Category Archives: Quality of care
Toby Cosgrove, MD, CEO of the Cleveland Clinic, spoke about bringing a business lens to health during a panel discussion this morning at the Spotlight: Health expansion program of the Aspen Ideas Festival. In an article in this month’s Harvard Business Review, he wrote that “Fixing health care will require a radical transformation, moving from a system organized around individual physicians to a team-based approach focused on patients.”
NewPublicHealth spoke to Cosgrove about this transformation just before the Spotlight: Health conference.
Toby Cosgrove: The first thing we did is that for the last decade we’ve been very transparent around our quality, and we’ve released books on quality outcomes which are available both in paperback form and on our website. The second thing that we’ve done is we’ve consolidated services. For example, we started out having six hospitals in the system that provided obstetrics care, and now we’ve got three and are about to have two. And each time we’ve consolidated we’ve increased the volume of patients and improved the quality. We’ve done consolidations with pediatrics, cardiac surgery, rehabilitation, psychiatry, trauma and obstetrics. We think that it’s called the practice of medicine—the more you practice at it, the better you get at it, and every time we’ve done that we’ve seen that happen.
In Cleveland, for example, we partnered with Metro Health, a large network of health providers. We previously had five trauma centers in Cleveland. Now we have three and as we’ve done that, the mortality rate has improved 20 percent. So there are real activities that have begun to drive the business approach.
NPH: What are other ways that the Cleveland Clinic has been able to respond to consumer needs using a business model?
Cosgrove: We think you’ve got to do three things. You’ve got to have improved access, quality and affordability. The access is not just having insurance—the access is actually getting to see a provider, and last year we provided about one million same-day appointments in addition to our scheduled ones. We also took our emergency room wait times from 43 minutes to 11 by changing the system that we use. And in our call center we’ve reduced the number of dropped calls and improved the speed of answers. All of that is aimed at giving patients access to the caregivers. We also reorganized our internal system so that when you, say, have a neurologic problem, instead of coming to see a neurologist and then a neurosurgeon, you come into the neurologic institute where you can be seen in one location under one leadership of neurology, neurosurgery and psychiatry, so that you are seamlessly seen with all the specialties right there in one location.
The Public Health Quality Improvement Exchange (PHQIX) is an online communication hub for public health professionals interested in learning and sharing information about quality improvement in public health. Created by RTI International and funded by The Robert Wood Johnson Foundation, PHQIX launched in September of 2012 with the goal of sustaining national efforts at quality improvement by providing public health practitioners with the opportunity to learn from the experiences of their colleagues. PHQIX includes:
- An online database of quality improvement efforts by public health departments across the country
- Search and query functions to help users find relevant examples for their own work
- A forum for dialogue on quality improvement
A recent initiative shared on the site called Operation Chuckwagon looked at the maintaining quality control of food safety for mobile food trucks in Northern Kentucky.
Food trucks are growing in popularity across the country as an inexpensive way to try different cuisines, and following some of the weather disasters this past year, some municipalities dispatched food trucks, with cost covered for residents, to areas without power and in need of food. Safety is critical. A recent report in the Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention found an outbreak of 91 salmonella cases linked to lunch trucks in Alberta, Canada. An investigation by food inspectors found many food storage and handling violations.
The Kentucky project increased the percentage of properly licensed mobile food vendors to 100 percent from a baseline of 25 percent, and also achieved a 100 percent compliance rate with required temperature controls, which had been a big problem during initial inspections.
NewPublicHealth recently spoke with Ted Talley, environmental health manager at the health department, about the quality improvement initiative.
NewPublicHealth: What’s novel about how you’ve approached the food trucks and made it easier for them to have food safety inspections?
The Public Health Quality Improvement Exchange (PHQIX) is a brand new online community designed to be a communication hub for public health professionals interested in learning and sharing information about quality improvement (QI) in public health. PHQIX was created by RTI International and funded by the Robert Wood Johnson Foundation. The key goal of the site is to share national QI efforts by health departments of all sizes so that public health experts can learn from the experience of their colleagues across the country. NewPublicHealth recently spoke with Jamie Pina, PhD, MSPH, PHQIX project director, and Pamela Russo, senior program director at the Robert Wood Johnson Foundation about the new resource and its promise for helping health departments continuously improve their performance and achieve the national standards set forth by the Public Health Accreditation Board.
NewPublicHealth: What’s the vision of PHQIX, and how did it come about?
Pamela Russo: Public health departments are looking for ways to be more and more efficient and to eliminate waste and to make their limited budgets have the maximum possible impact. That’s the major value of QI, to show what works and where you can improve.