Cardiology services remain among the most profitable hospital services and even marginally successful hospitals tend to make money on this business line. But the upper tier of American hospitals — those achieving top HealthGrades rankings and who crack the U.S. News & World Report's "America's Best Hospitals" — has remained there for years, carving longstanding reputations for quality that attracts the top physicians, nurses and patients from around the country and across the globe.
Department leaders at three hospitals ranked in the Top 50 listing and an interventional cardiologist leading heart programs at two Chicagoland hospitals approaching that elite status say getting to the top is hard work, but there is a path and following it religiously will deliver better results and patient outcomes, even if it takes time to reach the top rung.
Maureen Ogden of Tampa General Hospital
Maureen Ogden, vice president of cardiovascular and transplant services for Tampa (Fla.) General Hospital, says 2009 was the first year the tertiary care hospital was ranked by U.S. News & World Report, which listed it as number 42 among the Top 50 heart programs nationally. Tampa General, a former public hospital that became a private, not-for-profit academic medical center affiliated with the University of South Florida in 1997, opened its Cardiovascular Center in Bayshore Pavilion in April 2008 for preoperative and postoperative patients. It features six cardiac cath labs and six interventional radiology suites within 77,000 square feet. Tampa General is the eighth busiest heart transplant center in the country. Its stroke program has earned a five-star ranking from HealthGrades and its ventricular assist device program was certified with the Joint Commission's Gold Seal of Approval for quality.
Ms. Ogden says the new facility is successful in part because the hospital involved physicians and staff in the design. Ms. Ogden, who joined the hospital in 1980 as a night nurse in cardiology and has worked there as a nurse, manager and director, says employee commitment and physician involvement are key to climbing the quality ladder. "We have an amazing group of people who really care for the patients here," she says. "Making the U.S. News & World Report list wasn't easy or fast. It's a very slow process. When we decided to build the pavilion in 2002, we committed to a new way of doing business. Our goal was to become the employer of choice, to recruit and train the best physicians, nurses and staff."
She says being a regional organ transplant center is a big draw. "We get referrals from many smaller hospitals who don't feel comfortable with really complex patients. All that came together for us. We wanted to get Magnet certification and received it four years ago, which helps us recruit the best nurses. We wanted to receive Joint Commission disease specific recognition and we did. We wanted to work off of national benchmarks and we did."
She says that Tampa General developed its own customer service program after key staff underwent intensive training. "We based our program on the Disney model for customer services and created an educational process in which 100 percent of our staff was trained. We've seen perceptions change."
She says achieving physician buy-in starts with recognizing physician needs. "One of the things you have to do as a leader is to make yourself available at the time best for them. You can't schedule a meeting at 11 a.m., but at 5 a.m. or 7 a.m. You have to respect how valuable a doctor's time is and how difficult it is for them to find time. But physician involvement is critical," she says. "You also must provide as much transparency as you can provide to achieve trust on both sides. Physician ease of practice is something we consider very carefully."
She also suggests consistently seeking physician input and giving feedback. "They need to be decision makers in the process. That's crucial to a cardiology department's success. We fully appreciate and value our physicians. They have choices and can take their patients elsewhere."
Ms. Ogden says maintaining elite status is challenging. "It's crucial to stay current with the science and technology and plan for it five years from now. Who's teaching me? My doctors. I seek them out and they keep me current."
Joseph Butz of Sentera Norfolk General Hospital and the Sentera Heart Hospital
Joseph Butz, vice president of the Cardiac and Transplant Program at Sentera Norfolk (Va.) General Hospital and the Sentera Heart Hospital, says that his organization's program unites a longstanding team of cardiac super specialists within an advanced facility "built from the ground up for superior cardiac care."
Sentera was ranked 38th on the U.S. News & World Report Top 50 hospitals for heart care. Its Heart Hospital adjoins the level one trauma center and tertiary care hospital, Sentera Norfolk General, and offers an opportunity to house all cardiac services in one area to better focus cardiac patient care. The hospital achieved a ranking of fourth in the nation in mortality for cardiac procedures, with excellent quality outcomes. Mr. Butz points out that half of the heart hospital's volume comes from outside the Norfolk market, serving populations in North Carolina, and Virginia's Eastern Shore and its Upper Virginia Peninsula.
