The mission of The CommonwealthFundis to promote a high performancehealth care system. The Fund carriesout this mandate by supportingindependent research on health careissues and making grants to improvehealth care practice and policy.
Case Study
High-Performing Health Care Organization
•
June 2010
To download this publication andlearn about others as they becomeavailable, visit us online atwww.commonwealthfund.organdregister to receive Fund e-Alerts.Commonwealth Fund pub. 1410Vol. 46
Mmoial Halthca Sstm:A Pblic Sstm Focsing onPatint- and Famil-Cntd Ca
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ennifer
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Location:
Broward County, Fla., north of Miami-Dade County.
Type:
Public health care system.
Beds:
1,742 beds, including 301 at Memorial Hospital Pembroke, 1,014 at Memorial RegionalHospital and Memorial Regional Hospital South, 299 at Memorial Hospital West, and 128 atMemorial Hospital Miramar.
Distinction:
Two Memorial Healthcare System hospitals scored in the top 1 percent of public andprivate U.S. hospitals on a composite of 23 process-of-care quality measures (Memorial HospitalPembroke and Memorial Regional Hospital); two others scored in the top 5 percent of hospitalsnationally (Memorial Hospital West and Memorial Hospital Miramar). More than 2,000 public andprivate hospitals were eligible for the analysis.
Timeframe:
July 2007 through June 2008. See Appendixfor full methodology.This case study describes the strategies and factors that appear to contribute to high adherence to“core” quality measures at Memorial Healthcare System. It is based on information obtained frominterviews with key hospital personnel, publicly available information, and materials provided by thehospital in September and October 2009.
SuMMAry
Memorial Healthcare System (MHS) has provided public hospital care in SouthBroward County, Florida, for 56 years.
1
Over time, the system has grown anddiversified to include primary and long-term care, cancer care, and a dedicated pediatric hospital. Starting in 1993, MHS accepted responsibility for the county’s public clinics and continues to operate these programs in an effort to coordinate
1
For this case study series, public hospitals were defned as those that are government
owned and/or members of the National Association of Public Hospitals. It was not
possible to compare hospitals by their payer mix, since hospitals may defne payer
categories in different ways.
For more information about this study,please contact:Jennifer Edwards, Dr.P.H.Health Management Associates jedwards@healthmanagement.com
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Exhibit 1. Staff Communication About the Recognition Program:Memoral Health System
The award recognizes outstanding employees for their achievements and commitment to providing a healing environment that is safe,
efcient, customer focused, and of superior quality. As we strive to become the safest healthcare system in the nation, we salute our employees for always putting patients and families' needs rst.
Nominations
Eligibility
All Memorial Healthcare System employees, with the exception of Department Leaders and Administrative Ofcers, can be nominated for
the recognition program. Nominations can be made for individuals who exhibit extraordinary behavior, as outlined in the criteria below.
Review Process
To nominate fellow employees for this award, we ask that you please review the pillar-specic criteria below. Select the pillar that most
closely illustrates the extraordinary behavior. We recognize that some behaviors will have characteristics that fall into more than one pillar category. All nominations received will be automatically routed to the respective hospital or healthcare system entity where the nominatedemployee works. Each facility will have a designated committee to review the nominations and select the award recipients.
Pillar Criteria: Safety, Quality, Service
Safety Criteria:
Individuals who go “above and beyond” for patient, family, or employee’s safety
•
Potential for harm is avoided
•
Patient safety is a focus
•Identication of a situation that warrants immediate intervention•
Employee speaks up and is persistent regardless of hierarchal position or resistance encountered
•
An Incident Report must be completed and fled with Risk Management, when appropriate•
Quality Criteria:
Challenges the “status quo” and attempts to promote change that benets the organization•Suggests and/or implements an idea that improves quality of care and increases productivity/efciency•
Develops a new strategy for improvement
•
Develops improved techniques
•Detects aw/imperfection and brings to the attention of others•
Service Criteria:
Manager attestation
•
Recognized by customers as consistently exceeding Memorial Healthcare System’s Standards of Behavior
•
Promotes optimism, teamwork, and collaboration on a consistent basis
•
Recognizes others for their efforts in meeting or exceeding department/organization goals
•
Respectfully welcomes open-minded and diverse opinions which creates a fertile environment for
•
learning and collaboration
Identied as a great mentor and/or wise counsel•
Excels at interdisciplinary collaboration
•
Source: MHS, 2010.
