healthcare

New Jersey Among Nation’s Leaders

in Healthcare Quality

By Kerry McKean Kelly On Feb 25, 2014

Healthcare customers, including employers, insurers and consumers – now more than ever – are demanding “value” in healthcare. High-quality care is a key component of the value formula, and it’s an area where New Jersey’s healthcare community stands among the nation’s leaders.

Since its inception in 2001, the Institute for Quality and Patient Safety at the New Jersey Hospital Association (NJHA) has led New Jersey’s healthcare providers in a coordinated effort to improve the quality and safety of healthcare services delivered in the Garden State. Those efforts have culminated in the Partnership for Patients, a nationwide initiative under the Affordable Care Act that is yielding significant results in improving healthcare quality and safety and reducing hospital readmissions. NJHA is one of 26 Hospital Engagement Networks (HENs), or HENs, designated by the Centers for Medicare and Medicaid Services, to lead hospitals in this important work.

Every acute care hospital in the state is participating in the Partnership for Patients effort. Sixty-two of those hospitals have joined NJHA’s HEN, and they are achieving remarkable results in improved patient safety. They include:

  • A 48 percent decline in adverse drug events
  • A 47 percent decline in surgical site infections
  • A 43 percent decline in pressure ulcers
  • A 92 percent drop in early elective deliveries, which can lead to higher C-section rates and increased complications linked to prematurity.

Other areas where hospitals have improved quality and safety include: patient falls; ventilator-associated pneumonia; urinary tract and bloodstream infections; and hospital readmissions.

All told, New Jersey hospitals’ efforts under the first two years of NJHA’s Partnership for Patients initiative have averted an estimated 6,300 adverse events for patients and resulted in an estimated $63 million in healthcare savings.

In fact, recent data from the US Agency for Healthcare Research and Quality placed New Jersey ninth in the nation for the overall quality of its hospital care.

Those results were recognized when CMS recently extended NJHA’s HEN contract for a third year, allowing NJHA to continue its work with New Jersey hospitals in further quality improvement.

“We are very excited to have the opportunity to continue this valuable initiative in 2014. New Jersey’s hospitals are to be commended for the progress they have achieved in the first two years of this project. It reflects the importance our hospitals place on quality and patient safety,” says NJHA’s President and CEO Betsy Ryan.

Under the Partnership for Patients initiative, NJHA has been engaging hospitals and health systems in a collaborative model that has created an interactive group engaged in evidence- based education, analysis, information and data exchanges.

For patients, this work has resulted in healthcare that is safer, more efficient and ultimately more affordable. Based on this work, and reflected in the data, patients in a New Jersey hospital today are less likely to: develop a post-surgical infection; experience an adverse event from improper medication or a fall; get pneumonia, a urinary tract infection or a bloodstream infection while hospitalized; or develop a pressure ulcer.

Aline Holmes, RN, senior vice president of clinical affairs and director of NJHA’s Institute for Quality and Patient Safety, says, “I’m very proud of what our hospitals have accomplished. 
They have embraced the challenge of improving healthcare quality, and it has led to a culture change throughout healthcare that encompasses the executive office, the Board room and the patient units. But while we’re proud of these results, we’re never satisfied. Quality improvement is a constant quest, and we are always striving for more.”

Focused on Efficiency

One feature that has set NJHA’s HEN apart from others is its unique collaboration with the Institute for Healthcare Optimization (IHO), based in Boston. Fourteen participating hospitals have joined NJHA and the IHO in this intensive program that identified patient flow and work flow reforms in hospitals’ operating rooms and emergency departments. After 15 months of working with the IHO’s consultants on “smoothing” and other workflow strategies, the participating hospitals projected summary results of:

  • 11,800 to 17,300 additional patients that could be treated without adding inpatient beds or operating rooms
  • Roughly 20,000 additional patients that could be accommodated in hospital emergency departments
  • 21 percent to 85 percent decrease in wait times for emergency department patients to be admitted to a hospital bed
  • Reductions in the length of hospital stays ranging from 3 percent to 47 percent for certain groups of patients.

The work was led by Eugene Litvak, P.h.D, IHO’s president and CEO and a specialist in operations management and cost-effective medical decision-making. A native of Kiev, Ukraine, he also serves as an adjunct professor in operations management in the Department of Health Policy & Management at the Harvard School of Public Health. Dr. Litvak is an expert in healthcare bottlenecks – spotting them, identifying their causes and designing solutions to smooth them out. His research has discovered certain peaks and valleys in the daily operations of hospitals, especially in the operating room and emergency department. Left unaddressed, those peaks and valleys can lead to longer waits for care for patients, increased costs from staff overtime and missed opportunities for added revenue by providing more procedures.

Under NJHA’s initiative, New Jersey hospitals analyzed the inefficiencies in their operations, including uneven usage of operating rooms, which led to long waits, overtime costs and cancellation of procedures at peak times and wages paid to idle staff during low usage. Others identified bottlenecks in admitting patients to inpatient beds, which forced many patients to wait long periods in the emergency department or in post-surgery units. Solutions included a reallocation of Operating Room (OR) space and staffing, including the creation of designated blocks for emergency and urgent surgeries; and new standardized discharge processes to increase bed availability.

Based on current data, individual hospitals adopting these strategies project some impressive long-term results:

  • One hospital expects to schedule 1,000 additional surgical cases, resulting in a potential $1.27-million to $5-million increase in annual revenue.
  • Another projects annual cost savings of $1.7 million for redesigning its OR scheduling and operations.
  • One hospital expects to reduce its wait time for emergency surgery to just 18 minutes, based on its OR redesign.
  • Another reported an increase in patient satisfaction scores from 56 percent to 73 percent.

Dr. Litvak says the success of the New Jersey hospitals in reengineering processes and producing measurable results can provide a model for the rest of the nation in improving the value of the healthcare delivery system.