Barnes-Jewish Hospital’s Performance and Policies

Healthcare industry requires setting high standards of performance and evaluating the current efficiency of an organization with regards to those standards. As Krause (2017) states, benchmarking is an essential component of strategic planning in any industry. The practice is vital for both motivating the employees and in encouraging them to improve their performance. Furthermore, benchmarking can help gain an understanding of which parts of the establishment’s performance need to be adjusted in order to provide the patients with the best quality of care. The purpose of this report is to evaluate the performance of the Barnes-Jewish Hospital, analyze the effect of healthcare policies on the performance and offer a target metric for improvement.

General Information about the Facility

The hospital, chosen for the dashboard benchmark evaluation is Barnes-Jewish Hospital. It is considered to be the largest hospital in Missouri. It was established in 1996 and functions as a teaching center for future medical professionals. The hospital prides itself on having “Best Doctors in America” (BJC Healthcare, n.d., para 1). In addition, it has been ranking in the U.S. News & World Report for twenty-five years. Thus, the medical center should demonstrate a high standard of patient’s care, which should be reflected in the benchmarks.

Hospitals Size and Demographics

The size of the facility is significant, as it employs over 9,920 people, has 1,249 staffed beds, and admits 53,637 patients a year (BJC Healthcare, n.d.). The establishment delivers a variety of patient care services (e.g., emergency medicine, elderly care, general surgery). The total population that the hospital serves is 311, 404 people (BJC Healthcare, n.d.). Out of those, 160,688 are females, and 150,716 are males.

The population’s ethnicity is predominately Black or African American (146,838). The number of people of white ethnicity is 145,843; Asian 10,242, and those who are considered to have two races 7,449. The Hispanic population is numbered at 12,547 people. The socioeconomic level of the community is not indicated directly. However, the organization provides statistics of people who have insurance, which can give an insight to the metric. 85.5% of the population has access to healthcare services. Therefore, the establishment serves as a health center for a large and diverse population.

Dashboard Evaluation Analysis

Although each medical establishment should focus on setting personalized benchmarks, there are common metrics that can be applied to any establishment. In addition, a specific state or federal laws can dictate the parameters. The Barnes-Jewish Hospital evaluates the performance based on the Vizient Scorecard and Clinical Quality Scorecard. Overall, the hospital is performing well across most metrics. In addition, “Barnes-Jewish Hospital achieved an overall Best-In-Class score of 1.04 in 2017” (“Patients safety & quality annual report”, n.d., para 1). This means that the establishment is operating and performing its mission in accordance with the federal and state laws. However, some of the metrics should be improved as they score below the minimum.

In Barnes-Jewish Hospital, the readmission levels for Ischemic stroke for CMS patients age 65 and older (Vizient) were at 9,36% in 2016. According to Krause (2017), readmission rates are among the essential benchmarks in hospital performance evaluation. The benchmark ranking indicates that the metric needs to be improved. In addition, other metrics that need to be enhanced are the overall patient experience and standardized infection ratio for central line-associated bloodstream infection. Both parameters were at the below minimum level in 2016.

Challenges in Meeting the Benchmarks

In 2017, the hospital has set a goal to improve patients experience through enhancing standards and communication. In addition, the hospital has implemented an E3 model (Every Patient, Every Person, Every Moment) (“Patients safety & quality annual report”, n.d.). The effort is aimed at improving the benchmark of patient experience that is at the below minimum rank. Overall, improving the patient experience can be difficult, as the topic is subjective and can be influenced by bias, which is the primary challenge for the issue. In addition, the hospital staff is working with a diverse population that requires a specific approach.

The problem can be addressed by educating the staff on how to work with the diverse community. It can be argued that staffing can be a contributing factor as lack of medical personnel can influence the overall experience. The hospital employs over nine thousand people, yet it is a big establishment that serves a community of over 300,000 people. Thus, the staffing policy in the hospital needs to be improved.

The readmission rate can be challenging to improve due to the financial aspect of the problem. LaPointe (2018) states that “CMS penalized over 2,500 hospitals by more than $564 million in 2017 for excessive 30-day hospital readmission rates” (para 6). In addition, readmissions lead to extensive spending for hospitals, thus improving the metric is essential. Standardized infection ratio can be enhanced by promoting the overall healthcare awareness in the community and the hospital. The primary challenge presented by the issue is the additional costs associated with safety programs that the hospital might implement to address the issue.

How Underperformance Affects the Hospital

The challenges contribute to the benchmark underperformance as they obstruct the efficiency of performance in the hospital. The metric that is underperforming its benchmark by the most significant degree is the Overall Patient Experience: Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest) (HCAHPS). Barnes-Jewish received a score of 72,4% for this metric. It is the most widespread underperformance metric as the Vizient scorecard indicated that patient-centeredness in the hospital is 5.28% out of the 15.75% benchmark. This is the lowest score in the hospital’s performance according to Vizient.

