Distinct enough? A national examination of Catholic hospital affiliation and patient perceptions of care.

BACKGROUND: Catholic hospitals play a critical role in the provision of health care in the United States; yet, empirical evidence of patient outcomes in these institutions is practically absent in the literature. PURPOSE: The purpose of this study was to determine whether patient perceptions of care are more favorable in Catholic hospitals as compared with non-Catholic hospitals in a national sample of hospitals. METHODOLOGY: This cross-sectional secondary analysis used linked data from the 2008 American Hospital Association Annual Survey, the 2008 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, the 2008 Medicare Case Mix Index file, and the 2010 Religious Congregations and Membership Study. The study included over 3,400 hospitals nationwide, including 494 Catholic hospitals. Propensity score matching and ordinary least-squares regression models were used to examine the relationship between Catholic affiliation and various HCAHPS measures. FINDINGS: Our findings revealed that patients treated in Catholic hospitals appear to rate their hospital experience similar to patients treated in non-Catholic hospitals. Catholic hospitals maintain a very slight advantage above their non-Catholic peers on five HCAHPS measures related to nurse communication, receipt of discharge information, quietness of the room at night, overall rating, and recommendation of the hospital; yet, these differences were minimal. PRACTICE IMPLICATIONS: If the survival of Catholic health care services is contingent upon how its provision of care is distinct, administrators of Catholic hospitals must show differences more clearly. Given the great importance of Catholic hospitals to the health of millions of patients in the United States, this study provides Catholic hospitals with a set of targeted areas on which to focus improvement efforts, especially in light of current pay-for-performance initiatives.

Intrasectoral variation in mission and values: the case of the Catholic health systems.

BACKGROUND: Catholic health systems represent a unique sector of nonprofit health care delivery organizations because they must be accountable to institutional pressures of the Roman Catholic Church, in addition to responsiveness to market pressures. Mission statements and values are purported to be the driving force of Catholic institutional identity. Central to the understanding of the Catholic health care delivery sector is the exploration of variation in mission and values statements across the homogeneous field of organizations. PURPOSES: The purposes of this study were to identify expressed organizational identity variation-in terms of keywords in mission statements and values-of Catholic health systems in the United States by applying a methodology that integrates text and social network analytical techniques. METHODOLOGY: Data were obtained from the Web site of The Catholic Health Association of the United States and the Web sites of 50 Catholic health systems in 2007. Catholic health system mission statements and values were assessed using a cross-sectional study design. Text analysis and social network techniques were employed to identify the most central words in the texts and linkages among mission statement components and values. FINDINGS: This study identifies the components of a common mission statement and the most shared and unique values for a Catholic health system. Even with tremendous similarity, there is also evidence of intrasectoral variation between Catholic health system keywords in mission statements and values. PRACTICE IMPLICATIONS: Management implications include the consideration of word relationships developing and constructing mission and values statements to form the framework for strategic vision and management decision making, to assess potential partnership arrangements based on expressed mission statements and values, and to use in executing due diligence in mergers and partnerships.

Getting care levels right from beginning to end.

To enhance management of admissions and length of stay, hospitals should: Review the processes that clinical decision technology will support, and revamp those processes as necessary. Create clearly defined processes. Identify a physician champion and support his/her effort to lead the change necessary for adoption of improvement processes. Collect data to evaluate the program. Encourage clinical collaboration.

Religious health care as community benefit: social contract, covenant, or common good?

The public responsibilities of nonprofit hospitals have been contested since the advent of the 1969 community benefit standard. The distance between the standard's legal language and its implementation has grown so large that the Internal Revenue Service issued a new reporting form for 2008 that is modeled on the Catholic Health Association's guidelines for its member hospitals. This article analyzes the appearance of an emerging moral consensus about community benefits to argue against a strict charity care mandate and in favor of directing efficient care delivery and healthy community initiatives to underserved populations. The analysis turns on three moral conceptions of community benefits, the social contract model of hospital critics and the common good and covenantal models of Catholic and Jewish hospitals.

Productivity improvement: Catholic Health East reaps rewards.

Healthcare organizations that want to implement a productivity program should: Name an executive champion to lead the initiative. Develop a business model. Establish a productivity steering committee in each hospital. Use standardized definitions and auditable data. Define and monitor goals.

Preventing falls and eliminating injury at Ascension Health.

BACKGROUND: For Ascension Health's Healthcare That Is Safe strategy, eight hospitals served as alpha sites in the program to prevent falls and eliminate falls with injury. METHODS: The alpha sites implemented four key strategies: (1) assessment and re-assessment of patient risk factors for falls, (2) visual identification of patients at high risk, (3) communication of patient fall risk status, and (4) education of patients, families, and staff about fall prevention. RESULTS: The recommendations of the alpha initiative spread rapidly throughout Ascension Health and preceded measurement of the fall ratio. Even so, a 9.9% systemwide reduction in acute care fall rates from January to October 2006 was observed, and the average rate of falls with serious injury was less than 0.10 per 1,000 patient days. Compared with national rates, falls with serious injury at Ascension Health were less than 10% of the expected rate. DISCUSSION: Although it is not possible to prevent all falls in acute care facilities, decreasing the number of falls and the risk of serious injury from falls is possible. Key steps caregivers can take to prevent falls and fall injuries include establishing a trusting relationship with patients and their significant others; frequently reorienting patients to their environments, reminding those at high risk of falls not to get out of bed without help; checking on patients frequently and keeping their personal articles within reach; and protecting patients from falls at all entry points into the health care system.