"We defined success for our program to be in the top 10 percent in quality and we've achieved it in most areas," he says. "We believe that good quality medicine is good business. If we can maintain our high quality rankings, we will continue to draw business from outside of our market and do well financially."
Mr. Butz says that the quality of clinicians draws referrals. "Doctors don't want to refer their patients to physicians they don't think are any good," he says. "The quality of those clinicians is important to insurers as well. That's really what makes a preferred hospital provider. Nursing competence is important as well. We've achieved status as a Magnet hospital. Finally, efficiency is a big seller to physicians as well. At Sentera we do joint ventures that help align incentives and work towards a common goal. Physicians, staff and administration together drive quality. The dedication to doing the best medicine drives volume and cost effectiveness."
He says at the Heart Hospital committees select and analyze data to investigate trends and establish best practices and benchmarks. Mr. Butz says one means of achieving high levels of performance is to apply a programmatic approach to care, "to hard-wire quality into everything. That's why the Cleveland Clinic, the Mayo Clinic and Johns Hopkins are always at the top. The program has to be hard-wired so it can survive the departure of an administrator," he says. "I can leave tomorrow and this place will remain a Top 50 hospital. But just because it's hard-wired in doesn't mean it stays. Things change. There needs to be strong infrastructure in place to allow it to continue. You have to keep moving the bar forward. We are constantly looking at programs and making improvements."
Mr. Butz says every healthcare market is unique.
"Hospitals need to figure out what their communities need and how best to meet those needs," he says, pointing out that not every community requires multiple tertiary referral centers. But every community has cardiac service needs and if a hospital is meeting those needs with a strong emphasis on quality, Mr. Butz predicts it will attract that next level of recognition.
"When your CEO says quality is the top goal and making it into the top 10 percent is the measurement, it gets you focused on the right thing, which isn't always volume or cost," he says. "Physicians are instrumental, as is getting everyone on same page. Our physicians are very committed to making this program run better and if it runs better, everyone does better."
Dr. Paul Jones of Mercy Hospital and Franciscan Physicians Hospital
Interventional radiologist Paul Jones, MD, chairman of the department of cardiovascular services at Chicago's oldest continually operating hospital, Mercy Hospital, and medical director of cardiovascular services at Franciscan Physicians Hospital in Munster, Ind., says before hospital executives and their affiliated physicians consider expanding or consolidating heart services, they should crystallize their program's objectives and structure services not just for today's market, but tomorrow's. Dr. Jones says any new program needs to be in synch with the latest technological advances in cardiac care.
"Cardiology program planners should think ahead to make sure the program structures will be where the research and technology are going and the field of cardiovascular disease management is headed," he says. "That's the value of cutting-edge interventional cardiology: having unique tools and some administrative skills to put those two together to structure program ready for what tomorrow's tech will look like."
He says planning for the coming technology isn't enough. "Programs must be quality-based from their inception. They must be structured and programmed with quality in mind and systems for evaluating quality outcomes."
Dr. Jones says CMS and private insurers are increasingly tying reimbursement to quality outcomes through pay-for-performance incentives. "That will become more and more prevalent," he predicts. "The challenge in the years to come will be to convince hospital administrators to grow from a position of quality. I've been fortunate at Mercy and at Franciscan to have had that kind of support over the years."
Mercy has a long history of cardiac quality. He says Mercy's heart program was ranked in Solucient's Top 100 hospitals and achieved status as a Blue Cross and Blue Shield center of distinction.
Franciscan Physicians Hospital, a joint venture between the Mishawaka, Ind.-based Sisters of St. Francis Health Services and physician co-owners, is a relatively young hospital Dr. Jones says is quickly developing a reputation for quality cardiac care. He says he was recruited to develop a cardiac program modeled after Mercy's at Franciscan.
"You have to be honest about the program's weaknesses and strengths and be clear what you want to achieve," he says. "We've developed a continuous quality improvement model that allows us to look objectively at our problems and develop solutions. We want to foster a strong sense of teamwork. The strength of the program does not ride on the shoulders of a single individual, but the quality of the team assembled."
He says he led efforts at Mercy to consolidate heart-related services, including cardiac surgery, into the department of cardiovascular services.
"From a hospital operational perspective it's easier to have of those services all under one umbrella department," he explains. "It also makes us more accountable under our continuous quality improvement program.
