Whatever form the health care legislation under debate in the House and Senate takes, one priority is shared by lawmakers from both sides of the aisle: improving quality and safety. President Obama’s proposed 2010 budget includes a recommendation to implement a hospital quality-incentive payment program; the budget projects that such an initiative could result in savings of $11 billion over the next decade. In addition, the Medicare Payment Advisory Commission has recommended that Medicare revise its payment-system incentives to adjust provider payment based on quality of care, and has suggested that Congress create a wide-reaching quality-incentive payment policy for hospitals and physicians.

With quality and safety in the spotlight on a national level, hospitals across the country are renewing their commitment to ensuring that their services meet or exceed the core measures for quality set by the government. For many facilities, this is a massive, daunting undertaking, requiring a comprehensive reexamination of even the simplest daily processes to ensure that all members of hospital staff are enforcing the common goal: improving patient care.

Memorial Hermann Healthcare System (MHHS), Houston, Texas, embarked on a new quality initiative in 2003. The hospital began by developing a brand promise that Michael Shabot, M.D., chief medical officer, describes as striking at the health care system’s core mission: “That the system provide the highest possible quality and safe health care combined with an outstanding patient experience.”

Shabot, who came onboard in January 2007 as chief quality officer, was hired, in part, to reinforce this renewed commitment to patients. “Everyone talks about differentiating themselves on the basis of quality care and safety,” he says. “Our commitment was actually to do it and demonstrate it. It required real dedication.”

Shabot was instrumental in implementing the second wave of the system’s new initiative, which became known as the Breakthrough in Patient Safety campaign. One idea that set the Breakthrough campaign apart was that it took cues from what Shabot calls high-reliability industries, such as nuclear power and naval aviation, which conduct specialized training for every single employee. “We brought in consultants from other industries to retrain all of our employees, including the kitchen staff, the maintenance staff—everyone who works for MHHS,” Shabot says. “We even train our volunteers to speak up when they think something’s not right. It’s everybody’s job to make every patient safe.”

All MHHS facilities honor a safety hero of the month (an individual who has intervened to ensure patient safety); the system has also designated 600 employees as safety coaches, who perform safety-monitoring services on work areas other than their own. In addition to meeting or exceeding safety and quality standards set by the government, MHHS ensures total transparency by publishing its own core measure data on its Web site.

In May 2009, the National Quality Forum presented MHHS with its 2009 National Healthcare Quality Award. By that time, the health system had been recognized by the New York Timesfor having the best heart-attack care in the city of Houston, averaging less than 90 minutes from the door to percutaneous coronary intervention. The system has revolutionized triage for both stroke and pneumonia, leveraging top-of-the-line imaging and PACS equipment to create what Shabot calls “a true culture change for everyone involved.”

“Our imaging capabilities are crucial to ensuring rapid, quality care,” Shabot says. “Modalities like CT angiography, CT, and MRI are crucial for rapid diagnosis of trauma. If a patient comes into the emergency department with chest pain, he or she gets an immediate ECG, and if there’s any evidence of an ST-elevation myocardial infarction, the catheterization laboratory is immediately activated.” In some cases, ECGs are actually read wirelessly from ambulances, meaning that the catheterization laboratory is ready by the time the patient arrives at the hospital. “It’s like a ballet,” Shabot says. “We have to make sure all of our staff is committed to this, on call, and available.”

Shabot and the team have also implemented a comprehensive program for appropriate dose in pediatric imaging. “In retrospect, we were often using more radiation than was necessary, like the rest of the country,” he recalls. “At appropriate lower doses, you can get the same quality images, and in the past few years, the need to attenuate these doses for children has become a priority.”

Though the Breakthrough campaign has already cost MHHS around $18 million, Shabot expects the investment to pay big dividends down the line. “We’ve made these improvements because it’s the right thing to do, but reimbursement is very important,” he says. “If we’re able to take a patient who was going to have a heart attack and literally reverse it—so that instead of spending days in critical care, clinging to life, he or she can go home in 48 hours or less—we’ve done the right thing for the health care economy. In our day-to-day operations, quality saves money and it saves lives. It’s a win–win situation.”

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