By Julie Yonek, Stephen Hines, and Maulik Joshi
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.
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.
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.
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.
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 (firstname.lastname@example.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.
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