Excellence requires, among other things, good communication and unprecedented cooperation. Thus, employees from different departments and disciplines needed to identify new ways to improve existing care processes and work together as a multidisciplinary team. Hospitalists had a unique role that led to several changes.
“Hospitalists are involved in pretty much anything that happens at Bronson,” says Hussein Akl, MD, medical director for Bronson’s Hospitalist Service.
It was that involvement that led Bronson to change its approach to hip fracture care. Previously, the surgeon managed the hip fracture patient from admission to discharge. Bronson’s hospitalists proposed a new model, however: The hospitalists would manage the patient medically, leaving the surgeons to focus on what they do best: repairing the hip.
The success of the program is measured in clinical outcomes; length of stay has declined significantly since the specialists began collaborating in this way. In 2005 HealthGrades, an organization located in Golden, Colo., that rates care in 5,000 U.S. hospitals, awarded Bronson its highest rating (five stars) for hip replacement surgery and for treatment of acute myocardial infarction.
Hospitalists also took the lead in preparing for Primary Stroke Center Certification, a status Bronson achieved from the Joint Commission on Accreditation of Healthcare Organizations last year, and are leading physician engagement in Bronson’s computerized physician order entry project.
Dr. Larson emphasizes that achieving a level of excellence that meets Baldrige standards requires alignment, meaning that organizational, department or service, and individual performance goals must be congruent. Dr. Akl concurs: “Hospitalists had to align with our orthopedists to improve hip fracture care, and with neurologists on stroke.”
This level of excellence also requires constant vigilance and measurement, which is why Bronson uses scorecards to follow core indicators that reflect compliance with best practices for conditions like heart failure, and community acquired pneumonia. They also track their risk-adjusted Medicare mortality rate, which at 3.5% in 2005 was better than their 2004 rate (4.8%) and considerably better than the national average. Scorecards are distributed electronically and discussed in all meetings. Targets established at the beginning of the year are reviewed, and the hospitalist service’s performance is examined and compared with aggregate data for other admitting physicians. Management acknowledges that drilling data down to the individual level—except in rare cases—is often difficult and does not necessarily reflect an individual’s true performance.
“Patients are co-managed often, making individual provider data somewhat misleading,” explains Dr. Larson.
If recruitment and retention are an indication of employee satisfaction, Bronson’s hospitalists are satisfied. Few hospitalists have left; however, one hospitalist who left returned a year later citing Bronson’s well-structured program, the fact that all hospitalists have equal decision-making authority, and physician-based care (Bronson does not use physician extenders) as re-employment incentives.
“Of course, he said the pay was good, too,” quips Dr. Akl. At Bronson, results are rewarded and recognized generously.
The Patient’s Perspective
Bronson’s approach to hospital care translates into distinct differences—from the moment patients enter until discharge. Also recognized internationally as a Pebble Project Partner, Bronson’s facility design proves that function follows form. (See “The Pebble Project,” p. 39.) The building has a first-class hotel feel to it, with well-planned spaces and indoor gardens. Staff emphasizes privacy and service—not just care. Acknowledging that patients have needs and responsibilities outside the hospital that don’t pause while they are admitted, Bronson offers amenities such as wireless computers so patients can stay connected to their lives, beepers so family members can leave a surgical waiting area without fear of missing the surgeon’s post-operative visit, 24-hour room service, and a concierge to run errands or quarterback problems.