Top hospital performers’ secrets unveiled 

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Quality improvement

Top hospital performers’ secrets unveiled

Leaders focusing on quality put on the best show

After reading this article, you will be able to:

  • Describe characteristics of high-performing hospitals

Fifteen years of research on hospital performance has given Thomson Healthcare’s senior vice president an idea of what it takes to be one of the nation’s 100 top-performing hospitals: more bedside nurses, less outsourcing, and, above all, a focus on quality from top leadership.

“We found that boards [of top hospitals] are more engaged, that there are more physicians on the board, and the boards do not have a lot of committees,” says Jean Chenoweth, senior vice president of performance improvement and 100 Top Programs at Thomson Healthcare. “They don’t have time for nonsense … They spend more time in board meetings on quality, and they inform the CEO and the senior team on quality and finance performance.”

Successful hospitals have boards that are active through traditional powers and raise the bar for medical staff reappointments and recruitment, Chenoweth says. The CEOs of these hospitals also build a different type of senior team, creating boards that are more similar to a corporate structure and include a chief nursing officer, a fundraiser, and HR. Lesser-performing hospitals typically added a chief medical officer, she adds.

The Thomson Healthcare study, National Benchmarks for Success, uses the two most recent years of data to identify hospitals that consistently achieve high performance on a combination of eight key metrics based on quality, patient safety, and efficiency, Chenoweth says. They are awarded a top 100 position because they have higher survival rates and fewer patient complications, among other factors. To level the playing field, hospitals are ranked in five categories according to size and type.

Chenoweth says the research confirms a difference in the leadership boards of top hospitals and their peers: High-performing hospitals focus less on creating more committees and structure and more on reacting quickly when a process fails.

These hospitals usually also have sicker patients and more patients overall, yet their costs are lower and their lengths of stay are shorter, whereas salaries are higher.


Leadership involvement helped Poudre Valley Hospital in Fort Collins, CO, which has landed in the top 100 for the fifth consecutive year. Ric Detlefsen, RN, director of quality and risk management at the 241-bed teaching hospital, says a genuine focus on quality at the top of the hierarchy is a necessary component to quality improvement. He adds that leadership must decide on which key metrics to measure and what the goals are.

“I have to say, of all the places I’ve worked, the leadership of this organization is truly some of the most aligned and committed leaders that I’ve ever worked for. They get quality and safety, and they value it,” says Detlefsen.

“Getting it” also means a willingness to spend mon- ey now on quality efforts that require more staffing or technology but will help reduce costs in the future, Detlefsen says. Top hospitals tend to be early adopters of new technology, but only when it helps meet well-planned goals, Chenoweth adds.

Detlefsen says his organization’s willingness to spend money helped cut patient falls by one-third. One intervention for reducing falls required staffing for video monitors in the neurology unit. The organization agreed to have staff members watch the monitors around the clock, sounding off a special page if a patient was attempting to get out of bed. “It costs to do that, but given the price of falls, we estimate that the cost absolutely saved us money, as well as saving patients from getting bad injuries,” Detlefsen says.

Other stringent measures, such as accompanying high-risk patients whenever they are out of bed, including all bathroom trips, helped reduce falls, he says, adding that the only time these patients are left alone is in bed or in a chair.


In addition to a strong commitment to quality, research shows a difference in nursing structure among top hospitals. Chenoweth says the focus on nursing has been evident in top hospitals included in the 15 years of research.

“They tend to have a higher percentage of RNs at the bedside, and a little bit lower in nursing management or hierarchy, and they tend to have a higher RN-to-[licensed practical nurse] ratio,” she says. “They have more shared governance … They try to do less outsourcing.”

Shared governance is a trademark of ANCC Magnet Recognition Program® hospitals, which are abundant on Thomson’s top 100 lists. “That’s been true for many, many years,” Chenoweth says. “A focus on nursing is a very important component of high performance.”

Hospitals that outsource less and pay their staff members more tend to see their investment pay off in efficiency and quality.


Quality Improvement Report, May 2008, HCPro, Inc.