In today’s rapidly changing healthcare landscape, smaller hospitals are challenged to meet top performance thresholds with fewer resources and much smaller denominators used to calculate overall success rates. One “fall out” in a measure can push rates outside benchmark and top performance thresholds. There is little room for error.
In 2014 Texas Health Presbyterian Hospital Rockwall, a small Texas Health Resources (THR) facility near Dallas-Fort Worth, joined the Premier, Inc., (NASDAQ:PINC) QUEST Collaborative. The eight-year-old initiative is one of the nation’s oldest and most comprehensive directed at improving quality and safety while reducing costs.
Now in its third iteration, QUEST seeks to drive superior performance among the 350-plus participating hospitals in seven domains: mortality, safety, appropriate hospital use, evidence-based care, cost and efficiency, patient and family engagement and community health.
Texas Health Rockwall is a joint venture with THR as majority owner and more than 60 physicians from Rockwall and Rowlett. Because of its size combined with the demands of a fast growing population, hospital staff recognized that multidisciplinary teamwork was critical to achieving success. Shortly after joining QUEST, staff of the 50-bed hospital also recognized the need to evaluate established methods of care and rethink opportunities to improve.
“We’re like the little engine that could . . . a small hospital with a big heart. There’s a lot of accountability and buy-in to make the best better. That’s our culture. How can we be better?” said Kerry E. Baucom, RN, BSN, MBA, director of quality. “And our way of doing things aligns well with QUEST. We’re always open. If someone’s doing it better, we want to know it.”
Baucom said staff are laser focused on improvement initiatives. “And we try to be as transparent and open as possible. Our attention is on NOW – what we’re doing today, not what we did three weeks ago. When concerns surface, we stress what we’re doing today, right now. How is it working? That makes a difference,” she said.
Staff and physicians have bought in, she stressed. “Our physicians know that if we are ‘tapping them,’ it’s not that we found something they didn’t do. It’s here’s an opportunity. Can you look into it? Quality is not the police. The atmosphere is collegial, not punitive.”
In the patient and family experience area, Baucom said, “It’s about everybody being accountable. It’s not one person disseminating scores once a month. They’re available online every day so any employee can pull them up. It’s about where we are right now. It’s about our discharge advocates doing follow up calls, touching base with the patient and family sooner rather than later. Checking to see how the visit went. Did you get your appointment with your doctor? Are there questions we can answer for you?”
That’s never more evident than in the emergency department which is often strained beyond capacity in the fast-growing suburban area. The hospital has EMT-trained staff in waiting areas working with family. “They’re looking for changes a lay person may not detect. They are actively touching and talking with waiting patients.”
At the 2015 Premier Breakthroughs Conference and Exhibition, Texas Health Rockwall was one of two THR hospitals to be recognized as a QUEST® Award for High-value Healthcare Finalist for achieving top performance in six of seven domains in the initiative. The other was Texas Health Harris Methodist Hospital Azle in Azle, TX.
Texas Health Rockwall fell short in mortality. Each mortality is reviewed now. “We hadn’t been asking the right questions,” Baucom said. Staff revised the mortality review process using newly available benchmarking data from PremierConnect™ Quality (QualityAdvisor™). The hospital also created a palliative care program and staff are working earlier in admission with patients who may be candidates.