Pursuing Quality
At Tallahassee Memorial HealthCare in Florida, doctors used to write prescriptions on paper slips and deliver them to the hospital pharmacy. The pharmacy prepared the drugs and delivered them to the units where a nurse verified a three-way match between the patient’s ID bracelet, the drug label and the patient record with the doctor’s order. It was a system rife with potential errors.

Today, however, that process has been re-engineered. Prescriptions are generated online, sent to the pharmacy electronically (nurses view them on hospital terminals) and dispensed automatically from multiple points. Eventually, nurses will use bar codes to match the drug, patient bracelet and electronic order. The pharmacy initiative is part of a system-wide revamping at Tallahassee Memorial supported by a $1.9-million grant from Pursuing Perfection: Raising the Bar for Health Care Performance, a Foundation program to help hospitals and physicians’ organizations dramatically improve patient outcomes by aiming for zero errors in all of their major care areas. Tallahassee Memorial is one of seven health care systems that received funding in 2002 for their quality improvement initiatives.

Even if systems strive to improve health care quality, their efforts can be hindered by a reimbursement system designed to reward expensive procedures, rather than prevention or improved outcomes. A Foundation-supported report found that providing financial and nonfinancial incentives for those on the front lines of health delivery is critical to improving quality. A new $8.8-million Foundation program, Rewarding Results: Aligning Incentives with High-Quality Health Care, in which the California HealthCare Foundation is a partner, seeks to support health plans that encourage and reward high-quality health care. One such plan, Blue Cross Blue Shield of Michigan, offers hospitals a reimbursement bonus if they meet certain quality goals, such as reducing surgical and hospital-acquired infection rates.