Preventable Complication in 90 days & Your Care is Free

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I recently returned from the Pinnacle EMS Forum, which is the leading conference for leaders of prehospital emergency medical transport services (i.e., paramedics). The keynote speaker was my friend Robert Lloyd, PhD, executive director of performance improvement for the Institute for Healthcare Improvement. Dr. Lloyd led fantastic plenary and breakout sessions presenting a pragmatic and action-based approach for using data to test changes, improve process, and enhance performance. He was very well received.

The concept of quality in organizations, especially health care, is freely thrown around, but rarely do we get to witness it in action. On my flight out to St. Pete Beach, FL, I reached into my bag for the magazine I had packed for that brief period between takeoff and 10,000 feet, when I can “turn on approved electronic devices.” On this particular trip, I mistakenly packed an old edition of Fast Company, which I had read months before. As I flipped through the pages, I came across a story I had forgotten about that really impressed me. It was about Geisinger Health System in central Pennsylvania.

Geisinger is an interesting case of the commitment to continuous improvement and serving patients. In Peter Carbonara’s article The Cure: How a small network of hospitals in Pennsylvania is defying convention, cutting costs, and improving health care, he tells how the CEO, Glenn Steele, and his doctors and staff have put providing the right care, on the first try at the forefront of all their focus. It’s all part of their ProvenCare program.

The components of ProvenCare are:
•    Patient-centricity
•    Appropriate care
•    Evidence/consensus-based best practices
•    Highly reliable care
•    Optimized work flows
•    Explicit accountabilities
•    Packaged pricing
•    Performance-based reimbursement
•    “Warranty”

So, how effective has this one health system been when they focus on patient centric, evidenced-based care, with continuous process improvement? Patients receive nearly 100% of the generally accepted treatments for their condition – compared with 55% found in one New England Journal of Medicine (2003) Study. An example of how they achieve this aim is in surgery; each surgery case involves 40 documented steps to confirm all of the right treatments are performed. A study of CABG patients in the Annals of Surgery (2007, February) found patients had 16% shorter hospital stays and that the end patient bill was 5% less. Other benefits included a 45% reduction in readmissions and a 60% decrease in neurological complications. Geisinger’s CEO is so serious about the system’s mission, he’s quoted as saying they “should’t get paid if we don’t do the right thing.” More than just a slogan, it’s actually a guarantee. If you end up back in the hospital in 90 days as a result of a preventable complication, the hospital will take care of the bill.

In a time when politicians are arguing over health insurance versus improving health care, it’s important to not loose sight of real and tangible examples of getting it right. Geisinger Health System is not alone as a best practice, but it reflects a strong will, a focused aim, and a pragmatic, daily approach to enhancing performance, controlling costs, and keeping attention on the core business – the patient.