Main Navigation

Annual Reports on Quality

Fourteenth Annual Report on Quality

What a year it’s been since we presented you with our last Annual Report on Quality! These times have been exciting yet overwhelming for health care, no matter what your perspective is. The winds of change have become a full-force hurricane: The Affordable Care Act of 2010 is now being implemented, and in the past six months we have seen a number of significant developments. For example:

The proposed regulations for Accountable Care Organizations, or ACOs, were released. A key provision of the Affordable Care Act, ACOs will attempt to create incentives for hospitals, doctors, and other entities to work together to improve the quality of care and increase efficiency, thereby reducing costs.

The Department of Health and Human Services (HHS) unveiled its National Quality Strategy. As the country’s “road map” for health care in the future, it has three broad aims: Better Care, Healthier Communities, and More Affordable Care. From these three aims, HHS has developed the first six priorities of the quality strategy:

Safe care
Patient-centered care
Effective communication and coordination
Prevention and treatment of leading causes of mortality in the community
Promotion of healthy living
Development and spread of innovative models for health care delivery systems

The Partnership for Patients: Better Care, Lower Costs initiative made its debut. This public/private sector initiative, sponsored by HHS and the Center for Medicare and Medicaid Services (CMS), has two goals: keep patients from being injured, and help patients heal without complications. It recently provided grants totaling $1 billion, half for projects focused on preventing adverse events and the other half for preventing readmissions.

CMS began its Value-Based Purchasing Plan. This will change the way CMS pays hospitals for the care of Medicare patients. CMS is increasingly using financial incentives and penalties to improve quality of care, outcomes, and the patient experience.

If you look closely, you will see that there are common themes running through these programs and projects.

First is the focus on preventing adverse events. While we lead the world in medical innovation, research, and development, and while we educate and train outstanding physicians, nurses, and other health care professionals, we often fail to consistently provide exceptional care to our patients. There is mounting evidence that serious adverse events are more common than any of us ever thought. The Inspector General’s Report to Congress last November noted that 1 in 7 Medicare patients suffered a serious adverse event during their hospital stay, and 44 percent of these events—almost half—were preventable. Adverse events are so costly not only in actual dollars, but in the emotional cost and burden to patients, their loved ones, and—though this is often overlooked—the clinicians involved.

Another theme is patient- and family-centered care. I am often asked, “What does this phrase really mean?” It means providing care as seen through the eyes of the patient. It means including the patient and family in medical decisions and respecting their wishes. It means ensuring they understand what we are recommending for their care, they have rapid access to this care, and that we provide comfort and a clean, safe environment all of the time for every patient.

The third theme is the need for greater efficiency. There is enormous waste in the health care system: unnecessary testing, delays, double-work, excessive paperwork, and most of all, inefficient work flows. Although we can look to technology to help us, it won’t be a panacea. Achieving efficiency will take hard work that breaks down barriers and silos. We will have to work together seamlessly as a health care team—inpatient and outpatient physicians and staff, physicians and nurses, hospitals and physicians, private practice and employed physicians. We must not continue to look at care as separate fragments: the office visit, the hospital experience, the operative procedure. And we can’t persist in the notion that doctors, nurses, and other members of the health care team can have their own independent agendas for patient care. We’re all responsible for patients’ outcomes and their experience of care. It’s not OK to stay silent if your peer does not communicate clearly and compassionately. It’s not OK for physicians to ignore the issue of patient falls because it’s a “nursing thing,” or for the surgical scrub tech to fail to speak up when a step is missed in the pre-operative checklist because it is a “doctor thing.” At the end of the day, we’ll be judged on our collective outcomes, and we all wear the same team jersey.

If you think about it, the three themes I just highlighted—less harm, patient-centered care, and increased efficiency—will lead us to what we aim for: better care that costs less. Perhaps I could have said this all more simply by using the words of Dr. Thomas Russell, the chairman of the board of the American College of Surgeons. Last October at the College’s meeting, Dr. Russell’s lecture focused on what surgeons will encounter in the new paradigm of health care. He highlighted the characteristics of what he called “the past generation” of health care delivery: physician-centric care that is anecdotal and mentor driven; solo practice-based care with a fee-for-service model; and minimal concern for resource utilization and cost. As he himself said, “That was then, and this is now.” He noted that these five points will set the tone for the future:

Patient-centered, value-driven care
Evidence-based guidelines
Integrated systems of care
Waste reduction
Emphasis on wellness, prevention, and a conservative approach to care

The fact that this came from the leadership of the American College of Surgeons shows the extent to which these priorities have become mainstream.

So, wouldn’t we all like to jump ahead about 20 years and see how this all turns out? We can’t do that, but there are health systems out there that can help us understand what the future is going to look like. At this year’s Crozer-Keystone Health System (CKHS) Quality Retreat, we were fortunate to hear from leaders with two of them: Virginia Mason Medical Center in Seattle, and closer to home, Geisinger Health System in central Pennsylvania. In many ways, they already embody the essential elements of transformation I have highlighted, as you will see in Part 1 of this 14^th Annual Report on Quality.

CKHS may not be quite as far along in its transformation of care as these institutions are, but we have made great strides. For the 14th year in a row, this Report will share highlights of what we’ve done over the past year to keep our patients safe, improve outcomes, make care more seamless and more efficient, and improve the experience of patients and families who turn to us for help. You will find a selection of some of our most notable case studies in Part 2. In reading them, I hope you’ll see that we are already in step with the priorities set forth by HHS in its National Quality Strategy. These concepts are not new to CKHS—and as a result, we are well-positioned to thrive in a health care environment that is transforming before our very eyes.

And finally, I wish to call your attention to an exciting change in how we are reporting our annual CKHS Quality and Evidence-Based Medicine results, which traditionally have been included in this Annual Report on Quality. You can now access these anytime on our newly redesigned website at http://patientsafety.crozerkeystone.org. There you’ll find performance data for our EBM projects, patient safety and patient experiences of care, and hospital acquired infections.

Change is challenging but necessary. The fact that CKHS has been focusing on quality for more than a decade speaks volumes about our commitment as a health care system. With each Annual Report on Quality, I grow even more excited about CKHS’ progress and potential. I hope you enjoy accompanying us on this journey.

Eric Dobkin, MD, FACS, FCCM
Chief Quality Officer
Vice President, Quality and Patient Safety
Crozer-Keystone Health System