Reshaping inpatient care: efficiency and quality in New York City hospitals

Between 1992 and 1995, the United Hospital Fund engaged two groups of New York City hospitals in collective efforts to address crucial issues of length of stay and patient-centered care; the three-year, $1.1-million Length of Stay Initiative, which supported projects in seven New York City hospitals to identify and change practices that unnecessarily prolong inpatient stays; and the two-year, $700,000 Patient-Centered Care Consortium, through which 15 hospitals surveyed patients and received grants and technical support to design, implement, and evaluate improvements in meeting patients' expressed needs for more personalized care. Specific strategies and interventions developed and tested through the Length of Stay Initiative included continuous quality improvement programs to reduce delays and prevent duplication of diagnostic tests; clinical pathways to reduce unnecessary and inefficient variations in the treatment of common conditions and diseases; and a variety of other techniques, such as work redesign, diagnostic-specific clustering of patients, interdisciplinary design teams, and interdisciplinary rounds. Activities undertaken by the hospitals participating in the Patient-Centered Care Consortium included an initial survey of 3,423 patients and subsequent focus groups, individual interviews, and additional surveys to better understand the nature and causes of problems with care and to target, design, and test small-scale improvements. Among the first products to the consortium were patient education and information programs; daily treatment plans; improvements in the coordination of care and in teamwork among health care professionals; redesigned interpreter services, and improved methods of providing emotional support. Through their projects in the Length of Stay Initiative and Patient-Centered Care Consortium the participating hospitals learned some important lessons about what it takes to increase efficiency, improve the quality of patient care, and provide better service to patients. Strong leadership, institutional support, the involvement of medical staff, an interdisciplinary approach, an investment in staff training, the ability to work through resistance to change, systems and support for collecting performance data, and ways to evaluate how well improvements work were found to be especially key.