Back in 2008, Florida hospitals worked hard to deliver quality care and thought they must be some of the best in the country, according to Thomas Kelley, MD, chief quality officer of Orlando Health's South Seminole Hospital in Longwood, Fla.
However, when they looked at data from the Dartmouth Atlas of Health Care and other sources, they found they were mistaken. They were actually ranked high on costs and relatively low on quality, Dr. Kelley said. Subsequently, under the leadership of the 239-member Florida Hospital Association, the state's hospitals vowed to work to deliver better care. As a result, so far readmissions have declined by 15 percent, surgical complications have dropped 14.5 percent, blood stream infections have declined by 41 percent and urinary tract infections have decreased by 37 percent statewide.
At the Becker's Hospital Review 5th Annual Meeting in Chicago on May 17, Dr. Kelley shared the following five tips for other hospitals looking to embark on a quality improvement journey.
1. Collaborate with other hospitals. Before they launched the FHA-led effort, Dr. Kelley said Florida's hospitals realized one of the reasons they ranked lower than they thought was because they were working hard to deliver quality care individually, rather than joining forces. They realized they had to opportunity to improve if they cooperated instead of competing. "Competition is key to what we do every day, but this was really not a time for competition," he said. "It was a time for collaboration."
2. Work with health insurers. Reaching out to health insurers as well as other hospitals was also a crucial part of improving care and the patient experience. For instance, Dr. Kelley said they discovered that after heart failure patients were discharged, their health insurers and the hospital would separately give the patients and conduct follow-up phone calls, creating confusion. "There was some opportunity to share that information and to work together more carefully," he said.
3. Gather good data. When explaining care improvement initiatives, Dr. Kelley said he would lose his physician audience completely if they could find an issue with the data supporting his idea. "You have to be data-driven, but, most importantly, you have to have accurate data," he said.
In Florida, the hospitals worked to collect comprehensive data. For instance, they examined surgical care outcomes by digging through patient charts and making phone calls to patients after they had been released. "This is important because up to half of surgical complications occur after the patient is discharged," Dr. Kelley said. "The return on the investment was we now had good data, accurate data, to work on, so we knew what opportunities for improvement would be."
4. Focus on sustainable change. Comparing efforts to improve quality and implement change to tennis, Dr. Kelley said, "We sometimes have a great swing, but we don't always have a great follow-through." Therefore, he advised hospital leaders to be aware of the need for sustainability and actively work it into their plans.
5. Drive cultural change. The hospitals in Florida worked to drive culture changes to reduce the rate of infections. For instance, for catheter-associated urinary tract infections, Dr. Kelley said, "We talked to our nursing colleagues and said, what does CAUTI stand for? If you don't have a catheter, no CAUTI. We know that a lot of times catheters are used for convenience rather than the true needs of the patient."
The hospitals also looked to bring the issue "down to people's hearts" by asking them if they would want a loved one or family member to suffer from an HAI. "I think that's where we made the biggest impact in achieving a culture change," Dr. Kelley said. "I just can't emphasize enough how much culture impacts quality."
More Articles on Quality Improvement:
Fine Wine and Healthcare Quality: What We Get Wrong About Both
Is Twitter a Platform to Assess Care Quality?
AHA Launches Symposium for Leaders in Healthcare Quality