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The Truven Health Blog


The latest healthcare topics from a trusted, proven, and unbiased source.


Correlation Between Baldrige Award Recipients and 100 Top Hospitals Winners


By Jean Chenoweth/Tuesday, November 18, 2014
Once again, the selection of St. David’s HealthCare and Hill Country Memorial as 2014 Malcolm T. Baldrige award winners and performance on the 100 Top Hospitals® National Balanced Scorecard overlap. Hill Country Memorial and five of the six hospitals in the St. David’s HealthCare system are or have been 100 Top Hospitals winners. This is important because a significant statistical association between use of Baldrige best management practices and highly balanced performance excellence, as measured by the 100 Top Hospitals National Balanced Scorecard, was found in a study performed for the National Institute of Standards and Technology in 2011. At that time, only 21 hospitals had been named Baldrige Award recipients since its initiation in 1991. These new dual winners add to the growing list of dual winners announced by the Malcolm T. Baldrige program in 2013 (see listing below). This is all very good news for measurement of the impact of leadership in hard data.

The identification of a growing overlap between use of known best management practices (Malcolm T. Baldrige program) and objective measurement of leadership impact on an organization (100 Top Hospitals program) is a testament to the enormous potential of the emerging science of management. Unlike efforts to measure clinical and financial practice in healthcare, the objective research on measurement of leadership effectiveness is miniscule. There are good reasons for that. Very much like the now 30-year old effort to develop evidence-based medicine, complete success is elusive. Both the practice of medicine and the practice of effective leadership have a heavy component of “art” that defies quantification. Almost all of the thousands of management books published are experiential or philosophic – not empirical. Jim Collins’ books on chief executive officer characteristics and practices are among the very few evidence-based business books ever published. That is what makes the increasing number of Baldrige award winners who are also 100 Top Hospitals winners so heartening! There is the potential of an increasingly strong link between actual practice and empirical measurement.

To be explicit, the hospital recipients of the 2014 Baldrige Award are frequent 100 Top Hospitals award winners, which is based solely on a balanced scorecard analysis of public data:

  • Hill Country Memorial is a four-time 100 Top Hospitals winner (2014, 2013, 2012, 2003) in the very difficult category of Small Community Hospitals.
  • St. David’s Medical Center, Austin (which includes St. David’s Heart Hospital and St. David’s Georgetown) is a five time 100 Top Hospitals winner (2014, 2013, 2012, 2011, 2010) and is in the Large Community Class.
  • St. David’s Heart Hospital, a part of St. David’s Medical Center, is a 2015 and 2013 50 Top Cardiovascular Hospital winner.   
  • St. David’s North Austin Medical Center is a three time 100 Top Hospitals winner (2014, 2013, 2012) also in the Large Community Class.
  • St. David’s Round Rock is a 2012 100 Top Hospitals award winner in the Medium Community Class which is the most difficult class to be selected a winner.
  • St. David’s South Austin Hospital was a 2001 award winner and also is in the Medium Community Class and a 2005 and 2004 50 Top Cardiovascular Hospital award winner.

In 2013, the Malcolm T. Baldrige program issued a listing of Baldrige and state or sector based state and sector program award winners who had also won the 100 Top Hospitals award. 

Baldrige Award Recipients

  • Advocate Good Samaritan (Downers Grove, IL) a 2010 Baldrige Award recipient
  • North Mississippi Health Services North Mississippi Medical Center (Tupelo, MS) a 2012 Baldrige Award recipient
  • Poudre Valley Hospital (Fort Collins, CO) a 2008 Baldrige Award recipient
  • Regional Medical Center at Plano (Plano, TX) a 2011 Baldrige Award recipient
  • Sutter Davis Hospital (Davis, CA) a 2013 Baldrige Award recipient

