At Texas Health, we know patients and consumers have more choices for their health care needs than ever before.

We also know consumers want quality, affordable and seamless care close to home. Delivering an exceptional consumer experience not only builds trust, it also improves our patients’ outcomes, lowers costs and reduces readmission rates — all things that are essential to fulfilling our Mission, Vision and Values.

An Exceptional Care Experience

We strive to provide an exceptional care experience focused on evidenced-based service strategies and characterized by compassion, clear communication and care navigation. We provide extensive training and coaching to embed adoption of these strategies and continuous improvement.

Consumer Satisfaction (%)
Goal: We strive to achieve top decile performance in consumer experience and earn the lifetime loyalty of the people we serve.
Awards and Recognition

The following Texas Health entities received Press Ganey’s Guardian of Excellence Award® for achieving the 95th percentile for patient experience:

Texas Health Harris Methodist Hospital Southwest Fort Worth also received the Pinnacle of Excellence Award® for high levels of excellence over three years in patient experience.

2017 Performance

To drive excellence and make it easier for patients and consumers to navigate our health care system, we spent the year realigning our consumer experience functions and programs. For example, we started expediting the discharge process by completing many tasks ahead of time, such as filling prescriptions, pre-ordering home medical equipment and consulting with families on care follow-up.

To gain deeper insights into consumers’ wants and needs, we began measuring their experiences differently. Instead of simply assessing overall satisfaction, we are asking questions to learn more about what occurred throughout their entire experience with Texas Health. This information will help us shape and refine our strategies moving forward.

Texas Health Physician Group (THPG) includes more than 830 physicians, physician assistants, nurse practitioners and medical professionals who provide primary and specialty care. To drive performance improvement and strengthen consumer experience, THPG launched an online rating service to allow people to rate their interactions on a scale of one (lowest) to five (highest), as well as provide comments about their experience.

Physician communication behaviors included the consistent review of the patient’s pertinent medical history, communicating clearly with the patient while providing easily understood instructions and spending adequate time with the patient while listening attentively and respecting their input. Access to care behaviors included the ability to make an appointment as soon as needed, providing answers to medical questions via phone as soon as needed and appointment wait times. This feedback is helping THPG providers respond to questions or address service issues.

Consumer Experience Ratings (%)

We have an ethical and moral obligation to provide the highest quality of care — to every single person we care for, every single time. Reducing variation in how care is delivered improves health outcomes, lowers costs and reduces readmissions.

As part of our journey to become a high reliability organization, Texas Health is working to consistently provide a safe, quality experience to our patients each time they visit any of our hospitals, outpatient facilities, wellness centers or physician offices. This work is intentional and strategic, requires extensive research and literature reviews to identify evidence-based best practices, and involves the expertise of our administration, clinical leaders, employees, as well as safety and quality improvement teams across all facilities.

We deploy numerous strategies to provide safe and quality care. In addition to enhancing the consumer experience, these primarily include:

Care Design
Reliable Care Blueprinting™ brings together physicians and staff to break down silos, collaborate on best practices, innovate and create a foundation of high-quality standardized processes for various care procedures. Standardizing our approach allows us to consistently deliver evidenced-based care. We apply it to everything from how we take a patient’s vitals, to treating sepsis, to processing lab specimens, to how best to prevent a patient fall. To drive ongoing improvements, we review industry benchmarks, share lessons learned and set more aggressive performance goals.

Patient Engagement
Actively listening, observing and communicating with patients and their families are essential to providing better care experiences and health outcomes. Through our intake and discharge process and regular rounding, our care teams engage patients to drive alignment and understanding of their care regimen. This also helps us identify individuals at risk for poor self-management and readmission based on their health history.

Care Management
Care management focuses on coordinating care and helping patients and caregivers more effectively manage health conditions. At Texas Health, clinical nurse leaders (CNLs) oversee this effort. With master’s degrees in nursing, CNLs work with unit managers, physicians and bedside nurses at all wholly owned hospitals to improve care delivery. This helps to align the entire care team on care plans and follow-up requirements. This approach has led to faster discharges, fewer hospital-acquired infections and reduced readmissions.

Care Transition
We design care transition plans based on patients’ unique needs, their support systems and network of providers. Prior to discharge, we share patients’ health histories and care plans with other providers to align on their follow-up care and monitoring. Effectively managing patients’ transitions from hospital to home helps us improve health outcomes and reduce their length of stay and likelihood of readmission.

