It's the work, not the man, that manages.

We are indeed fortunate to be forging an integrated laboratory serving a healthcare system that is very focused on clinical quality (see article from The Dark Report below).  Laboratory test results and diagnoses comprise roughly 70% of the empiric the data in CarePlus and are said to drive 90% of clinical decisions in modern medical care.  And all this comes at a favorable operational and capital cost, especially in our developing hub-and-spoke, core-lab delivery model.  Therefore, the laboratory will be key to supporting many advances in clinical quality throughout the Henry Ford Health System.

Our Pathology and Laboratory Medicine goal is drive a higher level of quality and seamless of laboratory testing for all patients across the System by adopting LEAN management with its underlying Deming principles and our hospital-based innovation of the Toyota culture of the empowered worker armed with intelligent quality tools. Your role as a leader, focusing on designing standardized means to enable our workers to perform our important work better, is critical to making and sustaining this transformation to continually improve our approach to work. 

This concept is not new for as Henry Ford said almost a hundred years ago- "It's the work, not the man, that manages."

The Dark Report - Meet the Nation's Top 10 Healthcare Systems for Quality

October 26, 2009

Advanced use of EHRs is one characteristic of nation's quality leaders

It's a new study and ranking of top-performing health systems that Dark Daily readers will find interesting and useful. Thomson Reuters announced its latest Top 10 rankings, and identified three main ingredients for attaining higher-quality outcomes. They were: 1) a corporate-level coordinating committee; 2) ample involvement in planning from front-line caregivers; and a system-wide electronic health record system (EHR).

Thomson-Reuters evaluated 252 health systems, representing 1,720 hospitals. Its findings were published exclusively in Modern Healthcare. Its rating was based on five clinical performance measures: mortality, complications, patient safety, length-of-stay and use of evidence-based medicine. No attempt was made to measure financial performance. The health systems study used 2007 information from two public databases, the Medicare Provider Analysis and Review and Center for Medicare and Medicaid Services' Hospital Compare.

Interestingly, all but one of the 10 top systems are in the Midwest. The exception is Prime Healthcare Services of Victorville, California, which was also the only for-profit system in the group. As judged by Thomson Reuters, the top ten health systems in the United States were, in alphabetical order:

  • Advocate Health Care, Oak Brook, Illinois
  • Catholic Healthcare Partners, Cincinnati, Ohio
  • Health Alliance of Greater Cincinnati, Cincinnati, Ohio
  • HealthEast Care System, St. Paul, Minnesota
  • Henry Ford Health System, Detroit, Michigan
  • Kettering Health Network, Dayton, Ohio
  • OhioHealth, Columbus; Ohio
  • Prime Healthcare Services, Victorville, California
  • Trinity Health, Novi, Michigan
  • University Hospitals, Cleveland, Ohio

Each quality measure had equal weight on the Thomson Reuters scorecard. To make the Top 10 list, one requirement was that each health system had to score at or above the median level of performance on all quality measures. Those health systems making the Top 10 list outperformed expectations.

For pathologists and lab managers interested in the clinical performance of these top performing health systems, Thomson Reuters published these collective accomplishments:

  • Risk adjusted mortality was 0.82%, which is 17.6% lower than the 1% median score for peer systems;
  • Complications rate was 0.83%, a figure that is 16.8% lower than the median peer score;
  • Patient safety measures of 0.97%, or 3% better than the median for peers;
  • 93.5% adherence to evidence-based practices, compared to 88.7% for peer systems; and
  • Average length-of-stay was five days, or 10.7% lower than median 5.6 days at peer hospitals.

Trinity Health's corporate leadership council illustrates the value of coordinating quality initiatives from the executive level. The council decides on which quality improvements to pursue. It includes the chief medical, nursing, and pharmacy officers from all 28 of the system's hospitals. A team of front line caregivers and support staff is assembled to develop the plan for improving relevant patient care processes.

Trinity uses its EHR system to introduce its clinical quality initiatives. For instance, Trinity has created an electronic order set for pediatric dosages of antiviral drugs in response to the novel H1N1 influenza threat. This order set was developed and made available to physicians only 48 hours after the Centers for Disease Control and Prevention (CDC) issued novel H1N1 antiviral recommendations for children.

At Prime Healthcare, use of the EHR now plays an essential role in a comprehensive wound initiative. The first step in the process involves accurate assessment of wounds in the EHR as part of the admissions process. Data on wounds must be correctly keyed into the system before the admission process can proceed. That locks out a problem-common in the past-where "not applicable" to questions about the wound allowed the procedure to continue. Information of pre-existing wounds, including photos, is also attached to remind physicians to order treatment plans.

One key insight for laboratory administrators and pathologists is the sophisticated ways that these Top 10 health systems use EHRs. In turn, when laboratory test data is available in real time in the health systems' EHRs, it is possible for clinicians to use that lab test data to support a variety of clinical initiatives designed to reduce medical errors and improve patient outcomes. Thomson Reuters' Top 10 list of health systems provides another reminder of how quickly integration of clinical services and operational functions is occurring within the nation's hospitals.

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