Integration-Driven Quality Is Not A Myth

Co-Authored by Sonya Pease, MD, MBA, Chief of Quality, Safety, and Patient Experience of Cleveland Clinic Florida.

A recent study published in the New England Journal of Medicine has called into question the ability to achieve quality gains through hospital mergers and acquisitions. In a review of nearly 250 hospitals acquired in deals between 2009 and 2013, researchers looked at four performance measures and found that hospital quality stayed the same or worsened.

We cannot speak to the experience of other institutions, but we can say with unequivocal certainty that it has not been the Cleveland Clinic experience.

In January we marked the one-year anniversary of Indian River Medical Center and Martin Health System joining the Cleveland Clinic health system and the establishment of a five-hospital regional system serving southeast Florida. It was an incredible year of learning and collaboration and just the beginning of a multi-year integration process.

More than a simple sharing of name, our integration is a union of people, resources and best practices. The process has included team building, comprehensive planning, and intense communication and collaboration across all settings and levels of care. Our goal -- to deliver the same quality and experience of care at any Cleveland Clinic location, anywhere on the globe.

While still in the early stages of our integration, the benefit to patient care is already being felt across the region. Several preliminary indicators show early progress achieved through clinical and operational alignment within our regional system.

• Quality initiatives resulted in a 53 percent reduction in central line-associated blood stream infections and a 73 percent reduction in Clostridium difficile infections across the region over the last six months. 
• A maternal morbidity task force established in the spring saw a reduction in transfusions by 50 percent, reduced disseminated intravascular coagulation by 30 percent, and no cases of eclampsia in 2019.
• Sepsis mortality rate declined 9 percent across the region in the past six months.
• Patient satisfaction ratings for our Treasure Coast hospitals showed increases related to communication with physicians, nursing and overall teamwork following patient experience initiatives.

While full patient safety, satisfaction and outcomes data for 2019 will take several months to be compiled and reported, we believe these first-year achievements demonstrate that we are on the right path. We also expect to see more quality gains across the region in the years ahead through our continuous improvement efforts.

At the core of our success, and where others may have fallen short, is a strong cultural alignment and unified value system. Both Indian River and Martin Health were healthy organizations with great reputations and time-honored traditions prior to joining the Cleveland Clinic health system. Together we are all stronger.

Today our patients in Florida have access to the combined expertise of healthcare providers from a global organization that is 66,000 caregivers strong. Clinicians across the Cleveland Clinic enterprise are sharing best practices and working to improve outcomes by developing clinical protocols to reduce variation in diagnosis and treatment for thousands of diseases and disorders.

Can quality gains be achieved by working together? Absolutely. Is integration-driven quality a myth? Not when your team embraces a shared mission and is committed to providing the highest standards of care and excellent outcomes.