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Implementing Care Transformation at Adventist Health System

In 2017, Adventist Health System (Altamonte Springs, FL) set out to enhance the way care was delivered across its 46-hospital enterprise. In its aim to become a high reliability organization, this meant removing unwarranted care variation to provide exceptional care for all patients.

Spurred by new system-wide imperatives – Engage the Consumer, Improve the Product, Improve People Systems, Expand the Network, Lower the Cost and Manage Risk – and part of its continued pursuit of excellence, Adventist Health System launched several organizational goals. These goals included having all hospitals obtain a four-star or five-star rating from the Centers for Medicare & Medicaid Services by the end of 2020, all hospitals obtaining an “A” safety grade from the Leapfrog Group by the end of 2020, and all hospitals being in the top quartile nationally for the observed-to-expected mortality rate by the end of 2020.

“There was a consensus arrived at among our senior executive team that this was a very significant and important initiative that we needed to do,” said Loran Hauck, MD, chief clinical officer for Adventist Health System at the time.

As the team began examining how to meet these newly outlined expectations, they wanted help determining how new practices and guidelines could be implemented across all hospitals.

“There was a question of, can we launch this work successfully ourselves given that we have inconsistent performance across the system today or would it be helpful to engage a consulting firm to come in and help guide us to launch this work,” Hauck said. “So, we created an RFP and sent it out to several consulting companies, including Premier®, and ultimately selected Premier’s advisory services to help us in this engagement.”

In the summer of 2017, Premier Performance Partners visited six sites covering all of Adventist Health System’s regions and interviewed a cross-section of employees, from frontline clinicians to C-suite executives. This process helped ascertain employees’ understanding of care transformation, the level of readiness to implement care transformation, what resources were available across the health system, and if the appropriate structures and governance were in place to implement care transformation.

During Premier’s consultation report, one finding showed that confusion existed among the health system’s frontline staff on how reduction of care variation would be executed, highlighting a need for strong leadership across the health system during the process of care transformation.

“Premier was very helpful in identifying the kinds of resources that we had regionally and here at the corporate office that would be essential to drive this initiative,” Hauck said. “They also recommended a new organizational chart for the Office of Clinical Effectiveness. Subsequently, we put that organizational chart in place, and the key positions that were recommended by Premier have been filled with strong leaders.”

Adventist Health System has begun implementing some of Premier’s recommendations, and is already building momentum as 28 of its hospitals received a Leapfrog Safety Grade “A” rating in the spring of 2018, a 40 percent improvement from the fall of 2017.

“This illustrates that once you put a goal out there and a stake in the ground, you can better drive toward accomplishing it,” Hauck said.

Read more about Adventist Health System's journey to closing gaps in care.

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