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Holmes SK, Cohen AB, Restuccia JB, Horwitt J, Shwartz M. Strategies for Improving Hospital Quality and Efficiency: Lessons from Eight Hospitals. Paper presented at: AcademyHealth Annual Research Meeting; 2010 Jun 28; Boston, MA.
Research Objective: To understand the factors driving hospital performance and to identify quality improvement (QI) strategies and best practices that offer lessons and tools for hospitals. Study Design: We performed case studies of 8 hospitals selected on the basis of six performance measures: risk-adjusted inpatient mortality for the AHRQ inpatient quality indicators; risk-adjusted efficiency; CMS process of care measures for AMI, CHF and pneumonia; HCAHPS patient satisfaction measures; and survey-assessed patient care quality by hospital CQOs and front-line clinicians. For each hospital, we averaged ranks across 6 measures to produce an overall average-rank composite. Data were stratified by bed size and region, and arranged in quintiles. Hospitals in the top quintile were considered high performers, and hospitals in the middle quintile were considered average performers. We selected 5 high performers and 3 average performers for study in 2008 - 2009. Population Studied: Study hospitals initially were drawn from a sample of 253 hospitals that (1) had responded to a 2006 survey of CQOs and front-line clinicians regarding hospital QI activities, and (2) had reported sufficient HCAHPS and CMS performance data. From these, we recruited 2 large ( 400 beds) high performers (South and West regions), 2 medium-sized (100 - 399 beds) high performers (Midwest and Northeast) and 1 small (25 - 99 beds) high performer (Midwest)., and matched 1 average performer to each size category. Principal Findings: Average-performing hospitals engage in many of the same QI activities as high performers but do so to a lesser degree and with less intensity. Key differentiating factors include: leadership and organizational commitment to QI goals; an organizational culture and set of values that facilitate improvement; and resource levels sufficient to support improvement efforts.
