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Healthcare leaders identify 10 strategies to improve care quality

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WASHINGTON, DC — Collaborating under the auspices of the Institute of Medicine (IOM), CEOs and senior executives from 11 leading hospitals and health systems have developed a comprehensive checklist to promote high-value healthcare that delivers better results at reduced cost.

Released today, “A CEO Checklist for High-Value Health Care” is a discussion paper from the Institute of Medicine in which the authors present a checklist of 10 strategies that have proven effective in reducing waste and improving outcomes. The checklist is available online at www.iom.edu/CEOChecklist.

The authors of the checklist represent CEOs and senior executives from the following institutions: Cincinnati Children’s Hospital Medical Center, Cleveland Clinic, Denver Health, Geisinger Health System, Hospital Corporation of America, Intermountain Healthcare, Kaiser Permanente, Partners HealthCare, ThedaCare Center for Healthcare Value, Veterans Health Administration, and Virginia Mason Health System.

The development of the checklist occurs at an important time for healthcare in this country. As those who purchase healthcare — employers, families, and federal, state and local governments — continue to struggle with rising costs, they are increasingly seeking providers that can deliver high value care. This changing healthcare marketplace is forcing hospital and health system executives to focus both on providing the highest quality care and doing so at reduced cost.

Reflecting on the importance of this initiative, Institute of Medicine President Harvey Fineberg noted that “The CEO checklist provides concrete strategies to deliver better healthcare at lower cost. The prominent health executives behind the checklist, and others like them, are leading the way to superior care at reasonable costs. We can all learn from their example.”

The strategies outlined in the checklist are unique in that they save lives and money. They describe a comprehensive approach to promoting high-value healthcare, and can serve as a blueprint for other hospital executives when considering their own efforts to improve the value of care delivered. Checklist items include:

  • Senior leadership that is committed, visible, and determined;
  • Institutional culture of continuous improvement and real-time learning;
  • Comprehensive IT systems for integrated, streamlined, and safe care;
  • Evidence-based care to ensure the best care is delivered every time;
  • Optimized resource utilization to reduce waste;
  • Integrated care delivered in the setting most appropriate for the patient’s needs;
  • Patient–clinician collaboration on care plans;
  • Targeted resources for the sickest patients;
  • Safeguards to reduce injury and infection; and
  • Internal transparency on performance, outcomes and cost.

To demonstrate the potential of each of the 10 checklist items, “A CEO Checklist for High-Value Health Care” includes supporting case material describing the experiences of authoring institutions already working to implement these strategies, including:

  • Cincinnati Children’s Hospital Medical Center: Smoothing patient flow through the ICU has avoided $100 million in capital costs and reduced delays due to bed availability.
  • Cleveland Clinic: Internal transparency on quality spurred a 40% reduction in central line-associated blood stream infections (CLABSI) in the ICU, with $30,000 saved per avoided infection.
  • Denver Health: Lean improvement activities have reduced observed-to-expected hospital mortality and saved $158 million since 2006.
  • Geisinger Health System: The ProvenHealth Navigator medical home model decreased admissions and readmissions by 20% and reduced the total cost of care by 7%.
  • Hospital Corporation of America: Evidence-based perinatal services have reduced newborn complications helping HCA save $68 million annually and set new national benchmark levels for the industry.
  • Intermountain Healthcare: Evidence protocols for elective labor reduced inappropriate induction from 28% to less than 2%, saving $50 million dollars.
  • Kaiser Permanente: Early intervention protocols for community-acquired sepsis reduced mortality by roughly 60%.
  • Partners HealthCare: A home-monitoring program for heart failure patients reduced readmissions by roughly half, and has saved more than $10 million ($8,000 per patient).
  • ThedaCare: Patient-centered, team-based care at ThedaCare’s Collaborative Care Units has reduced the length of stay by 10 to 15 percent, improved patient satisfaction by 30 percent, reduced errors, and reduced the indirect and direct cost of care by 25%.
  • Veterans Health Administration: A system-wide prevention initiative for Methicillin-resistant Staphylococcus aureus (MRSA) has saved lives by reducing ICU infection rates by 62% nationwide.
  • Virginia Mason Health System: An intensive care management program for Boeing employees improved outcomes, improved the timeliness of care, and reduced costs by 33%.

Scaling the results already experienced within these institutions nationally has the potential to save thousands of lives and millions of dollars each year.


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