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15 Top Health Systems – Quantifying ‘System-ness’

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Jean Chenoweth is Senior Vice President for Performance Improvement and the 100 Top Hospitals Program

Unlike in other industries, hospital industry consolidation[1] has not yet led to the development of a consistent brand experience. Just as travelers know what to expect from a well-known hotel chain regardless of city and can depend on consistent taste of a latte at their favorite coffee shop franchise, patients and families should – at some point – expect consistency at branded hospitals within a health system.

While few health systems have achieved this goal, health system alignment is evolving slowly.  Just 10 years ago, when we first launched our 15 Top Health Systems annual study to identify the top-performing health systems in the U.S. based on overall organizational performance, measurement of performance of the system as a whole was a challenge. The performance of the health systems was so skewed by the widely varying performance of hospitals within the systems that we could only name 10 winners in the first year. That led us to focus on how to measure the performance alignment of the hospitals within health systems in the ensuing years.

Alignment is not an easy metric to capture. It involves tracking the variability of risk-adjusted, ranked performance of each hospital across nine different clinical and operational performance benchmarks, displaying those results at the system level in two dimensions – long term improvement and resultant performance – to capture the concept of “system-ness.”

Measurement of system-ness is much clearer with a picture. Figure 1 below depicts a health system that shows very little alignment. With some hospitals in the best performance quartile, others in the worst and a smattering across the middle, it is almost hard to imagine these institutions operating under the same leadership.

By contrast, figure 2 below depicts a health system that is highly aligned, with all but one of its member hospitals achieving top rank on overall long term improvement and resultant performance.

The good news is that we’re starting to see more of this type of consistency among the country’s top-performing health systems.

This year’s 15 Top Health System study finds a small but discernable difference in the level of individual hospital alignment within top-performing health systems than is found in peer group health systems. Specifically, the annual volatility in key performance measures is 1.9 percentage points lower among the member hospitals of winning health systems than it is among peer group health system members.

What this means is that, when it comes to core clinical and operational performance measures – such as mortality, complications, healthcare-associated infections, readmissions, length of stay, ED wait times, cost and patient satisfaction scores – the 15 Top Health Systems in the country have less performance variability across their member hospitals. In a word, they are more consistent.

Clearly, this is an area that requires more research. While we have found that the trend of lower overall variability within individual member hospital performance metrics among winning health systems is statistically significant over a five-year period, we still want to understand more about how this pattern is manifesting itself within individual hospitals and health systems and within individual performance metrics.

At this point, the alignment metric, combined with anecdotal evidence drawn from countless conversations with health system leaders, seems to suggest that a focus on development of employee engagement, clinical protocols and operational standardization is having a positive effect on quality of care and overall health system performance.

While it’s still too early to suggest that health systems will successfully develop a consistent patient experience across the communities they serve, we can say with certainty that alignment is a key health system metric to track as consolidation continues.

To read the highlights of our 2018 15 Top Health Systems report, please click here. For the full report, please click here.


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