Last month we talked about some quick ways to get the most out of your online marketing via "traditional" search and engaging users searching with intent.

This month we continue the discussion by talking about optimizing social media to capture the group of users who are "discovering" you online.

1)	Use Distributive Messaging
	a.   First, understand that different people with different interests use different sites. The makeup of people on Facebook varies slightly from that on MySpace and Twitter. Do your research to find the sites and areas on those sites that most cater to your target audience.
	b.   Content aggregators save time. Sites like FriendFeed, Tubemogul and even RSS feeds can automatically migrate your content and posts from your website and social media sites to many other social media sites. This concept of "spreadability" - distributes your content to many locations for broader exposure (plus, it saves you time!).
2)	Understand Where People Spend Their Time
	a.   According to Compete, the number of monthly unique visitors on Facebook is quickly approaching that of Google.
	b.   And, according to Nielsen, the average time users spent on Facebook in July, 2009, was over five hours. Compare this to the amount of time one spends on a Google search.
	c.   Knowing that Facebook (and other social media sites) are highly trafficked and are considered "destination" sites, including them in your marketing campaign is imperative.
3)	Spread the Right Virus - By including social media into your marketing mix, you also are suddenly faced with a great deal of competition for people's attention. In order to succeed, you need to create content that can spread easily and rapidly like a virus.
	a.   Create relevant, interesting and bite-sized content. Your hospital's social media content should be:   i.   Relevant - Create content that makes sense for the audience, and is relevant to your message.   ii.   Interesting - Boring content is often overlooked (in traditional and social media). Create content that captures people's interest immediately, sometimes in as few as 140 characters.   iii.   Bite-sized - Keep your content brief, so that your readers can quickly understand what you are saying, and they can also easily forward it on to others through their social media sites.   iv.   Have back links to your site - Your website is the best way to convert patients; for things like subscribing to your newsletter, calling your physician referral line, etc.
	b.   Promote it everywhere you can online - Spread your content throughout multiple social media sites. Use different types of content - text, audio, and video - to appeal to different types of viewers.
	c.   Watch it spread - Good content spreads rapidly through social media, word-of-mouth, and the online equivalent, viral marketing.
4)	The ROI of Social Media - Remember these two simple ideas when trying to measure your return on investment:
	a.   There is no definitive ROI in social media - Trying to measure the "return" on Facebook fans or followers of your Twitter account is difficult. How do you measure the value of a relationship? Social media should primarily be used to communicate and converse with potential patients, not "sell to them."
	b.   Drive them to your authoritative web page.   i.   Have clear calls to action. These can include taking an online health assessment, scheduling an appointment through your physician referral line, or attending a seminar.   ii.   Be able to track it informally or using a Customer Relationship Management System (CRM).

Using these tips and those from last month, you should be able to expand your online marketing presence throughout the entire web ecology:

• Search Engine Marketing
• Search Engine Optimization
• Social Media Optimization

And never forget to align your online marketing strategy with your hospital strategy.

Learn more about how HealthGrades works with hospitals to develop these strategies and others.

Was this series on online marketing helpful to you? Tell us what you think, email cmonroe@healthgrades.com. Also let us know about other content you'd like to see here.

Looking for some quick ways to get the most out of your online marketing? First consider the ecology of online marketing, which is the intersection of Search Engine Marketing, Search Engine Optimization of your website and Social Media Optimization.

"Traditional" search marketing involves engaging end users who are searching with intent. These are users whose searches are authoritative and targeted. To best capture these users, follow these three tips:

1)	Define the "www" of your website:
	a.   Who are you? This includes information such as location, visiting hours, service lines and staff, your hospital's role in the community, etc.
	b.   Why are you? Why are you different? What sets you apart (consider awards your hospital has earned from HealthGrades or other organizations)? Do you have differentiating technologies and what are they?
	c.   What do you want them to do? Here a "call to action" is key. Just driving them to your website isn't good enough. A user needs to know what you want them to do and you should have a way to measure their responses to see how effective your marketing is-whether it's directing them to register for a seminar, call a physician referral line or take on online health assessment, know what you will be measuring before you start.
2)	Use Search Engine Marketing that Matters. When using search engine marketing, optimization is key. Here are some tips to do this:
	a.   Be specific about what you are marketing. Know the difference between general branding and service line targeted marketing promotions.
	b.   Make your text relevant. Be sure to have some of the keywords in your ad for what you are advertising. These will get better click throughs because they are more relevant to the user. For example, if you are buying the term "joint pain", make sure your ad contains that phrase. Don't just use the same exact ad for every key word you buy.
	c.   Use specific URL's. Drive people deep into your website to a specific page that talks about what you are marketing. Don't just use the home page or people will lose interest and bounce from your site.
	d.   Have a relevant landing page. If you are marketing a seminar on bariatric surgery, try to create a page dedicated to that only, rather than to the home page or the bariatric home page.
	e.   Manage your campaign. It can take several months to fully optimize a search engine marketing campaign. Don't just outsource it to an agency. Stay on top of it, as much as daily at first to be sure you are getting the most for your money. Check the statistics on which ads people click through the most, pause or delete keywords that aren't being clicked on and adjust spending as necessary to optimize click throughs.
3)	Your website is not enough. There are many other online resources out there to help drive people to your site. Claim your local Google, Bing, Yahoo and DexKnows map listings, update your hospital's profile on Wikipedia, HealthGrades and others.

