What best practice medicine can do to improve health care quality

Last year marked the historic passage of health care reform. As provisions of the act begin their multiyear phase-in, health care organizations are clamoring to identify new and better ways to deliver the highest quality of care and improved clinical outcomes in a cost-effective manner.

Smart Business turned to MemorialCare Health System President and CEO Barry Arbuckle, Ph.D., whose organization has gained national attention as a unique model for establishing outstanding clinical care through best practice medicine.

What is best practice medicine?
Approximately 15 years ago, a group of MemorialCare physicians decided to make a difference in the way health care is delivered. They believed that quality — and not economics — was the most important element in health care.

Today, the physicians at MemorialCare continue to lead teams of nurses and other clinicians devoted to the study and implementation of best practice, evidence-based medicine. Together, they identify the best diagnostic, treatment and preventive techniques, focusing on specific populations of patients and a wide variety of diagnoses and procedures. These include heart care, emergency medicine, cancer, orthopedics, childbirth, pulmonary disease and scores of other medical conditions. The best practice clinical guidelines that develop from these efforts have become standards of practice at all of our Southern California facilities.

How does it affect outcomes and cost of care?
While these accomplishments in clinical excellence ultimately translate to lower cost of care, more importantly, they translate into extraordinary quality, proven treatments and comprehensive care that continually raise medical standards for our patients. We are constantly improving our efficiency and effectiveness and profoundly impacting our patients and their families. By pursuing those treatments and therapies that work best, the results are outcomes that frequently exceed state and national averages for most diseases.

What has been the impact on staff?
An empowered and powerful network of clinicians and support staff works in the best interest of every patient. With shared purposes and bold goals to achieve perfect care for our patients, every health care team member is devoted to aligning safety and quality aims, while also offering support and continually learning from one another. And the Physician Society — that includes 2,000 physicians and drives our clinical standards and performance — issues report cards to its members so they can track their progress in surpassing state and national outcomes. Quality, safe health care and a passion for excellence remain MemorialCare Health System’s top priorities, keeping us clearly focused during challenging times.

Can we expect other changes in patient care?
As the United States enters an era of transformation in health care delivery, hospitals are redesigning the way they provide patient care. For our health system, care model redesign is being guided by the principles of perfectly executed care by the right people at the right time. We’re ensuring the most qualified person is closest to the patient to provide perfect care and reduce duplication — all at the lowest cost. It’s about streamlining the way we provide inpatient care and also offering ambulatory services outside of the hospital to help patients manage chronic disease and stay healthy.

What’s the role of digital patient records?
Electronic medical records, or EMRs, are critical to patient quality and safety. EMRs place a patient’s full medical history onto computers and information systems, which allows clinicians to better coordinate care through immediate access to patient data. This maximizes clinical quality through real-time decision support at points of decision-making and also eliminates most paper used in patient documentation. Paper records can slow care and create environments that are ripe for error. Efficient electronic care delivery prevents unnecessary orders and diagnostic tests, reduces medical errors and improves patient quality, safety and health. MemorialCare is among a small percentage of hospitals nationwide to implement fully integrated medical records linking inpatient, emergency and outpatient patient records at all our major sites.

How can employers help ensure quality care for their work force?
Learn about the steps hospitals and physicians are taking to improve health care in your community. Do they have best practice teams design and implement best practice tools, offer education and monitor outcomes and opportunities for further improvement? Are clinical outcomes documented and, if so, easily accessible? Have or will they shortly be implementing comprehensive electronic medical records in inpatient and ambulatory settings that interface with affiliated physicians? How intensive is their focus on supporting a strong culture of patient safety and vigilance? What procedures have they implemented to reduce hospital acquired infections and risk of complications? And what awards and recognition have they received for quality and safety performance?

BARRY ARBUCKLE, Ph.D., is president and CEO of MemorialCare Medical Centers (www.memorialcare.org) and past chair of the California Hospital Association. Reach him at arbuckle@memorialcare.org or (562) 933-9708. The not-for-profit MemorialCare Health System includes Long Beach Memorial Medical Center, Miller Children’s Hospital Long Beach, Orange Coast Memorial Medical Center in Fountain Valley and Saddleback Memorial Medical Center in Laguna Hills and San Clemente. For additional information on excellence in health care, please visit memorialcare.org.