Eliminating perioperative adverse events at Ascension Health.

BACKGROUND: For Ascension Health's Healthcare That Is Safe strategy, Sacred Heart Hospital (SHH) and Columbia St. Mary's (CSM) served as alpha sites to develop strategies to eliminate perioperative adverse events (POAEs). The alpha sites set an interim goal of a 50% reduction of POAEs, then 100%, or elimination of POAEs by July 2008. IMPLEMENTATION: The alpha sites identified a process for data management to establish clear, measurable elements for each of the five strategies of the alpha initiative; created an infrastructure to foster transformational change in the operating room suite; and implemented tactics to measure the success of the five strategies. STRATEGIES AND TACTICS: The sites implemented tactics for five strategies: (1) prevention of errors due to human factors, (2) prevention of surgical site infections, (3) prevention of adverse perioperative cardiac events, (4) prevention of postoperative venous thromboembolism, and (5) prevention of postoperative hemorrhage. RESULTS: Both alpha sites achieved > or = 90% reduction in the POAE rate. DISCUSSION: A number of key learnings were drawn from the alpha experiences, including the need to adjust to evolving definitions and guidelines for implementation and measurement of perioperative care.

What's the return? Assessing the effect of "pay-for-performance" initiatives on the quality of care delivery.

This article evaluates the impact of the Centers for Medicare & Medicaid Services/Premier pay-for-performance demonstration project on performance improvement in three clinical areas in a multihospital health care system. The study compares a group of hospitals participating in this project against a control group of similar hospitals that did not participate. Although the incentives are extremely small, the findings show that participation in the pay-for-performance initiative had a significant impact on the rate and magnitude of performance improvement. The project led to marked improvement in the quality of clinical process delivery and accelerated the adoption of evidence-based practices.

Eliminating nosocomial infections at Ascension Health.

BACKGROUND: Eliminating nosocomial infections was identified as one of eight priorities for action for Ascension Health. St. John Hospital and Medical Center (SJHMC), and St. Vincent's Hospital (STV), designated alpha sites, developed best practices for the prevention of catheter-related blood stream infections (CR-BSIs) and ventilator-associated pneumonia (VAP), respectively. METHODS: Both hospitals used the Institute for Healthcare Improvement model of "bundles" to achieve the goal of reducing nosocomial infections and also implemented multidisciplinary rounds and the use of daily goal sheets in the intensive care unit (ICU). RESULTS: Through the use of ventilator bundle, central line (CL) bundle, MDRs, and daily goal sheets, both facilities reduced CR-BSIs and VAPs by more than 50%. DISCUSSION: SJHMC saw the benefit of having the physical presence of the ICPs in the ICUs, providing the staff with on-the-spot reinforcement of the initiative. STV found by starting the change process through the use of a flexible MDR team, the hospital was able to successfully implement positive changes in its ICU culture. On the basis of the success in the ICU, the concept of MDR teams eventually was adapted and spread to all units. Open communication among all patient caregivers was extended and served to provide improved patient care throughout the hospital.

St. Francis Health System overhauls heart attack care process.

For scoring in the top 20% of hospitals for acute myocardial infarction (AMI), Bon Secours' St. Francis Hospital, in Greenville, SC, received a $54,000 bonus check last November from a Medicare pay-for-performance demonstration project. By implementing several process improvements, including improving its door to balloon time--the time it takes for a heart attack patient to enter the emergency department and then having an angioplasty in the cardiac cath lab--St. Francis' composite quality scores improved to 98% from 90% for AMI, or heart attack.

Straight talk--new approaches in healthcare. The best starting point for performance improvement: a healthy bottom line. Panel discussion.

Bon Secours Health System's South Division launched a multitude of performance-improvement projects in 2004 even though it boasted a 9% margin. Why? Officials at the Catholic healthcare system wanted to increase the amount of money available for its nation-wide charitable commitments as well as to invest in capital projects critical to its mission. In this installment of Straight Talk, we look at the performance-improvement initiatives of the South Division of Bon Secours Health System, Inc., which saved $8 million in just five months and expects to gain a total of $41 million after it completes all projects. Modern Healthcare and PricewaterhouseCoopers present Straight Talk. The session on performance improvement was held on March 22, 2005 at Modern Healthcare's Chicago headquarters. Fawn Lopez, publisher of Modern Healthcare, was the moderator.

Magnetic direction.

