"Hospitals and systems need to engage closely with every member of the healthcare team — physicians, clinical and non-clinical employees — to reduce variation in operations and quality. Clinical dashboards should be developed to identify the organization's performance in clinical areas, with organization-wide action plans developed to evaluate and improve any area of concern. Improvement in quality and safety is difficult and complicated, as it takes changes in the way we deliver care to improve the care. Again, there are many external metrics to use to compare the organization's performance, and those should be used to target top performance." — Chris Van Gorder, president and CEO of San Diego-based Scripps Health
"First, as the people in an organization are a major determinant in the care hospitals provide, it's important to focus on the recruitment and retention of staff. You want people who are skilled at the highest level, regardless of their role, and who are committed to working together as a team to contribute to the growth of the institution. Second, care is generally not delivered by an individual but by teams, so systems need to seamlessly come together to achieve needed outcomes. It's important to pay attention to patient flow and processes that enable care delivery. Appropriate use of information technology can enable systems and processes to work efficiently with the goal of improved outcomes." — Louis Shapiro, president and CEO of Hospital for Special Surgery in New York
"Hospitals at the top of the quality spectrum see quality as something that's never 'done' — there is always a new benchmark to achieve and process to be improved. The best hospitals have highly engaged and committed clinical staff who strive to serve each patient and the other providers caring for that patient — which, for academic medical centers like ours, always includes the referring physician. We embrace the Joint Commission's concept of a culture of safety and 'collective mindfulness' of safety. Clinical leaders at top-performing hospitals set clear goals for quality, safety and patient experience using guidelines and evidence-based medicine, and they communicate and inspire their staff to embrace these goals. They also embrace information technology as a tool to track and improve processes and outcomes." — Eric J. Beyer, president and CEO of Tufts Medical Center in Boston
"This is where the best hospitals are at the top of their game. They've engaged physicians, staff and support systems to focus on the ultimate outcomes of care. This is the best of times and the worst of times for quality in healthcare. We have far more data and transparency than ever before, and that is gradually raising the bar for all — which is a great benefit to our patients and our organizations over time. The downside is there are way too many measures out there, many requiring more data than the value they create. We have a long way to go, and it will be nice when we can move from mostly counting errors to measuring successful outcomes of care." — Ted Townsend, president and CEO of St. Luke's Hospital in Cedar Rapids, Iowa
"You need to identify best practices for patient types, patient conditions and patient diagnoses. If you implement best practices and use them as a starting point, then you can adapt as you go on an individual basis." — Brock Nelson, president and CEO of Regions Hospital in Saint Paul, Minn.
"Hospitals and health systems must find a way to perform financially even though reimbursement is trending down, particularly from federal and state programs. To identify a top-performer financially, one only needs to look at the ratings given to the organization by the rating agencies — Moody's, S&P and Fitch. The metrics for those various ratings are published by each rating agency, and those are the targets for the healthcare organization to achieve. Then it's simply a matter of execution — managing costs and revenue in such a way to create value for the patient and community while remaining viable as a business enterprise." — Chris Van Gorder, president and CEO of San Diego-based Scripps Health
"Clinical quality at the highest possible level is needed for financial health. Does your hospital deliver the highest possible quality of care and create an exceptional experience for patients? What makes a hospital a top performer in clinical quality — staff and efficient processes — are also key ingredients in maintaining strong financial growth. In today's environment with constrained resources, hospitals are looking at lessons from other industries, such as lean production. Growth is also an important factor contributing to the bottom line." — Louis Shapiro, president and CEO of Hospital for Special Surgery in New York
"Top-performing hospitals need to be able to access capital. In order to do that, they need to demonstrate — to the financial community — an ability to repay their debts. That's increasingly challenging for hospitals in this health reform environment, where there's tremendous downward pressure on reimbursement. Last year, Tufts Medical Center achieved a BBB rating and was able to issue $195 million in debt. This enabled us to retire older, more expensive debt and to fund some key capital investments needed to further enhance our clinical programs. In order to accomplish the debt offering, we had to demonstrate to the financial community that we had positive cash flow and a solid strategic plan that would lead to continued financial success in this challenging healthcare environment." — Eric J. Beyer, president and CEO of Tufts Medical Center in Boston
"[Hospitals] need to show profitable performance in the short-run and a sufficiently strong balance sheet to weather whatever reimbursement storms come out of the Patient Protection and Affordable Care Act, or deficit reduction. This is a crucial reason why many remaining single-site independents are looking for system alignment. From a debt financing standpoint in particular, bondholders are looking for historical track records and access to a deep pocket to deal with whatever comes." — Ted Townsend, president and CEO of St. Luke's Hospital in Cedar Rapids, Iowa
"A hospital needs to have its expenses run commensurate with its revenue. When those two are not linked, it's a recipe for a lack of success. That ability to run your expenses with your volume is so vital to a hospital's financial health." — Brock Nelson, president and CEO of Regions Hospital in Saint Paul, Minn.
