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Voices on Hospitals: Electronic Health Records and Consistent Quality of Care

Quality care diceWe have often heard the phrase, “Perception is reality.” Although this phrase may not be entirely true, perception is important because it happens when we use our senses, such as sight, taste, sound, touch and smell. In short, our perception is both pure and objective.

However, our interpretation of our perceptions — also known as ‘perspective’ — invites both experience and emotions, which can be more subjective and unique, and, therefore, more about opinion. I suppose perception is reality IF we exclude interpretation of our experiences and emotions.

My point is this: Opinions are important and certainly do matter!

This week, we continue to address how Iowa employers perceive hospitals within their communities on two new performance indicators:

  1. Electronic Health Records (EHRs)
  2. Consistent Quality of Care

Indicator #3: Electronic Health Records
As indicated in our ‘Voices for Value’ white paper, electronic health records (EHRs) are designed to accurately capture data on the patient at all times. This allows providers to view the patient’s entire medical history without the need to track down the patient’s previous medical record, and to ensure the data is accurate, appropriate and legible. Using one modifiable file, it is widely believed that patient EHRs will help make the healthcare delivery process more efficient with fewer medical errors.

Using a 10-point scale, (1 is ‘failing’ and 10 is ‘excellent’), Iowa employers rated statewide hospitals a 6.9 regarding the use of EHRs. Converting this score to a grade, the overall statewide grade for this indicator is a ‘C+.’

However, when rating employers on a regional basis using size-weights (size-weighting is discussed in my June 25th blog), only the northwest region received an acceptable grade of a ‘mid-level C.’ All other regions, grade in around the ‘mid-D’ range.

Regional - Electronic Health Records Map-Master

Indicator #4: Consistent Quality of Care
Quality of care that is consistently applied, regardless of provider and location, is really the end-game for all of us, right? Let’s be brutally honest, we pay world-class prices for the care we seek, so quality of care should be our minimum expectation.

Yet, Iowa employers are clearly dubious about receiving consistent quality of care. As with all three previous performance indicators, the northwest region received the highest score/grade compared to the other regions within the state, while the northeast region barely secured the yellow ‘C’ grade.

Regional - Consistant Quality of Care Map-Master

Thus far, after reviewing four of the 12 performance indicators, the northwest region has been consistently outperforming the other four regions. Are hospitals in the northwest region of Iowa embracing slightly different approaches that appear to be resonating more positively with employers in their communities?

I have many questions, but it is too premature to speculate. For now, we will rely on the perceptions, perspectives and opinions of the Iowa employer.

Next week:  “Trust”

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Voices on Hospitals: Access and Patient Satisfaction

Finding Your VoiceBefore I continue my discussion on employer perceptions of Iowa hospitals, I would like to react to a Commonwealth Fund report “Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally” published on June 16th.

It is a fact that we pay for world-class healthcare in the U.S. No one can honestly dispute this. Yet, there’s a major gap in what we pay for healthcare versus the outcomes we receive — commonly known as ‘value.’ 

When we compare our expensive healthcare system to 10 other major industrialized countries, as the Commonwealth Fund recently did, the U.S. ranks dead last in the quality of its healthcare system. As we already know, we spend far more than any other country on healthcare (per capita), and yet the Commonwealth Fund reports “…further findings indicate that from the patients’ perspective, and based on outcome indicators, the performance of American health care is severely lacking.” In fairness to U.S. healthcare providers, this report factors in other criteria that does not directly relate to provider performance here in the U.S., such as our troublesome access to insurance coverage and equity issues.

This report is like fingernails on a chalkboard — for one key reason. In Iowa, we continue to compare our health outcomes ‘progress’ to other states, rather than with our international counterparts. I understand it is more convenient to compare Iowa metrics with comparable metrics from other states, after all, each state operates under the same federal healthcare ‘system’. But let’s be honest, it is very easy to be selective on which metrics to use when comparing the progress of our outcomes with other states. Aren’t we merely comparing Iowa to other under-achieving benchmarks?

It’s really about our expectations, right?

Since we are paying world-class prices for our healthcare, then we need to proactively compare our outcomes to…well, the world. Incrementally making progress comparisons to other states only serves to prolong our inevitable desire to produce world-class outcomes. With the risk of sounding naïve about this subject, I am convinced Iowa can and should take the lead by being the petri-dish for world-class care. But to do so, we must ‘think’ world-class and, consequently, use the appropriate benchmarks to get us there.

There, I said it. Now, shoot me.

As previously mentioned, future blogs will address how Iowa employers view hospitals on 12 different ‘indicators’ across five Iowa regions. Today’s topic addresses employer perceptions on hospitals regarding “Access to Services” and hospitals’ “Concern for Patient Satisfaction.”

Employer perceptions about our hospitals can be interpreted as unique perspectives coming from key stakeholders who have much to gain (or lose) from the local care that is provided to their workforce.

