The Society of Hospital Medicine, the society representing more than 31,000 hospitalists and the hospital medicine specialty, has implemented several successful patient safety initiatives that have produced greater efficiencies and savings.
SHM's quality improvement programs focus on four main initiatives: Project BOOST, a program for helping older adults transition to home after hospital discharge; Glycemic Control Mentored Implementation, a program for caring for diabetic patients and preventing hypoglycemia; Hospitalist Orthopedic Patient Service Co-Management, a program to integrate hospitalists in orthopedic surgery; and VTE Prevention Collaborative, a program to prevent deep vein thrombosis and massive pulmonary embolism. Besides improving patient safety and satisfaction, these measures are ultimately financially beneficial.
Readmissions
Greater patient safety can save hospitals money because beginning in 2012, Medicare will reduce payments to hospitals with excess preventable hospital readmissions. SHM CEO Larry Wellikson, MD, SFHM, says that working to improve patient safety now is important despite the current payment system's inconsistency with the future, quality-rewarding model.
Dr. Wellikson says that SHM reduced preventable VTEs in a San Diego hospital from 50 to three per year. He says that while a hospital could perceive this reduction as lost revenue because they treated fewer patients, it could instead realize that the hospital expended fewer resources and thus saved money.
Many states have already begun projects to reduce readmissions, and at least one is considering penalizing hospitals for undue admissions this year, before the Medicare law starts. Maryland, for example, is considering a payment program that would cap inpatient care payments at 2010 levels, which would reward hospitals that reduce readmissions and penalize those that increase readmissions. And Massachusetts, Michigan, Washington and Ohio are participating in a pilot project State Action on Avoidable Rehospitalizations Initiative, established in September, to reduce readmissions.
Transitioning
Dr. Wellikson says one of the biggest challenges in implementing patient safety is the transition period before healthcare reform legislation begins enforcing its regulations. "It's well known that a percentage of hospitals in this country need the extra income from what some people call unnecessary readmissions to make their bottom line. I think all hospitals will prefer to do the best job that they can to give a better patient experience, but some may not want to put resources to cutting off some of their revenue supply," he says. In addition to sacrificing a portion of current revenue for future savings, hospitals must have willing leaders and adequate resources to establish the program and collect data on the patient safety measures.
Dr. Wellikson expects that as financial incentives for reducing infections are established, more and more hospitals will be able to focus on patient safety. However, he thinks healthcare will take about ten years to fully adjust to this "major transformation."
One of the reasons that universal implementation of patient safety programs will take time is because the programs must be tailored to fit each hospital. SHM President Jeff Wiese, MD, SFHM, says, "For [patient safety programs] to be successful, we need more than a cookie cutter measure. We need somebody who has experience implementing the measure and someone with expertise in a particular [health] system." SHM uses a mentored implementation program in which experts on the patient safety initiatives mentor hospitalists — experts on their hospital — to implement the initiatives.
Improving patient safety
One of the reasons for SHM's success is that they focus on a few specific goals instead of broadly trying to improve the entire system. Dr. Wellikson says hospitals can get "quality improvement fatigue," where "every month there seems to be a new initiative involving the same people." To prevent hospitals from becoming overwhelmed and desensitized to patient safety initiatives, SHM chose patient safety measures that were important, definable, feasible and unique among initiatives other organizations were pursuing. SHM chose VTE prevention because it met these requirements and because some of SHM's leaders had expertise in this area. Similarly, SHM decided to target glycemic control because diabetic patients affect several hospital departments: surgery, obstetrics and general medicine.
Dr. Wiese suggests that hospitals make a flow or process map to identify components of the system that are preventing patient safety success. He says that improving patient safety "is more than telling physicians and hospitals to try harder; everyone is trying as hard as they can. You need to look at the system. Ask yourself what about your system and the way it's designed is producing [poor] results." After identifying system weaknesses, hospital leaders can target those areas and then reassess patient safety — a process Dr. Wiese calls PDSA: plan, do, study, act. He says that once hospitals increase patient safety, they may also receive an indirect financial benefit from an improved reputation, which may attract more patients.
Both Dr. Wellikson and Dr. Wiese emphasize the importance of creating a culture of improving patient safety that will result in financial benefits instead of narrowly focusing on immediate savings. Starting now to prioritize patient safety goals will help hospitals become more efficient, and thus more profitable.
