of Beaumont Health System's Heart and Vascular Center of Excellence, which was created about three years ago. "Patients are aware that their wait times are less, that the nurse is there to answer their call buttons quicker. We measure patient satisfaction on a regular basis; it's only gone up since we started doing these centers of excellence." Patients with better experiences are more likely to return to the hospital, generating greater revenue and a stronger reputation for the hospital.

Target 2: Physician alignment

Physician alignment is both a necessity and a consequence of developing centers of excellence.

Physician alignment as necessity
To create standard protocols that will increase quality, physicians' and hospitals' incentives should be aligned.

Pat LuCore is assistant administrator of Sacred Heart Hospital.

Pat LuCore
Incentivizing physicians for low variation, high patient satisfaction and overall high quality can ensure everyone works collaboratively to meet the goals of a center of excellence.

For example, Sacred Heart Hospital in Eau Claire, Wis., aligned with physicians for its robotic surgery center of excellence. By giving physicians a leadership role on a robotic surgery committee, the hospital and physicians reached alignment on goals and approaches to quality care. "What brought our success so far is our active robotics committee. We have representation from administration, surgery and technicians," says Pat LuCore, RN, MHA, assistant administrator of the hospital.

Physician alignment as consequence

Establishing a vision for a center of excellence can also facilitate physician alignment with administrators because they have a shared goal of high quality. Dr. Sakwa says center of excellence development can also align physicians with other clinicians and staff. "The concept of a center of excellence is to work together with staff to come up withways to improve," he says. "As doctors, we found that nurses were hungry for more communication. They wanted to come on rounds with us; they wanted to improve quality. They respected the fact that we were taking an interest in it, and realized that together we would be able to make dramatic changes."

Pursuing center of excellence development as a strategy can thus create a platform for aligning physicians and creating a stronger level of integration of physicians in the hospital.

Target 3: Attract physicians

Besides aligning with physicians who are currently partnered with the hospital, centers of excellence can also attract physicians to a hospital. "What attracts doctors is they want the best tools to treat patients. If better technology results in better patient outcomes, they're going to go to the organizations that have the best technology," Mr. Moreau says. Sacred Heart Hospital's development of a center of excellence around the da Vinci robot helped recruit physicians to the hospital. "It helped attract new physicians that are very skilled, focused and interested in this," says Faye L. Deich, RN, MS, NEA-BC, senior vice president of division operations and COO of Sacred Heart Hospital. "Some physicians would not have come to our community if the robot was not available for them to use because they trained on it."

Steve Moreau is president and CEO of St. Joseph Hospital.
Steve Moreau

Target 4: Setting industry standards

In addition to improving quality within the center of excellence itself, standardizing evidence-based practices can improve quality within an entire health system and in health systems across the country. "Once we develop different ways to improve care, we go back to other physicians within the system — other cardiologists or referring physicians — and show them how we improved; by improving, it also helps them," says Dr. Sakwa.

Similarly, best practices developed at a center of excellence can be shared with other health systems so everyone can benefit from processes proven to be successful in improving quality and lowering costs. "The fact that centers of excellence have contributed to improving quality and developing evidence-based practices that others can see has impacted care and the standard of excellence across the country," Mr. Moreau says.

Moreover, the ability of centers of excellence to set industry standards and examples of best practices helps create a reputation of innovation, leadership and quality at the hospital. "When your organization is successful and has demonstrated practices leading to better outcomes, you get greater visibility," Mr. Moreau says. "You begin to get regional or national visibility because you're asked to write papers or make presentations across the country, which then become national best practices." For example, St. Joseph is asked by Premier, a best practice organization, to make presentations several times a year to share best practices with the national healthcare community, according to Mr. Moreau.

Investing in centers of excellence as part of a hospital's overall strategy can pay significant dividends in elevating the organization's brand and reputation to a national level. "As we improve even more, the entire hospital brand improves," Dr. Sakwa says. "In [the heart and vascular] area, Beaumont's brand had already been very strong; over the last three years, it's only gotten stronger and more visible."

Dr. Marc Sakwa is chair of Beaumont Health System's Heart and Vascular Center of Excellence.
Dr. Marc Sakwa

Target 5: Market differentiation

By standardizing best practices and aligning physicians and staff to improve quality, centers of excellence differentiate hospitals from their competitors. Centers of excellence can become destination sites for patients by guaranteeing a level of value that similar organizations do not offer — at least not as conveniently. "One of our strategies is how to differentiate ourselves in a market that has very strong, high-quality providers," Ms. Deich says. "Our strategy is [looking at] where we can do very well and developing specialty services locally so people don't have to be referred outside. It's the direct opposite of what has been the strategy of our competitor." By offering robotic surgery in several specialty areas, Sacred Heart Hospital has set itself apart from other providers that do not have this service.

St. Joseph Hospital has created differentiation in two areas of cancer care — outreach to the underserved population and services. St. Joseph Hospital received funding from the National Cancer Institute to develop its cancer program for the underserved. "That's an example of a differentiation that gives us a lot of visibility regionally and to an extent nationally," Mr. Moreau says.

Center of excellence development as part of a strategic plan can help set hospitals apart through quality and unique offerings, which can give hospitals the edge they need to win out over competitors.

Target 6: Cost savings

Centers of excellence provide an avenue for cost reduction through standardization and quality improvement. As mentioned earlier, meeting quality metrics is necessary to share savings in models like bundled payments and value-based purchasing. By creating standard protocols, healthcare teams can more consistently meet quality targets and improve care efficiency, which creates cost savings that can then be reinvested in quality and patient experience, according to Dr. Sakwa. "Having a well organized center of excellence is one of [Beaumont's] key strategies. It helps us not only improve research and quality, but also financial performance; it aligns our physicians and makes sure we're on the same strategy page as our administration," he says.

Center of excellence investment as key strategy
By investing in centers of excellence, hospitals and health systems can improve quality, which can help align and attract physicians as well as create market differentiation. Standardizing evidence-based practices and eliminating wasteful processes can position hospitals for success as reimbursement models take into account quality and patients seek top-tier care.

More Articles on Centers of Excellence:

How Bundled Payments in Orthopedics Can Help Build the Foundation for a Center of Excellence
Including Center of Excellence Development in a Hospital's Strategic Plan

Developing Successful Spine Centers of Excellence and Managing Quality

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