Julie Yonek, Stephen Hines, and Maulik Joshi

High-performing hospital systems use three strategies to successfully carry out systemwide strategic plans.

Having a systemwide strategic plan for quality and safety with measurable goals across multiple dimensions is a best practice for improving system performance. Many systems establish threshold, stretch, (and for some) high-stretch goals and then track the progress frequently using system performance dashboards.

Set both measurable short- and long-term goals. Many organizations set annual goals (short-term), as well as three- to five-year goals (long-term) in key quality and patient safety areas.

Set goals for quality and safety based on the pursuit of perfection rather than incremental improvement. Organizations use a variety of approaches to goal setting, including considering statistically significant improvement from the previous year, top decile nationally, or an "all or none" method, such as striving for zero harm events or 100 percent of perfect care. The common theme is that the goals are stretch goals and represent for the organization a dramatic improvement versus incremental improvement.

At Covenant Health System, Inc., when all facilities are meeting a system goal (e.g., the top decile for a national benchmark) they set a more aggressive stretch goal based upon their internal performance.

Another hospital system, IASIS, sets system goals using the highest benchmark available (e.g., a state benchmark instead of national).

This is similar at Memorial Hermann Health System where threshold targets are set at the 85th percentile and stretch targets are set at the 90th percentile of national benchmarks. When national benchmarks are not available or they have exceeded the top decile of performance, they look at internal data and set a new (higher) target percentage improvement. Setting very high stretch goals and achieving these goals was cited as having had the greatest impact on their system's performance within the past two years.

Link the system's quality goals with operational and financial goals. For many organizations, the link between quality and finance are critical to their strategic plan.

Aurora Health System established a new area called Care Management Growth to examine the impact of quality improvement on revenue and expenses. They analyzed the number of lives touched and number of dollars saved due to quality improvement initiatives. Each year they plan to focus on four key evidence-based initiatives that are expected to enhance operational performance.

As another example, Bon Secours ties finance, quality, and operations together to meet teh system's strategic objectives. Goal setting is done collaboratively using a "clinical transformation collaborative," which includes the following staff from each local facility: vice president of medical affairs, chief nursing officer, and CFO. Choosing the "right" quality of care issues will result in financial savings for the system and increase capacity to care for more patients without needing to add more staff.


Julie Yonek, is senior researcher at Health Research & Educational Trust (HRET), Chicago. Stephen C. Hines, PhD, is vice president of research, HRET. Maulik S. Joshi, DrPH, is president, HRET, and senior vice president of research, American Hospital Association (mjoshi@aha.org).


This article is excerpted with permission from the following resource: Yonek, J., Hines S., and Joshi, M., A Guide to Achieving High Performance in Multi-Hospital Health Systems, HRET, Chicago, Ill., March 2010.

Publication Date: Tuesday, April 20, 2010