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To learn what opportunities exist for all hospitals to achieve greater efficiency, we conducted case studies of four of the 13 Leapfrog Group-designated "Highest Value Hospitals." These included Fairview Southdale Hospital in Edina, Minn., North Mississippi Medical Center in Tupelo, Miss., Park Nicollet Methodist Hospital in St. Brigham and Women's Hospital is a 777-bed nonprofit, teaching hospital located in Boston, Massachusetts.Scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey show that it is a leading hospital nationally on measures of patient satisfaction.
Since 2002, the hospital has followed three strategies to improve patient satisfaction: allocating significant new funding for quality measurement and process improvement work, including establishing a Center for Clinical Excellence; developing a management information system for hospital leaders that tracks patient and family experiences, along with other hospital performance indicators; and seeking to enhance patients' experiences by working with frontline staff, including implementing new recruitment, training, management, and improvement strategies.
This private hospital has a designated team, known as the Vascular Access Specialist Team, comprising about 10 registered nurses who have a minimum of two years of nursing experience and are specially trained in central line insertion techniques, ultrasound guidance, and Centers for Disease Control and Preventioninfection prevention guidelines.
This report synthesizes lessons from four hospitals that reported they did not experience any central line-associated bloodstream infections in their intensive care units in 2009.
Lessons include: the importance of following evidencebased protocols to prevent infection; the need for dedicated teams to oversee all central line insertions; the value of participation in statewide, national, or regional CLABSI collaboratives or initiatives; and the necessity for close monitoring of infection rates, giving feedback to staff, and applying internal and external goals.
Members of The Commonwealth Fund Commission on a High Performance Health System observed Denver Health during a site visit in March 2006, to assess its operation and determine whether it might serve as a model for other public and private health care systems around the country.
Case Studies In Health Care Management Solving Relationship Problems
The Commission concluded that Denver Health is indeed a "learning laboratory." It has succeeded at providing coordinated care to the community, promoting a culture of continuous quality improvement, adopting new technology and incorporating it into everyday practice, taking risks and making mid-course corrections, and providing leadership and support—and accepting accountability—both at the top and throughout the organization.
The network relies on multidisciplinary teams who are accountable to leadership for meeting goals; reviews and publicizes performance indicators across hospitals in its network; and redesigns care processes so that standards can be achieved as a matter of routine.
Denver Health, a comprehensive and integrated medical system that is Colorado's largest health care safety-net provider, has a national reputation as a high-performance organization.
Fairview Southdale Hospital was recognized as one of 13 "Highest Value Hospitals" by the Leapfrog Group in 2008, based on efficiency scores that took into account quality of care as well as resource utilization.
The hospital, which was selected from nearly 1,300 hospitals that had voluntarily submitted data, received a top efficiency score for all four conditions/procedures examined: coronary artery bypass graft, percutaneous coronary interventions, treatment of acute myocardial infarction, and pneumonia care.