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Loudoun Hospital aims to improve through transparency, talking to patients

By Jim Barnes,

Inova Loudoun Hospital has begun two programs to increase transparency and gather feedback from patients in an effort to improve quality.

The public can view a quarterly report on the hospital’s Web site, www.inova.org/ilh, that summarizes how Inova Loudoun is doing with respect to national standards, hospital officials said. The hospital is also surveying patients and meeting with small groups of patients and family members.

Martha Calihan, chairman of the hospital’s board of directors, introduced the quarterly report as a “Compact With the Community” in an Oct. 11 announcement.

“Everybody is measuring the metrics. That’s standard,” Calihan said in an interview. “I think we’re pushing the envelope a little bit by being proactive. That’s our intent, to be proactive about this and to be transparent.”

Calihan said that although the information in the report was available to the public before, “it’s just not easy to access, and I don’t think it’s intuitive for people to go looking for this sort of data.”

The first part of the report covers how well the hospital follows commonly accepted procedures for surgical care and in treating heart attacks, heart failure, pneumonia and children’s asthma.

For example, it is standard practice that within 90 minutes of arrival, a heart attack patient receives an angioplasty, which removes artery blockage. At the time of discharge, the patient is given an aspirin to prevent blood clots and a prescription for a statin, which lowers cholesterol.

The national benchmark is 100 percent of these procedures. Inova Loudoun’s percentages in the first six months of 2012 were 94 percent for meeting the angioplasty standard, 99 percent for providing aspirin and 100 percent for prescribing a statin at discharge.

On every measure in the report, with the exception of children’s asthma, which Calihan said is based on a very small number of patients, the hospital’s percentages ranged from 94 to 100 percent.

The report will be expanded to include measures on immunizations and the emergency department “when we have the good comparative data,” hospital chief executive H. Patrick Walters said. The data in the report allow comparisons over time, to see whether the hospital is improving, and also to other hospitals that collect the same data, he said.

The second part of the report looks at outcomes, including readmission rates for certain illnesses and “hospital-acquired conditions,” such as rates of infection and injuries from falls.

The report showed that the number of hospital-acquired conditions decreased from 10 in 2010 to six in 2011, to two in the first half of last year.

The report also summarizes the results of a survey of patients about their hospital experience. Walters said that the survey, administered annually to about 500 patients, is based on national benchmarks.

The survey measures patients’ satisfaction in areas such as communication with nurses and physicians, responsiveness, pain management, communication about medication and discharge instructions. Inova Loudoun’s ratings on these measures, ranging from 57 percent to 84 percent satisfaction, were close to national averages.

“Our immediate goal is to get to the 75th percentile,” Walters said. “As a system, specifically at Inova Loudoun, our goal is to be performing in the top 10 percent in any measurable, clinically appropriate, patient appropriate metrics that we can develop. So we are looking at measurement and targeting how we get from wherever we are to that top” 10 percent.

Calihan said that although numbers are important, they do not tell the whole story.

“You can have all the measures, and actually do pretty well on those measures, [but] what the patient and family member might experience in our care can still be different,” Calihan said. “When somebody leaves here and has a really good feeling — or not a really good feeling — about what happened to them, it may or may not have anything to do with those numbers that we have shown in the report.”

At Calihan’s suggestion, the hospital formed a Patient Experience Committee to meet with small groups of former patients and their family members to discuss their hospital experiences.

“It gives us a different insight, a real qualitative insight to connect to the quantitative results that we get,” Walters said.

He said the hospital has changed some procedures based on comments from the small group meetings, addressing issues in areas such as room noise, communication, admission procedures and billing.

After Leesburg resident Madelyn Hetherington, 44, underwent a double mastectomy May 16, she and her husband were invited to meet with the Patient Experience Committee, along with two or three other couples. She said that the meeting began with “a wonderful buffet dinner” in a hospital conference room and that doctors and hospital administrators sat with them, rather than across the table.

“It was such a feeling of having your voice heard,” Hetherington said. “I don’t know any other hospital that does that.”

Other participants in the meeting raised concerns about the care they had received.

“If some questions came up, [hospital officials were] definitely jumping on it and saying, ‘We’re going to look into that,’ ” Hetherington said.

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