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Using Consistent Practices and Robust Data to Provide Quality Patient Care

September 07, 2023

Consistency, collaboration and continuous evaluation are some of the cornerstones for achieving quality patient care across HCA Healthcare. Our approach to ensuring high-quality care is rooted in our belief in always doing what is right for our patients. This commitment to prioritizing quality throughout all hospitals and facilities has been recognized nationally by leading institutions (see the end of this page).

From our more than 37 million annual patient encounters, we develop and share best practices across our enterprise that help continuously improve patient care, using evidence-based guidance, tools, measurement, advanced analytics and data science to support safe, effective and compassionate care.

From coast to coast – and across the Atlantic – our facilities and caregivers are working to deliver the kind of care that raises the bar for all of healthcare. Here are just two examples of facilities in the HCA Healthcare family that are helping to raise the standard for quality care.

A journey, not a destination

At HCA Healthcare’s Grand Strand Medical Center in Myrtle Beach, South Carolina, the keys to success are following protocols, maintaining consistency and making high-quality care part of the culture. From the morning staff huddles to hospital board meetings, conversations are anchored by how they are delivering quality care. It’s a team effort, says George Helmrich, MD, chief medical officer at Grand Strand Medical Center. He also says quality care is now ingrained as part of their culture.

“Quality, for us, is a journey. It’s never a destination,” he says.

Although Dr. Helmrich says he and the hospital’s chief nursing officer are responsible for driving quality, there are two teams he relies heavily upon to help them achieve their goals.

The first is the Resident Quality and Safety Council, which is a committee composed of residents who are a part of the Graduate Medical Education (GME) program at Grand Strand Medical Center.

“They are an integral part of our delivery of care because they are frequently on the front lines,” Dr. Helmrich says.

One of the issues the committee tackled was hospital-acquired infections. They were able to significantly reduce these infections by setting protocols, which helped establish consistency in care. One measure was to follow a checklist whenever a central line (an IV catheter, which carries a higher risk of infection) was placed in a patient. Another was regarding dressing (bandage) changes. New standards for applying the bandages lead to cleaner, more consistent dressing changes.

The beauty of HCA Healthcare is that we have a ton of clinical experience at our fingertips, and collectively we truly know the best way to approach virtually everything.

— George Helmrich, MD, chief medical officer at Grand Strand Medical Center.

The other group Dr. Helmrich frequently turns to is the Resident Intensive Care Unit (ICU) Nurse Council.

“The ICU is a place where there’s a lot of in and out, a lot of high-pressure decisions that are made — sometimes very quickly,” he says.

The main impetus for the council was to bridge communication barriers, says Tiffany R. Keys, chief nursing officer, MBA, BSN, RN, NEA-BC, CPXP.

“It’s important that we discuss real and perceived issues and mutual ideas for resolutions,” she says.

Some of their accomplishments include timing and notification of multidisciplinary rounding (MDRs): Resident teams send iMobile broadcasts when moving patients from one ICU to another so that nursing teams can be at their bedside to discuss care plans. Another improvement was adding white boards in the surgical trauma intensive care unit (STICU) for care teams and families to use for communication.

“It’s not only resulted in better quality care but better satisfaction as well, both for the residents and the ICU nurses,” Dr. Helmrich says.

His entire team of service line members — from the emergency room to bariatrics — aim to integrate quality and infection control into everything they do.

Because quality is an ongoing journey, these teams are constantly seeking ways to improve what they’re doing. Dr. Helmrich also cites their strategy of achieving consistency through best practices.

“The beauty of HCA Healthcare is that we have a ton of clinical experience at our fingertips, and collectively we truly know the best way to approach virtually everything,” he says. “That information is available to us, whether it’s in playbooks or just best practice out of Atlas. As long as you’re using the best practices consistently, you’re going to have the best outcomes.”

I feel like my job is to help tell our story on quality and patient outcomes here at the hospital.

— Kerri Skarke, vice president of quality at Medical City McKinney.

Tracking data and friendly competition

The story of how Medical City McKinney rose to their high-quality standards is revealed in the data. Kerri Skarke, vice president of quality at Medical City McKinney, thinks of herself as a storyteller.

“I feel like my job is to help tell our story on quality and patient outcomes here at the hospital,” she says. “I take a look at lots of different metrics that are used publicly, as well as internally, to evaluate how well we are doing with quality of care for our patients.”

From there, she works with the teams in those areas to create sustainable plans for maintaining excellence for their patients in McKinney, Texas. Her team of nurses – whose duties include managing infection prevention, quality and patient safety – identifies what needs their attention and ensures that efforts are focused to effectively address any issues that may arise. They conduct audits to validate and ensure that their practices are working and hold weekly meetings to review metrics.

These efforts have already seen success within her hospital’s walls. The accomplishment Kerri is most proud of is their reduction of healthcare-associated infections (HAIs). After evaluating their enterprise-wide HAI ranking in 2022, the facility knew there was room for improvement. Over the course of the next year, Medical City McKinney rose to first place in the enterprise (out of more than 180 hospitals).

