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pnemonia
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Published by khaderbasha2020
case study
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Case Study Series on

Pneumonia Care
Improvement Measures:
Improvement Strategies
ofTop-Performing
Hospitals
The following synthesis of performance improvement strategies is
based on a case study series published on The
CommonwealthFund Web site, WhyNotTheBest.org. The hospitals
profiled in this series were identified based on their performance
on thepneumonia care improvement measures that are reported
to the Centers for Medicare and Medicaid Services. Please see the
casestudies for a full description of the selection methodology.The
case studies describe the strategies and factors that appear to

contribute to performance improvement on the pneumonia

measures.It is based on information obtained from interviews with
key hospital personnel and materials provided by the hospitals.
The hospitals profiled in the case study series are:
i

Holland Community Hospital, Holland, Mich.

Parkview Medical Center, Pueblo, Colo.

St. Lukes Regional Medical Center, Sioux City, Iowa

Walla Walla General Hospital, Walla Walla, Wash.

Western Baptist Hospital, Paducah, Ky.

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Category Pneumonia Care Strategy Example/MethodGeneral
Quality Improvement Strategies, Applied to Pneumonia Care

Set internal benchmarks against which core measure

performance, includingpneumonia care performance, will be
monitored. Increase the benchmarks eachyear. (Holland
Hospital)Set benchmarks and goalsBenchmark hospitals across
the health care system. Member hospitals can seehow they
compare to peers. This friendly competition can be a
motivatingfactor in quality improvement efforts. (Walla Walla
General Hospital)Establish an interdisciplinary team to monitor
pneumonia care performance,review non-compliant cases,
perform root cause analysis, and developpneumonia care
improvement strategies. (Walla Walla General Hospital;Holland
Hospital; Western Baptist Hospital)Establish interdisciplinaryteam
focused onpneumonia careimprovementInclude physicians on the
team to provide an opportunity for meaningful input.Having

physicians on the team is critical to achieving physician buy-in for

newinitiatives. Physician leaders can help sell the core measures
and performanceimprovement initiatives among the medical staff.
(Walla Walla GeneralHospital; Holland Hospital; Western Baptist
Hospital)Cultivate a blame freecultureWhen investigating the
root cause of a non-compliant case, brainstormopportunities to
improve established patient care processes instead of
placingblame on individuals. (Holland Hospital)Allow physician
leaders to naturally emerge through participation in
qualityimprovement activities, such as inclusion in pneumonia
care improvementteams. (Holland Hospital)Have a physician take
on the informal role of physician champion. Physicianchampions
can help develop pre-printed order sets and provide direction on
thebest ways to present changes to medical staff. (St. Lukes
Medical Center)Establishing andnurturing cultureof
qualityimprovementEngage physician leadersin pneumonia
careimprovement efforts toattain physician buy-in andkeep
energy levels highIdentify a physician champion to lead
performance improvement teams.Solidify the physician
champions role in a formal agreement and providecompensation.
Responsibilities can include: 1) providing reports and updates at

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Category Pneumonia Care Strategy Example/Method

medical staff meetings; 2) reviewing core measure performance

data and casesof non-compliance; and 3) meeting one-on-one
with non-compliant physicians.(Western Baptist Hospital)Perform
concurrent review as a way to address issues of non-compliance
beforea patient is discharged from the hospital. (Western Baptist
Hospital; WallaWalla General Hospital; St. Lukes Medical Center;
Holland Hospital;Parkview Medical Center)Use the concurrent
review process to build relationships with clinicians andeducate
them about the pneumonia care core measures and how they
improvepatient care. Effective concurrent reviewers will be
considered part of thepatient care team and not as a rule

enforcer. (Parkview Medical Center)Review patient medical

records five to 10 days after discharge to correct chartsas needed.
(Walla Walla General Hospital)Flag core measures patients in the
hospitals EMR and send patient cases to thequality department
for an analyst to review and follow. As an additionalassurance,
compile daily status reports of core measures patients that
clinicalmanagers and directors can review. (Holland
Hospital)Perform concurrent reviewor daily audit of patientmedical
recordsMeet with staff to provide education in real time about
cases that are notmeeting the core measures. (Western Baptist
Hospital; St. Lukes MedicalCenter; Parkview Medical
Center)Involve primary users, such as internists and emergency
department physicians,in the development of the order set.
(Holland Hospital; St. Lukes MedicalCenter; Walla Walla General
Hospital)Rely on a recognized provider of clinical decision support
tools to ensure thatpre-printed order sets are up to date with the
most current evidenced-basedmedicine. (St. Lukes Medical
Center)Incorporatingimprovement toolsand processes intodaily
routinesDevelop pre-printed ordersets to standardize
thepneumonia care processand guide clinicians in theprovision of
careMake sure order sets are convenient, easy-to-use, and
accessible. Order setsshould be easily incorporated into physician
routines. Remove any extraneousinformation from order sets. (St.
Lukes Medical Center)

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