By Julie Yonek, Stephen Hines, and Maulik Joshi

One of the fundamental opportunities for a health system is to standardize care processes and to accelerate learning among the health system organization for adoption of best practices.

Higher performing multihospital systems tend to report more standardization for both their training and care processes, according to our research. These differences may not directly produce differences in care quality since it's quite possible to standardize on paper processes that are very different in practice. However, systems that have made the effort to work through these issues and build consensus relate to standardization may achieve better results.

Establish a Process for Identifying and Standardizing Best Practices

High-performing health systems employed multiple and various ways for identifying and standardizing best practices across the health system. Although local autonomy is important, for the high-performing systems, there is an expectation that evidence-based practices are consistently implemented throughout the health system in every facility.

  • At Avera Health, there is a best practice committee comprised of quality directors and clinical leaders from each region. Best practices are identified using outcomes data. Strategies from hospitals with the best outcomes are selected for systemwide implementation.
  • Alegent Health standardizes best practices by creating systemwide evidence-based order sets.
  • At Providence Health and Services, when evidence-based best practices are identified, system leaders decide which ones to standardize and determine the process for how standardization will occur. For example, in the past 10 months, they have adopted two standardized processes: the WHO surgical safety checklist and protocol for screening and prevention of excessive bilirubin in newborns. Individuals responsible for implementing these in a common fashion are then identified.
  • At Catholic Health Initiatives, the selection process occurs collaboratively between the staff from the national office and the local hospital markets. On an annual basis, the collaborative identifies evidence-based practices being used either in one of the local markets or from the medical literature. They then roll out policies and procedures linked to these best practices. This year, they are rolling out 15 bundled best practices.
  • Ardent Health Services uses their clinical quality council to identify and spread evidence-based best practices across the system.
  • At IASIS, system level best practices are determined in partnership with its hospitals. For example, systemwide adoption of multidisciplinary ICU rounding came out of hospital participation in the Institutes for Healthcare Improvement.
  • Virtua Health uses a Six Sigma mechanism for deployment. Each time a facility-specific quality improvement (QI) project is completed, black belts are required to describe (and document) to others throughout the system on how they will spread and implement the practice throughout the system.

Use of Ongoing Education and Skills Development to Spread Best Practices

From the interviews with health systems, high-performance health systems noted they were more likely to use ongoing education and skills development to spread best practices. For example, expanding the role of nurses to include participation in systemwide quality improvement was cited as a key driver of performance improvement. Specifically, nurses being accountable for entering heart failure discharge instructions and for following up with physicians regarding ACE inhibitor use led to measurable improvement.

As an example, at Catholic Healthcare Partners, the system CEO personally participates in Leadership WalkRounds at the individual facilities for improving patient safety. The CEO's experience has been profound, and the feedback from all the participating facilities and their staff has had a positive effect as a mechanism for improving safety systemwide.

Effectively Disseminating Best Practices Across the Health System

Although best practices may be identified, the effective and efficient dissemination and adoption of better practices by other parts of the health system requires strong processes.

  • Baystate Health, for example, hardwires the practices by incorporating best practices and clinical guidelines into its electronic medical record system.
  • Aurora Health System has created a searchable "lessons learned database" to capture best practices by staff.
  • Iowa Health System stores best practices electronically, and they are made accessible via the intranet.

Culture as a Foundation

The spread of best practices across the system is an important element to high performance. However, this practice rests upon a foundation that includes a culture that enables performance improvement. 


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, September 21, 2010