CHICAGO — What are some of the hottest issues that are top of mind for hospital leaders, and what are the nation’s top performers doing to address them?
That question was the topic of a conversation today at the American College of Healthcare Executives 2016 Congress. The trade group rounded up a handful of notable researchers to chew over high-level issues, and some of those covered weren’t necessarily what you might expect.
Health care-associated infections have been a key point of concern for hospital executives, according to ACHE, alongside patient satisfaction and consumerism/price transparency. Here’s a quick rundown of what was discussed at the Forum on Advances in Healthcare Management Research.
Eradicating HAIs in the emergency department
Health care-associated infections, or HAIs, have become a pressing concern for hospital leaders in recent years, thanks to some big numbers attached to them.
There were about 722,000 HAIs in U.S. acute care hospitals in 2011, and recent estimates peg the annual cost of such infections at $9.8 billion, notes Leslie Mandel, a researcher and associate professor with the Regis College School of Nursing and Health Sciences. It’s all the more concerning because at least half of the most common HAIs are preventable, she adds.
Much of the focus on addressing these infections has been on the inpatient side, in places such as the intensive care unit. And yet, other areas, like the emergency department, are rife with the possibility of HAIs. Plus, these departments often emphasize expedience over careful steps toward prevention.
“The ED is a perfect breeding ground for infection because of its settings,” Mandel says. “Patients are very diverse; there is lots of crowding, patients in the hallways separated by currents. You have people who are extremely ill, compromised, next to people who are not. It’s a challenging environment when you talk about infection.”
Relatively few hospitals have a dedicated strategy to address HAIs in the emergency department, Mandel says. She set about conducting site visits with 14 EDs in the U.S., with sustained compliance of infection-avoidance practices of greater than 80 percent. After conducting interviews with managers and holding focus groups, a few best practices stood out:
- Motivation toward infection prevention was “overwhelmingly” tied to departmental or institutional factors, rather than outside regulatory requirements.
- The use of data to demonstrate departmental infection rates is a crucial motivator in high performers.
- It’s also critical that you have a management champion who makes dropping infection rates his or her mission. “It comes from the executive suites where we sit down and we have more meetings,” one survey respondent said.
- Mandel also stressed how important it is for staff to feel that they’re accountable for patient morbidity and length of stay. There must be a culture of quality that permeates throughout the organization. “It isn’t just one person who’s the clean-hand person, it’s everybody,” one respondent said.
The bottom line is that hospital leaders should be sure to enlist both the staff and leadership of their EDs in hospitalwide efforts to improve quality.
‘The dark side of autonomy’ in health care delivery
Doctors and nurses can sometimes desire autonomy in their work, looking for freedom to think and problem-solve on their own. And yet, autonomy pulls providers away from collaboration and team-based care, and could possibly be detrimental to patient satisfaction, theorizes David Dobrzykowski, a researcher and assistant professor with Rutgers University’s business school.
Aiming to better understand autonomy and its impact on employee motivation and patient satisfaction scores, he and his colleagues interviewed leaders at hundreds of hospitals and analyzed HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey data to come to the following conclusions:
- Engaging your clinical staff is motivating, so it’s important to keep an eye on the “HR ball.”
- When staff are motivated, it “delights patients” and helps to improve the bottom line, indirectly. Take extra steps to keep staff motivated.
- While you may want to find other ways to motivate your staff, remember that autonomy does improve patient satisfaction indirectly.
- Even though autonomy has a positive side by encouraging staff to innovate and think differently, there can be a dark side if it diminishes teamwork and collaboration.
- Patient satisfaction doesn’t always drive net income. Unbalanced professional service organizations may need to find other drivers of financial performance.
- Considerations may be different for teaching hospitals, where power shifts more toward management.
“What we show is that, if you motivate your staff, that will improve your HCAHPS scores and you may not need to spend time on mahogany and fireplaces,” Dobrzykowski says.
A rundown of what’s out there on price transparency
We’re all familiar with the factors that are fueling patients to think more like consumers in their health care choices. High-deductible health plans, high out-of-pocket costs, consumer groups and states reporting health care and quality data to the public, etc.
Price transparency is a key consideration for both patients and hospital leaders. But how well are websites doing in supplying accurate, reliable information about the price of care? Alissa Ratanatawan, M.D., with the University of Texas School of Public Health, is trying to answer that question.
She and her research colleagues sifted through dozens of transparency sites across the Web, gauging them based on their scope, comprehensiveness, utility and presentation, among other factors. Ratanatawan offered hospital executives a few nuggets of information, gleaned from that research:
- There is tremendous variation in these different user interfaces, and efforts are needed to standardize and centralize information for patients.
- The number of websites and money spent on this endeavor is increasing rapidly.
- Consumer websites may be effective tools in influencing consumer purchasing decisions.
- The usability of information on price and quality also varies greatly.
- More research is needed to fully understand the potential impact of publicly available price and quality information.
- Competitive health care providers must stay abreast of these changing scopes of price and quality that consumers are seeking and obtaining.