"Improvement in patient satisfaction is not the end result of a 'smile program,' although courtesy is always important. Sustainable improvement requires changes in systems that have been designed for the convenience of the providers — not necessarily our patients. It can also require facility and operational changes in addition to having all staff focus on the total well-being of the patient and their family." — Chris Van Gorder, president and CEO of San Diego-based Scripps Health
"First, hospitals need to place a high value on patient satisfaction as a strategic priority. Hospital for Special Surgery has been at the 99th percentile for 'likelihood to recommend' for 14 consecutive quarters when benchmarked against other facilities in the Press Ganey Magnet Peer Group. It's a number one strategic priority for everyone in our institution. Second, patient satisfaction is directly linked to employee morale. Employees are 100 percent committed to what we're trying to accomplish as an organization, and they view themselves as owners [of that mission]. Patient satisfaction needs to be hardwired into your organization. For example, we implemented hourly rounding for our nurses to reduce the need for patients to use their call bell. By anticipating our patients' needs, we improved their satisfaction and made nurse workflow more efficient. Now that is part of how our nurses work every day." — Louis Shapiro, president and CEO of Hospital for Special Surgery in New York
"At Tufts Medical Center and Floating Hospital for Children, we have a motto: 'Every Patient, Every Time.' We know that every interaction with a patient is an opportunity to create a superior experience or a disappointing one. After patients are discharged, they are surveyed on their level of satisfaction with the care they received here. Those results are posted on national websites for the public to review and use in making decisions about their own healthcare. In addition, any patient at any time can instantly communicate with his or her entire social network about the care they received from us — great or not-so-great. It is critical for hospitals to educate their employees about the aspects of patient care on which we're officially and unofficially judged, and to communicate feedback we receive to frontline staff in ways that enable them to take action." — Eric J. Beyer, president and CEO of Tufts Medical Center in Boston
"Patient Satisfaction is the 'other side of the coin' for quality. Doing the right things clinically is a start, but if we don't do it the right way or with a caring attitude, then we've not served the patient well. High-performing hospitals have learned how to make sure that the first thing their associates do is care about 'the person' before they start providing care to 'the patient.' And they do it time after time." — Ted Townsend, president and CEO of St. Luke's Hospital in Cedar Rapids, Iowa
"Have a plan. Be consistent. You need to learn what satisfies patients. Most importantly, make sure everyone in the hospital contributes to the cumulative result of all the patient interactions, from the parking attendants to the food service people to the medical staff. Everyone needs to be engaged." — Brock Nelson, president and CEO of Regions Hospital in Saint Paul, Minn.
