Think of some of the changes we have had since the year 2000: The first iPhone was released seven years ago, and more than 160 million were sold just in the last 12 months. Almost 1 billion more people live on Earth. Facebook was created and now has more than 1 billion active monthly users. And health care has made incredible, rapid progress along the Institute of Medicine’s six aims — safe, effective, patient-centered, timely, efficient and equitable care. The six IOM aims are still the foundation for health care quality, and we’ve seen impressive results.
1 | SAFE: Hospitals nationwide are implementing a culture of safety. Results include a 41 percent decrease in the adult intensive care unit rate for central line-associated blood stream infections, and more than 10,000 harms prevented in the last two years for hospitals in the AHA/HRET Hospital Engagement Network [reports available at www.ahrq.gov.].
2 | EFFECTIVE: Accountability measures of evidence-based care processes have improved among hospitals. In 2013, the Joint Commission reported that its accredited hospitals “achieved 97.6 percent composite accountability measure performance on 18.3 million opportunities to perform care processes closely linked to positive patient outcomes.” The data show an improvement of nearly 16 percentage points since 2002.
3 | PATIENT-CENTERED: Many hospitals today are establishing open (24/7) visiting hours, creating patient and family advisory councils and using bedside change of shift reports — all of which engage patients and families as active partners on the health care team.
4 | TIMELY: As one example, from 2005 to 2011, the percentage of heart attack patients who received percutaneous coronary intervention within 90 minutes of arrival improved from 42.1 to 93.7 percent, with improvement for all genders and racial/ethnic groups [from the Agency for Healthcare Research and Quality’s 2013 National Healthcare Quality Report].
5 | EFFICIENT: Hospitals and health care systems are working to reduce preventable readmissions by improving care coordination and transitions of care. More than 1,500 hospitals in the AHA/HRET HEN have prevented more than 60,000 readmissions since 2012.
6 | EQUITABLE: A recent survey conducted by the AHA’s Institute for Diversity in Health Management and the Health Research & Educational Trust showed that U.S. hospitals have made progress in several key areas of health care equity, including collecting demographic data and providing cultural competency training. While hospitals have improved quality of care for diverse patient populations, more work needs to be done. As part of the Equity of Care initiative, the AHA and four national partners released goals for the initiative’s three core areas, outlined at www.equityofcare.org.
Hospitals and health care systems invest heavily to improve quality, and the current priorities are to accelerate progress in achieving results in efficiency and equity of care. One can only imagine the changes that will rock our globe and the health care field during the next 14 years. By sharing best practices, providing opportunities for peer-to-peer learning and coaching; and building improvement capacity at the hospital and state levels, hospitals can keep making progress.
Maulik S. Joshi, Dr.P.H., is president of HRET and senior vice president of research at the AHA.
News from the AHA
Health equity videos
The Equity of Care website features video vignettes of 19 health care leaders' sharing their ideas and work to eliminate health care disparities, increase leadership and workforce diversity, and provide culturally competent care. Topics include making the business case for diversity; developing a diversity dashboard to stratify patient outcomes by race and language preference; breaking through cultural barriers to improve outcomes for diabetic patients; and assessing the role of women as leaders in health care. All these leaders agree that hospitals have improved quality of care for diverse populations and increased leadership diversity, but more work needs to be done. View these videos at www.equityofcare.org.
Safe surgery practices
“Reducing the Risks of Wrong-Site Surgery: Safety Practices from The Joint Commission Center for Transforming Healthcare Project” describes the work of seven hospitals and ambulatory surgery centers that measured the risk of wrong-site surgery in their perioperative processes, pinpointed contributing causes and developed specific solutions to reduce them. Targeted solutions were developed in scheduling, pre-op/holding, operating room and organizational culture, and thoroughly tested in real-life situations. A Targeted Solutions Tool was created for hospitals to monitor surgical cases for weaknesses that could result in wrong-site surgery. Visit www.hpoe.org and www.centerfortransforminghealthcare.org.
Care transformation resources
Health care leaders have easy access to case studies, reports and guides, toolkits, webinars and other content for performance improvement and care delivery transformation on the Hospitals in Pursuit of Excellence website. Resources are organized by topic, resource type and hospital type. Physicians will find information on physician- and team-based leadership. HPOE.org links to organization websites and articles, making it a one-stop portal for hospital leaders' working to transform care delivery. Visit www.hpoe.org.