Small Hospital Provides Big Lesson in Quality of Care

John Commins, for HealthLeaders Media, September 10, 2008

If you get a chance, read the testimony presented on Tuesday (Sept. 9) to the U.S. Senate Finance Committee by Greg Schoen, MD, regional medical director at Fairview Northland Medical Center in Princeton, MN, located about 50 miles north of the Twin Cities. It provides a blueprint for success for improving patient outcomes.

In its first year of participation in CMS' Hospital Quality Incentive Demonstration project, Fairview Northland found itself ranked among the bottom 10% of participating hospitals. Within three years, after identifying and correcting a number of problems, the 54-bed hospital was ranked among the top hospitals in the program.

In my job, I've had the pleasure of speaking with executives and physicians from some of the nation's most successful hospitals and healthcare systems. So, there really isn't anything in Schoen's testimony that I haven't read or heard before. That's the beauty of it. It turns out, there is a recipe for success.

Yes, of course, no two hospitals are the same. Each hospital has a different set of challenges, some greater than others. However, there is a handful of common sense strategies that I have heard from every hospital executive and physician I've ever interviewed, strategies that all hospitals can undertake to measurably improve patient outcomes. And you can find them all in Schoen's testimony.

Lesson No. 1: Understand what your problems are. When Fairview Northland decided to take part in the HQID project, Schoen says he was "surprised by our poor performance." The tiny hospital scored in the bottom 10% of the 250 participating hospitals of varying sizes in the six areas that were being measured: heart attack, heart failure, coronary artery bypass graft, pneumonia, and hip/knee replacement. "The scores were a wake-up call that we had work to do," Schoen told the committee. The moral of the story: It's hard to correct a problem when you don't know you have a problem.

Lesson No. 2: Don't rule by fiat. Involve administrators and medical staff, and give them incentives. "The quest to improve quality started with a straightforward approach to physicians and staff: we can and will do better," Schoen told the committee. "Our employees—particularly physicians—responded positively to the fact that our hard work would not only improve patient care but it would also be rewarded with incentive pay from the demonstration project."

Lesson No. 3: Find workable solutions. Some problems are more nettlesome than others, but they can be solved. Schoen says Fairview Northland immediately found that some of its low scores were attributable to documentation errors. The care was being delivered but it wasn't documented either on charts or in billing.

After pruning that "low hanging fruit," Schoen says, Fairview Northland took on the more complicated problem of "good people using bad processes." Interdisciplinary care teams comprised of physicians, nurses, x-ray and lab technicians, support staff and administrators were told to fix the problem. "These were the best people to create new processes, since they would have to use them every day," Schoen testified. "They created new and better ways to provide care and then hardwired those processes into place." Those processes can be as simple as ensuring that chest pain patients receive an EKG and a dose of aspirin before seeing a physician.

Lesson No. 4: Monitor your progress. Changing the way you deliver healthcare is pointless if you don't continually monitor yourself to ensure compliance. Fairview Northland, for example, added prompts in paper documents and order sets for physicians, and hired additional staff to monitor compliance.

There you have it. Four steps to improving quality and patient outcomes at your hospital.

One other thing that Schoen didn't mention but that I feel is vitally important: Don't be bashful about success. If you improve quality of care and patient outcomes at your hospital, let people know about it. A press release is not sufficient. Set up an editorial board meeting with your local newspaper. Request an on-site interview with your local television station. And of course, make sure your patients and their families know. It's important that the people you serve know and understand the steps you are taking to improve their healthcare. Besides, to quote the immortal Dizzy Dean, "It ain't bragging if you've done it."

John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at
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