Increasingly evidence links architectural design to outcomes in many healthcare settings, and Bronson has acted on the evidence. The hospital is easy to navigate, and because a major building campaign finished this facility in 2000 every patient room is private with its own hand-washing station. Patients needn’t worry about a roommate’s noisy guest or snoring, but, more importantly, private rooms are associated with lower nosocomial infection rates and speedier recovery.
Operating and labor costs are also lower because patients are not transferred as often. At Bronson, infection rates fell 11% overall compared with the rate in their former facility that had a combination of private and semi-private rooms.
Bronson continues to monitor infection rates and also tracks employee turnover, outcome measures, length of stay, cost per unit of service, waiting times, patient satisfaction levels, nosocomial infection rates, and organizational behaviors.
Sharing Caring
Bronson’s hospitalists actively engage in information sharing. They share their protocols within the Bronson healthcare system and with other hospitals and providers. One recent project has been the successful effort to improve the discharge process—an area of emphasis for many quality-promoting oversight organizations and other facilities. Their next step is to automate their interventions.
Some also participate in a half-day Physician Leadership Academy, a gathering held quarterly to develop physician leadership skills and collaborate on identifying and implementing best practices.
Because Bronson’s overall atmosphere and organizational culture differ from older facilities or less avant-garde organizations, Harrelson, Dr. Larson, and Dr. Akl have difficulty identifying one unit where care might be considerably different than what the patient would receive elsewhere. Dr. Akl says that the hospitalists as a group discussed this question and determined that all Bronson units are held to the same high standards, but that the Adult Medical Unit (AMU) is an interesting model for serving the geriatric population.
In the AMU hospitalists lead the team to reach desirable outcomes. The unit’s propensity to admit elderly patients created unique needs that staff has met in correspondingly unique ways. Nursing’s commitment and capability is evident because all AMU nurses are NICHE (Nurses Improving Care for Health System Elders) certified. NICHE certification promotes systematic nursing change that ensures sensitive and exemplary patient-centered care for older patients. The hospitalists, too, have participated in this cultural change and created a protocol that anticipates elderly patients’ needs, and all hospitalists rotate through AMU to support this part of the continuum of care.
The Outcomes
Bronson measures everything, and uses established best practices, benchmarks, and data to ensure that they meet and exceed national standards. They monitor clinical excellence using Centers for Medicare and Medicaid Services performance rates, Blue Cross Blue Shield targets, and the CareScience (Philadelphia) database. They also follow the JCAHO standards and Leapfrog Groups’ National Quality Forum’s measures.
They monitor patient satisfaction using Gallup Polls and “listen and learn” methods that build on the idea that the customer’s opinion and experience is often more valuable than that of an outside consultant. And, they monitor corporate effectiveness using tools that measure employee learning, vacancy rates, and commitment to the environment and the community.
Bronson’s persistence and desire to be the best has paid off. Patients receive beta-blockers and pre-surgical antibiotics at rates that exceed best practice. They have significantly reduced the incidence of ventilator-acquired pneumonia in all ICUs—the pediatric ICU has had none since 2004. Patient satisfaction increased from an already high 95% in 2002 to an astounding 97% in 2004.
For the past three years, Bronson has been named by Fortune and Working Mother magazines as one of the nation’s 100 best companies to work for. They have also been named by Solucient as one of the 100 Top Hospitals in the United States for 2005. Another acknowledgment is the Environmental Leadership Award from Hospitals for a Healthy Environment for reducing waste and pollution. The list of their achievements and awards is seemingly endless, but so too is their energy to continue to improve and deliver excellent care.