Health Care System "In Pursuit of Excellence" Case Example
Hospital Sisters Health System (HSHS)
Hospital Sisters Health System (HSHS) is a multi-institutional health care system that sponsors 13 Local System hospitals in 12 communities across Illinois and Wisconsin, and includes an integrated physician network. The health system’s “mission of integration” means bringing together all the threads from which the organization’s mission and legacy are woven, including:
- The health care mission of the Hospital Sisters of St. Francis, a ministry of the Catholic Church;
- Work rooted in the spirit and commitment of Francis of Assisi, including care for all, especially those must vulnerable. Being attentive to the whole person is a key component;
- A commitment from all who share in the HSHS mission to serve the health care needs of the local community; and
- Recognizing that HSHS is the steward of the ministry to which it is entrusted, as well as the resources needed to provide quality health care services to the communities served.
HSHS serves approximately 2.5 million people in Illinois and Wisconsin. In 2008, the health system had over 14,000 employees and 4,500 volunteers.
The approach of Hospital Sisters Health System is to bring together elements of today’s fragmented health care delivery system to provide superior value to patients and promote efficiency. The HSHS Care Integration initiative is the organization’s blueprint for achieving that vision. It focuses on breaking down barriers so that all key players in the health care equation can work together seamlessly for the benefit of all. It also focuses on providing care for the whole person, from preventive care to quality treatment to follow-up care, rather than simply treating the disease.
HSHS understands that today’s health care consumer is more likely to receive care outside of the traditional hospital setting and uses Care Integration to bring continuity of care at every point of access in the health care system.
Reduced fragmentation leads to closer, more personal relationships between patients and their care providers. Providing care from the patient perspective also means focusing on practical ways to make health care access easier for patients, such as online scheduling of appointments, faster check-in and registration, and attention to detail and reduced duplication. In addition, new technology will provide patients with a single point of access to information and services throughout HSHS.
As part of the Care Integration initiative, Hospital Sisters Health System is building partnerships with a variety of providers. Its strategy is to unify the key components of health care delivery in Illinois and Wisconsin communities, using both technology and relationships to link patients, providers and care facilities to provide seamless care.
The Rationale for Care Integration at HSHS. Hospital Sisters Health System has been led by the Franciscan legacy for over a century. In 1978 the health system established the formalized Hospital Sisters Health System of today. In 2006, the Sisters that oversee the organization recognized that in the future the Catholic presence of Sisters may not be as prominent as it has been in the past and sought to ensure that the organization had the spiritual basis to successfully continue without the same presence of the Sisters overseeing it. The leaders held a series of meetings and examined other health care systems to determine whether to operate under the current structure or explore other options. The decision was made to remain the sole sponsor of HSHS, with greater clarity about how the organization’s operations should be carried out in the future.
This decision led to the development of eleven guiding principles that guide how the Sisters envision HSHS operating in the future. Four of the eleven principles were directly tied to the need for greater care integration: 1) providing excellent care; 2) serving communities; 3) fiscal stewardship; and 4) being true to the mission.
In February 2008, HSHS held a planning retreat with leaders from all 13 Local System hospitals and physicians from across the system. After dedicating the full retreat solely to fostering hospital/medical staff relationships, it was agreed that a fundamental system priority was providing patients with integrated care that results in high quality, coordinated, seamless care at a low cost. The management team was charged with developing a Care Integration strategy incorporating the principles discussed at the retreat.
A significant component of the Care Integration strategy was driving “waste” from the system. System leaders pointed to an April 2008 study sponsored by PricewaterhouseCooper that identified $1.2 trillion of waste in the health care system. They agreed that if health care organizations did not address this “waste” independently, it would ultimately be forced on them by the government.
Securing Input Before Moving Forward. Although the long-term goals of Care Integration were clear, HSHS leaders did not have a clear vision for how to achieve those goals. To kick-off the development process, they held a two-hour webinar in July 2008 to gather physician input before moving forward. Over half of the invited physicians appeared in-person for the meeting rather than calling in, a clear sign that the partnership was moving in the right direction.
