The Right Place With the Right Tools

The United States spends more than any other industrial country on healthcare, yet regardless of demographics, life expectancy is shorter and the US population is less healthy compared with populations in other countries. As highlighted by Thornton Kirby, president and CEO of South Carolina Hospital Association, the US healthcare system is in need of transformation.

Kirby explained that although the current system is very good at fixing acute illness at any cost, the US healthcare system is not currently built to promote good health, manage chronic disease, contain costs, and encourage collaboration among competing hospitals and physicians.

It is this last point that Kirby emphasized in his presentation during a session entitled “The Right Place With the Right Tools.”

“Collaboration to improve quality and safety in healthcare is key,” said Kirby, adding that hospitals often are the catalyst for change; however, partnerships with other organizations are required to succeed. Kirby highlighted the need for healthcare organizations to change their business model based on the requirements of the Affordable Care Act.

Kirby also discussed implications for hospitals, based on the new law, including the requirements to achieve solid clinical alignment between hospitals and physicians, achieve superior outcomes and reduce costs, develop integrated information systems, form strategic alliances, and prepare for new payment models.

Kirby used the example of the state of South Carolina to highlight the effectiveness of collaboration in transforming a healthcare system from one that was performing poorly to one that, in a short period of time, has achieved recognition for its quality and safety of healthcare in various clinical areas such as heart care, hospital infection rates, and surgical safety. Kirby said that South Carolina was ranked 46th among all US states in health status in 2012.

Kirby continued by explaining how hospitals in 3 South Carolina cities collaborated to standardize treatment of heart care that resulted in cutting the response time for a heart attack in half (ie, from 93 minutes, on average, to 45 minutes), making heart care in these hospitals rated one of the best in the states. This collaborative effort, along with others, has resulted in South Carolina becoming a top 5 state in demonstrating health improvement in hospitals.

Along with discussing how collaboration is key to accelerating performance improvement, Kirby highlighted the critical importance of making the Triple Aim an essential part of one’s strategy.

Components of the Triple Aim include population health, experience of care (ie, quality, safety, and patient satisfaction), and per capita cost. He emphasized that all 3 components need to be worked on simultaneously to achieve success.

Kirby concluded his discussion by focusing on the need to build a culture of safety and to look to high reliability organizations as models for how to engage in a high-risk enterprise with a very low safety risk.

Citing the airline industry as a high reliability organization, Kirby explained that a culture of safety is a critical component of these organizations, along with the engagement of leaders and a robust process improvement strategy.

“An initiative just launched in South Carolina called Safe Care is bringing together 20 to 21 hospitals to work together to figure out how to be a high reliability system,” Kirby said, adding that there are currently no models of high reliability systems in healthcare.

Donna Isgett, RN, corporate vice president for clinical effectiveness at McLeod Health in South Carolina, spoke about the collaborative success of McLeod Health, a consortium of hospital systems, in achieving quality and safety in terms of patient care.

Isgett focused on 6 aims that her organization focused on that led McLeod Health to receive the American Hospital Association McKesson Quest for Quality Award. These aims include safety (avoiding injuries to patients from care intended to help), effectiveness (providing evidence-based services to those who will benefit), efficiency (avoiding waste), timeliness (reducing wait times), being equitable (providing consistent care that does not vary in quality based on demographics), and being patient centered (providing care that ensures the values of the patient guides all clinical decisions). She emphasized that an underlying ongoing tenet of McLeod is a continuous commitment to creating a better tomorrow.