In 2003, Sacred Heart Medical Center leaders faced several challenges seen through its emergency department (ED). Patient satisfaction levels were average at best. Ambulance diversion seriously impacted patient care. ED volume continued to rise. A lack of inpatient functional capacity exacerbated the problems.

It was the typical ED. Too many patients left before even being seen by a clinician. Patients waited for 2-3 hours just for the next step in the ED process, then waited even longer for admission to the hospital. No one staff member owned the process of moving patients through and out of the department. Everyone managed the patient within his or her own "silo" or sphere of influence.

Additionally, Sacred Heart Medical Center (SHMC) faced low reimbursement rates and significant increases in charity care and uncompensated care due to increased numbers of uninsured. A majority of uninsured/underinsured patients entered the hospital through the emergency room, and the ED was jammed to the point where ambulance diversion reached 20 hours per week. SHMC was losing patients and revenue to other hospitals.

With their ED often the gateway to the hospital, leadership recognized the need to improve operational performance in order to increase patient satisfaction, recapture revenue, remain competitive in the marketplace, and attract and retain high quality committed nursing staff.

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Spokane, Wash. — Sacred Heart Medical Center has been named one of the top four performers in a nationwide groundbreaking Centers for Medicare and Medicaid Services (CMS) / Premier Inc. project. As part of the pay-for-performance project, CMS awarded incentive payments of $8.7MM to 115 top-performing hospitals for delivering higher quality care in five clinical areas.

Launched in 2004, the CMS/Premier "Hospital Quality Incentive Demonstration" helps participating hospitals improve the quality of care in treating acute myocardial infarction (heart attack), heart failure, coronary artery bypass graft, pneumonia, and hip and knee replacement.

"Sacred Heart has sustained its improvements since the program's first-year review, and now has been rated in the top 10 percent for treatment of heart attack and heart failure and in the top 20 percent for treatment of patients undergoing coronary bypass surgery," says Denise Dominik, the Medical Center's director of Performance Improvement.

As a result of these top-quality results, Sacred Heart will receive a bonus payment of more than $256,000—the fourth highest amount awarded to any hospital.

"The success we achieved in our clinical quality indicators is definitely supported by the comprehensive changes we have made in patient care processes," said Elaine Couture, COO of Sacred Heart. "Without fixing processes enterprise-wide, I do not believe we would have the opportunity to continue with or sustain those levels of quality."

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