By Debra Wood, RN, contributor
July 23, 2010 - Landing a spot on U.S. News’ coveted Honor Roll, hospital leaders shared how they succeeded in securing not just a Best Hospital ranking but also how they scored near the top in six or more specialties, qualifying for a place among the 14 most elite facilities in the nation.
Karen Haller, Ph.D., RN, said innovation, collaboration and a commitment to patient safety has kept Johns Hopkins Hospital at the top of the rankings.
“Everybody who gets to the top ranking is an excellent facility,” said Karen Haller, Ph.D., RN, vice president for nursing and patient care services at The Johns Hopkins Hospital in Baltimore, which has earned the top spot for 20 years in a row. “What keeps Hopkins at the top is our unique ability to take what has been developed in a research lab and bring it into clinical practice.”
Honor roll inductees credit innovation, “patients-first” philosophies, collaboration, nursing care and recognition of staff members’ accomplishments with contributing to their high rankings.
U.S. News designed the Best Hospitals lists as guides to help patients in need of high-level expertise find the right facility. It ranks hospitals in 16 specialties, considering reputation, mortality index, the patient safety index and other care factors, including nurse staffing, technology and quality measures. For this year’s rankings, the news magazine evaluated 4,852 hospitals, excluding college infirmaries, prison hospitals and military installations. Only 152 ranked high enough in any specialty to make the 2010 listings.
From interviews with several of the Honor Roll organizations, the following eight factors were found to be common themes in explaining their success:
Holly Lorenz, RN, MSN, credited nurses at the University of Pittsburgh Medical Center with helping the hospital earn an Honor Roll ranking.
A desire to practice in an environment that embraces evidence attracts nurses and other staff to Honor Roll hospitals.
“Nurses love the innovation at UPMC, whether that’s the technology or the specialty work,” said Holly Lorenz, RN, MSN, chief nursing officer and vice president of patient care services at the University of Pittsburgh Medical Center in Pennsylvania. “Research is used in a clinical setting and translated into clinical practice.”
Herbert Pardes, M.D., president and CEO of New York Presbyterian Hospital in New York, also cited innovation as a key factor in achieving Honor Roll status. New York Presbyterian researchers are working on more than $750 million in research projects.
Heidi Crooks, RN, MA, reported that UCLA invests in its people, so they can deliver the best care possible.
Research and technology also contributes to the high ranking received by the Ronald Reagan UCLA Medical Center in Los Angles, said Heidi Crooks, RN, MA, senior associate director of operations and patient care services.
Sarah Sinclair, executive chief nursing officer at Cleveland Clinic in Ohio, reported that technology and research combined with doctors and nurses focused on delivering superior patient care and embracing Cleveland Clinic’s motto of “patients first” help the facility excel in various specialties.
2. Patients-first philosophies
Considering patients’ needs before any others guides many of the Honor Roll hospitals’ decisions.
“We have an outstanding nursing staff,” Pardes said. “It’s large, it’s good, and they are committed to high-quality care. They put patients first. That pervades the entire staff.”
Nineteen thousand people work at New York Presbyterian. They and the medical staff focus on the patient.
“The message of putting the patient first is part of every discussion we have,” Pardes said.
Johnese Spisso, RN, MPA, clinical operations officer for the University of Washington Medicine Health System and vice president for medical affairs, also cited the organization’s dedication to improving health and placing patients first as an important factor in the rankings.
The same held true at the University of Michigan Hospitals and Health Centers in Ann Arbor.
“We have a clear commitment to patients and families as our driving value, and we work hard to engage our hired community to focus on that,” said Margaret Calarco, senior associate director of patient care and chief of nursing services at the University of Michigan Hospitals and Health Centers.
Doreen Frusti, RN, chair of the department of nursing at number two-ranked Mayo Clinic in Rochester, Minn., also credits the organization’s primary principle of placing the needs of the patient first.
“Every person from physician to nurse to the person who cleans the room can quote our primary principle,” Frusti said. “We have good working relationships between nurses and physicians and other staff. That’s very intentional. All staff have the same expectations and hold true to that. We work on team-based care.”
Teamwork creates better outcomes, and many Honor Roll hospitals have embraced fostering greater collaboration between disciplines.
“Our efforts to establish a more collaborative environment allow nurses to step up to the role of true integrators of care,” Cleveland Clinic’s Sinclair said. “We are one team with one mission despite our different responsibilities.”
Sheila Antrum, RN, MHSA, chief nursing officer and executive director of patient care services at University of California, San Francisco Medical Center, also cited the importance of teamwork.
“We pride ourselves on effective collaboration among all departments to achieve the organization's mission to deliver exemplary patient care,” Antrum said.
