For Hospitals, Culture Matters Most

According to a recent study, the number one factor that distinguishes top-performing hospitals from bottom-performing hospitals when it comes to mortality rates for heart attacks is organizational culture.

Not the size of the hospital. Not “superstar” physicians. Not electronic medical records systems.

Culture.

The study, published in The Annals of Internal Medicine (abstract here), involved 11 hospitals that ranked either in the top 5% or bottom 5% in mortality rates for acute myocardial infarction (AMI). The researchers conducted more than 150 in-depth interviews with leaders and staff at these hospitals, then correlated hospital performance data with themes from the interviews. The researchers concluded that “hospitals in the high-performing and low-performing groups differed substantially in the domains of organizational values and goals, senior management involvement, broad staff presence and expertise in AMI care, communication and coordination among groups, and problem solving and learning. Participants described diverse protocols or processes for AMI care (such as rapid response teams, clinical guidelines, use of hospitalists, and medication reconciliation); however, these did not systematically differentiate high-performing from low-performing hospitals.”

In other words, the difference between high- and low-performing hospitals is the quality of leadership, not the quality of physicians, technology, or equipment.

One of most effective ways to develop a cohesive vision and build a successful culture is by integrating the Baldrige model. Take a moment to read the profiles of hospitals that have won the Baldrige Award and you will be struck by the strength of their cultures:

• Advocate Good Samaritan Hospital has 99% of its heart failure patients complying with their…

A Baldrige Award Winner’s Health Pyramid

The Baldrige model values a systems perspective. One of the most impressive system perspectives I’ve seen was shared by Heartland Health, a 2009 Baldrige Award winner, in its award application summary. It’s called the Health Pyramid.

There’s a lot going on in this diagram and it all relates to how Heartland Health (HH) serves the health care needs of its communities.

The “tip of the iceberg” shows the diseases that most healthcare organization in the U.S. spend all of their time and money treating. HH provides this care through the Heartland Regional Medical Center (HRMC), a 353-bed tertiary care hospital, and Heartland Clinic (HC), a group of 107 physicians.

The causes of death from these diseases, human behaviors such as tobacco use, poor diet, and inactivity, are less visible but more important to actually preventing disease. HH promotes health and provides disease management and insurance to individuals and companies that need coverage through its Community Health Improvement Services (CHIS) and through HRMC, HC, and the Heartland Foundation (HF).

The drivers of these behavioral choices are the root causes of poor health. According to HH’s application, the Heartland Foundation “empowers youth, adults, and organizations to build better, healthier, and more livable communities and does so by creating dialogue, funding innovative collaboratives, and sponsoring initiatives promoting and enhancing the community.”

All three levels of the Health Pyramid support Heartland Health’s Vision, which is shown in the top left corner with key words—best, safest, healthy, and productive—aligned with the levels. Each level also aligns with a Heartland Health…

AtlantiCare’s Baldrige Journey

It’s always interesting to read about the journeys taken by Baldrige Award winners. This month’s Quality Progress describes AtlantiCare’s nearly decade-long integration of the Baldrige model, which resulted in receiving the Award in 2009.

Like a lot of organizations, it used the state award process first, receiving a bronze award from Quality New Jersey in 2001. It first applied for the Baldrige Award in 2006 but did not get a site visit. That came in 2007, and again in 2008, before the site visit in 2009 led to the Award. In the article, AtlantiCare’s president and CEO, David Tilton, said, “You don’t know how much work you have to do, but we knew we were not Baldrige worthy when we had our first site visit. We knew we could be better.” (“Jersey Score,” Brett Krzykowski, Quality Progress, September 2010).

Organizations that are new to the Baldrige Criteria often struggle with identifying their strategic challenges. It’s been my experience that most healthcare organizations have very similar challenges. With that in mind, here are AtlantiCare’s:

1. Engaging physicians in new models of collaboration and partnership.
2. Creating sustainable growth outside of the primary service area.
3. Identifying and prioritizing healthcare service opportunities for investment and recruitment.
4. Developing new business and care models to support and grow primary care.
5. Identifying and improving critical success factors for community health and wellness.
6. Increasing quality of care through clinical communication and transparency.
7. Using technology to improve patient safety and clinical quality.
8. Recruiting, training, and retaining a highly skilled workforce.
9. Succeeding in an environment of decreasing reimbursement and access to capital, and…

A Healthcare Innovator

The Henry Ford Health System built its first new hospital since 1915 a couple years ago in West Bloomfield, 30 minutes from downtown Detroit. According to William C. Taylor, the hospital “truly must be seen to be believed.” (“One Hospital’s Radical Prescription for Change,” HBR, June 2, 2010)

Here are a few things that made Taylor a believer:

• The hospital sits on a wooded 160-acre campus
• All 300 rooms are private and designed so that family members can stay overnight if they wish
• All patients go right to pre-assigned rooms when they arrive
• A concierge helps patients and families with errands
• A “tea sommelier” recommends different teas for different situations
• There’s a day spa and an indoor farmer’s market every Wednesday
• There’s a 90-seat demonstration kitchen to teach patients’ families and the community how to prepare better food
• A celebrity chef spent two years creating 3,000 healthy recipes for patients to choose from
• The atrium features more than 2,000 trees lining paths to shops that sell products that can improve health

There’s a Baldrige connection to this story: West Bloomfield’s new CEO is Gerard van Grinsven, who joined Henry Ford after a long career with two-time Baldrige Award winner Ritz-Carlton. Skeptics questioned the wisdom of hiring someone with no healthcare experience to run the new hospital. Van Grinsven thinks it was a smart move. “I had a fresh pair of eyes and no baggage when I arrived,” he said. “The real opportunity for reinvention is to rethink the role of a hospital. How do we position ourselves as a community center for…