Case Studies

Carolinas Medical Center was established by the Charlotte-Mecklenberg County Public Authority in 1939 to meet the health care needs of Mecklenberg County residents, and opened its first hospital in 1940. Keeping pace with population growth, multiple facilities now continue the original mission to "care for all who come." High scores on process-of-care, or "core," measures distinguish the Carolinas Medical Center network hospitals as a group, and Carolinas Medical Center–University as the top performer among them. The network relies on multidisciplinary teams who are accountable to leadership for meeting goals; reviews and publicizes performance indicators across hospitals in its network; and redesigns care processes so that standards can be achieved as a matter of routine.  — View Case Study

Memorial Healthcare System (MHS) has provided public hospital care in South Broward County, Florida, for 56 years. MHS hospitals scored very well on process-of-care measures, not only compared with other publicly owned hospitals but compared with all hospitals. MHS leaders have developed a multifaceted quality and safety strategy that relies on storytelling to convey to staff and patients the type of care they wish to provide. Monitoring and reporting of performance data, combined with careful design of care processes, help the hospital achieve its goals. Staff also receive training and coaching on ways to enhance the quality of care. In addition, hospital leaders’ desire to appeal to privately insured patients, and to keep people healthy before and after hospitalizations, appears to drive improvement. For further information about the public hospital selection process and cross-cutting lessons about their improvement efforts, please see our introduction to the public hospital case study series.  — View Case Study

This case study focuses on Norman Regional Health System's achievement in providing recommended treatment on process-of-care, or "core," measures. Nearly a decade ago, Norman’s Board chair and a top physician administrator became champions for quality improvement, motivated by the fact that Norman had achieved just average scores on quality measures. Organizational, cultural, and system changes at Norman Regional, including the development of order sets and care plans, performance data transparency, concurrent review for certain patient groups, as well as a pharmacist-driven intervention, have led to sustained progress. For further information about the public hospital selection process and cross-cutting lessons about their improvement efforts, please see our introduction to the public hospital case study series.  — View Case Study

Compared with other hospitals, public hospitals are generally assumed to face multiple barriers to providing high-quality care: lower revenues; sicker patients who may have infrequent contact with the health care system; and an older infrastructure, particularly related to health information technology. This case study series set out to find how some public hospitals have succeeded in achieving excellence in quality of care, in spite of such challenges. We sought to understand the strategies and factors that contribute to high performance, as well as the barriers and challenges public hospitals face. To do so, researchers examined aggregate quality scores on 23 process-of-care measures reported by CMS, for all hospitals submitting data from July 2007 through June 2008. They selected for case study analysis eight public hospitals from among 14 that performed among the top 10 percent of more than 2,000 public and private hospitals reporting during this period.  — View Case Study

The New York City Health and Hospitals Corporation (HHC) is a mission-driven, $54 billion, public benefit corporation serving 13 million New York City residents-the largest municipal hospital and health care system int the United States. In response to external pressures, HHC has undertaken a series of improvement initiatives that appear to be transforming its organizational culture, systems, and care processes. This case study describes how HHC is achieving higher levels of performance through a common clinical information system that promotes information continuity across care settings, care coordination to improve chronic disease management, teamwork and continuous innovation to improve the quality and value of care, and access to appropriate care that is responsive to patients needs. Factors that the organizations leaders identify as critical to successful change include strategic use of information technology, leadership to promote collaborative learning and staff initiative, spread of best practices, alignment of financial incentives, and transparency of results  — View Case Study