Overview

In 2005, under pressure to improve performance on indicators of financial well-being, patient satisfaction, and clinical quality, St. Mary's Health Center leadership made a deliberate decision to focus on Centers for Medicare and Medicaid Services process-of-care measures, or "core" measures. They set in motion a series of activities that resulted in striking improvement in core measure scores across four clinical areas (heart attack, heart failure, pneumonia, and surgical care improvement), eventually reaching the top percentile nationwide. The main strategies were: clear communication of the new directive by the hospital's president and Board of Directors; physician-led committees taking responsibility for performance improvement and communicating the goals to medical staff; intensified efforts to standardize core measure and other clinical processes through order sets; dedicating a full-time staff member to data abstraction and initiating a system of concurrent and post-discharge review of medical charts; continuous measurement and analysis of performance data; providing feedback to staff through reporting, scorecards, and follow-up when performance varies from the care standard; and sharing successes, lessons, and tools across hospitals in the health system.

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This study was based on publicly available information and self-reported data provided by the case study institution(s). The aim of Commonwealth Fund–sponsored case studies of this type is to identify institutions that have achieved results indicating high performance in a particular area of interest, have undertaken innovations designed to reach higher performance, or exemplify attributes that can foster high performance. The studies are intended to enable other institutions to draw lessons from the studied institutions' experience that will be helpful in their own efforts to become high performers. Even the best-performing organizations may fall short in some areas or make mistakes—emphasizing the need for systematic approaches to improve quality and prevent harm to patients and staff. The Commonwealth Fund is not an accreditor of health care organizations or systems, and the inclusion of an institution in the Fund's case study series is not an endorsement by the Fund for receipt of health care from the institution.