Case Studies

Significant variability in 30-day readmission rates across U.S. hospitals suggests that some are more successful than others at providing safe, high-quality inpatient care and promoting smooth transitions to follow-up care. This report offers a synthesis of findings from four case studies of hospitals with exceptionally low readmission rates—McKay-Dee Hospital in Ogden, Utah; Memorial Hermann Memorial City Medical Center in Houston, Texas; Mercy Medical Center in Cedar Rapids, Iowa; and St. John’s Regional Health Center in Springfield, Missouri. Hospitals’ environments contribute to their capacity to reduce readmissions. The four hospitals studied are influenced by the policy environment, their local health care markets, their membership in integrated systems that offer a continuum of care, and the priorities set by their leaders.  — View Case Study

Reid Hospital and Health Care Services is a high performer on process-of-care, or core measures. The measures, developed by the Hospital Quality Alliance HQA, relate to achievement of recommended care in four clinical areas: heart attack, heart failure, pneumonia, and surgical care. This case study focuses on Reid's achievement in providing recommended care to surgical patients in order to reduce the risk of a hospital-acquired infection.  — View Case Study

Leaders at Ridgeview attribute achievements in surgical care to the hospital's organizational culture and service line structure. Referred to as The Ridgeview Way, the hospital's systems, structures, and processes are designed to provide evidence-based care and enhancep atients experiences. The hospital also collaborates with quality improvement organizations at the state and national levels. For a small, independent organization such as Ridgeview, these partnerships provide valuable access to quality improvement resources and opportunities to work with peers.  — View Case Study

Sentara Healthcare, an integrated health care delivery system serving parts of Virginia and North Carolina, has developed a systematic program to foster a culture of safety throughout its member hospitals, with the aim of reducing the potential for patient harm. During the past five years, Sentara has intensified and expanded the program by engaging the health system’s physician group and other operating units in efforts to: 1) encourage employees to be mindful of the signals of inadequate care and act on those signals; 2) provide leaders with concrete methods of reinforcing employee behaviors that enhance patient safety; 3) reinforce bulwarks against medical error by instituting processes for learning from mistakes; and 4) reward the attainment of high standards of performance. The initiative has helped to reduce the measured rate of serious safety events at Sentara hospitals by 80 percent over seven years.  — View Case Study

This private hospital found that engaging frontline staff was more effective than top-down directives for adopting and maintaining new practices. Also, the hospital relies on a small number of critical care intensivists to conduct or oversee central line insertions, including those performed by residents.  — View Case Study

From 2004 to 2008, St Charles Hospital achieved dramatic improvement on process-of-care, or core, measures, particularly on those intended to reduce surgical complications. Conversations with administrative and clinical staff indicate that St Charles achievements in surgical care can be attributed to a hospital wide focus on quality improvement spurred by involvement in the national Surgical Care Improvement Project as well as to reliance on best-practice literature to get surgeons on board, use of preprinted order sets to standardize care processes, and a steady focus on tracking performance data and communicating results to physicians and other staff  — View Case Study

St. John’s Regional Health Center has very low readmission rates for heart attack, heart failure, and pneumonia—the three conditions for which hospitals report readmission rates to the Centers for Medicare and Medicaid Services. Its rates are better than the top 10 percent of hospitals reporting.  — View Case Study

St. Luke's Medical Center has made significant improvements in its performance on the pneumonia care core measures over the last five years. The hospital, which was once achieving as low as 30 percent to 50 percent compliance with the pneumonia care core measures, now performs well above state and national averages. Those interviewed credit the organization's improvement in pneumonia care to the energy and attention to quality improvement provided by the frontline staff, who have embraced the core measures as an opportunity to improve patient care. Concurrent review, ongoing nursing staff education, and streamlined standing order sets also have helped the hospital improve its performance.  — View Case Study

Under pressure to improve performance on indicators of financial well-being, patient satisfaction, and clinical quality, St. Mary's Health Center leadership made a deliberate decision to focus on Centers for Medicare and Medicaid Services process-of-care measures, or "core" measures. They set in motion a series of activities that resulted in striking improvement. The main strategies were: clear communication of the new directive by the hospital's president and Board of Directors; physician-led committees taking responsibility for performance improvement; intensified efforts to standardize clinical processes through order sets; dedicating a full-time staff member to data abstraction and initiating a system of concurrent and post-discharge review of medical charts; continuous measurement and analysis of performance data; providing feedback to staff; and sharing successes, lessons, and tools across hospitals in the health system.  — View Case Study