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the use of outpatient and inpatient care and providesavings for taxpayers who help fund bad debt andcharity care at MHS.On average, public hospitals do not perform aswell as private hospitals on the process-of-care, or “core,” measures reported by hospitals to the Centersfor Medicare and Medicaid Services (CMS). The coremeasures, developed by the Hospital Quality Alliance(HQA), relate to achievement of recommended treat-ment in four clinical areas: heart attack, heart failure, pneumonia, and surgical care. The differences in coremeasure performance between public and private hos- pitals are not well understood, but may relate to publichospitals having more complex patients, tighter bud-gets, or older infrastructure. MHS hospitals, however,scored very well on process-of-care measures, not onlycompared with other publicly owned hospitals butcompared with all hospitals. All four Memorial hospi-tals were in the top 5 percent of hospitals on a com- posite measure, and two were in the top 1 percent(among more than 2,000 hospitals in the analysis cov-ering the year ending June 2008).MHS leaders have developed a multifacetedquality and safety strategy that relies on storytelling toconvey to staff and patients the type of care they wishto provide. Monitoring and reporting of performancedata, combined with careful design of care processes,help the hospital achieve its goals. Staff also receivetraining and coaching on ways to enhance the qualityof care. In addition, hospital leaders’ desire to appealto privately insured patients, and to keep peoplehealthy before and after hospitalizations, appears todrive improvement. For further information about the public hospital selection process and cross-cutting les-sons about their improvement efforts, please see our introductionto the public hospital case study series.
Oganization
MHS is the nation’s fifth-largest public health caresystem. It operates five hospitals (in six sites), twocancer institutes, a nursing home, an adult day care program, and numerous community and school-basedclinics. Legally the South Broward Hospital District,Memorial Healthcare System is governed by a seven-member board appointed by the governor. While gov-ernors have replaced board members at staggeredintervals of four to eight years, the president and CEO,Frank Sacco, FACHE, has been leading the organiza-tion for more than 22 years.MHS has experienced steady growth over thelast few years as patients from across South Floridaseek care from its hospitals and clinics, and as newhospitals have been acquired within a fairly small area(the farthest hospitals are 15 miles apart). Inpatientand outpatient volume are on the rise, with admissionsgrowing by 17 percent between 2005 and 2009 andoutpatient visits growing by 18 percent during thesame period.County tax revenue helps to support the cost of uncompensated care at MHS, which reached $725 mil-lion in FY2009; that year, bad debt and charity carerose by 19 percent over FY2008 levels. Despite theincreased demand for indigent care, the system’sFY2009 financial performance was the strongest in itshistory, according to hospital leaders. Effective finan-cial management has allowed the board to lower taxesin each of the past three years. County tax-generatedrevenue is less than 4 percent of the system’s totalrevenue.MHS is implementing components of an elec-tronic health record system. In some parts of its hospi-tals, physicians use the system to order treatments,tests, and consultations. An automated pharmacy sys-tem alerts clinicians about allergies, duplications, andrisks. Bar-coding technology enables clinicians tocompare a medication’s bar code with a patient’s iden-tification bracelet to help prevent medication adminis-tration errors. The move from paper to electronic med-ical record documentation is under way. In many patient care areas, clinical staff can access electronicnursing notes, progress notes, vital signs, and other clinical information, but physician notes are not yet part of the system.
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Public System Focus: Family Centered Care
Memorial Healthcare System: A Public System Focusing on Patient- and Family-Centered Care
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