Huntsville Hospital Case Study

Huntsville Hospital (HH), located in Northeast Alabama, is part of the Huntsville Hospital Health System, originating in downtown Huntsville, Alabama in the late 1800’s. As the not-for-profit, public hospital system developed, HH became the second largest employer in Madison County, Alabama with an estimated 7000 employees, 2000 nurses and 1000 physicians.
Nine separate campuses constitute the Huntsville Hospital Health System representing more than 1500 hospital beds, a level 1 trauma center and a regional referral center. All healthcare specialties are represented with the exception of burn and transplant medical care, while the emergency room at the main campus provides 85 beds averaging 155,000 annual visits. Education is a large part
of the HH organization as residents, interns, and nursing students are provided learning opportunities daily. The fifth largest U.S. public owned hospital system, Huntsville Hospital, governed by an appointed board known as the Health Care Board of Authority of the City of Huntsville (HH 2015). Many levels of managers, directors and the leadership team consisting of a chief executive officer, chief operations officer, chief quality officer, and a chief medical officer oversee day-to-day operations.
All of which are under the management of the Health Care Board of Authority.
According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the definition of quality exists as the level of health services for populations must be current with real-time professional knowledge providing desired health outcomes (JCAHO 2015). Huntsville Hospital’s strives to provide excellence in health care maintaining a mission to provide quality care that improves the health of the patients we serve (HH 2015). The Quality Assurance program of Huntsville Hospital (HHQA) is an ongoing systemic evaluation of health professionals and the health services serving our patients and community and the impact of those services. The focus of the HHQA continues to be on customers, leadership, and involvement of staff. However, also, visualized as components of the evaluations are structure, process, and outcomes both with internal and external quality assurance and improvement. For example, structure evaluation reveals the hand hygiene system in use, while the process evaluation shows staff performing recommended care based on professional standards of care (Dejonge et al. 2011). Lastly, the outcomes evaluation provides
information that is of the utmost importance to patients and assist patients in choosing facilities. Instead of identifying a failure in quality of a select service and then correcting it, instead HH focuses on continuous quality improvement (CQI) measures allowing for statistical information to continuously analyze data and engage in continuous improvement. For example, one of HH’s CQI continues to be the improvement of Ventilator associated pneumonia (VAP). In the last decade, the implementation of a national protocol that incorporates best practice or guidelines continues to assist HH in obtaining closer to the goal of zero VAPS. Secondly, the desire to eliminate urinary tract infections created an opportunity to follow another mandate and guidelines producing outstanding results in reducing UTIs. HH produces once a year a quality report disbursed to the public explaining quality areas of focus and the trend of results, along with public education in the hospital’s and patient’s roles. HHQA uses the process of plan, do, check, and act cycle allowing protocols to be developed, put in place, check to see if they are working and then respond to the results. CQI focus on the processes rather than one particular person or group of people that might be at fault allowing increased buy-in by staff and ultimately better outcomes.
External quality assurance agencies assist HH in obtaining the deliverance of high quality health care. For example, two external quality assurance tools used by HH continues to be the Hospital Consumer Assessment of healthcare providers Systems (HCAPPS), and Joint Commission Accreditation. In 2006 Huntsville Hospital began using the HCAHPS in order to collect information and measure patient’s perspective of quality and service based on national standards. By using this patient survey tool, HH has been able to improve quality of care, quality of the workplace, and increase the hospital’s transparency. Secondly, Centers for Medicare and Medicaid Services (CMS) and Joint Commission, JCAHO, provides Core Measures and mandates followed by HH in the areas of strokes, acute myocardial infarctions, congestive heart failure, and deep vein thrombosis as well as others. Core measures are used as quality indicators, showing HH how to prevent recurrences and reduce the risks of complications. Set guidelines are in place, followed by physicians and staff, evaluated, and publicized.
Hospitals strive for the goals of high quality patient care and to experience zero ” never events”.
Huntsville Hospital strives for perfection as well, unfortunately “never events” have occurred within the walls of the hospital. The National Quality Forum literally defines a “never event” as a preventable adverse event occurring in a health care setting that should never happen; like, wrong site surgery, patient falls, and medication errors as examples (Gitlow et al., 2013) A patient admitted to the hospital to receive right wrist surgery woke up with surgery to the left wrist. The event was researched, evaluated, reported, and resulted in changes within the institution. A malpractice case filed against the surgeon and the hospital existed and was settled. The adoption of the mandates of JCAHO allowed for implementation within Huntsville hospital to prevent wrong site surgery consists of many valuable steps such as; asking the patient what surgery and where, marking the surgical site with a permanent marker or using the alternative site marking form to identify, limb alert bands, and also the time-out, allowing anyone involved in the patient care to stop the procedure to ensure accuracy. The responsibility to improve quality patient care is assigned to each individual employee that works for a facility and will proceed in continuing to develop even higher quality, on top of the existing quality, CQI (Hashmi
2015).
Huntsville Hospital exhibits the drive to provide high, quality health care to the surrounding population with safety, innovation, transparency, and people. Continuing to improve the quality of care for the population served allows Huntsville Hospital to strive for the best health care systems in America in clinical care and customer service.