Cutting Costs and Improving Quality: The Everett Experience

Abstract

THE FEATURE ARTICLES Cost Cutting in Health Systems Without Compromising Quality Care and Cost Reduction in Health Systems: Lessons from an Analysis of $200 Million Saved by Top-Performing Organizations examine fundamental aspects of achieving high-quality, lower-cost healthcare. Both emphasize the importance of tracking and analyzing data, creating a supportive culture, and effective feedback and monitoring techniques to ensure that changes become part of an organization's fabric. Both identify numerous key factors for success: * A mindset of clinical quality * Keeping the patient first when considering change * Alignment of stakeholders, including clinical staff, physicians, and other providers * Transparency of strategic imperatives and goals * Use of clinical and operational data to pinpoint and track progress * Adherence to evidence-based practices and protocols that ensure consistent implementation across all patients and programs * Standardization of management based on these best practices * Clear accountability for results * Consistent monitoring of those results and data * An organizational belief that status quo is not acceptable ACHIEVING TOP PERFORMANCE Based on extensive research, Caldwell, Butler, and Poston write of the successful techniques of top performers. They found that rarely were all senior leaders in a top-performing organization themselves top-performing leaders. They state, Certainly, the collective competencies of the entire teams determined the direction of each organization's performance, but leadership was not the defining characteristic. Factors such as structure, prioritization, goal setting, use of data, and organizational culture provided a much richer differentiation than leadership alone. While leadership is an important factor, the research heralding the collective competencies of the entire team rings true at Providence Regional Medical Center. Many higher-quality, lower-cost practices are born out of physician and staff innovation - teams of people working together for the good of the patient. For example, one such team developed Providence Regional's Cardiac Single-Stay Unit (CSSU). For more than a decade, Providence Regional has operated an award-winning cardiac program; however, in 2003, a cardiac surgeon and a critical care nurse started asking, Why do we move the cardiac surgery patient from ICU to telemetry to an acute care floor, when it would be best for the patient to stay in one room and the care to move around the patient instead? This innovative, anti-status-quo thinking led Providence Regional to be among the first in the nation to open a cardiac single-stay unit. The traditional model involves more handoffs and an increased risk of infection and complications. The CSSU model keeps the patient in the same room after surgery, with staff and equipment moving in and out as needed, minimizing many of the risks and difficulties. The cardiac single-stay unit was - and remains - a highly successful approach to care. Today, the 15-bed CSSU has routinely scored in the top decile of performance, and length of stay is one day shorter than the national average - which results in reduced costs. Plus, patients experience significantly lower infection rates and readmissions. DIAMONDS IN THE DATA In keeping with the findings by Clark and Caldwell and their colleagues, successes in reducing costs while improving quality are largely attributable to emphasis on effective data mining and use ofthat data to identify opportunities for cost savings, as well as clinical integration initiatives that focus on patients' well-being and measurable quality outcomes. The feature article by Clark, Savitz, and Pingree also challenges past assumptions that more is better. In fact, they write that Intermountain Healthcare's clinical outcomes data suggest that quality can actually be enhanced when some cost drivers are appropriately minimized and standardized within the context of providing value-driven healthcare. …