An earlier article on this blog talked about physician rankings. In this post let’s look at hospital rankings.

America’s best hospitals

There are various agencies and organizations that rank, index and grade american hospitals. Some of the well know ones are US News, Thomson Healthcare (top 100) and more recenlty web 2.0 sites like HealthGrades. The idea behind these rankings is to provide consumers a guide map to choosing hospitals.

Methodology

Methodology that these publications and agencies use range from internally developed surveys to benchmarking databases and others use information that is collected and published by United States Department of Health and Human Services. US news ranks by specialty as their goal is to identify facilities that excel at treating variety of illnesses within a specialty, as opposed to just few procedures. US News uses data from the American Hospital Association survey of its members.

Web 2.0 application - Finding a hospital near you

Recently we came across a web based application that lets you search for hospitals in your neighborhood (by zip code) and tells you how good the hospitals perform on a variety of process measures that the hospital compare database (Department of Health and Human services)tracks. The best hospitals have green stop lights and the worst has red. We tried this on Washington DC area hospitals and here is what we came up with. Check it out for yourself.

The benefits of improving patient flow go way beyond reducing wait times. While most healthcare administrators tend to focus on reduced diversions (in the ED), elopments, elective surgery cancellations, improving flow can positively impact quality of worklife for physicians, nurses and staff . This can in turn have a very positive impact on patient satisfaction and quality of care.

Here are top 5 tried and tested strategies used to improve flow.

1. Evaluate and monitor bed status in Med surg and Intermediate care units continuously - Don’t sweat the small stuff, the biggest bottleneck for patient flow is mainly in these units. In any acute care hospital, when you hear ‘we don’t have beds’ that usually means there are no monitored beds. So focussing on these units instead of the rest of the house helps. Also, these are the units where there are lots of activity during the day (usually not captured in midnight census which is used to measure occupancy usually). Increasing bed capacity in these units will help flow greatly.

2. Minimize transfers: Again this is counter intuitive but if you actually observe data you will see that transfer consume the most resources (beds, staff, environmental services etc). So do it right the first time and put patients in the right level of care. This can also reduce your insurance denials and impact finances positively.

3. Create an admissions unit to reduce stress on your ED: If your diversion hours in the Emergency Department and admission times are hitting the roof, you know you are in crisis. For quick relief create and admissions unit to keep the ED rooms/beds turning over quicker than usual. The admissions unit can focus on tracking and expedite flow to different units while the ED focuses on providing emergency care and evaluation.

4. Create a discharge lounge : Add a checkout lounge with a coffee bar and flat panel tvs to move patients waiting for a ride, so the valuable beds can be turned over to accomodate other patients. This will also impact patient satisfaction positively.

5. Airlines style surge staffing with demand: Use the airline model when it comes to staffing. Airlines tend to staff proactively during peak hours (and don’t worry about productivity in the short run).Also rememeber this does not only mean nursing staff. This applies to support staff as well. If you don’t have adequate environmental services staff for instance, there is not chance of beds opening up quickly on discharge. Moreover, support staff don’t cost much but are an asset in opening up beds.

 Let us examine some interesting facts on healthcare spending.

U.S. Health Care Spending to Double by 2017

According to a recent report published in the online edition of Health Affairs,U.S. healthcare spending is projected to reach $4.3 trillion. This equates to approximately one fifth (or 19.5%) of the gross domestic product(GDP).Hospital spending is expected to increase and gradually slow down through 2017, going from $696.7 billion in 2007 to more than $1.3 trillion in 2017. Prescription drug spending is expected to slow down initially and then start to accelerate through 2017. Drug spending will increase from $231.3 billion in 2007 to $515.7 billion in 2017.

Healthcare spending to double in India by 2012

For an emerging economy, India spends a small $14.8 billion on healthcare which equates to roughly 5.2% of the GDP. This will however change quickly and the country is expected to spend $33.6 billion by 2012 with healthcare spending accounting for 8.5% of the economy.

Here is a graph comparing spending for some countries as a % of their GDP of their  stack up currently (Source: WHO Health Statistics,2007).

Video update!!!

