the commonwealth fund 2003 commonwealth fund international health policy survey of hospital...
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THE COMMONWEALTH
FUND
2003 Commonwealth FundInternational Health Policy Survey
of Hospital Executives
Summary Chartpack
Cathy Schoen, Robert J. Blendon, Catherine M. DesRoches, Robin Osborn,Elizabeth Raleigh, Phuong Trang Huynh, Alice Ho, and Kinga Zapert
22003 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
ContentsI. Introduction 4
II. Methods 5
III. System OverviewChart III-1 Satisfaction with the Health Care System 7Chart III-2 Two Biggest Problems Faced by Hospitals 8Chart III-3 Quality of Hospital Resources 9Chart III-4 Concern About Losing Patients to Competitors 10Chart III-5 Preparedness for a Terrorist Attack 11
IV. Hospital FinancesChart IV-1 Hospital Finances 13Chart IV-2 Current Financial Situation in Hospitals 14
V. Capacity and Waiting TimesChart V-1 Patients Wait Six Months or More to Be Admitted for Elective Surgery 16Chart V-2 Average Emergency Room Waiting Time 17Chart V-3 Average Hospital Waiting Times 18Chart V-4 Diversions of Patients to Other Hospitals Due to Lack of Emergency Room or Hospital Capacity 19Chart V-5 Delays or Problems with Discharge Because of Limited Availability of Post-Hospital Care 20Chart V-6 Waiting Times for Elective Surgery in the Past Two Years 21
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VI. Improving the Quality of CareChart VI-1 Hospital Does NOT Have a Written Policy for Informing Patients of a Preventable Medical Error Made in Their Care 23Chart VI-2 Effectiveness of Hospital’s Program for Finding and Addressing Preventable Medical Errors 24Chart VI-3 Physician Support for Reporting and Addressing Preventable Medical Errors 25Chart VI-4 How Effective Would Electronic Medical Records Be in Improving Quality of Care? 26Chart VI-5 How Effective Would Computerized Ordering of Drugs Be in Improving Quality of Care? 27Chart VI-6 How Effective Would Standard Treatment Guidelines Be in Improving Quality of Care? 28Chart VI-7 How Effective Would Outcome Comparisons with Other Hospitals Be in Improving Quality of Care? 29Chart VI-8 How Effective Would Bar Coding of Medications Be in Improving Quality of Care? 30Chart VI-9 Effectiveness of Government Policies and Regulations Designed to Improve Quality of Care 31Chart VI-10 Opposition to Disclosure of Quality Information to the Public 32
VII. Staffing IssuesChart VII-1 Staffing Shortages 34Chart VII-2 Canceling or Postponing Scheduled Surgeries Due to Staff Shortages 35Chart VII-3 Nurse Staffing Levels Compared with Two Years Ago 36Chart VII-4 Strategies to Recruit and Retain Nurses 37Chart VII-5 Rating Physician Morale 38
VIII. Information TechnologyChart VIII-1 If You Had New Funding to Invest in a One-Time Capital Improvement to Improve Quality of Patient Care in One Area of Your Hospital, What Would It Be? 40Chart VIII-2 Major Barriers to Greater Use of Computer Technology 41
IX. Summary and Policy Implications 42
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I. Introduction The Commonwealth Fund 2003 International Health Policy Survey is the sixth in a series of surveys designed to provide a comparative perspective on health policy issues in Australia, Canada, New Zealand, the United Kingdom, and the United States. The 2003 survey consistedof interviews with a sample of hospital chief operating officers or top administrators of the larger hospitals across the five nations. The survey sought these executives’ perspectives regarding current resources and efforts to improve quality of care. Comparative findings from the survey were reported in the May/June 2004 issue of Health Affairs.*
This chartpack represents a summary of the survey findings and is divided into the following sections:
• System Overview• Hospital Finances• Capacity and Waiting Times• Improving the Quality of Care• Staffing Issues• Information Technology
* R. J. Blendon, C. Schoen, C. M. DesRoches, R. Osborn, K. Zapert, and E. Raleigh, “Confronting Competing Demands to Improve Quality: A Survey of Hospital Executives in Five Nations,” Health Affairs (May/June 2004): 119–35.
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• Telephone survey of hospital executives in Australia, Canada, New Zealand, United Kingdom, and the United States.
• Conducted by Harris Interactive and subcontractorsfrom April to May 2003.