"Our endovascular program has received national attention and we've created a program for physicians to train here to perform endovascular procedures," he says.
"Everyone has to understand the true importance of that continuous quality improvement program. People can get complacent about that," he says. "But we cannot let our guard's down."
Chris Thomson of The Christ Hospital's Heart and Vascular Center
Chris Thomson, executive director Heart and Vascular Center at The Christ Hospital in Cincinnati, is a veteran hospital cardiology executive who has led 10 different programs in his career, most recently with St. Thomas Health Services in Nashville, Tenn.
"My career has been building heart programs," Mr. Thomson says. "For collaborative partnerships to work between physicians and hospital leadership there must be a true focus on patient care and quality. The rest of it just happens."
Mr. Thomson says there are numerous effective process programs and analytical tools that work. "What it comes down to is how patients flow through your system and how you analyze that to improve care, how you work together to improve quality. It always comes back to personalities and a commitment to quality. Nothing will happen unless there is a commitment to quality. And people who focus on quality end up with fame and money."
He concedes that some well-intentioned programs do not achieve success, usually because there was no common consensus or unity of vision.
"The reality comes when people don't want to change," he says. "The world around us is changing and what worked in Nashville last year won't work in Cincinnati this year."
He says the vision must be shared top to bottom. "The person cleaning the cath lab is just as important," he says. "If it's only the physicians and administrators, real success won't happen. If you ask the people delivering care what is the vision of the cardiac service line at Christ Hospital, they all can tell you it's quality outcomes, patient satisfaction and physician satisfaction. Everybody throughout the service line has to understand that. And if everyone is going in same direction, you can't help but succeed."
Mr. Thomson says he's seen his share of "one-hit wonders" who appear on the top hospital lists one year and disappear after that.
"Someone came in and shook things up and got them going, but didn't drive down to the lowest level of people to make it stick," he explains. "I can't fix things alone. I can lead toward the fix, but my job is to make sure everyone has the tools they need and understands where they're going.
"They need to bring in someone who makes sure they can follow up and maintain the progress. I'm a builder, not a maintainer. I build it and then move on. It's the responsibility of the builder to figure out how to maintain it and who would be best at that," he says, while conceding: "People can only accept so much change before fatigue sets in. The key to all this is successful collaboration and agreement on the vision driven all the way down throughout the organization."
Contact becker@beckersasc.com.
Department leaders at three hospitals ranked in the Top 50 listing and an interventional cardiologist leading heart programs at two Chicagoland hospitals approaching that elite status say getting to the top is hard work, but there is a path and following it religiously will deliver better results and patient outcomes, even if it takes time to reach the top rung.
Maureen Ogden of Tampa General Hospital
Maureen Ogden, vice president of cardiovascular and transplant services for Tampa (Fla.) General Hospital, says 2009 was the first year the tertiary care hospital was ranked by U.S. News & World Report, which listed it as number 42 among the Top 50 heart programs nationally. Tampa General, a former public hospital that became a private, not-for-profit academic medical center affiliated with the University of South Florida in 1997, opened its Cardiovascular Center in Bayshore Pavilion in April 2008 for preoperative and postoperative patients. It features six cardiac cath labs and six interventional radiology suites within 77,000 square feet. Tampa General is the eighth busiest heart transplant center in the country. Its stroke program has earned a five-star ranking from HealthGrades and its ventricular assist device program was certified with the Joint Commission's Gold Seal of Approval for quality.
Ms. Ogden says the new facility is successful in part because the hospital involved physicians and staff in the design. Ms. Ogden, who joined the hospital in 1980 as a night nurse in cardiology and has worked there as a nurse, manager and director, says employee commitment and physician involvement are key to climbing the quality ladder. "We have an amazing group of people who really care for the patients here," she says. "Making the U.S. News & World Report list wasn't easy or fast. It's a very slow process. When we decided to build the pavilion in 2002, we committed to a new way of doing business. Our goal was to become the employer of choice, to recruit and train the best physicians, nurses and staff."
She says being a regional organ transplant center is a big draw. "We get referrals from many smaller hospitals who don't feel comfortable with really complex patients. All that came together for us. We wanted to get Magnet certification and received it four years ago, which helps us recruit the best nurses. We wanted to receive Joint Commission disease specific recognition and we did. We wanted to work off of national benchmarks and we did."
