The Key to a High-Performance Multihospital System

Janice Simmons, April 1, 2010

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 overall, it is difficult to link one specific element that ties together high-performing multihospital systems.

Multihospital health system leaders do have a significant impact on the quality of American healthcare, according to HRET's new guide. After all, the 200 largest hospital systems—with a hospital system being defined as having two or more general acute care hospitals—account for more than half of all hospital admissions.

Interviews with leaders of 45 multihospital health systems and analysis of publicly available quality data allowed the guide researchers to identify three major themes related to higher performing systems.

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

Overall, the researchers said, it became quite evident that high-quality scores were achieved by a variety of different system type—large or small systems, regional or multi regional systems, and systems that were academic and non-academic.

So any type of system—regardless of size, geographic location, or financial situation—can achieve high quality care.

(2) 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.

While simplistic solutions are appealing, the researchers noted, these solutions are often wrong. The goal of providing consistently high-quality care is achievable—but not through any one single change.

(3) 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.

Janice Simmons Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at
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