British Healthcare system
The  National Health System(NHS) is the publicly funded healthcare system in the UK. The NHS provides the majority of healthcare in England, including primary care (such as general practitioners), in-patient care and long-term healthcare. NHS hospitals are increasingly competing with other private health systems and facing financial difficulties.

Lean applied in Birmingham Heartlands hospital

Recently, the NHS health system and other health systems have adopted ‘lean principles’ that evovled from the Toyota production system to reduce waste. They are primarily focussing on clinical areas such as emergency departments but plan to use it ancillary areas, pharamcy and other support functions.
They have also come up with innovative solutions such as using Nurse practicioners in the ED to treat low acuity patients . They have been able to reduce the number of patients waiting from over 40 to less than 10. 

Emerging trends in healthcare: Physician Ranking systems

A previous post, on this site briefly touched on ‘Zagat survey style’(for those not familiar, the Zagat survey rates restuarants in the US and around the world) physician ranking systems making their presence felt in the websphere. Believe it or not, this is not a flash in the pan. Infact, there are several establish sites that already rank physicians. Some others are extending this to hospitals, but more on that later.For this post we will stick to physicians and providers.

N.Y. leads the way

Late last year, New York’s attorney general  Andrew Cuomo announced  a first-of-its-kind agreement with Cigna Corp. The plan is to establish an industry standard for the doctor-rating systems that health insurers increasingly use to guide consumers. While health plans and insurers have been doing this for years, public will now have access to how health plans measure and rate doctors in terms of quality of care and cost efficiency.   

Sounds fair and square? So what is the caveat? If you are a health professional you will probably identify right away that there is a possibility that this might eventually steer patients to the cheapest, rather than the best doctors and services. UnitedHealth, for instance, gives doctors and hospitals that follow certain care guidelines and are cost-efficient a “UnitedHealth Premium” designation.

Quality or Cost ?

Jim Collins in his best selling book ‘Good to Great’ says that Good is the enemy of Great.  However the same logic can not be applied here. Meaning, “Quality is not the enemy of cost”. If you are not convinced all you have to do is look at other industries. In the auto industry for instance, they have realized that at some point there is a tradeoff between quality and cost and so good quality at a reasonable cost has become widely accepted. Quality guru, Walter Massing  states that the only viable policy is to concentrate on failure costs and to justify prevention measures for one problem at a time. 

What consumers need to know and health 2.0 sites need to publish?

So where does all this lead? Healthcare providers have a stake in this and so they will need to brace themselves, start looking at quality of care and efficiency a little more seriously. The serious Health 2.0 sites need to start publishing performance / rating on a host of information besides bedside manners and pleasantness of physician (which are important, but do not provide any insight to the physician’s chances of success in the treatment process). 

Here is a sample list of indicators that we need to look at to determine the best doctors/providers for our friends and family.

• Customer satisfaction metrics:Bedside manners
• Process metrics: Average wait times
• Clinical quality and outcomes: Hospitalization rate and risk-adjust mortality
• Other measures: Clinically integrated IT systems (known to influence medication and surgery risks)

TGIF!! to all our loyal readers. We are happy to unveil our new presentation and cool new features.

Why we changed our site presentation? 

As you can see we have changed our site layout design. The motivation behind this is to provide better readability and user friendly interface. Also, we picked this design after exhaustively researching usability of several hundred designs. As our site and community grows, we would like to provide many more exciting features and this site is better suited for that.

What is new ? 

1. Registration: Readers can now register by simply clicking the register link under Meta. This is particularly useful for users who would like to contribute articles, ideas and tools on a regular basis

2. Search: We don’t need to explain that to the googler’s of the world do we ?

3. Entries RSS and widgets to embed in your site: You can now subsribe to this site via a host of reader services such as google reader, news gator, netvibes etc.

You can also embed entries on this site as a widget on your personal site or social network page!!. Just click on entries rss for this.

4.  Monthly Archives: Access prior month posts quickly and easily with the archives organized by month. You can get to the archives using either the left navigation panel and the right navigation panel

Enjoy these pictures . And  keep it coming!!!