She says that Tampa General developed its own customer service program after key staff underwent intensive training. "We based our program on the Disney model for customer services and created an educational process in which 100 percent of our staff was trained. We've seen perceptions change."
She says achieving physician buy-in starts with recognizing physician needs. "One of the things you have to do as a leader is to make yourself available at the time best for them. You can't schedule a meeting at 11 a.m., but at 5 a.m. or 7 a.m. You have to respect how valuable a doctor's time is and how difficult it is for them to find time. But physician involvement is critical," she says. "You also must provide as much transparency as you can provide to achieve trust on both sides. Physician ease of practice is something we consider very carefully."
She also suggests consistently seeking physician input and giving feedback. "They need to be decision makers in the process. That's crucial to a cardiology department's success. We fully appreciate and value our physicians. They have choices and can take their patients elsewhere."
Ms. Ogden says maintaining elite status is challenging. "It's crucial to stay current with the science and technology and plan for it five years from now. Who's teaching me? My doctors. I seek them out and they keep me current."
Joseph Butz of Sentera Norfolk General Hospital and the Sentera Heart Hospital
Joseph Butz, vice president of the Cardiac and Transplant Program at Sentera Norfolk (Va.) General Hospital and the Sentera Heart Hospital, says that his organization's program unites a longstanding team of cardiac super specialists within an advanced facility "built from the ground up for superior cardiac care."
Sentera was ranked 38th on the U.S. News & World Report Top 50 hospitals for heart care. Its Heart Hospital adjoins the level one trauma center and tertiary care hospital, Sentera Norfolk General, and offers an opportunity to house all cardiac services in one area to better focus cardiac patient care. The hospital achieved a ranking of fourth in the nation in mortality for cardiac procedures, with excellent quality outcomes. Mr. Butz points out that half of the heart hospital's volume comes from outside the Norfolk market, serving populations in North Carolina, and Virginia's Eastern Shore and its Upper Virginia Peninsula.
"We defined success for our program to be in the top 10 percent in quality and we've achieved it in most areas," he says. "We believe that good quality medicine is good business. If we can maintain our high quality rankings, we will continue to draw business from outside of our market and do well financially."
Mr. Butz says that the quality of clinicians draws referrals. "Doctors don't want to refer their patients to physicians they don't think are any good," he says. "The quality of those clinicians is important to insurers as well. That's really what makes a preferred hospital provider. Nursing competence is important as well. We've achieved status as a Magnet hospital. Finally, efficiency is a big seller to physicians as well. At Sentera we do joint ventures that help align incentives and work towards a common goal. Physicians, staff and administration together drive quality. The dedication to doing the best medicine drives volume and cost effectiveness."
He says at the Heart Hospital committees select and analyze data to investigate trends and establish best practices and benchmarks. Mr. Butz says one means of achieving high levels of performance is to apply a programmatic approach to care, "to hard-wire quality into everything. That's why the Cleveland Clinic, the Mayo Clinic and Johns Hopkins are always at the top. The program has to be hard-wired so it can survive the departure of an administrator," he says. "I can leave tomorrow and this place will remain a Top 50 hospital. But just because it's hard-wired in doesn't mean it stays. Things change. There needs to be strong infrastructure in place to allow it to continue. You have to keep moving the bar forward. We are constantly looking at programs and making improvements."
Mr. Butz says every healthcare market is unique.
"Hospitals need to figure out what their communities need and how best to meet those needs," he says, pointing out that not every community requires multiple tertiary referral centers. But every community has cardiac service needs and if a hospital is meeting those needs with a strong emphasis on quality, Mr. Butz predicts it will attract that next level of recognition.
"When your CEO says quality is the top goal and making it into the top 10 percent is the measurement, it gets you focused on the right thing, which isn't always volume or cost," he says. "Physicians are instrumental, as is getting everyone on same page. Our physicians are very committed to making this program run better and if it runs better, everyone does better."
Dr. Paul Jones of Mercy Hospital and Franciscan Physicians Hospital
Interventional radiologist Paul Jones, MD, chairman of the department of cardiovascular services at Chicago's oldest continually operating hospital, Mercy Hospital, and medical director of cardiovascular services at Franciscan Physicians Hospital in Munster, Ind., says before hospital executives and their affiliated physicians consider expanding or consolidating heart services, they should crystallize their program's objectives and structure services not just for today's market, but tomorrow's. Dr. Jones says any new program needs to be in synch with the latest technological advances in cardiac care.