In April 2005, the American Nurses Association (ANA) awarded St. Joseph Hospital, Nashua, NH, its highest honor for excellence in nursing: "Magnet Recognition." The Magnet Recognition Program was developed by the ANA's American Nurses Credentialing Center in the early 1980s to recognize health care organizations that provide the best in nursing care and uphold the tradition of excellence in professional nursing practice. St. Joseph began pursuing Magnet status more than three years ago, starting with a number of enhancements to nursing practices. The hospital worked hard to improve nurse-to-patient staffing and included many of its nurses on the nursing quality council, division advisory, and cultural diversity committees. Magnet program appraisers visited the hospital this January to conduct an intensive, on-site three-day examination. They interviewed patients, staff nurses, physicians, hospital employees, administrators, board members, and nursing leadership to evaluate St. Joseph's nursing care, services, and delivery of care to patients and their families. Soon after, Magnet status was bestowed.

Clinical pathway care improves outcomes among patients hospitalized for community-acquired pneumonia.

PURPOSE: To examine the impact of a unique evidence-based clinical pathway on six outcomes of care in patients hospitalized for community-acquired pneumonia (CAP). METHODS: A retrospective cohort study of CAP patients discharged between January 1999 and December 2001, from 31 Adventist Health System institutions nationwide. A total of 22,196 records were available for multivariate analyses. Odds ratios (OR) for the outcomes were calculated and stratified by a unique severity score. The severity score ranged from 1 to 5, where 5 indicated the most severe condition. RESULTS: Pathway patients were significantly less likely to die in-hospital compared with non-pathway patients in four of the five severity strata (OR in severity level 1=0.37; 95% confidence interval [CI], 0.20-0.70). In all severity strata, pathway patients were approximately twice as likely as non-pathway patients to receive blood cultures and appropriate antibiotic therapy. Among patients who were classified as severity level 1, pathway patients experienced an 80% reduction in the odds of respiratory failure requiring mechanical ventilation (OR=0.20; 95% CI, 0.12-0.33). CONCLUSIONS: Patients who were placed on pneumonia clinical pathway care were much more likely than non-pathway patients to have favorable outcomes of care.

Laparoscopy for appendicitis and cholelithiasis during pregnancy: a new standard of care.

BACKGROUND: Subsequent to a report from the authors' institution, the laparoscopic management of symptomatic cholelithiasis and appendicitis during pregnancy has become the standard of care at LDS Hospital using institutional guidelines. For comparison with previous outcomes described by the authors, 59 additional laparoscopic cases are reported. METHODS: Medical records of all pregnant patients at LDS Hospital who underwent open or laparoscopic cholecystectomy or appendectomy between 1998 and 2002 were reviewed. The outcomes were compared with the authors' previous data. RESULTS: The laparoscopic management of symptomatic cholelithiasis and appendicitis during pregnancy increased from 54% to 97%. No significant differences in preterm delivery rates, birth weights, or 5-min Apgar scores were found between the two periods. No birth defects or uterine injuries occurred. CONCLUSIONS: With the use of the authors' guidelines, laparoscopy has become the standard of care for managing symptomatic cholelithiasis and appendicitis during pregnancy at LDS Hospital without significant increase in morbidity or mortality.

A memo from the central office: the "Ethical and Religious Directives for Catholic Health Care Services".

In 1994, the National Conference of Catholic Bishops revised the "Ethical and Religious Directives for Catholic Health Care Services." A goal of the Directives is to maintain the moral integrity of Catholic health care institutions and to address controversies in bioethics and health care. The Directives represent a shift to an exclusively principle-based approach to moral reason. This shift threatens to undermine the very tradition that the bishops seek to protect.

The morality of induced delivery of the anencephalic fetus prior to viability.

In situations where anencephaly is diagnosed and where the mother's life or health is threatened Roman Catholic hospitals are faced with the dilemma of waiting until viability before inducing the fetus, thus potentially putting the mother at further risk. According to most Roman Catholic ethicists, induced delivery before viability is contrary to the Church's prohibition of direct killing of the innocent. The authors propose for discussion a reconsideration of this position in the case of the anencephalic fetus and conclude that taking the life of such a fetus does not constitute an attack on its personal dignity and therefore is morally permissible.

TeamWorks: a model for continuous quality improvement in the health care industry.

Total quality management (TQM) or continuous quality improvement (CQI) are terms no longer being used exclusively within the manufacturing industry sector. Health care facilities, such as hospitals and nursing homes, are beginning to actively compete with each other for patients as well as face new regulations from the government. Hence, it is imperative that these facilities reevaluate their services and correct any production problems in order to be cost-effective and efficient in providing quality. Therefore, the objective of this article is to describe a model developed for improvement of hospital-wide services provided by the Baptist Health Systems' Montclair facility, a private, community hospital located in Birmingham, Alabama. The TeamWorks for Quality model, used to charter over 40 teams, illustrates how managers and employees can build a multifaceted process that delivers services in excess of customer expectations.