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Annual Reports on Quality

Thirteenth Annual Report on Quality

Doing It Better:” Thriving in a Changing Health Care Environment

Nationally and locally, this has been another tumultuous year in health care. We now stand at the threshold of the implementation of new policies brought about by health care reform. After all of the wrangling and debating, forums, editorials, and voting, it is now a reality. The details of this new reality are still being hammered out, but make no mistake: We are in a changed environment. We will see dramatic and ever-increasing changes as we go forward, and the pace of change will only accelerate—affecting not only who is covered and how clinicians are reimbursed, but also how health care is delivered.

One thing is very clear: Providing high-quality care that removes or minimizes the risk of harm to patients will mean the difference, in the long run, between success and failure. Like many hospitals and medical systems, Crozer-Keystone Health System (CKHS) has spent much of the past decade listening to and acting on experts’ advice about how to ensure quality and patient safety. We have worked hard to put systems in place to eliminate harm—making sure, for instance, that no patient acquires an infection in our hospitals, or misses out on the recommended standard of care, or receives the wrong medication or wrong dosage. While our main concern is always the safety of the people we care for, we also know that mistakes can lead to longer hospitalizations, additional treatment, and even readmission, all of which make care more expensive.

CKHS is working to put an end to potentially avoidable harm and the unnecessary costs these incidents create. That is what I mean by “doing it better.” This involves all of us working as a team to care for patients, ensuring they receive the right care when they need it and where they need it. We are shifting our paradigm away from what John Nance, author of Why Hospitals Should Fly, described as a “farmer’s market mentality” in which the hospitals provide the roof and tables and doctors simply rent the space to ply their trade. “Doing it better” means working together as true partners to make sure the best care is given.

This change will be hard. I can’t help but think of this quote on how people react to change: “Given the choice of changing or proving that change isn’t necessary, most people get busy working on the proof.” At CKHS, we have moved beyond resisting change. We feel a sense of urgency in taking an even harder look at how we provide care and how we perform. Improving quality and patient safety are the levers to better outcomes, greater efficiency, and lower costs. And there are two potential catalysts for improving quality and safety: clinical effectiveness and clinical integration, both of which are intimately related. With clinical effectiveness, we improve care by using best practices, evidence-based medicine, reductions in variation, and better communication to improve quality and eliminate waste. Clinical integration can accelerate this model by emphasizing that physicians must team up with other physicians and the hospital to improve the quality of care provided.

As you will see in this 13th Annual Report on Quality, Crozer-Keystone Health System is poised to deliver such effective, integrated care and thrive in a changing environment. This report continues the story of our last 12 reports, but it takes on even greater significance in light of the historic passage of health care reform. Section 1 discusses what some health care thought leaders are saying about “doing it better”—including the two speakers who presented at our annual CKHS Quality Retreat. In Section 2, we present a series of case studies that indicate how CKHS is working continuously to deliver care that is effective, patient-centered, and efficient. And finally, in Section 3, we share results that will show you how CKHS has performed on a range of quality measures.

Throughout CKHS, I can see that an awareness of the importance of patient safety and quality is everywhere—from top to bottom and bottom to top. But we are still working to make sure that all of our physicians, administrators, and staff members know that they have a role to play in “doing it better.” Our goal is not to react to the changes that health care reform may bring, but to position ourselves to lead the way.

Eric Dobkin, MD
Vice President, Quality and Patient Safety
Crozer-Keystone Health System