Learn more about Society of Hospital Medicine.
SHM's quality improvement programs focus on four main initiatives: Project BOOST, a program for helping older adults transition to home after hospital discharge; Glycemic Control Mentored Implementation, a program for caring for diabetic patients and preventing hypoglycemia; Hospitalist Orthopedic Patient Service Co-Management, a program to integrate hospitalists in orthopedic surgery; and VTE Prevention Collaborative, a program to prevent deep vein thrombosis and massive pulmonary embolism. Besides improving patient safety and satisfaction, these measures are ultimately financially beneficial.
Readmissions
Greater patient safety can save hospitals money because beginning in 2012, Medicare will reduce payments to hospitals with excess preventable hospital readmissions. SHM CEO Larry Wellikson, MD, SFHM, says that working to improve patient safety now is important despite the current payment system's inconsistency with the future, quality-rewarding model.
Dr. Wellikson says that SHM reduced preventable VTEs in a San Diego hospital from 50 to three per year. He says that while a hospital could perceive this reduction as lost revenue because they treated fewer patients, it could instead realize that the hospital expended fewer resources and thus saved money.
Many states have already begun projects to reduce readmissions, and at least one is considering penalizing hospitals for undue admissions this year, before the Medicare law starts. Maryland, for example, is considering a payment program that would cap inpatient care payments at 2010 levels, which would reward hospitals that reduce readmissions and penalize those that increase readmissions. And Massachusetts, Michigan, Washington and Ohio are participating in a pilot project State Action on Avoidable Rehospitalizations Initiative, established in September, to reduce readmissions.
Transitioning
Dr. Wellikson says one of the biggest challenges in implementing patient safety is the transition period before healthcare reform legislation begins enforcing its regulations. "It's well known that a percentage of hospitals in this country need the extra income from what some people call unnecessary readmissions to make their bottom line. I think all hospitals will prefer to do the best job that they can to give a better patient experience, but some may not want to put resources to cutting off some of their revenue supply," he says. In addition to sacrificing a portion of current revenue for future savings, hospitals must have willing leaders and adequate resources to establish the program and collect data on the patient safety measures.
Dr. Wellikson expects that as financial incentives for reducing infections are established, more and more hospitals will be able to focus on patient safety. However, he thinks healthcare will take about ten years to fully adjust to this "major transformation."
One of the reasons that universal implementation of patient safety programs will take time is because the programs must be tailored to fit each hospital. SHM President Jeff Wiese, MD, SFHM, says, "For [patient safety programs] to be successful, we need more than a cookie cutter measure. We need somebody who has experience implementing the measure and someone with expertise in a particular [health] system." SHM uses a mentored implementation program in which experts on the patient safety initiatives mentor hospitalists — experts on their hospital — to implement the initiatives.
Improving patient safety
One of the reasons for SHM's success is that they focus on a few specific goals instead of broadly trying to improve the entire system. Dr. Wellikson says hospitals can get "quality improvement fatigue," where "every month there seems to be a new initiative involving the same people." To prevent hospitals from becoming overwhelmed and desensitized to patient safety initiatives, SHM chose patient safety measures that were important, definable, feasible and unique among initiatives other organizations were pursuing. SHM chose VTE prevention because it met these requirements and because some of SHM's leaders had expertise in this area. Similarly, SHM decided to target glycemic control because diabetic patients affect several hospital departments: surgery, obstetrics and general medicine.
Dr. Wiese suggests that hospitals make a flow or process map to identify components of the system that are preventing patient safety success. He says that improving patient safety "is more than telling physicians and hospitals to try harder; everyone is trying as hard as they can. You need to look at the system. Ask yourself what about your system and the way it's designed is producing [poor] results." After identifying system weaknesses, hospital leaders can target those areas and then reassess patient safety — a process Dr. Wiese calls PDSA: plan, do, study, act. He says that once hospitals increase patient safety, they may also receive an indirect financial benefit from an improved reputation, which may attract more patients.
Both Dr. Wellikson and Dr. Wiese emphasize the importance of creating a culture of improving patient safety that will result in financial benefits instead of narrowly focusing on immediate savings. Starting now to prioritize patient safety goals will help hospitals become more efficient, and thus more profitable.
Learn more about Society of Hospital Medicine.
