How hospitals measure quality

For many years, patients have often measured the quality of their hospital care in very subjective terms. As long as caregivers were compassionate and seemed competent, patients simply trusted that the doctors, nurses, and hospitals all had what it took to provide them great care.

In reality, beyond those crucial elements of patient experience, much more is necessary to ensure quality patient care. Eastern Maine Medical Center’s and Acadia Hospital’s absolute priority, even in the face of growing financial pressures, is providing high quality patient care. We work at it every minute of every day. Our caregivers provide the best quality care they can and then look for ways to do it better, and we have lots of tools to help us.

For many years, the gold standard for hospital quality review has been accreditation from the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). Seasoned professionals from a variety of disciplines visit hospitals every few years to rigorously review adherence to numerous standards, from the timeliness of medical documentation and storage of pharmaceuticals to fire safety and nurse staffing. State licensing inspections come with similar regularity and attention to detail, and as many as 40 other organizations evaluate subsets of hospital services.

Bangor should be proud that its two Eastern Maine Healthcare hospitals have recently gone through these JCAHO reviews, and have been ranked among the nation’s top 9 percent for quality standards. In August, Acadia Hospital was visited by JCAHO. A year earlier EMMC hosted a JCAHO review team. Both hospitals scored in the high 90s with no “Type One Deficiencies.” Medical staff performance was especially noteworthy in both surveys. Nationally, these high scores are rare, and EMH has done it twice in a row.

Pursuing value from healthcare dollars means balancing a quality vs. cost equation. The 1999 Institute of Medicine Report, “To Err is Human,” illustrated that there is room to improve hospital quality. The incredible technology and life-saving drugs are still ordered and administered by human beings who are, by nature, fallible. Large employers and insurers are now getting involved. One initiative begun in the nation’s largest cities is the “Leapfrog Initiative.” Leapfrog evaluates the quality of large hospitals based on some relatively simple measures and rewards hospitals that compare favorably by sending them patients. Leapfrog looks for things like specialized physician staffing in intensive care units, patient volume on certain high tech procedures (like cardiac catheterizations and bypass surgeries), and the use of computerized tools to standardize and double check medication orders.

Maine, with its small, mostly rural hospitals, is not targeted for Leapfrog participation. Nevertheless, EMMC recognizes the value of implementing these measures. We are actively pursing all of the Leapfrog criteria, and intend to implement them over the next couple of years. We are confident we’ll compare very favorably with other hospitals across the country.

Quality improvement investments are significant. Still in the long run, they will help balance the quality and cost equation. The EMMC Board of Trustees has authorized the hospital to invest $30 million in its “Patient First” effort over seven years. Patient First will redesign the patient care process, reduce redundancy and paperwork, and computerize many paper-based processes. This will help reduce errors, improve patient care and patient safety, cut the cost of preventable complications, and give nurses more time at the bedside.

Likewise, Acadia Hospital is not content to rest on its excellent JCAHO rankings. Acadia has applied to become a “Magnet” hospital. This recognition is based on the “forces of magnetism” research undertaken by the American Academy of Nursing and focuses on a series of care quality and nursing excellence measures. The research demonstrates that “Magnet” facilities have positive outcomes for patients, families, and nursing professionals. The nation has about 50 Magnet hospitals, and Acadia hopes to become the first “magnet psychiatric hospital” later this year.

The quality initiatives I have mentioned above are just a few of the dozens that we work on daily at EMMC and Acadia. Regardless of the specifics, the initiatives are focused on three themes: quality of patient care, cost of patient care, and access for the patients needing care. Absent a clear national or state public policy on healthcare quality, hospitals like EMMC and Acadia must drive our own response to the patient’s expectations for high quality. Recently some insurors in New England have expressed an interest in partnering with hospitals, to invest in these quality initiatives. We look forward to working with these forward-thinking companies on worthwhile projects that will improve healthcare.

In health care being good is never good enough. In a small community like ours, the employees and physicians of EMMC and Acadia are probably your friends and neighbors, and I hope you will join me in congratulating them on their accomplishments relative to measurably improving quality. And speaking for our board and management team, I can say that it is all part of our commitment to deliver high quality care, as close to home as possible, in a financially responsible manner.

Norman A. Ledwin is president and chief executive officer of Eastern Maine Healthcare.