The two metrics can be connected as the patient-centeredness can improve the overall patient experience. The metric is significant, as it affects all the patients that are admitted to the Barnes-Jewish Hospital. The parameters that underperform and jeopardize the staff are the Standardized infection ratio as it is part of the safety metrics in the dashboard. The underperformance in these metrics result in the community not receiving the highest quality of care that should be provided. The most significant opportunity for improvement is the patient experience and the patient-centeredness care that can be beneficial for the overall healthcare outcomes.

Affordable Care Act

The Affordable Care Act’s (ACA) main aim was to “reduce the number of uninsured, make coverage more affordable, and expand access to care” (“The future of U.S. healthcare,” n.d., para 1). Part of the ACA’s aim is improving the health care quality, which can be checked by evaluating the benchmark performance. The changes shift the focus “from volume-driven to value-driven reimbursement based on meaningful outcomes measurements, incentivizing high-quality, safe, efficient, and cost-effective care” (IOM (Institute of Medicine), 2014). This is reflected in the Barnes-Jewish’s strive to improve the patient experience metric.

The set goal should help achieve better patient satisfaction. In addition, the improvement in the readmission rate metrics can help the hospital improve patient outcomes and become more cost-efficient, as readmissions are associated with additional spending (LePointe, 2018). Therefore, the hospital is adhering to the ACA’ regulations regarding the quality of care and strives to improve its metrics.

Recommended Metric to Target for Improvement

As Barnes-Jewish Hospital is a large organization; it is difficult to evaluate the performance of each specific measure. Furthermore, the changes should be both ethically correct and culturally sensitive, as the hospital operates in a diverse environment. In addition, it requires “numerous KPI to cover all of their strategic objectives” (Behrouzi, Shaharoun, & Ma’aram, 2014, p. 208). This means that the hospital should create smaller goals and targets in order to improve its performance effectively.

Patient Satisfaction

The essential metric that requires improvement in the Barns – Jewish Hospital is the patient satisfaction. The target for improvement is 77,5 % of patients (“Patients safety & quality annual report”, n.d.). The primary stakeholders here are the patients that get admitted into the hospital and the medical staff. In this case, the medical staff should take the appropriate measures to improve the quality of communication, and patients care. The ethical rules that the group can utilize to develop the metric are the adherence to the standards of care, which include providing patients with compassion and freedom of choice regarding their health. The same strategy can be applied to improve the patient-centeredness in the hospital.

Readmission Rate

The readmission rate is the metric that needs improvement as well. The primary stakeholders, in this case, are the patients that have to return to the hospital due to reoccurring illnesses. The target for improvement is 7,14% of returning patients (“Patients safety & quality annual report”, n.d.). The metric possesses the ethical issue as improving it would be beneficial for the hospital’s overall score.

It can be argued that this can lead to problems with patient admission in order to keep the metric’s score on a reasonable level. LaPointe (2018) states that an essential step in improving the parameter is identifying the causes that lead to the return of the patient and addressing them. Additionally, discussing the importance of patient care before the benchmarks is essential as well. An understanding of the importance of both improving the metric and providing good quality health care is essential to this issue.

Standardized Infection Ratio

The issue should be addressed by improving safety measures in the facility and through raising awareness about the problem. The recommended target for the ratio is 0,82, and currently, the hospital’s evaluation showcases the metric of 1,14 (“Patients safety & quality annual report”, n.d.). There are no ethical issues that are directly associated with improving the ratio. The primary stakeholders, in this case, are the infected patients and the medical personnel that works with them.

Conclusion

Overall, the Barnes-Jewish Hospital is performing well according to most metrics. The hospital operates in accordance with the Affordable Care Act which was implemented in 2010. However, some critical aspects need to be improved, such as readmission levels, overall patient experience, and standardized infection ratio. The three benchmarks are below the standard scale, set by the Vizinet and clinical quality scorecard. The improvement of the benchmark ratios should be made in accordance with the ethical and cultural standards.

References

Behrouzi, F., Shaharoun, A. M., & Ma’aram, A. (2014). Applications of the balanced scorecard for strategic management and performance measurement in the health sector. Australian Health Review, 38(2), 208-217. Web.

BJC Healthcare. (n.d.). Facts & figures. Web.

IOM (Institute of Medicine). (2014). The impacts of the Affordable Care Act on preparedness resources and programs: Workshop summary. Washington, DC: The National Academies Press.

Krause, J. (2017). Four questions to ask about healthcare benchmarking. Web.

LaPointe, J. (2018). 3 strategies to reduce hospital readmission rates, costs. Web.

Patients safety & quality annual report. (n.d.). Web.

The future of U.S. healthcare: Replace or revise the affordable healthcare act? (n.d.). Web.