A recent HealthGrades study has found that best-performing hospitals offer higher quality of maternity and cardiovascular care for women than poor-performing hospitals. The study shows that top-performing hospitals report much fewer maternal complications than lower-performing facilities, and that mortality rates for women treated for cardiovascular disease have dropped in recent years.
Nebulous. That's how Eric Dobkin, MD, chief quality officer at Crozer-Keystone Health System describes the responsibilities of a hospital quality officer in this month's HealthLeaders magazine.
Infection control, clinical outcomes, and compliance with The Joint Commissions' standards are common tasks assigned to a quality officer, but often, the responsibilities don't end there. CQOs hear about it when the hospital noise level is too loud or the cleaning staff misses a spot on the hallway floor.
"You could make the argument that quality should only be measured by the outcomes required, or you can look at the food served in the cafeteria," says Dobkin, who also serves as the vice president of patient safety for the five hospital system in Delaware County, PA. "They all fall into the rubric of quality."
While the role may be nebulous, the growing importance of hospital quality isn't, evidenced by the number of hospitals—big and small—that are bringing quality responsibilities to the executive table by creating the chief quality officer role.
"Patients, regulatory agencies, the government—they're all demanding quality, says Beka Warren, RN, chief quality officer at The Memorial Hospital in Craig, CO. "In the past, what has been important to the board of trustees is the financial component. If we were doing well financially, we were considered to be doing well. [Today] in this hospital, we look very much at the quality things that are going on."
And just as a CEO has a chief executive who deals with the financial, he or she also should have an executive to oversee quality. But appointing just anyone to the position is ill-advised, Dobkin and Warren say. To be a good CQO, a person must work well with numbers, make sense of statistics, and be optimistic. They must always strive for excellence and be able to lead, even when they encounter resistance.
"It's your job to inspire a hospital to more than what's easy," Dobkin says. "Part of a CQOs job is to educate everyone—from the board to the C-suite to the staff level—about what quality and patient safety are all about."
But perhaps the most important thing that a CEO should remember when hiring a quality officer is that assigning an executive to oversee quality doesn't mean he or she can wash her hands of that responsibility. At The Memorial Hospital, CEO George Rohrich makes daily rounds and meets with his executive team to discuss what he observes on these rounds. He remains on the front lines of the 25-bed hospital's quality improvement efforts, and talks about it often with staff at all levels.
There’s no question that quality is important to him, Warren says, and his emphasis shows the importance of it.
Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
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As a hospitalist, Philip Vaidyan, MD, saw patients on nearly every floor and in a variety of units. He soon found he was spending too much time moving among patients or answering pages from another area of the hospital. Then Vaidyan learned about a growing number of hospitals that reduced these frustrations by assigning hospitalists to specific units of the hospital. These hospitals, including SSM St. Mary's Health Center in St. Louis, say the move has nearly eliminated wasted travel time and given physicians more time with patients, families and staff. The hospitals also hope better access to physicians will lead to better communication, and allow treatment to begin sooner.
A bill passed by the Louisiana Senate will allow two doctors to remain on St. Bernard Parish's hospital commission while also being employed by the Franciscan Mission. The Mission is competing with Ochsner to operate a still-to-be-built hospital in the parish. However, while the doctors can serve on the St. Bernard Hospital Service District Commission, they will not be allowed to vote on any issue involving the Franciscan group. The bill now heads to Gov. Bobby Jindal.
SSM Healthcare-St. Louis recently announced another round of departures, another example of hospitals facing increasing pressure to improve care while cutting costs. In addition, quality directives from managed-care companies and the government are coming with slight, if any, increases in payment. St. Louis Post-Dispatch columnist Mary Jo Feldstein notes that one source of the economic problems facing hospitals is that as health plans raise the patients' portion of their medical bills and more families have fewer dollars to spend, some might be holding off on care. The problem is worsened as outpatient and testing services continue to grow and sends more patients out of the hospital for care, Feldstein says.
As one of the fastest growing counties in the country, Montgomery County, TX, sees nearly a thousand trauma cases annually, but a scarcity of necessary medical staff at local hospitals has left the county in critical need of even basic trauma services, according to a new report.
At least one local hospital says a lack of physicians interested in providing trauma care has left them struggling to obtain Level III certification. "Our plan, even independent of this study was to move back to being a Level III trauma center. The major thing we are facing is our ability to recruit physicians. It's a very time consuming practice, and not everyone is cut out to do it. Our timeframe for getting certified basically has to do with how soon we can find physicians who want to do this work," says Conroe Regional Medical Center CEO Jerry Nash. Conroe Regional dropped its Level III center in 2005 because it could not find physicians who were willing to be on call to the extent needed for trauma care. Nash says the hospital is attempting to regain its certification because there is such a demand for critical care in the area.
Officials at Memorial Hermann-The Woodlands say they also recognize the need for trauma services in Montgomery County and hope to obtain certification at that hospital in the spring of next year. Ann Brimberry, director of public relations for the Memorial Hermann System says, "Trauma care is not a given for any one hospital. It requires a collaborative effort between the hospital and physicians along with talented and dedicated staff, facilities, equipment, and financial resources. With overburdened Level I Trauma Centers in Houston, the need for Level III and perhaps higher level trauma centers in the suburbs is critical," she says.
The study by The Abaris Group says that costs and the ability to find willing and able surgeons will remain a challenge; however, it says the area has enough trauma patients each year to support a Level III trauma center and in five years could could most likely support a Level II facility. The researchers also determined that hospitals can profit from a Level III trauma center. It is estimated that the annual cost to run a trauma center would be $730,000.