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Choosing Quality

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Establishing high quality may not be as simple as ABC, but there are some elemental characteristics to consider.

Editor's Note: This is based on Janice Simmons' April 1 online column, "The Key to a High-Performance Multihospital System."

A high-quality multihospital system can be defined specifically by: (a) high patient satisfaction; (b) good use of performance measurements; (c) low readmission rates; (d) up-to-date health information technology; (e) availability of top-notch providers; (f) its large or small size in the healthcare marketplace; (g) all of the above; or (h) none of the above. So what's the right answer?

Give up? How about "i" for: "It just depends."

A new guide from the American Hospital Association's Health Research & Educational Trust (HRET) in Chicago, with support from the Commonwealth Fund, found that it is difficult to isolate one element that ties together high-performing multihospital systems.

Interviews with leaders of 45 multihospital health systems and analysis of public quality data allowed researchers to identify three major themes related to higher-performing systems.

No one system type was most associated with high performance. The researchers examined the relationships of various system characteristics and compared them with composite measures of quality, as well as with specific measures, such as the Health Quality Alliance core measures, overall patient satisfaction, and combined, risk-adjusted readmission rates and mortality rates.

High-quality scores were achieved by a variety of different system types—large or small, regional or multiregional, and academic and nonacademic.

No single factor produces high-quality care in a health system. Although the researchers examined more than 50 system factors that could distinguish between top-performing systems and those with lower quality scores, "no one factor clearly separated top systems from others," they found.

In each case, factors found in high-performing systems were found in at least some of the lower-performing systems. Moreover, no unanimity was found among top-performing systems with respect to factors associated with high performance.

Creating a culture of performance excellence, accountability for results, and leadership execution are the keys to success. The guide found that many lower-performing systems had many of the same processes, policies, and structures as those with very high-quality scores. However, in conversations with system leaders, certain distinctions became apparent.

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