Baldrige-based State or Sector program awards

  • Advocate Good Samaritan Hospital (Downers Grove, IL), 2010 Illinois Performance Excellence recipient, 2010 Baldrige Award recipient
  • Advocate Lutheran General Hospital (Park Ridge, IL), 2012 Illinois Performance Excellence winner
  • Banner Boswell Medical Center (Sun City, AZ) – parent Banner Health, 2012 Showcase in Excellence Award (AZ) winner
  • Duke University Hospital (Durham, NC), 2013 Governor’s Award of Performance Excellence in Healthcare recipient (NC)
  • INOVA Fair Oaks Hospital (Fairfax, VA), 2006 U.S. Senate Productivity and Quality Award (VA) winner
  • Kettering Medical Center (Kettering, OH) – parent Kettering Health Network, 2010 Governor’s Award for Excellence (OH) winner
  • Maury Regional Medical Center (Columbia, TN), 2009 Excellence Award (TN) winner
  • McKee Medical Center (Loveland, CO), 2006 Timberline Award Recipient (CO)
  • Riverside Methodist Hospital (Columbus, OH), 2005 Achievement of Excellence (OH) winner
  • Sauk Prairie Memorial Hospital and Clinics (Prairie du Sac, WI), 2012 Wisconsin Forward Award winner
  • SSM St. Joseph Hospital West Lake (Saint Louis, MO) – parent SSM Health Care, 2011 Missouri Quality Award recipient, 2002 Baldrige Award recipient
  • St. David’s Medical Center and St. David's North Austin Medical Center (Austin, TX) – parent St. David’s Healthcare System, 2008 Texas Award for Performance Excellence winner
  • St. Luke’s Hospital (Cedar Rapids, IA), 2010 Iowa Recognition for Performance Excellence winner
  • Sutter Davis Hospital (Davis, CA), 2012 Governor’s Award for Performance Excellence (CA)
  • Texas Health Presbyterian Hospital Rockwall (Rockwall, TX) – parent Texas Health Resources, 2013 Texas Award for Performance Excellence recipient
  • University of Colorado Hospital (Aurora, CO) – part of a joint operating agreement with Poudre Valley Health System, 2010 Rocky Mountain Performance Excellence recipient, 2008 Baldrige Award recipient

Jean Chenoweth
Senior Vice President, Performance Improvement and 100 Top Hospitals


Penalties for Avoidable Medicaid Readmissions….And the Gang Piles On


By Jean Chenoweth/Friday, September 12, 2014
Jean Chenoweth imageThe release of the list of Illinois hospitals penalized for avoidable readmission of Medicaid patients in a recent Chicago Sun Times article was interesting reading! While the list was led by two brand name hospitals, Ann and Robert H. Lurie Children’s Hospital of Chicago and Rush University Medical Center, the list also included John H. Stroger, Jr. Hospital of Cook County, University of Illinois, University of Chicago, St. Mary, St. Catherine, and others with long histories of treating the poor and disadvantaged.

Policy wonks argue that the only way to reduce delivery system fragmentation, which is known to cause quality gaps, is by creating penalties that force changes in the structure of the delivery system. Development of metrics that force hospitals to be responsible for care beyond their current control has become much more common. Why? Because it’s the hospital that has the staff and financial resources to make changes in the delivery system across the community. If the penalty is high enough, the hospitals will innovate to avoid the penalties, ultimately transforming the healthcare system.

Transformation requires innovation, trial, and error, and the ability to rapidly correct error. Setting policies that attempt to drive innovation in the delivery system via stiff penalties is innovative itself! This approach might be reasonable if government could act fast enough to adjust for error inherent in the innovation process. However, in a democracy, government is deliberative by definition, and therefore slow to act. It is especially unfortunate that states are piling on to extend avoidable readmission penalties without taking into account socio-economic conditions of patients. Both state and federal government could simply exempt or reduce the impact of the penalties on safety net hospitals now. There are existing socio-economic adjustment methodologies that have been used for over a decade by health systems like Dignity Health. Neither solution is perfect, but fast action is necessary to reduce safety net hospital financial harm that is being exacerbated by the state “pile on.”
There is no doubt that the government is trying to innovate, and I applaud those efforts. Using hospital penalties to drive innovation and delivery system structural change might even work well in some cases.  But the risk of government’s inadvertent commission of “avoidable error” is too great, given its slowness to act. It would be better to run a few small pilots first to get the kinks out. Then, when the piling on occurs, it will not hurt those that are already hurting.

To read more about the connection between socio-economic factors and readmissions, download our white paper, Community Need Association with 30-Day Readmissions.

Jean Chenoweth
Senior Vice President, Performance Improvement and 100 Top Hospitals

Consistency – the Real Challenge of the Affordable Care Act for Health Systems, ACOs, and Insurers


By Jean Chenoweth/Monday, May 5, 2014
Jean Chenoweth imageMany may not have noticed a requirement within the Affordable Care Act (ACA) that requires that both quality and price performance be posted on healthcare exchanges for both insurance company networks and ACOs. That is a huge help for consumers looking to make more reasonable choices. The purpose of the expansion of transparency is to expose insurance companies and ACOs that offer networks that are low cost, but offer poor quality. In other words, performance must be BALANCED.

