One of the exciting things about the role of Chief Medical Officer at Brattleboro Memorial Hospital right now is the change in health care that is currently underway in the state. Vermont is leading the nation in health care reform. The process of implementation, which is going to take many years, has medical professionals paying attention to patient quality and safety and tying it to the patient experience in ways we never have in the past. The doctors and staff at Brattleboro Memorial Hospital have been committed to providing quality care since our founding in 1904. But health care has changed a lot since then! Staying focused on the patient as well as the process must always be the goal.
In the past decade, The Centers for Medicare and Medicaid Services (CMS) has required acute care hospitals, such as BMH, to participate in their Core Measures program. This program tracks compliance with a wide variety of processes, from the timing of antibiotic administration before surgery to the choice of antibiotics used for a patient with pneumonia. These measures help a hospital track its quality of care, and compare that to other hospitals in our region and across the nation.
In 2013 CMS required a new set of measures specific to care in the Emergency Department. We are measuring things such as how long it takes for a patient to see a doctor, how long it takes the doctor to determine if the patient needs to be admitted, and if admitted how long it takes to actually get that patient into their hospital room. The renovation and expansion of the Emergency Department at BMH not only brings us an expanded and pleasing space. It also provides us the opportunity to revise patient flow and staff processes so that we can achieve the parallel goals of excellent care that is delivered in a timely manner.
Measuring medical processes is only one part of determining quality. Also important is the patient’s perception of their care. Patient responses on the surveys called or mailed to them after they are home provide this very valuable information. Through comments and the voicing of concerns we at BMH get a much more complete picture of how we are doing. We gather more information about how we can improve both the details of care and the way in which it is provided. Our patients become our partners in delivering quality care by taking the time to respond.
One could look at a hospital’s overall patient satisfaction rate at 85 or 90 percent and think that’s good, but not if it’s your loved one that lands in the other 10 – 15 percent. The new federal guidelines are asking health care facilities to really dig down and be more proactive in looking at these measures with the goal of establishing national benchmarks for excellence, which are then tied to compensation. A hospital has to have all these different pieces reach very high levels to ensure everyone is getting high quality, error free, experienced care.
Whether the goal is zero hospital acquired infections or 100 percent adherence to guidelines for treatment, the notion that perfection is not attainable is starting to be challenged. It has to be hardwired into the processes of an organization in order to make it work, however. Physicians, nurses, techs and other kinds of clinical staff all want to do their duties perfectly every single time. That can’t happen just because everyone is trying really hard. We all try really hard, and we all need to continue trying really hard. But we have to have the systems in place that are set up to ensure that success.
CMS Core Measure data and our patient’s perception of care are both rolled up into a summary report for each hospital by the organization Consumer Assessment of Healthcare Providers and Systems. Check our website at bmhvt.org and you will find the link for Hospital Report Card at the bottom of the page. This link allows anyone to see the results for BMH, and to compare them to others locally and nationally. This link will also give you additional information about the quality of care at BMH.
While it is important that we pay attention to these indicators, it is also important that we keep in mind that quality care is what happens to a patient from the moment they step into the hospital until the point that they leave. And quality doesn’t end there. We have come to learn that it rolls over to the next care site, from the hospital to the outpatient doctor, and out into the community. Serving an increasingly health community is the goal of every hospital, and certainly our goal here at BMH. That’s the kind of accountability we are striving for and is one of the exciting aspects about being a member of the team at BMH.
Kathleen McGraw, MD, is board-certified in Hospital Medicine and is the Chief Medical Officer at Brattleboro Memorial Hospital.