"Cardiology program planners should think ahead to make sure the program structures will be where the research and technology are going and the field of cardiovascular disease management is headed," he says. "That's the value of cutting-edge interventional cardiology: having unique tools and some administrative skills to put those two together to structure program ready for what tomorrow's tech will look like."
He says planning for the coming technology isn't enough. "Programs must be quality-based from their inception. They must be structured and programmed with quality in mind and systems for evaluating quality outcomes."
Dr. Jones says CMS and private insurers are increasingly tying reimbursement to quality outcomes through pay-for-performance incentives. "That will become more and more prevalent," he predicts. "The challenge in the years to come will be to convince hospital administrators to grow from a position of quality. I've been fortunate at Mercy and at Franciscan to have had that kind of support over the years."
Mercy has a long history of cardiac quality. He says Mercy's heart program was ranked in Solucient's Top 100 hospitals and achieved status as a Blue Cross and Blue Shield center of distinction.
Franciscan Physicians Hospital, a joint venture between the Mishawaka, Ind.-based Sisters of St. Francis Health Services and physician co-owners, is a relatively young hospital Dr. Jones says is quickly developing a reputation for quality cardiac care. He says he was recruited to develop a cardiac program modeled after Mercy's at Franciscan.
"You have to be honest about the program's weaknesses and strengths and be clear what you want to achieve," he says. "We've developed a continuous quality improvement model that allows us to look objectively at our problems and develop solutions. We want to foster a strong sense of teamwork. The strength of the program does not ride on the shoulders of a single individual, but the quality of the team assembled."
He says he led efforts at Mercy to consolidate heart-related services, including cardiac surgery, into the department of cardiovascular services.
"From a hospital operational perspective it's easier to have of those services all under one umbrella department," he explains. "It also makes us more accountable under our continuous quality improvement program.
"Our endovascular program has received national attention and we've created a program for physicians to train here to perform endovascular procedures," he says.
"Everyone has to understand the true importance of that continuous quality improvement program. People can get complacent about that," he says. "But we cannot let our guard's down."
Chris Thomson of The Christ Hospital's Heart and Vascular Center
Chris Thomson, executive director Heart and Vascular Center at The Christ Hospital in Cincinnati, is a veteran hospital cardiology executive who has led 10 different programs in his career, most recently with St. Thomas Health Services in Nashville, Tenn.
"My career has been building heart programs," Mr. Thomson says. "For collaborative partnerships to work between physicians and hospital leadership there must be a true focus on patient care and quality. The rest of it just happens."
Mr. Thomson says there are numerous effective process programs and analytical tools that work. "What it comes down to is how patients flow through your system and how you analyze that to improve care, how you work together to improve quality. It always comes back to personalities and a commitment to quality. Nothing will happen unless there is a commitment to quality. And people who focus on quality end up with fame and money."
He concedes that some well-intentioned programs do not achieve success, usually because there was no common consensus or unity of vision.
"The reality comes when people don't want to change," he says. "The world around us is changing and what worked in Nashville last year won't work in Cincinnati this year."
He says the vision must be shared top to bottom. "The person cleaning the cath lab is just as important," he says. "If it's only the physicians and administrators, real success won't happen. If you ask the people delivering care what is the vision of the cardiac service line at Christ Hospital, they all can tell you it's quality outcomes, patient satisfaction and physician satisfaction. Everybody throughout the service line has to understand that. And if everyone is going in same direction, you can't help but succeed."
Mr. Thomson says he's seen his share of "one-hit wonders" who appear on the top hospital lists one year and disappear after that.
"Someone came in and shook things up and got them going, but didn't drive down to the lowest level of people to make it stick," he explains. "I can't fix things alone. I can lead toward the fix, but my job is to make sure everyone has the tools they need and understands where they're going.
"They need to bring in someone who makes sure they can follow up and maintain the progress. I'm a builder, not a maintainer. I build it and then move on. It's the responsibility of the builder to figure out how to maintain it and who would be best at that," he says, while conceding: "People can only accept so much change before fatigue sets in. The key to all this is successful collaboration and agreement on the vision driven all the way down throughout the organization."
Contact becker@beckersasc.com.