Governance Practices in an Era of Healthcare Transformation: Achieving a Successful Turnaround.

EXECUTIVE SUMMARY: This article illustrates the successful application of principles established by the American Hospital Association (AHA) to foster hospital transformations (). We examined a small community hospital's successful transition from one emergency care center (ECC) physician group to another and the methods by which significant improvements in outcomes were achieved. The foundation of this transformation included a generative governance style at the board level, a shared governance model at the employee level, a renewed sense of employee and physician engagement, and a sense of individual accountability. Outcomes included improved communication, a more unified vision throughout the ECC (which led to improved efficiency and accountability among staff), improved metrics, and a positive impact on the community's perception of care. Press Ganey scores and ECC operational metrics demonstrated significant increases in patient satisfaction and decreases in wait times for seven operational metrics. These data serve as a proxy for the transformation's success. Structured interviews revealed an increase in employee satisfaction associated with the transition. The positive outcomes demonstrate the importance of the AHA-articulated governance principles. The AHA recommendations for a superior value-based care model closely align with the methods illustrated through Bristol Hospital's successful transformation. Other institutions can apply the lessons from this case study to drive positive change and improve patient care.

An examination of Leapfrog safety measures and Magnet designation.

Leapfrog Hospital Safety Grades and Magnet designation are two publicly available measures that serve as proxies for health care quality and safety. We examine whether hospitals with a better rating in one Leapfrog safety measure also have favorable ratings in other Leapfrog safety measures and whether Magnet-designated hospitals have better Leapfrog safety scores related to outcomes, processes, and structures than non-Magnet hospitals. Our study found that hospital-associated infections (HAIs) were not strongly correlated with one another, but Leapfrog safety process and structural measures were significantly and strongly correlated with one another, suggesting hospitals that invest in processes/structures to improve quality tend to do so across many dimensions. Also, Magnet-designated hospitals had higher Leapfrog grades for structural measures but not systematically better infection rates. Only one HAI (central line-associated bloodstream infections) had lower rates in Magnet hospitals than non-Magnet hospitals. These analyses suggest that improvements in process and structural measures do not necessarily translate into lower HAIs. Hospitals may need specific quality improvement strategies to target each HAI since HAIs are not strongly correlated with one another. Future research is needed to identify what process and structural measures can decrease HAIs and how this should be reflected in Magnet designation evaluation criteria.

Correlation between hospital rating agencies' data: An analysis and recommendation.

Hospital rating agencies exist to inform consumers through publicly available patient safety data. The large number of rating agencies, the variability in their methodologies and data presentations leave few consumers considering these data in making healthcare decisions. The objective of this study was to analyze the comparability of data from four different healthcare rating agencies to understand whether there exists a correlation among the rating agencies' published data. Four well-known rating agencies' data were gathered for 30 Connecticut hospitals and analyzed using correlation methods. The overall rating score was used for comparison accounting for patients' probability of referencing this score in determining a hospital's safety. The results indicate little or no correlation between ratings of Connecticut hospitals among the reviewed rating agencies. The only statistically significant correlation was between CMS and Leapfrog. The lack of correlation among rating agencies' publicly available data identified in this study leads to consumer confusion. This research provides support for the need for a valid, reliable, and transparent healthcare rating system to inform patient decision making. These findings can be used to advocate for a legislatively mandated national reporting system that focuses on user understanding of the data.

Improving medical care for detained immigrants: a call for a legislative solution.

Health care services provided to detained immigrants are inadequate to provide for the needs of this population. We analyzed the medical care policies and procedures for immigrants in detention, government reports on detainee medical care, and available mortality and morbidity data. We conclude that the current system of medical care for this vulnerable population needs improvement. We suggest that a federal legislative solution is one essential component to address this issue and improve medical care. Principles to be embodied in a legislative proposal necessary to address the inadequacies in the current system are presented.

Centers for Medicare and Medicaid Services' "never events": an analysis and recommendations to hospitals.

In August 2007, the Centers for Medicare and Medicaid Services (CMS) released the inpatient prospective payment system for fiscal year 2008 prohibiting reimbursement for 8 hospital-acquired conditions. The changes were mandated by section 5001(c) of the Deficit Reduction Act of 2005. Beginning on October 1, 2008, hospitals will no longer receive higher payments for patients with these conditions, termed never events. For fiscal year 2009, a total of 9 additional events are proposed. This initiative signals a new reimbursement strategy of aligning payment to patient outcomes and represents a response to government and private entities' call for hospital accountability for health care quality. This article identifies key events leading to CMS' ruling regarding nonpayment for hospital-acquired conditions, outlines the main points of interest in CMS' new rules, identifies limitations and concerns with this policy, and suggests measures that each hospital should voluntarily take to comply with 2008 and 2009 deadlines.

Patient safety legislation: a look at health policy development.

On July 29, 2005, President Bush signed into law the Patient Safety and Quality Improvement Act. This long-awaited bill came after considerable debate in the Senate and the House that focused on patient safety highlighted by the Institute of Medicine's (IOM's) report, To Err Is Human. The IOM report brought the significance of patient safety issues to the national forefront and called for congressional action, but it was 6 years after that report before Congress passed legislation in this area. The article explores the development of patient safety legislation and provides a historical review and analysis of the events leading to the passage of the final bill. It provides background about the major issues requiring resolution and compromise, compares the positions of the competing stakeholders, and describes the importance and degree of influence that can derive from input by stakeholders in the passage of legislation.