Pathway to Proven Performance

Our transformational model “Living and Leading with Love” has helped University Hospitals receive the American Hospital Association (AHA) Quest for Quality Award and the International Hospital Federation (IHF) Leadership and Management Award (representing 160 countries). This model is simple and practical, yet informed by thousands of years of wisdom traditions as well as management and innovation theory. Click here to listen to examples on how UH is living and leading with love.

A core element in this model is to encourage our caregivers to “Believe, Belong, and Build.” We seek to ensure that all of us, across the entire spectrum of healthcare, believe our job is to improve value. We want all healthcare staff to be respected for their wisdom and brilliance, and be inspired to improve.

Healthcare workers enter this field inspired to help and comfort patients, to guide them through the often confusing and sometimes terrifying journey to recovery. We want to support and encourage this inspiration and unleash the great potential that exists in all of us. For every improvement effort, we create a learning community in which every person who has an impact on care has a voice in improving it. We support the free flow of ideas from all levels, departments and sectors of healthcare.?

We are all connected, and it is that connection, not our individuality, which gives us strength. Belonging to a greater good empowers us and accelerates innovation and improvement. It helps inform management and increases accountability.

We won these awards not just for our framework, but for the results it produced. This approach is a path to proven performance. Use it and you will improve. We applied it to more than 100 projects and are adding more, resulting in improvements in care not previously thought possible.?

Over the last year, we have made the following improvements:

• Reduced our observed to expected length of stay (LOS) from 1.31 to 1.16 days, our lowest levels ever, and all hospitals improved. Impressively, UH Cleveland Medical Center (CMC) reduced its LOS from 1.67 to 1.44 and the CMC hospitalists reduced LOS to 1.01. Fifty-five percent of patients now have a length of stay below the geometric mean length of stay, which dictates how Centers for Medicare and Medicaid Services (CMS) reimburses.
• Started a healthy-at-home virtual clinic a year ago to reduce costly readmissions. We now have more than 440 patients per month enrolled and an average daily census of 150.?
• Reduced denials among all payors from 4 to 2 percent.?
• Increased the percent of patients who have daily mobility from 42 to 64.8 percent.?
• Increased the percentage of patients scheduled with a follow-up visit from the emergency department from 2 to 20 percent.
• Increased enrollment in Enhanced Recovery After Surgery (ERAS) across 16 service lines in all UH hospitals from 59 to 68 percent.?
• Demonstrated that we can far outperform benchmarks when we ensure all patients receive high quality care by reaching an amazing 0.89 observed LOS for ERAS at the system level and 0.93 at CMC.

Over the last two years, we have made the following improvements:

• Decreased length of stay for surgery patients from 6.3 to 2.3 days.
• Reduced sentinel events by 80 percent.?
• Reduced 2,500 patient days by implementing direct pre-certification with payors.
• Retired 2,500 policies where the burdens exceeded benefits and cost caregivers and managers precious time.?
• Over the last three years, we have made the following improvements:
• Increased annual wellness visits from 60 to 80 percent.
• Increased the percentage of patients with controlled diabetes from 71 to 83 percent.?
• Increased the percentage of patients with controlled hypertension from 67 to 75 percent.
• Increased breast cancer screenings from 64 to 81 percent and increased colorectal cancer screenings from 57 to 74 percent.
• Finally, we saw that an amazing 92 percent of patients scheduled a follow-up visit before leaving an appointment.

Over the last five years, we reduced the annual cost of care for Medicare patients in Shared Savings Program by 33 percent and realized $170 million in shared savings.?Last year alone we realized $50 million in shared savings and quality incentives across our various payers and programs.

Over the last eight years, the annual number of catheter-associated urinary tract infections decreased from 92 to 10.?

In addition, our medication safety measures are hitting it out of the park. These measures were flat for several years until 2023 when we began reporting performance back to individual nurses. Now our compliance with medication safety measures 95 percent.

These are just a few examples of the results we are achieving together across our entire healthcare system. They all use the same transformation model “Living and Leading with Love” and encourage teams to “Believe, Belong, Build.”?When visiting these units or clinics, you feel the energy. It feels different.? And while we are seeing amazing strives forward, we still have work to do.

We need to continue to reduce harm, suffering, waste and inequities. The good news is we have found a path forward. Our model is simple and practical yet informed by thousands of years of wisdom traditions as well as management and innovation theory. When we leverage the power of love within and between people, everything is different. We improve better, faster and cheaper. To provide the kind of care that patients deserve, the public demands and payors desire, we need every UH caregiver to live and lead with love. Please join me on this journey.

With gratitude,

Peter J. Pronovost, MD, PhD, FCCM