By Debra Wood, RN, contributor
April 6, 2012 - Nearly 180,000 additional Medicare patients would be alive today if all hospitals had performed as well over a two-year period as those on HealthGrades’ list of America’s 50 and 100 Best Hospitals, according to the organization’s estimates and their extensive analysis of patient data. And many of those top hospitals credit their nursing staffs with helping them achieve the best safety records and high rankings.
Victoria King, MHA, MSN, RN, CNOR, NEA-BC, called nurses an important part of a collaborative team that strives to provide error-proof patient care.
“Nurses are most important and are very much a part of the team,” said Victoria King, MHA, MSN, RN, CNOR, NEA-BC, chief nursing officer at Memorial Hermann The Woodlands in Texas. “We’re very much a team. Nurses contribute, because they are at the bedside and are the captain of the ship every single day, watching those patients.”
Likewise, Donna H Griffith, MSN, RN, NEA-BC, CENP, FACHE, senior vice president/administrator and chief patient care officer at Martin Health System in Stuart, Fla., added, “Martin Health System has been fortunate to receive numerous national awards for quality care, and our nurses play a pivotal role in achieving that recognition.”
Donna H. Griffith, MSN, RN, NEA-BC, CENP, FACHE, said nurses play a pivotal role in achieving America’s 50 Best Hospitals recognition.
HealthGrades drew from 12 years of Medicare data, including 150 million patient hospitalization records for 26 different diagnoses and procedures, to identify America's 50 Best Hospitals and, for the first time, the nation's 100 Best Hospitals. To be included in the analysis, hospitals must have met minimum thresholds in terms of patient volumes, quality ratings and the range of services provided.
This year, the 50 Best Hospitals received HealthGrades’ Distinguished Hospital Award for Clinical Excellence for a minimum of seven consecutive years, and the 100 Best Hospitals achieved that recognition for at least four years.
HealthGrades estimates that 179,593 deaths of Medicare patients could have been prevented from 2008 through 2010 if all hospitals met the superior and sustained clinical quality of the top 5 percent of all hospitals in the nation, those considered America’s 50 and 100 Best Hospitals, which collectively had a nearly 30 percent lower risk-adjusted mortality rate across 17 diagnoses, such as acute myocardial infarction, pneumonia and sepsis.
Creating a quality and safety culture
“We don’t look at patient safety as a goal; we now think of it as a culture,” said King, explaining the hospital strives for no errors, and nurses go home knowing they did a good job. King attributes much of the success to the support of top executives.
“We’ve set the bar high, and [nurses] achieve that and feel good about their work,” King said.
Memorial Hermann recognizes nurses for speaking up if an error seems eminent and is not punitive when a mistake happens. Rather it looks at process issues.
“That makes our nurses feel free, safe and protected to do the right thing and speak up when they need to,” King added. She tells nurses to provide the same level of care for every patient as they would want for their own family members.
Sue Shkrab, RN, MSN, NE-BC, director of Magnet and nursing quality at Sarasota Memorial Hospital in Sarasota, Fla., reported an ongoing commitment to excellence at her hospital.
“That’s what we strive for and is our culture--continually raising the bar,” Shkrab said.
Banner Del E. Webb Medical Center in Sun City West, Ariz., also has focused on developing a culture of safety, said Sue Kelley, RN, MS, NEA-BC, the facility’s chief nursing officer.
“There are a lot of different components in creating that, but once you get it in place, it positions you to do great things,” Kelley said.
Encouraging professional collaboration
Teamwork offers another path toward achieving Top 50 status.
“Nursing and physician collaboration is integral in us being successful in our outcomes,” said Jan Mauck, RN, BSN, MSN, NEA-BC, chief nursing officer at Sarasota Memorial Hospital, one of only six public hospitals in the Top 100 rankings. She credits physician involvement and adopting evidence-based practices with helping it achieve the honor.
“We are constantly, every day, making sure our environment is safe for our staff, patients and visitors, and our patient care is where it needs to be from a quality and safety standpoint,” Mauck said. “It’s consistent evidence-based practice, its shared governance where staff have input into their practice, and collaboration with all of the stakeholders.”
Sarasota Memorial team members serve on collaborative councils and unit-based councils that work to improve outcomes, following evidence-based guidelines and supporting the patient experience. A nursing council tracks trends on nurse-sensitive indicators.
“It’s all about [nurses’] engagement in the quality process, and when you have engaged employees, you have better outcomes,” said Shkrab. However, she added that having physicians involved in quality and safety initiatives contributes to success.
Kelley also credits an engaged nursing workforce and good communication and collaboration among team members with contributing to its quality and safety achievements. Banner Del Web has taken collaboration to a new level with an orthopaedic floor co-managed in a joint venture with a group of orthopaedic surgeons.
Memorial Hermann’s governance councils are multidisciplinary, and its CNO Council shares best practices and will pilot new ideas always aiming for improvement.
Griffin, at Martin Memorial, also attributes the hospitals’ success to collaboration--including with patients, families and ancillary staff--and working to ensure patients receive the correct standards of care.
“We have put processes in place to make sure those standards are adhered to, including tools such as concurrent chart reviews for every patient,” Griffith said. “Our nurses are fundamentally involved in the development of those protocols and patient care processes, utilizing performance excellence strategies based on lean management techniques that are designed to deliver care in a more effective, efficient manner. Martin Health also emphasizes continuing education and training as a way to ensure our nurses and clinical staff remain at the forefront of industry best practices and new innovations.”
Making a Magnet connection
Nancy Susick, RN, said Beaumont Hospital, Troy uses the latest evidence-based research to care for their patients.
Many of the facilities achieving HealthGrades’ Top 50 honors, including Memorial Hermann The Woodlands and Sarasota Memorial, have obtained American Nurses Credentialing Center (ANCC) Magnet status, a mark of nursing excellence or, as with Banner Del Webb, they are on the journey.
“This puts our focus on using the latest evidence-based research to care for our patients, providing excellent communication with our entire patient care team as well as promoting continuing education and specialty certifications for our nurses,” said Nancy Susick, RN, vice president, chief operating officer and chief nursing officer at the Magnet-designated Beaumont Hospital, Troy in Michigan. “We are extremely proud of the hard work and dedication from our nurses which certainly contributes to us receiving this Top 50 recognition.”
Mauck added, “You don’t have to be a Magnet hospital to get good outcomes, but it’s a way of showing an excellence in nursing that we have at Sarasota Memorial.”
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