Care Navigation
Our patient navigators help people newly diagnosed with a serious or chronic health issue, or who face a long recovery from an injury or illness, from getting overwhelmed. They help patients find and receive health services, coordinate appointments, send medical records, arrange for translators, assist with paperwork and more. After discharge, they also follow-up with patients to confirm they are receiving the care and attention they need.

Infection Prevention
Our team of infection preventionists helps protect patients, employees and other caregivers from health care-associated infections. From handwashing, requiring masks, gloves or gowns, and ensuring sanitary equipment and tools, they put infection-prevention processes in place and monitor enforcement.

Goal: We aim to improve the delivery of quality, coordinated and reliable care systemwide. We also set annual quality and safety goals, such as reducing patient readmissions and hospital-acquired infections.
2017 Performance

Texas Health has deployed more than 30 care modules for treating sepsis, rapidly identifying and managing infections, screening for emerging diseases, preventing urinary tract infections, improving outcomes for hip-and-knee replacements and more. We spent much of 2017 training clinical teams on care design processes and ensuring their adoption. Preliminary analysis shows the modules are effective in improving care. Care management provided by our clinical nurse leaders and clinical teams helped reduce patients’ average length of stay from 5.0 days to 4.76 as well.

Also during the year, we sought to reduce the unnecessary use of long-term acute care and acute rehabilitation due to its high cost. We introduced a module to help identify eligible patients who could receive follow-up care in a more efficient and effective setting. This helped us not only save money, but also reduce readmissions by 4 percent for patients who went to skilled nursing facilities and 16 percent for those who went to acute rehabilitation centers.

Working with Texas Health Physician Group, we also created a network of skilled nursing facilities to help patients get back on their feet. This too reduced readmissions by 10.5 percent for this group of patients. For current quality performance data, please see our Quality and Safety Report.

All-Cause Readmission Rate (%)
Recognized for Nursing Excellence

In 2017, we had the privilege of recognizing all wholly owned Texas Health hospitals for excellence in nursing. Five of our largest hospitals achieved Magnet® designation, which is awarded to exceptional organizations that meet the American Nurses Credentialing Center (ANCC) standards for quality patient care, nursing excellence and innovations in professional nursing practice. This designation must be re-earned every three years. The ANCC designated 10 smaller hospitals with Pathway to Excellence® status, which recognizes positive practice environments where nurses excel.

Recognized for Quality Care

Texas Health Harris Methodist Hospital Southwest Fort Worth and Texas Health Harris Methodist Hospital Alliance were named Watson Health 100 Top Hospitals® from IBM Watson Health based on their patient care and satisfaction, operational efficiency and financial stability.

Opioid addiction is the largest preventable cause of death in the U.S. – and is reaching epidemic levels.

Declared a public health emergency, a person dies from an opioid overdose approximately every 12 minutes1 and opiates contribute to additional fatalities and injuries. The economic impacts of opiate addiction also are enormous – costing $504 billion2 in 2015 alone for hospital costs, treatment, lost productivity and other factors.

Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and prescritpion pain relievers such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine and more.

In Texas, the number of opioid addicts is escalating and will continue to grow, according to Gary Malone, M.D., an addiction psychiatry specialist and member of the medical staff at Texas Health Arlington Memorial Hospital.

“These drugs are being prescribed daily, they enter the country illegally through drug cartels or people can even order them online from China,” he said.

Developed originally to control pain in terminally ill patients, opioids create a euphoric high. However, it takes higher doses to reach that high each time the drug is used. Prescribed opiates should only be taken a few days, or the risk of addition escalates.

“Just taking two, 15-milligram doses of OxyContin twice daily doubles the risk of mortality,” said Glenn Hardesty, D.O., a member of the medical staff at Texas Health Plano.

“What people don’t realize is that opiates are so addictive that most people will die before they can receive treatment,” Dr. Malone said.

State and federal lawmakers have introduced legislation to prevent overprescribing these painkillers and to increase funding for treatment and monitoring programs. But for the millions of people already addicted to opiates, this support may come too late. Their best chance at survival is a nasal spray known as Narcan®, which can instantly reverse the effects of an overdose. The U.S. surgeon general issued an advisory urging Americans to have the drug on hand to help those who may need it.

“Even though first responders and ambulances carry Narcan, they often are too late,” Dr. Hardesty said. “We need to put this in the hands of everyone and advocate for its widespread distribution. At our wholly owned hospitals, we’ve issued a standing order for nurses to administer Narcan to overdose patients immediately.”

