Transformational Change in Hospitals: Case Studies of Six Transforming Hospitals

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Transformational Change in Hospitals Case
Studies of Six Transforming Hospitals

• January 24, 2006
• Presentation to
• AHQA Annual Meeting
• Crossing the Bridge
• Myles Maxfield
• Suzanne Felt-Lisk

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Objectives

• What is transformational change in hospitals?
• What long-term vision of the health care delivery
  system are these hospitals following?
• How can CMS support and facilitate
  transformational change?
• How can QIOs support and facilitate
  transformational change?

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Methods

• Identified 6 advanced hospitals
• McLeod, Florence NC
• Geisinger, Danville PA
• Tallahassee Memorial, Tallahassee FL
• Hackensack Univ. Med. Center, Hackensack NJ
• Exempla Healthcare, Denver CO
• Lincoln Hospital, Davenport WA
• 1-2 day in-person site visits
• Board member, CEO, CFO, COO, CMO, CNO, QI
  director, physicians, nurses
• How could CMS and QIO have helped at early stages
  of your transformation?

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What Is Transformational Change

• Recognition that quality can be improved
• CEO and board regard quality as job 1
• Transformational change is a process
• All staff are involved
• Systems need improvement, not people
• Working in teams
• Clinical process redesign

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Vision of the Future

• Continuity of care
• Patient-centered care
• New social contract
• Quality measurement
• Internal
• Public
• Technology

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Facilitating factors

• Adverse financial or quality events
• CEO with a vision and a passion for quality
• Quality will be rewarded
• Common vocabulary based on theory
• External assistance
• Non-profit status
• Close ties with physicians

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Transformation Costs and Benefits

• Financial costs
• HIT
• QI staff
• Staff training
• Benefits
• Reduced adverse events and LOS
• Competitive position
• Staff (and physician?) morale and turnover

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How Can QIOs Support It?

• Identify early adopter hospitals for QIO
  intervention
• Inspire and motivate
• Communicate with C-suite execs
• Overcome objections
• Business case
• Theory for vocabulary of change
• QI theory Deming, Donebedian, 6 Sigma,
  Lean-Toyota, PDSA, root cause analysis,
  microsystems
• Theory of organizational change John Kotter,
  Leading Change
• Reliability theory IHI

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How Can QIOs Support It?

• Clinical process redesign
• Literature synthesis
• Collaborative
• Arrange for experts
• Internal performance measurement
• Not how to report HQA data
• Best practices
• Engaging physicians
• Art, not science
• Sensitive to culture and training

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How Can QIOs Support It?

• Analytic services
• Trends in local Part A and Part B claims
• Disseminate transformational change case studies
• McLeod seminar
• Premier Rapid Improvement Programs
• IHI-like projects
• 100,000 lives campaign
• Avoid auditing relationships
• Reviewing individual medical records

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Potential National-Level Implications

• Lead with a vision of transformation
• Payment system
• P4P designed as share in savings
• CPT codes for desired behaviors
• Other financial
• Clinical process redesign
• Direct support of HIT

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Potential National-Level Implications

• Align regulations and statutes
• Conditions of participation
• State regulations
• Stark law barriers to continuity of care, EHR
• Refine quality metrics
• Real time, fine grained, physician-level
• Outcome measures, efficiency measures
• Respond quickly to changes in clinical best
  practice
• Data to support continuity of care
• Claims data across settings to facilitate chronic
  care management

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Potential National-Level Implications

• Support physician engagement
• Physician recognition program
• Medical school curricula
• Involve patients in their care
• Health literacy training
• Continue experimenting
• Engage transforming hospitals in designing demos
• Partner with IHI