• Sample of largest hospitals in each country: – 200+ beds in UK and the US– 100+ beds in AUS, CAN, NZ
• Final hospital sample size of:– 100 in AUS, 102 in CAN, and 103 in the UK– 28 in NZ– 205 in the US
II. Methods
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III. System Overview
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Chart III-1. Satisfaction with theHealth Care System
82937776
47
84
1612
4
0
25
50
75
100
AUS CAN NZ UK US
Somew hat satisfi ed Very satisfi edPercent
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Chart III-2. Two Biggest ProblemsFaced by Hospitals
Percent naming: AUS CAN NZ UK US
Inadequate funding 58% 62% 57% 39% 10%
Inadequate reimbursement 8 — — — 60
Staffing shortage 45 60 54 64 47
Inadequate/ overcrowded/ outdated facilities
32 39 54 42 7
Indigent care/ uninsured — — — — 17
Malpractice costs 6 — — — 11
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Chart III-3. Quality of Hospital Resources
Base: Hospitals that have the facility
Percent rating as“only fair” or “poor”:
AUS CAN NZ UK US
Intensive care unit 9% 13% 10% 11% 5%
Operating rooms or theatres
7 20 13 17 5
Emergency room or department facilities
21 48 30 17 20
Diagnostic imaging equipment or other medical technology
13 19 21 18 3
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Chart III-4. Concern About Losing Patientsto Competitors
Percent “very concerned” they will lose patients in next two years to:
AUS CAN NZ UK US
Other hospitals 16% 4% 7% 4% 19%
Free standing diagnostic or treatment centers
6 6 4 4 55
Free standing ambulatory or primary care centers
7 3 0 3 51
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Chart III-5. Preparedness fora Terrorist Attack
58 63 6146
62
1825 25
43
28
0
25
50
75
100
A US CA N NZ UK US
Somew hat prepared V ery preparedPercent
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IV. Hospital Finances
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Chart IV-1. Hospital Finances
In The Past Year: AUS CAN NZ UK US
Had a surplus or profit 35% 9% 11% 7% 71%
Broke even 25 22 7 61 6
Had a loss or deficit 40 70 82 32 23
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Chart IV-2. Current Financial Situationin Hospitals
* Does not include percent reporting sufficient to maintain current levels of service.
Percent
57
8175
63
30
112 4 8
32
0
25
50
75
100
AUS CAN NZ UK US
Insufficient to maintain current levels of service
Allows for some improvements*
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V. Capacity and Waiting Times
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Chart V-1. Patients Wait Six Months or Moreto Be Admitted for Elective Surgery
135222214
2221
912
0
25
50
75
100
AUS CAN NZ UK US
Very often
OftenPercent
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Chart V-2. Average Emergency RoomWaiting Time
23
46
17
58
39
0
25
50
75
100
A US CA N NZ UK US
Percent reporting an average wait of two or more hours
Base: Hospitals with an emergency room or department
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Chart V-3. Average Hospital Waiting Times for…Base: Hospitals who perform the procedure
A Breast Biopsy for a 50-Year-Old Woman with anIll-Defined Mass in Her Breast but No Adenopathy
Percent of patientshaving to wait: AUS CAN NZ UK US
Less than three weeks 74% 70% 48% 73% 93%
Three weeks or more 15 21 44 20 2
A Routine Hip Replacement for a 65-Year-Old Man
Less than six months 54 43 25 15 92
Six months or more 39 50 65 81 1
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Chart V-4. Diversions of Patientsto Other Hospitals Due to Lack of
Emergency Room or Hospital Capacity
7159 15
9
44
5
00
25
50
AUS CAN NZ UK US
Very often
OftenPercent
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Chart V-5. Delays or Problems withDischarge Because of Limited Availability
of Post-Hospital Care
252873424
15
3024
19
0
25
50
75
AUS CAN NZ UK US
Very Often
OftenPercent
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11
44
188
2721
9
29
86
14
0
25
50
75
100
AUS CAN NZ UK US
Gotten Longer Gotten Shorter
Chart V-6. Waiting Times for Elective Surgeryin the Past Two Years
Percent
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VI. Improving the Quality of Care
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Chart VI-1. Hospital Does NOT Have aWritten Policy for Informing Patients of a
Preventable Medical Error Made in Their Care
36
50 50
188
0
25
50
75
100
A US CA N NZ UK US
Percent saying hospital does NOT have such a policy
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Chart VI-2. Effectiveness of Hospital’s Program for Finding and Addressing Preventable Medical
Errors
7067716658
242441322
0
25
50
75
100
AUS CAN NZ UK US
Somewhat effective Very effectivePercent
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Chart VI-3. Physician Support for Reporting and Addressing Preventable Medical Errors
59 59 57 54 56
17 217
35 30
0
25
50
75
100
A US CA N NZ UK US
Somew hat supportive Very supportivePercent
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Chart VI-4. How Effective WouldElectronic Medical Records Be in
Improving Quality of Care?
