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Can small hospitals pave the way to smart outcomes for larger hospitals…and can working together benefit both organizations and improve quality and patient outcome?

In today's reality of cost reduction, increased regulatory requirements, new technologies and operational constraints, hospitals large and small are measured on their ability to meet their goals, administratively and clinically demonstrate efficiency and successfully execute strategies. We are witnessing a healthcare reform that is leading organizations to consider shifting and appending long-term practices with the “promise” of standardized practices for high quality of care and improved patient outcome.

Large Hospital Challenges

Unveiling what’s behind the promise can be broken down to bite-size pieces. Large hospitals are not only dealing with the challenges of today’s reality, but they’re facing additional obstacles such as:

• establishing and\or maintaining culture of quality through a systemic implementation of best practices,
• establishing and tracking performance indicators as a multidisciplinary function,
• deciding on the best education practices that are likely to work in the organization,
• getting leadership commitment and involvement, and
• employing technology practices and services that achieves the desired outcome.

The Figure (developed and distributed by the AHA) illustrates a model for enabling data quality and clinical indicators. The model also influences common challenges that large hospitals experience when working and developing outcomes and quality practices. These include:

1. EMR Program: While many of the hospitals have selected an EMR vendor, in some cases the solution isn’t deployed across the board and information is still captured outside of the EMR. As a result, the assembly of outcome data isn’t centralized or validated properly.
2. Technology Operations: In large hospitals it is often the case where the assembly of clinical workflows, documentations and structured data are given rushed timelines and immature specifications. As a result, there is insufficient opportunity to test and develop useable clinical systems.
3. Clinical Indicators: In attempts to capture the desired data, nurses and physicians are likely to invest much of their time analyzing and making changes to workflows to ensure quality and safety of patients. Each indicator can take up to 18 months to implementation.
4. Strategic Balance: In large hospitals, there are two common scenarios:
   1. Significant effort is invested by an organization on the account of other strategic priorities related to patient care and outcome.
   2. Insufficient resources and priority is given to clinical data and outcome, resulting in poor automation, care coordination and decision making.

Much of the challenges listed above are related to the inherently complex, inflexible operations in large hospitals. The corrective action is well documented and proven in best practices and policy recommendations, but to deploy an action plan in large hospitals is where often times the bottleneck exists and where small hospital can enable solutions that large hospitals can mirror in their environment as proven practices.

Small Hospital Challenges

A difficult financial environment and lack of resources have shown to have the most impact on small hospitals. The push to meet same standards of quality as large hospitals, comply with regulations, recruit staff, aging equipment, decreased reimbursements and lower rate of EHR adaptation are only a few of the road blocks small hospitals face.

What Can Be Done?

Simply put, solutions can be revealed through partnership and collaboration. In other words, there must be smart outcomes where small and large hospitals will both be presented with win\win situations.

The first step to establishing such collaboration should be in locating the right partner. It is preferably not a competing hospital and should have similar EMR technology and clinical systems, where both hospitals share common values and priorities for clinical outcomes and patient care.

Small hospitals can streamline bottlenecks and relieve pain points in many ways, including:

1. EMR Program: Most likely small hospitals are further ahead with deployment of the EMR system and in a position to share successful and failing practices,  breaking down the steps toward a “consolidated clinical world.”
2. Technology Operations: Collaboration is necessary among small and large hospitals, leveraging the agility of small hospitals to streamline and develop a realistic plan that can increase the rate to a successful outcome where information will be tested and executed with the highest degree of quality.  
3. Clinical Indicators: Protocols, practices changes and iterations to workflow mature faster in small hospitals due to a greater agility with staffing, resources and communications. This presents an opportunity to both small and large hospitals to partner and leverage each other’s resources for a common goal.     
4. Strategic Impact: Complementing values, leadership commitment to clinical quality and patient outcome can nurture shared responsibility for strategic direction where ultimately both hospitals and advance their strategic goals.

Patterns of Success

Patterns of successful partnerships include (but are not limited to):

1. choosing the right partner, striving to establish a win\win situation;
2. leadership commitment and engrossment;
3. assembly of a combined quality, multidisciplinary team;,
4. agreement on a smart scope of partnership;
5. sharing of best practices and policies; and
6. focusing on transparency and open communication.

Small and large hospitals need to broaden their quality horizon and apply technology to address specific business objectives in a collaborative manner going beyond justifying checkboxes. Those who don’t believe in partnership and collaboration to promote patient care and quality risk having their progress stall and will find themselves behind the curve. 

   While most hospitals are committed to reducing inappropriate care, improving patient safety and achieving good health outcomes for patients, the ingredients for success call for adopting a notion of partnership that fosters sharing and disseminating information.

Roni H. Amiel is CIO & CISO at Blythedale Children’s Hospital. 

For more information please contact me at roniamiel1@gmail.com or visit my website www.novolutions.com