After gathering input from physicians, members of the HSHS Care Integration Steering Team made site visits to four organizations in various stages of care integration journeys, including Bon Secours Richmond Health System, Richmond, Virginia; The Marshfield Clinic, located throughout Wisconsin; Geisinger Health System, Danville, Pennsylvania; and Prevea Health, which provides health care services throughout Green Bay and Northeast Wisconsin.
The combination of physician input and the on-site visits led the Care Integration Steering Team to identify three primary Care Integration goals:
- Define the integrated patient care model to meet the needs of those served;
- Design a physician-nursing-clinician relationship model; and
Develop implementation requirements for how to deliver the Care Integration model, focusing on lean processes to eliminate waste and infrastructure requirements (such as information technology and centralized billing).
Forming the “Care Integration Partnership.” Quick to recognize both the potential and the opportunity presented by Care Integration, Prairie Cardiovascular in Springfield, Illinois, became the first group to partner with HSHS and played a vital role in the foundational development of Care Integration. Both Prairie Cardiovascular and Prevea Health worked with HSHS to shape the new group’s governance, management, quality standards, compensation policies and more. The Hospital Sisters Health System Medical Group was officially formed in January 2009, including physicians from Prairie Cardiovascular and Prevea Health as well as nearly 120 additional physicians who plan to roll into the group in 2009 and 2010. Physicians who join the Medical Group are considered part of the partnership working toward Care Integration.
The HSHS Medical Group continues to grow. It is a network of clinical providers including physicians, nurses, medical professionals, multi-specialty groups, single specialty groups, solo practitioners and medical schools in Illinois and Wisconsin. Together, members of the network work to further the Care Integration mission of HSHS that includes the development of “medical homes.” Patients enter the network through many points of access, ranging from receiving care at a hospital or clinic to accessing the system through call centers or health information lines. Using the medical home concept, patient care focuses on preventive care and holistic care rather than only disease treatment, not only enabling providers to communicate easily with patients but also with other clinicians and hospitals within the system.
Maximizing Technology. Successful care integration requires ensuring the right infrastructure is in place to reduce waste, support the free flow of information, and ensure the entire system operates smoothly. Part of the Care Integration strategy at HSHS has involved the implementation of electronic medical record systems that both improve quality and prevent waste, linking physician offices, ambulatory care settings, hospitals, and care provided at the patient bedside into one system that allows physicians to focus on patient care rather than paperwork. The use of technology has also created an attractive and supportive practice environment for caregivers. The system involves two primary components: the Kiara Clinical Integration Network, and MEDITECH.
HSHS’ hospital clinical information system, called the Kiara Clinical Integration Network, serves as a centralized resource in the hospital setting, allowing clinicians to place orders and retrieve critical documentation from nurses and other staff. The system collects data from separate information systems and securely aggregates them into a comprehensive view for physicians and other health care professionals. Both physicians and patients appreciate the time-savings and quality of care that results from instant access to a single source of patient data, which means faster care decisions and cost savings resulting from reducing duplicate tests and procedures. The Kiara Clinical Integration Network is based on underlying technology provided by Medicity.
In addition, HSHS uses computer terminals and laptop computers powered by MEDITECH, which allow medical professionals instant access to patients’ complete medical records and medical history. The terminals are currently being installed at bedsides throughout HSHS.
Driving Costs Out of the System. Care integration has been highly successful at HSHS in part because the organization is a true health care system. The ability to leverage the system’s information technology and infrastructure has been essential. At the same time, maintaining a regional focus allows the divisions in each region to address local challenges, taking advantage of system benefits while still maintaining a local focus.
In addition, being part of an integrated system allows the various regions to leverage their experiences and share their expertise. To maximize this opportunity, HSHS holds Care Integration Meetings twice monthly and Division meetings quarterly. The meetings are an opportunity for leaders from various locations and divisions to come together to brainstorm how to approach issues and challenges, and ensure that all components of the system continue to work toward a shared mission and goals.
