Crème de la Crème: What makes a world-class hospital?

It may be one of the most overused words in the corporate lexicon, but that hasn't lessened its popularity. Jargon always dies hard, and healthcare industry jargon seems to die the hardest, especially as the convergence of flak-talk from both the IT and business worlds becomes a bigger part of its internal dialogue.

When buzzwords become ingrained in the culture of an organization, they usually become one of a few things: a staff punch line, shorthand for goals and intentions that are so often overstated as to lose all meaning; a meeting mantra, used to refocus discussion when brainstorming has gone so far afield as to become distracting; or a PR smokescreen, offered up in place of a more specific explanation to unwanted questions.

For today’s hospitals and healthcare providers, one of the most flagrant offenders in each category is the phrase “world class.” World-class service. World-class clinical care. World-class facilities. World-class accommodations. World-class experience. World-class research. World-class, world-class, world-class.

It’s a phrase that also disappears and reappears quickly. Ask someone if their institution is world-class, and they will say “absolutely!” Ask them what exactly they offer that makes it so, and they may stall and stammer or bluster and bloviate. “World-class” is a popular mantle to claim, but there are also many pretenders to the throne. So, at least as far as the biomedical department goes, we’ll try to tackle this high-profile issue.

Defining excellence

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“It’s kind of a curious question,” says Paul Hensler, CEO of Kern (County) Medical Center in Bakersfield, Calif. “I can think of some facilities that are just beautiful but lag on technology. I can think of hospitals that lag behind in terms of aesthetics but excel in terms of clinical care. So, what is ‘world-class?’ Clinical care? Teaching? Buildings?”

According to Steve Nitenson, RN, PhD, adjunct professor at the Institute for Technology and Management Division of the Ageno School of Business in San Francisco, some public hospitals in the Bay Area are marrying world-class medical care with world-class restaurateurism. They feature meals designed by signature chefs. Patients’ menus cater to a variety of dietary preferences.

“These aren’t even necessarily concierge hospitals,” says Nitenson. “You think of ‘world-class’ providing resources so that people can be treated best and fastest. Today, it also means that you get the best food, technology, and systems – and you pay commensurate prices.”

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Some definitions of world-class hospitals hinge on clientele. Hunn says that part of what validates the standards an institution establishes for itself is whether patients are willing to travel great distances to receive care. “[Renowned healthcare industry strategist] Michael Sachs of Sg2 recently stated that the technology race is really over and the performance wars are just beginning,” Hunn reveals. “Those seeking healthcare have the ability to go where they want. Where they choose to go is based in part on the perceived value and reputation of the institution.”

Hunn’s point about institutional reputation is well-made. Institutions are forever chasing staff and patient feedback. Qualitative metrics, such as service, value, and comfort, are all collected in surveys that attempt to quantify their experiences. Alongside data gathered about reimbursement rates, employee benefits, and coverage information, client satisfaction surveys off er insight that might inform strategic decisions at the administrative level.

“I’m in favor of any institution being inspired to do better,” says Hunn. “One of the main drivers is that things are becoming transparent and that we’re publicly reporting our data.”

What Hunn’s data tell him most of all is that high marks related to his patients’, visitors’, staff , and doctors’ experiences are tied to effi iency. Foremost for biomedical engineers, this means the hospital’s equipment must work correctly and efficiently. A uniform experience across the facility, he says, means patients receive a single standard of care throughout the hospital—and that’s one step in establishing a standard of excellence.

“In running a medical institution, there isn’t a single experience of patient care in this hospital that doesn’t involve clinical and biomedical equipment,” he says. “As much variability as I can take out of the system will improve quality and safety, and it will always save money. Improve communication, and you reduce risk,” he says. “Eliminate variability and disparate systems, and you improve effi ciency. Given the need for extreme education and shrinking reimbursement, we’re going to be in trouble if we don’t get clinical integration right. The better we can manage those systems, the better the service experience.”

A bleeding-edge example

Nitenson’s practical example of a bleeding-edge technological facility is the John Muir Hospital in Walnut Creek, Calif., which he considers state-of-the-art in terms of technology and infrastructure. Patient rooms—all single-beds—are totally wireless environments, equipped with flat-panel televisions and a foldout nurse’s station embedded into the wall for ease of storage. Electronic medical records (EMRs) track patient care from charting to ordering. Mobile devices operate seamlessly from room to room, and every patient-monitoring device interfaces with the hospital’s computer system. That way, clinical staff can manage and troubleshoot alarms from any in-room terminal.

“And how it plays out for biomedical engineering is it dramatically complicates how people do their work,” Nitenson says. “Although the technology component is well-intended, it causes a lot of complications. It used to be just a bed, a nurse, and a television. Now, you have everything else in that room. At the central nurse’s station, you now also have monitoring equipment for everything in the room. Then, the operating room is digitized and optimized, with 52-inch, high-definition screens.”

Nitenson continues. “Clinicians today not only have to know electronic medical record technology but device technology as well,” he says. “They have to have an understanding of the devices—how they work—and they have to be able to service them at bedside. We’ve increased our dependence on technology. Everything that used to be done based on the feel of the patient is [now] based on what the system tells you.”

Because so much of the service environment in a hospital like John Muir is powered by technology, there is a greater pressure on the clinical engineering team to maintain it, service it, and keep it running. Bill Fawns, the CIO under Hensler at Kern (County) Medical Center, describes how the uptime demands of such a system must be considered from the earliest stages of its design.

“From a purely technological standpoint, you need to put in as many backup strategies as possible to minimize the times that it doesn’t work,” says Fawns. “We have to look at strategies of redundancy in our communications networks.

"We have to look at locating our data storage and redundant servers in diff erent areas. You don’t want to put all of your experts and resources in a given region that might be susceptible to disaster.”

Likewise, Nitenson says, if design metrics haven’t been considered upfront, conflict can arise down the line. For example, hospital walls and floors are shielded to contain radiation and interference, which naturally affects the way wireless technology operates.

“On TV shows like House, you see all of these sliding glass doors and really interesting critical-care rooms,” Nitenson points out. “The technology that goes in these rooms is not always conducive to their design. WAP won’t work in a room with lead, even if it’s in the form of glass. So, the biomed has to do a workaround. The patient and his or her monitors have to fit in the room, and they all have to interface correctly. It has become a nightmare.

"One could argue that technology has gotten in the way of how we treat patients in these world-class hospitals,” he says. “We’re now putting so much technology around the individual that we have to wade through it to get to [him or her].”

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