Survey rage 

Measuring patient satisfaction and using surveys is getting increasingly popular in US healthcare. If you work for a hospital, physician practice or even a private clinic, you would have become familiar with some form of the patient satisfaction survey or another. If you are not then look online and chances are you are already being rated, ranked, scored and reported by someone online. Late last year America’s largest health benefits company(Well Point), engaged Zagat Survey to develop a new online survey tool. Even,  Google is supposedly working on an online rating app.

Making sense out of surveys

But how do you balance these scoring systems , with more meaningful assessments of care quality and competence? Patient safety guru Bob Watcher, who coined the term ‘hospitalist’ says that a balanced approach is more important than a single peephole. What he means by this is that, it’s important to look at a number of different factors(such as hospitalization rates, acuity etc) while determining patient satisfaction. We will save the discusssion on what such a survey might look like for another day.For now, let us focus on how to choose and use existing internal and external patient satisfaction systems.  Let us do that by asking a hypothetical question ….

“How would Toyota manage patient satisfaction ?”

Toyota management realizes the importance of accessing the “Voice of the Customer” . Its organizational structure has a  customer relations department that handles customer satisfaction (i.e., patient surveys in our case) and customer relations (i.e., employee training and incentives, patient assistance center, and dispute resolution).

• If you aren’t listening to your patients, you can’t have all the business attributes that provide them good care and value. However, if you aren’t using this information to create change, then don’t bother listening
• Toyota might establish a customer survey system that measures patient satisfaction with the process of care, the delivery experience, the service experience, and clinical quality. Based on the results of these surveys, they would develop your strategic plans to improve customer service.
•  Deparment/Service line Reporting- Summary evaluations and specific, but anonymous, customer comments would be shared with the departments. Departments/specialities would now monitor their own progress, which puts less pressure on the measures
• Elminitate inter department competition- Gaming occurs in nearly every system when two departments scores are compared. We all know how Inpatient units and Emergency departments often game the survey system to show inflated scores in hospitals. So Toyota would establish acceptable levels of performance and eliminate making distinctions of performance above that level.
• Telephone Surveys- Telephone surveys would be conducted to determine initial satisfaction with the care process. Standards for conducting the phone survey and processing the data would  also been established.

Air traffic control

There are many areas in a hospital that need dashboards to be able to identify and resolve problems. Let us look at an example. In many ways, a bed management or bed control function in the hospital is like an Air Traffic Control. They they control the take off (discharges) and landings (admissions). In hospital terms they control the patient flow from several areas such as emergency and surgery to  Inpatient units. But, there is one major difference between an air traffic controller and a hospital bed manager. While the former has ‘real time’ information and visual indicators to make decisions, the latter relies on numerous phone calls,faxes and experience to make their bed decisions. Naturally, the decisions are delayed or sub optimized (like when patients are shifted to a higher level of care even when there is not need for it). The result is bottlenecks and delays throughout the system. Which in turn increases ‘patient days’ and negatively impacts clinical and financial outcomes. 

Visual view of data

Hospitals in the US, tend to collect terrabytes of data annually. But the data is not useful in and of itself. Because, it remains inactionable unless its visually processed and represented in the form of a meaningful dasboard with bells and whistles built in. Reverting back to our example, if we do not have a handle on our daily/hourly admissions, length of stay and patient care hours and other key performance indicators, it is virtually impossible to reduce delays and length of stay for patients.

So what should a hospital dashboard look like. We did some research and found a great example. One of the best designs we found from our research was iDashboards . So check it out below !!!

Measuring performance

What we cannot measure,  we cannot manage. That is a proven adage, so have you ever wondered what healthcare report card will look like ? Or for that matter, if it is even possible to create such a report card and yet keep it simple?

 In Healthcare we usually collect a lot of data related to different aspects of the business. Everything from clinical quality to outcomes and patient satisfaction is measured. On average any hospital in the US tracks over 100 indicators every year to gain insight into their practice, patient preferences and overall business. So creating a common report card that would work for even a handful of hospitals can become a tedious task. 

Healthcare Report Card

Managment guru Tom Peters has created a healthcare report card to measure the state of US healthcare. He grades the overall system on 19 metrics or parameters. The beauty of this report card lies in it’s simplicity. The metrics have been chosen very carefully and the grading system is straight out of an elementary school test. The idea is to create a performance picture that is easy to understand and interpret.