The five arbitrarily-carved regions in Iowa consist of the following number of counties (99 total counties):

  • Central – 9 counties
  • Northwest – 27 counties
  • Northeast – 25 counties
  • Southwest – 17 counties
  • Southeast – 21 counties

Indicator #1: Access to Hospital Services
Using a 10-point scale, (1 is ‘failing’ and 10 is ‘excellent’), Iowa employers rated statewide hospitals a 7.3 regarding having access to their services. When converting this score to a grade, the overall statewide grade for this indicator is a ‘B.’ (See NOTE below.)

The following map shows little measurable difference between the five regions for this indicator. The northwest region has the highest average of 6.9, while central Iowa follows at 6.6. When applying weights to the regions, many regions actually grade at a mid-to-high ‘C.’ If you have not reviewed our ‘Voices for Value’ white paper, it is available for download. ‘Voices’ briefly addresses this particular subject on pages 14 & 15.

Regional - Access to Services Map-Master

Indicator #2: Concern for Patient Satisfaction
Overall, employers give statewide hospitals a score of 6.9, or ‘C+.’ However, when we look at the five regions under this indicator, it becomes more interesting. Employers in the northwest region clearly feel their hospitals have more empathy for patient satisfaction, grading hospitals at a low ‘B.’ The northeast and central regions grade their hospitals at a low ‘C,’ while both the southeast and southwest lag behind equally at high ‘Ds.’ Our ‘Voices’ white paper discusses this topic on pages 15 & 16.

Regional - Concern for Patient Satisfaction by County Map-Master

Former Massachusetts Congressman Tip O’Neill frequently stated “All politics is local.” As you will see in upcoming blogs, employer perceptions on Iowa hospitals vary greatly based on location. So we might say that “All healthcare is local.”

Local problems can be addressed with local solutions, to a great extent, but only if we have appropriate expectations of the desired outcomes we wish to seek.

Next week:  “Electronic Health Records” and “Consistent Quality of Care.”

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NOTE:  When grading the entire state, it is important to distinguish that employer respondents were not weighted, which means all employers (regardless of size) have an equal voice. However, when we break out the five Iowa regions, the results are size-weighted so that organizations with more employees have a louder “voice.” Because each region is size-weighted, the average regional scores will appear lower than the statewide average score, in this case, 7.3. Sorry to get technical, but I wanted to address why the statewide averages do not exactly jive with regional averages. If we dig deeper by county, the map becomes very colorful because not all counties are alike, since not all hospitals are alike.


It’s Time to Disinfect – Feedback on ‘Voices for Value’ White Paper

Woman Doing HousekeepingThe feedback I continue to receive on provider grades and our ‘Voices for Value’ white paper have been absolutely astonishing. It’s clearly exceeding any pre-conceived expectations that I had prior to embarking on this research in 2013. Employers have spoken loud and clear about their PERCEPTIONS and, most importantly, the EXPECTATIONS they have for the hospitals and physicians serving their communities.

A few typical comments shared with me by employers on ‘Voices’ include:

Why haven’t employers been surveyed on this before?

My Response:  Great question! I honestly don’t know.

I’m not surprised by the results. In fact, I thought the scores/grades would have been less generous than they appear.

My Response:  I don’t think anyone is surprised by these results, including the providers themselves. Our expectations on impending improvements within our healthcare delivery system are tepid at best (due primarily to glacial progress) – if not flat out skeptical, at worst. It is important to note that survey respondents included both hospitals and physician groups, who are after all, employers as well. Interestingly, hospitals and physician groups equally appeared to be brutally honest about their perceptions/expectations of – themselves!

How did providers within our location perform on these performance measures?

My Response:  It depends. Scores certainly vary by location. In most cases, employers located in urban areas appear to be more critical of their providers than their rural counterparts. It is quite clear, however, that employers located in the northwest region of Iowa appear to be more complimentary of their hospitals and physicians than employers located elsewhere in the state. At this time, the reasons for this difference are only speculations. In fact, in 10 of the 12 performance indicators, northwest region employers graded their hospitals higher than the other four regions in Iowa. The other two indicators, “Access to Services” and “Consistent Quality of Care” were tied as the best in the northwest region with at least one of the other regions. There is still so much more that we need to know about this topic.

Now that we have this baseline information on employer expectations, what can we, as employers, do to have a more meaningful impact on the value of healthcare received by our employees and their families?

My Response:  Stay tuned! New approaches and initiatives are just beginning to emerge from this work.

In my next several blogs, I will be providing region-by-region comparisons for each of the 12 performance indicators on hospitals. Next week’s blog (to be published on June 25) will address how employers view hospitals on “Access to Services” and “Concern for Patient Satisfaction.” Future blogs will address the other Iowa hospital performance indicators.

Making his famous statement on transparency in a 1913 Harper’s Weekly article, former U.S. Supreme Court Justice Louis D. Brandeis wrote the following:
“Sunlight is said to be the best of disinfectants.”

In the weeks to come, I will do my best to provide a bit more sunlight on this massive topic.

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