“We maintained that for four months in a row, which was huge because it really helped our team to see and know that the consistency in the care they were providing was effective,” she says.

They achieved this improvement with daily reviews of each patient who had lines, such as IVs and catheters, and determining if the lines were still needed. They had daily huddles with teams throughout the facility, including physicians, to discuss removing unnecessary lines from patients. That physician partnership is key. The physicians are supportive and now regularly discuss removing lines from patients to reduce their risk of infection.

The hospital also implemented line rounds with the infection prevention team to review lines and dressings in each patient’s room to ensure that they were clean and changed in a timely manner. If there is an infection, they trace its cause and figure out how to prevent it from happening again.

“We teach the teams right away to help make sure they understand what needs to happen and how important that is for that patient’s safety,” Kerri says.

Kerri explains that Medical City McKinney’s improvement and success were the result of building relationships, which led to better communication and, often, better problem-solving.

“I love my job and we have a great team here,” she says. “We believe in building relationships with physicians, the frontline staff and the nursing leaders in order to have strong communication. I believe those relationships also help people brainstorm and problem-solve.”

Shifting culture and building teams

The success story of culture at Mission Hospital in Asheville, North Carolina, is not unlike that of HCA Healthcare affiliates Grand Strand Medical Center or Medical City McKinney.

Their dedication to providing quality care is a mindset of always raising the bar. But what makes the narrative at Mission Hospital unique is its transformation. Mission Hospital in Asheville, is part of the flagship hospital of Mission Health, which serves an 18-county area spanning western North Carolina and areas of Tennessee, Virginia, South Carolina and Georgia.

Mission Health has a long-standing reputation for excellent care and consistently high Healthgrades ratings. Still, when Mission Hospital was acquired by HCA Healthcare four years ago, there was a massive culture shift and team-building effort to adapt to HCA Healthcare’s model of excellence. Both new and legacy team members completed training to learn HCA Healthcare’s standards and protocols. Each team also learned how their own roles support other teams to achieve quality care. This year, Mission Hospital was the only hospital in North Carolina to be named to Healthgrades’ America’s 50 best Hospitals list, putting Mission Hospital in the top 1% of hospitals nationwide for overall clinical performance across most common conditions and procedures.

“It is just culture — really just building a community in our hospitals where we engage each other and we all lean in for our patients,” says Olufunmilayo Ogundele, MD, MS, MBA, CPE, CHCQM, associate chief medical officer at Mission Hospital.

Mission Hospital’s quality team was tasked with extracting and sharing meaningful data with teams across the hospital. A physician ambassador program was also established to empower physicians to speak to the community about Mission Hospital’s quality care efforts. Additionally, HCA Healthcare and Mission Health have addressed the national staffing shortage through partnerships with educational institutions like Galen College of Nursing in Asheville and the Mountain Area Health Education Center (a UNC school), also in Asheville.

Anthony Spensieri, MD, MBA, FHM, CHCQM, chief medical officer at Mission Hospital, says that being a part of HCA Healthcare encourages them to continuously raise their bar for standards of care. HCA Healthcare’s network of high-performing facilities sets the standard for excellence, prompting teams across the network to up the ante.

“We’re constantly having to be smarter, think right and achieve higher levels of outcomes. The ability to have a line of sight into the metrics of 181 other hospitals is unique,” Dr. Spensieri says.

Laura Daly, DNP, RN, CPHQ, CPHRM, CPPS, who is vice president of quality at Mission Hospital and who has also been a nurse for 40 years, commends the dedication of their colleagues.

“The passion here is palpable. The commitment of the staff — that is a resource that you can’t replicate,” she says.

Award-Winning Quality Care

Last year, HCA Healthcare’s commitment to patient safety and quality was recognized nationally by leading benchmarking institutions including:

Healthgrades 2023 Specialty Excellence Award™

Healthgrades recognized 23 HCA Healthcare hospitals with its Specialty Excellence Award™ for delivering superior patient outcomes. Out of the 50 hospitals recognized, 46% were HCA Healthcare hospitals.

Fortune/Merative 100 Top Hospitals 2022

Twenty-four HCA Healthcare hospitals made the Fortune/Merative 100 Top Hospitals list — an increase from the 16 HCA Healthcare hospitals recognized in 2021.

U.S. News & World Report’s Best Regional Hospitals

U.S. News & World Report recognized 14 HCA Healthcare facilities in its Best Regional Hospitals ranking for 2022-23. Additionally, nine of those facilities were ranked in the top three for their metro area.

Best Hospitals for Maternity Care

Money and The Leapfrog Group named 11 HCA Healthcare hospitals in their Best Hospitals for Maternity Care list, which includes those providing care for uncomplicated pregnancies and high-risk deliveries.

Read more about our organization’s quality care on HCA Healthcare Today.