From the Director

Six Months and Making Progress
How hospitals are quickly improving quality of cardiac care

By Bruce Siegel, M.D., M.P.H.

Just how quickly can hospitals improve the quality of cardiac care they provide, while simultaneously helping to reduce racial and ethnic disparities? The answer may astound you.

In just six months, 10 hospitals selected to participate in the Expecting Success program are making serious headway. Most have already adopted a uniform framework for collecting data on patient race, ethnicity and primary language. The rest will quickly follow.

One hospital increased its record of providing smoking cessation counseling for heart failure patients from 67 percent to 100 percent in just three months. Another increased the percentage of patients receiving proper heart failure discharge instructions from 10 percent to 75 percent in four months. Another ensured that 100 percent of discharged patients had a follow-up appointment with a primary care physician–with only one missed appointment in February.

Collectively, the 10 hospitals serve as a national laboratory for determining best practices for improving the quality of cardiac care, but the work should not be limited to 10 sites. Hospitals nationwide can make progress toward improving quality and decreasing disparities.

Getting started and making progress takes serious commitment, but is not impossible. Some of the best practices I have noticed over the past several months include:

1.  Let the leaders lead.
I am convinced that the most important precursor to success is the involvement of hospital management and clinical leaders. In every instance, the 10 Expecting Success hospitals have enjoyed success because hospital executives and nurse and physician leaders have been involved. And in every instance, this support came with an expectation.

2.  Make disparities safe to discuss.
By far, the biggest stumbling block has been actually talking about disparities. Hospital teams that make progress, however, feel indemnified to discuss the disparities that may exist in the quality of care provided to different patients. They seem to understand that finding fault and casting blame will just block progress. They realize that they may discover things that give them pause, but view the discussion as part of their responsibility to bring equity to their patients' care.  

3. Keep it simple.
The hospitals that have enjoyed the earliest success began with small, iterative improvements using the systems they already have in place. They picked an area–in our case, cardiac care–assembled a team and identified realistic goals. Small steps are important. From what I have seen, the danger is not that hospitals won't make meaningful changes, but that they will take on too much.

4. Make a commitment to data.
All of the Expecting Success hospitals are beginning to track data based on patient race, ethnicity and primary language, which is a tremendous achievement. For the most part, hospital leaders have long avoided using patient demographics to evaluate the quality of their facility's care. With the patient population becoming increasingly diverse, however, this avoidance is a luxury few hospitals can still afford. In the near future, hospital leaders will need to prove that their facility consistently provides a high level of care, regardless of who that patient is, or risk alienating the customer.  

In almost every hospital in America, just starting to collect this data would be a revolutionary change in how hospitals view quality. As they evaluate the data, hospital leaders may see things that surprise them–sometimes it may be disparities, other times it may be overall poor quality–but only by collecting the data can they be sure that all patients receive the high quality they deserve. 

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Bruce Siegel, M.D., M.P.H. is director of the Expecting Success program. He is also a research professor in the department of Health Policy at The George Washington University School of Public Health and Health Services. Siegel has served as New Jersey commissioner of health, president of the New York City Health and Hospitals Corporation and president of Tampa General Healthcare.