Clinical improvement starts with a plan

Douglas A Koekkoek

Doug Koekkoek
Chief executive, Clinical Services
Chief medical officer

Jan. 22, 2014

Recently I shared that The Leapfrog Group gave Providence hospitals more “A” grades for safety than any other health system in our area. Last month we learned that the organization has placed two of our hospitals – Providence St. Vincent and Providence Portland medical centers – among the top hospitals in the country.

These recognitions aren't just happy accidents – they're the result of focus and commitment from all of our caregivers. And that focus starts with our quality blueprint, the Clinical Performance Improvement Plan.


The CPIP is only a portion of the quality-improvement and patient-safety work that takes place in our region. Individual hospitals, specific nursing units, Providence Medical Group and the various service-line programs each has additional quality projects and goals. However, the CPIP assures that our region's critically important goals maintain a high profile.

For 2014, our top priority is to reduce unnecessary hospital readmissions. We have been focusing on this work for years and continue to develop care management infrastructures in our clinics, hospitals and now, specifically, for the Medicaid and uninsured populations.

This work includes our skilled nursing facility, or SNFist, rounding program; expanding palliative care consult services and standardizing hospital-to-home transitions.

New this year is an increased focus on population health measures. These metrics, used primarily in ambulatory settings, include cancer screening and optimal chronic-disease management. This work is critical if we're to deliver on our system's goal of creating healthier communities. We will rely heavily on our primary care physicians to achieve these aims.

Improving patient safety is another focus for 2014. Eliminating hospital-acquired infections, preventing pressures ulcers, preventing postoperative venous thromboembolism and reducing medication-related adverse events are critical.

Patient experience continues to be a priority. This year we'll be giving greater visibility to net promoter scores. These scores measure patient loyalty and are based on the “likelihood to recommend” question in patient surveys. The net promoter calculation subtracts the lowest scores from the top box scores. The formula will help us learn how many patients are impressed enough with their experience to “promote” Providence as a great place to receive care.

On mortality reduction, we'll begin to report 30-day hospital mortality rather than just inpatient observed-over-expected rates.

Finally, now that Epic is in place at all of our hospitals and employed clinics, we'll focus on optimizing and integrating electronic records into our quality improvement efforts. Going forward we'll focus on building performance reports and hardwiring decision support to advance the medical care we deliver.

None of these quality improvement efforts will be successful without the engagement and support of our clinicians. Providence has a great name in the community as the place to go for the highest quality in health care. We cannot rest on our laurels and expect to maintain that enviable position. So let's lock arms and together we can focus on these important quality priorities.

2014 Oregon Region strategy: What Providence's care (r)evolution means for providers