This is the Healthcare Delivery Providers, part of the Healthcare Marketplace Specialization. This is Module 2.2.1, Measuring Hospital Performance. The learning outcomes for this lecture are that we will understand the high-level themes along which hospital performance is measured. And also review some internal and external measurement frameworks. Value based purchasing, accountable care organizations. So here's the familiar Triple Aim. So the IHI Triple Aim right here, and then the fourth Quadruple Aim. So I really want you to start thinking about the measurement for all of the healthcare delivery providers along these four axes. So in Experience of Care, there is the clinical quality, and there is the patient satisfaction. So it's actually two different metrics, right, in Experience of Care. In Per Capita Cost, that's the financials. The Caregiver or Employee Resiliency. And then the orientation towards Population Health, or the measurement of performance or value creation for the attributed members of the population that a healthcare system or a hospital takes care of. So we'll dig into this more, but the first domain of hospital measurement comes along at the Hospital Quality Measures. So here's the hospital. There's various measurement paradigms, which are divided up into metrics. And then those are posted on a hospital compare website so that the end customer can view them and make decisions about the hospital. So that's the overarching framework of the hospital quality measurement system. We will discuss this more in the next lecture, but I wanted to start introducing you to the Hospital Value Based Purchasing Program, where there are different types of metrics, either process or outcomes. And those measures determine how much the hospital gets paid. They are reported up into the federal government centers for Medicare and Medicaid, and then the hospital reimbursement or payment is adjusted based upon the performance. The second important domain around which hospital performance is measured is the patient experience. We will discuss more the VBP in the next lecture, the Value Based Payment methodology. But the patient experience is measured again through the HCAHPS that we have discussed in the previous lectures. So it is a survey methodology that is collected by a third party, based upon the patients that were discharged from the hospital. And then those surveys are aggregated and sent in for analysis by the federal government. Let's do a brief quiz here. The third domain of measurement is obviously financials. So the efficiency metrics, or cost reduction, or expense reduction metrics. And the various types of measurements here could either be external measurements, and we will discuss those, either through the governmental agencies, or through commercial insurance companies, or through accountable care organizations. Or it could be internal financial metrics of revenue over expenses, and to calculate the margin or the bottom line. Another important measure for hospital performance is the engagement of the staff. And we'll discuss this a little bit here, so let's say the hospital org chart that we've discussed, there's all the CEOs, the CXOs and then here's all the physicians and here's all the nurses, And other staff. And it is very important to get an idea of the employee base. So all of these employees, are they satisfied with their work? What is the churn or turnover rate? How engaged are they in the strategies, the mission, and the vision of the hospital or the health system? And that can be easily done through a regularly administered staff engagement survey. And based upon that, if signs of burnout or disengagement are noted, then tactics to employ or deploy countermeasures can be put in place. At this particular point, as we have discussed, the hospital industry and the health system and the health industry is in such incredible time of change and transformation that keeping the staff very close, highly engaged, and well satisfied is going to be key to the success of long term sustainability of the entire health system as well as the hospitals. Some of the other issues to note around hospital performance measurement is that there is an increasing thrust towards transparency of metrics. So we talked about the hospital compare website, where you can go and check out any hospital within the US. And I would suggest and recommend for you, as you are going through this course, to go out to the hospitalcompare.org website and look at a couple of the hospitals and get familiarized with some of the metrics along the Triple Aim domains. Another important issue that is coming up is the issue of, are the hospitals responding to the community's needs that it serves? So there is a methodology and a paradigm of community health needs assessments that has been regulated and now mandated through the Internal Revenue Service. So a community health needs assessment needs to be performed by each and every hospital in the United States. Based upon those needs of the community, the hospital needs to develop action plans to serve the community in better and improved ways. And then finally, the issue of governance and board of directors oversight comes in. So the board really is responsible for every single metric that the hospital has, be it quality, or cost, or patient experience. And a highly engaged and educated board is critical in making sure that the hospital or the entire health system succeeds on its vision, its mission and really ends up serving its community and population and patients to the very best of its abilities. So in summary, the hospital performance also can be measured according to the IHI Quadruple Aim and along those four domains. However, as we will discuss in the upcoming lectures, there are many different paradigms which can sometimes be confusing to the end customer around these measures. And so there is active work happening right now to streamline and align some of these disparate measures, so that they become easy to understand for the end users. Either the patient, the family, or even the staff, for example, the nurses and the physicians.