4319
393540
4668
504543
0
25
50
75
100
A US CA N NZ UK US
Somew hat effec tive V ery effec tivePercent
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Chart VI-5. How Effective Would Computerized Ordering of Drugs Be in Improving Quality of
Care?
3228243338
6061645155
0
25
50
75
100
A US CA N NZ UK US
Somew hat effec tive V ery effec tivePercent
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Chart VI-6. How Effective WouldStandard Treatment Guidelines Be in Improving
Quality of Care?
4650504139
4843465956
0
25
50
75
100
A US CA N NZ UK US
Somew hat effec tive V ery effec tivePercent
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Chart VI-7. How Effective WouldOutcome Comparisons with Other Hospitals Be in
Improving Quality of Care?
5565
51 48 57
33223633
38
0
25
50
75
100
AUS CAN NZ UK US
Somewhat effective Very effectivePercent
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Chart VI-8. How Effective WouldBar Coding of Medications Be in
Improving Quality of Care?
31304128 32
6252465236
0
25
50
75
100
A US CA N NZ UK US
Somew hat effec tive V ery effec tivePercent
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Chart VI-9. Effectiveness ofGovernment Policies and Regulations Designed to
Improve Quality of Care
3863 41 57 71
5
5
4
4
2
0
25
50
75
100
A US CA N NZ UK US
Somew hat effec tive V ery effec tivePercent
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Chart VI-10. Opposition to Disclosure of Quality Information to the Public
Percent saying should NOT be released to the public:
AUS CAN NZ UK US
Mortality rates for specific conditions
34% 26% 18% 16% 31%
Frequency of specific procedures
16 5 4 13 15
Medical error rate 31 18 25 15 40
Patient satisfaction ratings 5 2 0 1 17
Average waiting times for elective procedures
6 1 0 1 29
Nosocomial infection rates 25 10 25 9 29
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VII. Staffing Issues
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Chart VII-1. Staffing Shortages
Percent reporting “serious” shortages of:
AUS CAN NZ UK US
Nurses 23% 30% 11% 22% 31%
Pharmacists 26 33 14 27 14
Specialists or consultant physicians
11 26 7 17 16
Trained managerial staff 5 12 0 6 3
Lab technicians 3 9 0 17 4
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Chart VII-2. Canceling or Postponing Scheduled Surgeries Due to Staff Shortages
14
2621
24
14
0
25
50
AUS CAN NZ UK US
Percent reporting having to cancel or postpone 10%or more of scheduled surgeries due to staff shortages
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Chart VII-3. Nurse Staffing LevelsCompared with Two Years Ago
Percent
2824 25
15
25
4136 36
4840
0
25
50
75
AUS CAN NZ UK US
Situation is w orse Situation is better
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Chart VII-4. Strategies toRecruit and Retain Nurses
Percent saying they use: AUS CAN NZ UK US
Sign-up bonuses 16% 24% 4% 8% 60%
Tuition reimbursement 75 51 54 NA 97
Recruiting from other countries
57 30 86 88 35
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Chart VII-5. Rating Physician Morale
15 287
20 26
3
2
7
0
25
50
A US CA N NZ UK US
Only fair PoorPercent
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VIII. Information Technology
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Chart VIII-1. If You Had New Funding to Invest in a One-Time Capital Improvement to Improve Quality of Patient Care in One Area of Your
Hospital, What Would It Be?
Percent saying: AUS CAN NZ UK US
Electronic medical records/IT 35% 47% 46% 38% 62%
Emergency room/OR/Critical care facility
26 18 4 22 13
Basic hospital/patient facilities 17 14 21 22 3
Diagnostic equipment/medical technology
9 16 11 10 3
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Chart VIII-2. Major Barriers toGreater Use of Computer Technology
Percent saying major barrier: AUS CAN NZ UK US
High start-up costs 84% 84% 93% 69% 71%
Projected maintenance costs/insufficient technical staff
49 42 32 52 27
Lack of uniform standards within industry
49 35 50 31 44
Doctors’ resistance to change 20 21 18 8 39
Privacy concerns 20 26 7 8 17
Lack of training 11 12 4 9 15
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IX. Summary and Policy Implications
• Shared concerns across countries around financial health, waiting times, quality of basic services, staffing shortages.
• Challenge to maintain current levels of service and financial constraints may limit the ability of hospitals to make quality improvements.
• While attention is being given to patient safety, there remains
substantial room for improvement.
• Majority of hospital executives endorse public disclosure of quality data and quality initiatives.
• Nurse shortages are a concern but there is guarded optimismthat they are not getting worse.
• Information Technology is an investment priority but hospitals cite common barriers to moving forward.
• Cross-cutting issues offer opportunities to learn from varying approaches within different country systems.