Understanding That One Size Doesn’t Fit All. The HSHS leaders agreed that a successful care integration strategy required a comprehensive information technology system integrated throughout the organization. HSHS began by assuming the information technology system it was currently using would continue to be developed because it was already being used by a large portion of the providers. However, when HSHS began system-wide implementation of the system, the organization quickly realized that almost every physician had a different opinion about technology choices and options, because each physician has unique needs. They recognized the need to do a more thorough job of gathering physician input before moving forward with the information technology system, and that more than one model may need to be adopted and integrated with others. Because HSHS already had a comprehensive information technology process in place, it was able to implement multiple models to meet physicians’ unique needs while still pulling together the information into one centralized system.
Top Leadership and Physician Involvement Are Essential. HSHS’ President and CEO, Stephanie McCutcheon, has played an integral role in the success of the Care Integration journey. She takes ownership for the program and visibly communicates the sense of urgency and importance around the initiative, setting the tone throughout the organization. She also chairs the Care Implementation Team and the Care Implementation Project Team, both of which meet regularly throughout the year.
Equally important to support and leadership from the CEO is co-leadership and ownership among physician leaders. Maintaining continual communication with physicians and being receptive and responsive to their needs is essential. Successful Care Integration is built upon relationships and partnerships with all physicians, ensuring they are truly part of the care integration team. Many physicians have joined the Care Integration initiative because they recognize the need to implement comprehensive information technology and be part of a system that integrates all points of patient care together. Their desire to work together must be fostered by ensuring that physicians lead physicians, involving physicians in governance, and basing decisions with physician ideas and input.
Incentivizing Integration. Despite the desire from all stakeholders to provide patients with more integrated and coordinated care, some health care leaders, management teams and physicians in individual HSHS communities were somewhat leery of one another because they did not have previous successes to build upon. To strengthen partnerships and a sense of shared commitment, HSHS built $28 million in “seed money” into its 2009 Care Integration Budget. The seed money is used to support good business plans for Care Integration, incentivizing local management teams to work with physicians to determine what needs to be done to create better integration and coordination.
HSHS has identified specific criteria to measure the value of the Care Integration program, divided into three categories: 1) the Franciscan and spiritual dimension of care, which is critical to the HSHS mission; 2) quality of care provided; and 3) patient satisfaction. Each of the categories is defined by specific measures. For example, the impact of Care Integration on quality of care is measured by indicators such as reductions in mortality, measures of chronic disease management, and the use of evidence-based medicine.
Hospital Sisters Health System is in the early stages of putting the underlying structure in place for Care Integration, and it is too early to conduct a meaningful cost-benefit analysis. However, the health system believes that streamlining of information technology, establishing a centralized billing office, bringing physicians together into one group with shared goals and objectives, and developing medical homes will result in tangible advantages for the system, individual care providers, and patients.
Although the final stages of implementation are not yet complete, the system is already experiencing positive impacts. HSHS developed a system goal of removing $30 million of “waste” from the system. At the end of the last fiscal year, measurements determined that $36 million of waste had been removed. This could not have been achieved without the Care Integration platform, which aided in staffing efficiencies and reduced supply costs.
In addition to cost savings, HSHS has established goals to add new providers throughout the system to improve access to care in critical areas. The number of new physicians and specialty types targeted are unique to each location’s specific needs. The recruitment process is part of the Care Integration strategy, and successes already experienced are providing a clear physician recruitment advantage.
Finally, Care Integration is enabling HSHS to forge new relationships with providers and drive volume that is sustainable for future generations. Care Integration helps remove barriers that physicians encounter when caring for patients in both clinical and hospital settings, such as a complex admitting process or preadmission testing. HSHS’ goal is to keep growing its inpatient and ambulatory care volume despite the economic downturn and increases in bad debt. This could not be done without Care Integration, which makes patient care more seamless. Providers seek to work with HSHS facilities because the process of receiving care in multiple locations is easier for their patients, resulting in better care.
Contact Name: Peter Mannix
Title: Vice President, Strategic Development and Implementation
Email: c/o Lourine Lagerlof, firstname.lastname@example.org
Tel: (217) 492-5853
Fax: (217) 253-0542