This case study focuses on Texas Health Harris Methodist-Cleburne's achievement in providing recommended treatment related to surgical care. The hospital has relied on concurrent review, changes to care processes, and preprinted order sets to improve. It also has benefited from being a part of a larger health system. In 2004, when CMS introduced the surgical measures, the hospital formed an interdisciplinary workgroup to identify opportunities for improving its performance.  — 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

At The Valley Hospital, hospital leaders exemplify on a daily basis the hospitals dedication to patient service. Each morning, the chief executive officer and chief financial officer visit patients. Valley closely tracks patient satisfaction data on a hospital-wide and unit basis, with each unit given a performance target. Leadership Institutes for frontline supervisors through top executives emphasize accountability for reaching and maintaining high standards. In addition, nurses and other staff members solicit feedback from patients through rounding and post-discharge calls. Valley rewards extraordinary staff behavior through recognition and reward programs.  — View Case Study

As part of a systemwide transformation, the VA formed its National Center for Patient Safety to foster an organizational culture of safety within its nationwide network of hospitals and outpatient clinics. A recent medical team training program designed to improve communication among operating room staff was associated with a reduction in surgical mortality and improvements in quality of care, on-time surgery starts, and staff morale. The program is now being expanded to other clinical units, along with a patient engagement program that prevents errors by facilitating communication relating to patients' daily care plans. A recognition program stimulated facilities to conduct timelier and higher-quality root-cause analyses of reported safety events to identify stronger actions for preventing their recurrence. Other initiatives have reduced rates of health care–associated infections, patient mortality, and post-operative complications. Success factors include leadership accountability for performance and organizational support for testing, expanding, and adopting improvements.  — View Case Study

This case study focuses on United Hospital Center's (UHC) achievement in providing recommended treatment related to surgical care. UHC's rapid and significant improvement in this area can be attributed to hospital-wide strategies as well as policies and practices focused on the surgery department. Hospital-wide strategies include the creation of a subcommittee that reviews performance data and works across departments and disciplines to address performance gaps; careful data recording, assessment, and validation to gain the trust of physi-cians; engagement of the CEO, medical staff chairman, and medical staff; and communication of progress as well as challenges. Strategies specific to surgical care include: emphasizing best-practice literature to bring surgeons on board; providing consistent data feedback, including to individual surgeons; using peer pressure when needed; and standardizing operating room procedures through standing orders, practice sets, and checklists.  — View Case Study

An examination of nine hospitals that recently implemented a comprehensive electronic health record (EHR) system finds that clinical and administrative leaders built EHR adoption into their strategic plans to integrate inpatient and outpatient care and provide a continuum of coordinated services. Successful implementation depended on: strong leadership, full involvement of clinical staff in design and implementation, mandatory staff training, and strict adherence to timeline and budget. The EHR systems facilitate patient safety and quality improvement through: use of checklists, alerts, and predictive tools; embedded clinical guidelines that promote standardized, evidence-based practices; electronic prescribing and test-ordering that reduces errors and redundancy; and discrete data fields that foster use of performance dashboards and compliance reports. Faster, more accurate communication and streamlined processes have led to improved patient flow, fewer duplicative tests, faster responses to patient inquiries, redeployment of transcription and claims staff, more complete capture of charges, and federal incentive payments.  — View Case Study

Walla Walla General Hospital is one of the top-performing hospitals in the country on the pneumonia process-of-care measures, or "core," measures. The core measures, developed by the Hospital Quality Alliance and reported to the Centers for Medicare and Medicaid Services (CMS), relate to the provision of recommended treatment in four clinical areas: heart attack, heart failure, pneumonia, and surgical care. Walla Walla ranks in the 99th percentile for the pneumonia care core measures, the 91st percentile for the heart failure core measures, and the 97th percentile for the surgical care core measures. The hospital also performs very well on the heart attack core measures, but treats too small a population to reliably tell how well it is doing, according to CMS guidelines. Those interviewed credit the hospital's high performance on the pneumonia care core measures to education and reinforcement, as well as improvements to care processes, reminders, and other supports created to give staff the tools they need to succeed.  — View Case Study

Western Baptist Hospital is one of the top-performing hospitals in the country in the pneumonia care process-of-care, or "core" measures. Performance improvement teams, led by physician champions, have helped the hospital achieve its success in pneumonia care. The hospital also builds systematic process improvements into staff routines to facilitate compliance with the core measures and standardize care.  — View Case Study