While Narcan gives addicts the opportunity to live another day and hopefully enter treatment, only about one in 10 people receive the help they need3. This is due to the high costs or a lack of insurance coverage4. The cost to treat patients suffering from opioid dependence is more than 450 percent higher than for ordinary patients5. Rehabilitation centers offer financing plans, but costs for a 30-day program can range from $6,000 to $20,000 – or much more6.

For those who can be treated, qualified recovery centers often are at capacity.

“The state of Texas does not currently have the resources to deal with this problem,” Dr. Malone said. “Those seeking help are put on wait lists.”

Texas Health is the largest provider of behavioral health services in North Texas. It offers access to comprehensive mental, psychiatric and behavioral health services in both inpatient and outpatient settings across the Dallas-Fort Worth area. The Texas Health Recovery & Wellness Center also helps patients who need long-term treatment and recovery.

Dr. Hardesty chairs an opioid workgroup that is identifying additional strategies the health system can take to reduce opioid-related deaths. One strategy is to change how often opiates are prescribed – and to whom.

“Responsible prescribing is one of the cornerstones of addressing the issue,” he said.

This entails identifying patients who are have been prescribed opiates so alternative therapies can be administered. Strategies also may include setting limits on the duration prescriptions can be taken and altering order sets so that non-narcotic painkillers are given first.

The workgroup also is assessing technologies that can help clinicians quickly access patients’ prescription histories as well as tools that can embed prescription guidelines into electronic health records. Workgroup members will share their recommendations with senior leadership and hope to start implementing measures very soon.

From working on the front lines within the emergency department to collaborating with community health agencies, addressing the opioid crisis is part of Texas Health’s Mission to improve the health of the people in the communities we serve. To learn more about this crisis, listen to our podcast.

According to the Institute for Healthcare Improvement, four in 10 adults have experienced or known someone who experienced a medical error. Of these, 73 percent suffered a long-term or permanent impact on their physical or emotional health, financial well-being or their family relationships1. The cost of these errors is enormous. Each year, about 2 million errors and adverse events cause 100,000 deaths and increase health care costs by about $136 billion2. Considering these statistics, it is incumbent on not only Texas Health, but the entire health care industry, to keep patients from being harmed while under our care.

Consistently Providing a Safe Experience

As part of our journey to become a high-reliability organization, we are working to consistently provide a safe experience for our patients each time they visit a Texas Health facility. We are accomplishing this by strengthening our culture and processes to reduce system failures and respond effectively when they occur.

We brought the best of our strategies together in an “error prevention toolkit,” which provides a means for clear and concise communication between caregivers. We also use a reliability learning tool to capture safety events and incidents more accurately — such as falls, sepsis or hospital-acquired infections – so that we can accelerate improvements where needed. Having robust data helps us identify the root cause of these events so that we can act to prevent their reoccurrence. While we have deployed evidenced-based tools and strategies to protect patient safety since our inception, we routinely assess these approaches to make necessary refinements or to introduce new methods that are proven to be more effective.

Goal: Our goal is zero harm.
2017 Performance

To complement our patient safety and error prevention strategies, we implemented a reliability coaching program during the year. Coaches engage and positively reinforce the use of our error prevention tools with their peers with the goal of further reducing harm. We document these interactions and assess how the tools are being used so we can identify opportunities for improvement. This also has helped increase reporting of events and near-misses, which helps us identify trends and gaps in practices.

Also during the year, we enhanced how we are analyzing adverse events to drive consistency in how we manage them. Data about our current safety performance can be found in our Quality and Safety Report.

Texas Health Harris Methodist Alliance also received the 2017 AEIX Risk Management Award for creating practices to improve patient safety and enhance quality of care. Fourteen Texas Health hospitals also received an A or B rating from The Leapfrog Group for their robust safety practices.

In 2018, we plan to introduce a patient safety dashboard that will allow us to track outcomes faster and more effectively. It will include event types, harm levels and help measure the strength of our safety culture.

To fulfill Texas Health’s Mission, we must not only care for people when they are ill, but also work to keep them healthy and out of the hospital.

Identifying the specific needs of North Texas communities helps us collectively lower health care costs, achieve a better quality of life and improve productivity in the workplace.

Working With Key Communities

To improve population health, Texas Health is working with key business, industry and community leaders to make health care more affordable and accessible, while at the same time helping consumers make healthier choices every day.

2017 Performance

The population of North Texas is expected to grow significantly in the coming decades and Texas Health is doing our part to provide health services and care where they are needed. In 2017, we:

Goal: To make health care more affordable and convenient for patients and consumers who need it most.