Achieving excellence Featured

8:00pm EDT April 25, 2008

Quality has never been more important for health care providers. Employers ask for it. Payers demand it. Pay-for-performance is taking shape. Physicians increasingly choose hospitals known for high-quality care. External rating agencies measure outcomes, sharing results for all to see. Consumers use multiple media to research and identify best medical practices. And there’s an explosion in information accessibility and public reports and an increase in legislation and regulation.

Smart Business learned more from Barry Arbuckle, Ph.D., president and CEO of MemorialCare Medical Centers and chair of the California Hospital Association Board of Trustees, about what health care organizations are doing to improve quality measures.

What role does quality play among health care providers?

Quality and safety must be central to the mission of every provider — from hospitals, home health services and long-term care facilities to physicians’ offices, ambulatory facilities and other settings. That’s because we know even one preventable death or complication is one too many.

How can health care providers implement quality initiatives?

We have an example close to home. More than a decade ago, MemorialCare Medical Centers began aggressively documenting our quality through extensive clinical outcome studies. Through teams of doctors, nurses and clinicians from our six hospitals, we created best practice, evidence-based medicine and clinical guidelines that identify the best diagnostic, treatment and preventive techniques. Physician-led teams focus on specific populations of patients or diseases and develop and refine guidelines that support delivery of care at the bedside. These more than 300 guidelines have become standards of practice at all our facilities. We also are identifying bold goals to reduce mortality, attaining superior compliance to key measures of care, improving early response to prevent patient emergencies, reducing hospital acquired infections and complications and improving the experiences of patients and families.

What is the result of best practice standards?

Spending many months identifying and implementing optimal clinical standards allows organizations to achieve outcomes that can surpass national and regional benchmarks for most diseases. It can result in extraordinary quality, proven treatments and comprehensive care that continually raise standards. An empowered and powerful network of clinicians and support staff work in the best interest of every patient. With shared goals and purpose, every staff member is devoted to aligning safety and quality aims and learning from one another.

How do electronic medical records fit in?

Electronic medical records (EMRs) are critical to patient quality and safety. In this Smart Business February 2008 column, we shared how EMRs place a patient’s full medical history onto computers and information systems, allowing clinicians to better coordinate care through immediate access to secure patient data. This facilitates clinical workflows and handoffs. It minimizes waste and inefficiency of manual and paper-based processes, maximizes quality through real-time decision support at points of decision-making and eliminates most paper used in patient documentation and education. Efficient care delivery prevents unnecessary orders and diagnostic tests, reduces medical errors and improves safety.

How will quality impact financing?

It already has. In late 2006, a major credit ratings firm announced that credit ratings will be incorporating quality measures and specific metrics into the assessments of credit quality for health care organizations — a critical breakthrough in understanding and evaluating how hospitals operate. With outcome indicators and benchmark data growing abundant, analysts are integrating quality measurements into rating activities and ensuring a culture of quality and safety.

Before too long, all health care organizations will be submitting quality measures to rating agencies, just as we submit financials. Favorable clinical outcomes and low complication rates as well as zero events of avoidable patient harm and 100 percent performance on critical quality policies will be carefully studied by rating agencies and payors.

What actions can employers take to ensure their work force receives quality care?

Query local physicians and hospitals about their quality initiatives. Do they have teams that design and implement best practice tools, offer education and monitor outcomes and opportunities for improvement? Are clinical outcomes documented and easily accessible? Are they implementing EMRs? How focused are they on supporting a strong culture of patient safety? Do they document their goals to significantly improve quality? What procedures have they implemented to reduce infections and the risk of complications? And what type of awards have they received from external organizations for performance in quality and safety?

BARRY ARBUCKLE, Ph.D., is president and CEO of MemorialCare Medical Centers ( and chair of the California Hospital Association. Reach him at or (562) 933-9708. MemorialCare Medical Centers include Saddleback Memorial Medical Center in Laguna Hills and San Clemente, Orange Coast Memorial Medical Center in Fountain Valley, Anaheim Memorial Medical Center, Long Beach Memorial Medical Center and Miller Children’s Hospital in Long Beach.