Employee and physician morale
"Healthcare delivery is hard work — both emotionally and frequently physically. But, fortunately, healthcare attracts wonderful people who are dedicated to the care of our patients and our missions. Therefore, it's important for organizations to find ways to support — in every way legally possible — their employees and physicians by creating secure employment for employees and a supportive workplace for physicians. We need to provide competitive salaries and benefits, opportunities for education and advancement, and the opportunity to grow as a healthcare professional. But in an era of significant change and maybe even fear, job security is important as is engagement. Organizations with the right culture and engagement with staff and physicians will thrive even with the significant changes ahead." — Chris Van Gorder, president and CEO of San Diego-based Scripps Health
"The most important factors are involvement, communication and environment. People are what enable the organization to perform at the highest possible level, and people want to be involved in decision-making and improvement efforts. Communication goes hand-in-hand with involvement, feedback and follow-up. People need to feel that their opinions count. This means paying attention to and following up on their suggestions for improvement. It's important to communicate what is happening at the hospital so that employees don't feel inhibited or disconnected. Finally, everyone needs to have the tools to do their job, feel the organization is investing in their development, and know what's expected of them — then they're operating in an environment that lets them work at their highest possible level." — Louis Shapiro, president and CEO of Hospital for Special Surgery in New York
"I believe physicians and employees are attracted to hospitals that have great reputations for high clinical quality. At Tufts Medical Center, we not only have a great reputation for quality but for being warmer, more collegial and more nimble than many of our competitors. This culture appeals to physicians and employees alike. For physicians, this means they have opportunities to be entrepreneurial and that they'll be supported as they grow their clinical and research careers. Being somewhat smaller than many academic medical centers also means that individual physicians and employees really can make a difference here. We also support our physicians' practices with a strong community physicians' network and a network of affiliated community hospitals. We support our employees with strong managers who provide feedback and recognition and encourage employees to use their skills at the highest level." — Eric J. Beyer, president and CEO of Tufts Medical Center in Boston
"High-performing hospitals have taken the 'us/them' out of patient care and moved aggressively to make both their associates and medical staff part of a single team. From employed hospitalists to more engaged independent physicians, the best hospitals are finding ways to not just to align incentives but have also built strong cultures of mutual respect for each other as the best place to start the focus on achieving best practices." — Ted Townsend, president and CEO of St. Luke's Hospital in Cedar Rapids, Iowa
"Make sure everyone is engaged — involve all employees. Communicate often and talk straight. Create messages everyone across the organization can understand. Everyone should have the same ultimate goals in mind, and it should be clear what those goals are." — Brock Nelson, president and CEO of Regions Hospital in Saint Paul, Minn.
"I don't believe there is any shortage of great leaders and potential leaders in healthcare. But organizations need to create opportunities for staff and physicians to gain experience in leadership, management and co-management so they can advance to leadership roles within the organization. Success in leadership is due to a combination of education and experience — with the emphasis on experience. So organizations need to constantly develop leaders from within the ranks." — Chris Van Gorder, president and CEO of San Diego-based Scripps Health
"Walk the talk. Be visible and approachable. Make sure people know you. Don't lose your connectivity to what is happening on the frontline with the people doing the real work in the organization." — Louis Shapiro, president and CEO of Hospital for Special Surgery in New York
"Executive and board-level leaders at hospitals have never had to think and act more strategically than they do now. It's not enough to offer great patient care, cutting-edge medicine and do it in a way that makes patients feel welcome and families feel included — although all of that is imperative. We have to be extremely cognizant of changes in the market and stay ahead of them. Some years ago, big AMCs were adding lots of beds and trying to drive as much volume to their hospitals as possible. Tufts Medical Center has developed strong clinical partnerships at community hospitals where our [physicians] spend time, helping [those hospitals] expand their clinical offerings and improve quality. In turn, they send us more of their tertiary cases. We stay in close communication with referring physicians to ensure patients get seamless care. It's been a win-win for our partners, our medical center and most importantly for patients. We think this is the right model for the direction health reform is taking — in effect, we are operating as an accountable care organization." — Eric J. Beyer, president and CEO of Tufts Medical Center in Boston
"The best hospital leadership teams learned a long time ago to invert the pyramid. It's about meeting the needs of others, establishing a culture of mutual respect, listening and learning, as well as being able to translate a vision into, 'What does it mean to me?' Today more than ever that means having the ability to look over the horizon to see what's coming in healthcare and to be able not just to establish a direction but to communicate to each member of the care team in such a way that they can see their own way to the future." — Ted Townsend, president and CEO of St. Luke's Hospital in Cedar Rapids, Iowa
"Consistently keep one thing in mind: Always do what is best for the patient. Be authentic. Be relentless. Be without guile." — Brock Nelson, president and CEO of Regions Hospital in Saint Paul, Minn.
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