Case Studies: Improving Patient Care

Gaston Memorial Hospital: Driving Quality Improvement with Data, Guidelines, and Real-Time Feedback
At Gaston Memorial Hospital, a not-for-profit facility in Gastonia, N.C., adherence to evidence-based practice guidelines, multidisciplinary committees engaged in root-cause analysis, and strong leadership combined to produce near-perfect compliance with evidence-based process-of-care ("core") measures in four clinical areas. Hospital leaders also stressed the importance of working closely with the Institute for Healthcare Improvement (IHI), participating in a demonstration program led by the Centers for Medicare and Medicaid Services (CMS), and identifying physician champions in reducing the variance in practice patterns and adhering to best practices.


Luther Midelfort Mayo Health System: Laying Tracks for Success
Luther Midelfort Mayo Health System, a physician-led, integrated health system serving west-central Wisconsin, has advanced a culture that supports staff in their efforts to test new ideas and improve care. In a recent analysis by The Commonwealth Fund, Luther Midelfort achieved the third-highest score in the U.S. on a composite of 22 process-of-care measures that all hospitals report to the Centers for Medicare and Medicaid Services. The key components of Luther Midelfort's quality strategy are: exposing clinical leaders to the concepts of quality improvement, then giving them time to work with teams to apply their knowledge; creating expert, interdisciplinary teams for each clinical area to determine the right content of care and then turning over the implementation to a team with expertise in designing workflow and care processes; and rapid measurement and feedback, supported by a quality resources department that coaches teams through improvement cycles.

Flowers Hospital: Nearing Perfection on Core Measures
Flowers Hospital, a community hospital located in southeast Alabama, climbed from average to exemplary on process-of-care, or "core" measures, across four clinical areas—heart attack, heart failure, pneumonia, and surgical infection prevention—in just two years. Flowers' quality department identifies patients early in their hospital stay and continuously monitors their progress and care. The approach involves five critical elements: identification of patients who experience heart failure, heart attack, pneumonia, or have surgery at the beginning of their hospitalization, so that appropriate care can be provided in a timely manner; concurrent review provided by a nurse, who monitors each eligible patient to ensure care meets standards and intervenes as needed; tools for frontline staff, including resources to remind providers of evidence-based practices; quality improvement teams that review failures of compliance and modify care processes; and performance oversight conducted by team leaders in collaboration with the CEO.