The 15 Top Health System winners are clearly aware of the requirement. To measure consistency of performance across a health system, the 100 Top Hospitals team developed a metric to measure alignment of performance of the hospitals within a health system. To date, alignment of high performance is elusive. The data demonstrates that health systems leadership hasn’t been able to lead member hospitals to align performance on the vast majority of metrics. The good news is that Asante, OhioHealth, Advocate Health Care, and a small number of other 15 Top Health Systems have made progress. They are leading the way in establishing the methods to achieve consistency. However, the healthcare industry has many miles to go before it achieves the consistency of the airline industry or many other industries.

Jean Chenoweth
Senior Vice President, Performance Improvement and 100 Top Hospitals

The 2014 100 Top Hospitals Winners: Are They the Best Partners for Local Employers?


By Jean Chenoweth/Wednesday, March 5, 2014
Jean Chenoweth imageThe newly announced 2014 100 Top Hospitals® winners once again exemplify balanced excellence in performance. These are hospitals that outperform peers across the whole organization, not in just one performance area. Why does that matter? 

It matters because the healthcare industry is in turmoil. The Accountable Care Act (ACA) is  a disruptive event that requires hospital leaders to maintain high performance while guiding the successful transformation of the organization, and this is critical to the organization’s health. The leaders of the 2014 100 Top Hospitals have demonstrated these skills and are increasingly raising the value provided to the community, while others are falling behind. The 100 Top Hospitals management teams are able to serve their communities with reliable, high performance in the areas we measure: good inpatient outcomes, safety and adherence to evidence-based medicine, excellent post-discharge outcomes, effective clinical and operational efficiency, stable financial performance as a major community employer, and high patient perception of care. These hospitals have leadership teams who are also more consistent than their peers in demanding a balance across these measures. It matters because these are the hospitals that are well managed and most able to make successful change during tumultuous times.
The ACA is a disruptive event for employers and insurers as well.
Employers are increasingly aware that quality is not a commodity, and there needs to be a balance between cost and quality. They are learning that demands for only lower costs can be counterproductive, especially given ACA requirements for increased value and community health. Routine contracting with the lowest-cost health plans, without regard to quality, will result in higher costs and employee dissatisfaction in the long run. ACA transparency requirements for healthcare exchanges are designed explicitly to expose very low-quality health plan networks that don’t improve quality and community health. These far-reaching effects of the ACA are leading employers and providers to warm to the idea of mutually agreed-upon goals to lower costs and improve quality across the community.

Will ACA requirements and incentives result in employers and providers working together in the future?
While it makes sense that employers and providers should collaborate, it’s difficult to know whether the idea is ephemeral or the beginning of a new way of operating for the good of the community. Both talk about higher value, but it's unclear if either will walk the walk. If the concept does begin to gain momentum, well-managed hospitals with proven leadership, like the 100 Top Hospitals, will be the best partners that employers can have. Strong, effective management is NOT a commodity. But strong hospitals with effective management are the most likely to be the best partners of employers to drive increasingly high value and improved community health.

See the full list of winners.
Download the study overview and research findings.
Learn more at www.100tophospitals.com.

Jean Chenoweth
Senior Vice President, Performance Improvement and 100 Top Hospitals

Connecting CEO Compensation to Hospital Quality Measures


By Jean Chenoweth/Friday, January 24, 2014
Jean Chenoweth imageHeavy media coverage about the size of the compensation packages of some major health system CEOs has led to calls for “pay for performance” and greater transparency. Behind much of this uproar are two key drivers.   The first is the growing interest of legislators like Senator Charles Grassley, Chair of the  Senate Finance Committee and Governor Cuomo of New York state to convert hospitals from not-for-profit 501©(3) status to taxable entities. The second is the national demand for higher value in healthcare. Media focus on byzantine hospitals billing practices has led to spotlights on multi-million dollar pay packages for CEOs of not-for-profit hospitals, and the general public has responded with concerns

In a recent article in ACO News, "Hospital pay now at risk for CEOs," Jean Chenoweth, noted the relatively new trend of hospital boards using performance metrics to determine CEO compensation. If this becomes a standard practice, this will align the performance metrics required of physicians with those of executive leadership. Through the 100 Top Hospitals® program, Truven Health is developing performance benchmarks that will be one of the tools available to hospital boards for determining CEO compensation packages. The Balanced Scorecard consists of 10 measures across four domains: quality, efficiency, finance and consumer assessment of care identifies top performing hospitals. The benchmarks include diverse quality and financial matrices to help manage complex health systems and hospitals.

For more information about the 100 Top Hospitals program, please visit 100tophospitals.com. 

Jean Chenoweth
Senior Vice President, Performance Improvement and 100 Top Hospitals

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