Haller said Hopkins attracts a certain type of person who is dedicated to the mission and wants to work at the hospital.
“Once you get here, you become hooked on working with very smart and collaborative people,” Haller said. Different disciplines work together toward a common goal.
“It’s not just the medical expertise, it takes a whole community — the nurses, the support staff — to allow the institution to give excellent care,” Haller added.
Jeanette Ives Erickson, RN, MS, senior vice president for patient care and chief nurse at Massachusetts General Hospital in Boston, also reported value in multidisciplinary care delivery.
“Every discipline brings a special domain of practice, knowledge and skill,” Erickson said. “It takes a village.”
4. Quality improvement
Calarco added that a strong commitment to quality improvement has sustained the University of Michigan’s success over time.
Mary Ann Fuchs, DNP, RN, chief nursing and patient care services officer for Duke University Hospital and Health System in Durham, N.C., credited broad core competencies among the reasons for its high ranking.
“Structured processes for clinical services allow faculty, staff to define and sustain clinical practice standards and incorporate new findings into practice,” Fuchs said. “Care processes and measures for success are defined and measured via a balanced scorecard and published monthly. Rigorous and ongoing review supports our effort to assure consistent care.”
Cleveland Clinic also continually keeps an eye on quality measures. Both managers and nurses are expected to continually review and monitor the care process and challenge the status quo when needed to keep up with the latest advances.
“Our quality dashboards and scorecards promote data transparency and allow for monitoring of daily metrics,” Sinclair said. “We use best practice alerts within our electronic medical record to assure consistency in our standards of care.”
At UCSF, Antrum added that it takes clear expectations, an organization-wide focus on the same goals, and reporting at regular intervals to keep everyone on target for improvements.
5. Nursing care
Each facility’s nursing staff, and their quality of care, contributes to their high rankings.
“The nursing care aspect is a relevant part of what makes a difference,” said Lorenz, of UPMC. “Patients come to the hospital expecting the best doctor and they will be given the treatment they need for their medical condition to improve. What makes us different is the nursing.”
When compassionate nurses respond to patients’ concerns, it reflects well on the hospital, and those patients will tell other potential patients.
UPMC and most of the Honor Roll hospitals have achieved American Nurses Credentialing Center Magnet Recognition status.
Erickson noted that her facility, Mass General, and all but two of the top 10 U.S. News hospitals have gone through the process to become Magnet designated, meaning care is based on evidence; education and nursing research is valued; and there are strong rewards and recognition programs.
“Nurses are at the heart and sole of our organization,” Erickson said.
6. Positive work environments
Honor role hospitals strive to create environments where people can enjoy practicing.
“Sometimes, my role is motivator and cheerleader,” Lorenz said. “To retain and attract nurses, we have to create an environment where people want to work in.”
Frusti at Mayo agreed about the value of a professional environment. She considers it her job to create a place where nurses can practice the way they were taught in nursing school.
“In the tough times as well as in the good times, we consistently ensure a professional environment remains and high levels of staffing remain,” Frusti said. Mayo staffs based on patients’ needs for nursing care, not specific nurse-to-patient ratios.
7. Continuing education
Education for staff remains important for Honor Roll hospitals. UCLA trains nurses and other employees how to better connect with patients, how to behave in the room and how to follow up on queries or complaints. Crooks reported that UCLA invests in training and innovation to allow staff to become the best they can be.
“Training, education and a commitment to the goals of the organization are key,” Crooks said.
8. Engaging staff
Leadership in Honor Roll hospitals tends to stay visible and interacts with staff. For instance, Haller greeted nurses on all shifts, thanking them for their contribution toward achieving the Best Hospitals’ honor.
“When you engage people closest to the work or the issues to be solved, it respects the people,” Calarco said. “They want to know where the organization is going and what our driving value is, but they want to demonstrate how their work contributes to that.”
The University of Michigan Hospitals offer staff, volunteers and patients an opportunity to recognize an employee through it’s “Making a Difference” program. The employee receives a certificate stating the accomplishment, and recipients attend a celebration quarterly. It also highlights staff by publishing patient comments and peer acknowledgment of good care in a newsletter.
“It’s a great community builder and way to recognize people’s work,” Calarco said.
Pardes reports tremendous morale at NY Presbyterian. Executives meet regularly with staff and managers to thank them for their contribution.
UCLA provides every manager with a “recognition kit,” with gift cards and other items, and encourages them to use it to acknowledge things staff members are doing right. Senior management regularly rounds on all shifts to be accessible to the staff and praise them for a job well done.
“Our staff is superb and our competency levels high,” Crooks said. “We invest the time and effort in training, so they can be the best they can be.”
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