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National Groups Promote Efficiency Agenda


A number of national organizations are helping hospitals and hospitalists get a better handle on their efficiency. One such group, a Charlotte, N.C.-based performance improvement alliance of 2,600 hospitals called Premier, recently completed the third year of its ongoing collaborative, QUEST (QUality, Efficiency, Safety, and Transparency). Three-year results found 157 charter-member hospitals saving an estimated 25,000 patient lives (based on 29% lower mortality rates than risk-adjusted national averages) and $4.5 billion in costs, compared with hospitals not participating in the initiative.

The high-performing hospitals in the collaborative use an efficiency dashboard to pinpoint and quantify saving opportunities, says Richard Bankowitz, MD, MBA, FACP, an internist and medical information specialist who serves as Premier’s enterprisewide chief medical officer. Collaborators participate in education and training, consultation, conference calls, a national meeting, and an online performance-improvement portal, with a commitment to transparently share their data and a focus on quality in areas of mortality rates, harm avoidance, readmissions, costs, and patient-reported experience.

“We’ve shown quite a lot of improvement,” Dr. Bankowitz says. “We’ve been able to look at hospitals that appear to have excellent readmissions rates or nursing strategies, and then try to figure out their secrets.”

Even the best-performing hospitals have opportunities to pinpoint and eliminate inefficiency. “But we need to be more than efficient,” he adds. “We also need to be effective. Having perfect efficiency in providing unnecessary procedures doesn’t do anybody any good.”

Numerous tools and methods are freely available, he says, but he also encourages hospitalist groups to stay focused on what provides value and will impact efficiency in hospitals.

“Look for processes of care that bring value, versus waste,” he says. “Have we ever stepped back and thought about the way we provide care as a whole—from end to end? Really look at the utilization—of tests, of consultations, of pharmaceuticals—and consider all of the inputs. Are they really adding value? Do you know which patients account for the most costs?”

He also encourages hospitalists to pull together interdisciplinary quality teams and focus on the patients who are more frequently admitted or problematic and costly, such as heart-failure patients. “Get the team to design a process of care that includes inpatient, outpatient, and the skilled nursing facility,” he says, adding there is potential for waste in transitions of care.

Hospitals are in an increasingly tough position, Dr. Bankowitz admits. “They’re no longer able to just cut their way out of financial problems. Hospitalists have an important role,” he notes. “They can take more of a systems view, seeing care processes from end to end.”

Larry Beresford is a freelance author in Oakland, Calif.

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