Hospital Leadership and Quality Improvement: Short Survey Results CMS Conference on Hospital QI and

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Hospital Leadership and Quality
ImprovementShort Survey ResultsCMS Conference
on Hospital QIand Public ReportingMay 25, 2005

• Thomas Vaughn, PhD
• Eugene Kroch, PhD

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Collaborators

• University of Iowa College of Public Health
• CareScience
• National Committee for Quality Health Care
• ActiveStrategy
• Hospital Associations from 8 states

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Project Goals

• Identify how hospital leadership is involved in
  quality improvement.
• Link survey results to hospital quality outcomes
  (Quality Index).
• Share findings to promote a strategic approach to
  quality improvement in hospitals based on
  empirical findings.

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The Survey
(Handout slides 5 8)

• 18-question survey distributed via internet in
  early 2005 to 1,250 hospitals in 8 states AZ,
  CO, IL, IA, NJ, NY, PA, and WI.
• 413 hospital responses (rate 33)
• Examines hospital QI drivers and impediments,
  reporting methods, board and physician
  participation in QI, and senior executive
  incentives.

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We Related the Survey Responses to the
CareScience Hospital Quality Index
(Handout slides 9 14)

• Quality index is the risk-adjusted aggregate rate
  averaged across three adverse outcomes
• Mortality
• Morbidity
• Complications

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Engagement of Hospital Boards
(Handout slides 15 23)

• 24 of boards interact with the medical staff a
  great amount in establishing hospital quality
  strategy.
• 27 of boards spend more than one fourth of their
  time on quality issues.
• 80 of responding hospitals utilize a formal
  quality performance measurement method for
  reporting to their boards.

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Better quality outcomes are associated with
hospitals where...

• the board spends gt25 of time on quality issues
• the board receives a formal quality performance
  measurement report
• there is a high level of interaction between the
  board and the medical staff on quality strategy
• the senior executives compensation is based in
  part on QI performance
• the CEO is identified as the person with the
  greatest impact on QI (especially when so
  identified by the QI executive).

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Influence of Government and related factors on QI
(Handout slides 24 29)

• Better outcomes are associated with...
• hospitals saying that government/regulatory
  agencies and accrediting bodies have a high
  level of influence on QI activities.
• hospitals (in Pennsylvania) where respondents
  believe that public reporting has a high level of
  influence on QI activities.

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Pay for Performance
(Handout slides 30 33)

• 94 of survey respondents said that changing the
  reimbursement system to focus on quality would
  have a high/medium impact on improving patient
  care.
• 66 of hospitals base some type of executive
  compensation on measurable QI.
• 64 use quality metrics for executive performance
  reviews.
• 13 of hospitals tie quality improvement to
  executive base compensation packages.

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What single change would lead to the most
significant quality improvement in your
hospital? (handout slides 34-35)

• Information technology ranks high more so among
  QI executives and the CMOs than among CEOs.
• Physician engagement ranks highest among CEOs.
• Other items include payment alignment, resources,
  and staff education.

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Summary (handout slides 36-38)

• Government has great influence, but multiple
  requirements seen as impediment.
• Boards engaged in QI, but in a limited way.
• Quality varies by the extent of leadership
  engagement with the medical staff in QI strategy
  and implementation.
• Physician engagement and health information
  technology are seen as keys to QI.
• Attitudes toward external influences and
  perspectives on key leadership positions are
  related to quality.
• Hospitals want payment for performance, but
  senior executives compensation is weakly linked
  to quality performance.

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Next Steps

• Qualitative Core Study of 20 hospitals that
  examines similar issues to Short Survey Report
  from Univ. of Iowa August 2005.
• Recommendations related to hospital leadership
  practices in QI and public reporting to be
  consolidated from Short Survey, Core Study and
  this Conference.
• Study physician engagement and board reporting
  dimensions of hospital quality improvement.

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Scorecard/Dashboard Collection and Analysis

• 230 hospitals agreed to share templates of board
  performance reports.
• Reports will be analyzed to determine
• Composition and balance of indicators
• Report structure and format
• Benchmarks cited
• Software programs utilized
• Final report Summer 2005.

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Questions?

• Contact Information
• Thomas Vaughn, PhD
• University of Iowa College of Public Health
• tom-vaughn_at_uiowa.edu
• Eugene Kroch, PhD
• CareScience, Inc.
• ekroch_at_carescience.com