What health reforms can be implemented in hospital settings?

Hospital Health Reforms for Improved Patient Outcomes

Building a quality improvement culture and implementing system-wide changes are essential health reforms that hospitals should prioritize to reduce mortality, decrease complications, and enhance patient quality of life. 1

Building a Quality Improvement Culture

• Quality improvement should be integrated throughout the hospital system, not isolated to specialized QI staff, with health workers actively identifying problems and developing solutions before incorporating them into health systems 1
• Medical education institutions should incorporate QI principles into teaching, exposing students, interns, and nurses to models of good medical practice that will establish patterns for their entire careers 1
• Implementing continuous in-service education and training programs helps introduce quality improvement tools and methods into everyday practice 1
• Cross-cutting, system-level interventions are more effective than vertical program approaches that create parallel systems for different conditions (HIV, TB, etc.) 1

Implementing Patient Safety Programs

• Hospitals should establish dedicated safety teams with proper governance structures to act as catalysts for developing a culture of safety 2
• A multidisciplinary approach to serious safety events (SSEs) reduction can lead to significant decreases in adverse events and improvements in patient safety culture 3
• Implementing specific tactical interventions for high-risk areas, along with visible "lessons learned" programs, helps prevent future errors 3
• Creating an environment where healthcare professionals feel comfortable reporting errors allows hospitals to identify systemic problems and implement proactive measures 4

Addressing Healthcare Disparities

• Hospital reforms should specifically target underserved populations including older patients, women, minorities, those with low socioeconomic status, and individuals with lower education levels 5
• Quality-enhancing policies should include service referrals as "core" quality-of-care measures with public reporting of each hospital's adherence to performance measures 5
• Hospitals should assess social determinants of health including food insecurity, housing insecurity, financial barriers, and social support when making treatment decisions 5
• States should implement essential health benefit packages that ensure meaningful coverage of rehabilitation services for Medicaid expansion populations 1

Improving Hospital Readmission Rates

• The Hospital Readmissions Reduction Program (HRRP) should be adjusted for patient attributes associated with higher readmissions, including socioeconomic status, to avoid creating disincentives for hospitals to care for high-risk individuals 1
• Risk adjustment models should incorporate information from additional sources, including electronic health records, to better account for disparities 1
• Hospitals should implement robust qualitative and operational research regarding structures and processes of care within pragmatic trials to determine best practices for reducing readmissions 1
• Transparency should be maintained by reporting raw hospitalization and mortality rates among other patient-centered outcomes for underperforming hospitals 1

Standardizing Clinical Practices

• Hospitals should adopt and adapt evidence-based clinical guidelines as national standards, with translation, training workshops, and incorporation into undergraduate and post-graduate courses 1
• Implementing structured medical records, internal audits, performance-based accreditation systems, and mortality monitoring systems can significantly improve quality of care 1
• A hypoglycemia management protocol should be adopted and implemented by each hospital, with established plans for preventing and treating hypoglycemia for each patient 1, 6
• Treatment regimens should be reviewed and changed when blood glucose values fall below 70 mg/dL to prevent recurrent hypoglycemia 1

Enhancing Patient Experience and Satisfaction

• Hospitals should implement bedside care coordination rounds, medication best practices alerts, post-discharge follow-up calls, and frameworks for provider-patient interactions to improve patient satisfaction 7
• Patient health status surveys should be incorporated into national surveillance to ensure comprehensive assessment of health outcomes and treatment impacts 5
• Hospitals should promote shared decision-making with focus on quality of life outcomes 5
• Care teams should avoid therapeutic inertia and prioritize timely and appropriate intensification of lifestyle and/or pharmacologic therapy for patients who have not achieved recommended targets 5

Scaling Up Quality Improvement Initiatives

• Approaches to quality improvement should be tailored to local circumstances, with standard tools serving as starting points for adaptation, implementation, monitoring, and revision 1
• Ministries of Health should review current policies, standards, and programs, develop stakeholder lists, and identify coordinators across sectors 1
• Information gathering through surveys assessing quality of care in sample hospitals helps define local and national problems and priorities 1
• Stakeholder meetings including government representatives, educational institutions, healthcare providers, and administrators should develop consensus on priorities and ways forward 1

Common Pitfalls to Avoid

• Avoid viewing quality improvement as an expensive luxury; many approaches demonstrate that important advances can be made cost-effectively 1
• Don't rely solely on litigation and discipline for safety improvement, as they drive needed information underground and complicate cultural change 8
• Avoid fixed treatment protocols that don't match individual patient needs, particularly in areas like diabetes management where personalization is crucial 1, 6
• Don't delay implementation of safety measures waiting for perfect solutions; even simple safeguards can make significant differences 8