Next month we'll talk about optimizing social media to capture the group of users who are "discovering" you online.

Learn more about how HealthGrades works with hospitals.

The results of the HealthGrades Twelfth Annual Hospital Quality Study will be released to the public on October 13, 2009. On this date consumers will be able to view the ratings for every one of the nearly 5,000 non-federal hospitals in the nation. HealthGrades objectively rates hospitals on their quality of care based on hospitalization records that hospitals submit directly to state governments and Medicare.

HealthGrades utilizes the most recent three years of data - approximately 40 million hospitalization records - to determine its star ratings and awards. Star ratings are based on mortality and complication rates that are risk-adjusted, so that hospitals with different levels of patient acuity can be compared on equal footing. The ratings reflect objective patient outcomes at the nation's hospitals. No hospital can opt in or out of being rated by HealthGrades. Millions of consumers, and many large employers and health plans, rely on HealthGrades' ratings to find the best hospitals and physicians for their families.

For the first time ever, patients needing an organ transplant will have a simple way to evaluate the quality of organ transplant programs. On November 17, 2009, HealthGrades will announce the 2010 Transplant Excellence Award™ recipients.

HealthGrades conducted a survey of transplant patients and their families and found the following:

• 90% of them believe there are differences between transplant centers.
• 79% of those surveyed said it was somewhat or very important to have the ability to compare transplant centers.
• 93% of them would consider speaking with their doctor about other options/locations if they knew that one transplant program was better than another.

Outcomes for all solid organ transplants in the U.S. are compiled by the Scientific Registry of Transplant Recipients (SRTR) through its collaboration with the Organ Procurement and Transplantation Network (OPTN). Recipients of the Transplant Excellence Award™ are based on the most recent SRTR/UNOS data.

HealthGrades continues to lead America to better healthcare by providing consumers with valuable, easy-to-understand information on hospital quality.

Is your marketing strategy as closely aligned with your strategic service line initiatives as it could be? Have you carefully researched the "buying" habits of consumers by service line?

Service line marketing is a powerful way to drive patient volumes to your hospital. For our upcoming Bariatric Surgery Award release, we discovered some powerful statistics about bariatric patients.

For example, the average bariatric patient spends up to a year researching the physician and hospital they want to perform their surgery and much of that research is performed online. Are you taking advantage of this knowledge and applying it to your marketing strategy? This can give you a distinct advantage when marketing to this group.

And if you are a HealthGrades Bariatric Surgery Five-Star recipient, you have an even more distinct advantage. So no matter what service line you are marketing, do your homework. And if you have a HealthGrades distinction, talk with us about how we can help you leverage it to Grow Revenue, Engage Physicians and Enhance Reputation.

Want to tap into our knowledge base of working with over 400 hospitals?

Transparency Allows Hospitals to Expand Market Reach

Due to the downturn in the economy many hospitals will barely break fifty percent occupancy and struggle to turn a profit this quarter. In order to increase volumes, improve payer mix, and grow market share, a growing number of hospitals are focusing marketing efforts beyond their back yards.

"Hospitals are moving beyond their primary - or even secondary market - into every geographic area that they can," says Robert Sutton, founding partner at IMA Consulting," in the HealthLeaders' article Nasty or Nice: How Do You Grow Market Share?

"People are much more well-informed because of the Internet that they're willing to travel further to get the best service."

One service that lets hospitals increase their draw of patients from specifically targeted communities is Connecting Point, from HealthGrades. Through this service, hospitals can highlight their doctors among insured patients choosing doctors on HealthGrades.com. More than 180,000 patients choose a doctor every day on HealthGrades.com. Connecting Point allows hospitals to reach those patients who are specifically looking for immediate medical attention in their community. In fact, 82 percent of patients on HealthGrades.com will see a doctor within 30 days.

To see the results that other hospitals are attaining though HealthGrades Connecting Point™, click the link below, and then call us to see how many patients are using HealthGrades.com to select doctors in your community.

Click here to see other hospitals' results.

HealthGrades' 2010 Ratings and Awards announcements will be mailed during the next eight weeks. If you receive an announcement, be sure to open it and go to the web page listed inside to see all of your distinctions. A HealthGrades distinction is a proven, powerful tool your hospital can use to Grow Revenue, Engage Physicians and Enhance Reputation. And in this competitive market, don't you need all the help you can get?

Hospital marketers say enhancing physician relations is one of their fastest growing priorities, outpacing more traditional activities such as public relations and advertising. Second only to "patient experience and satisfaction," 64 percent of marketing respondents to the HealthLeaders 2009 Industry Survey selected physician relations and sales as a marketing function gaining in importance as they tackle more challenging and strategic goals for their organizations.

One simple yet powerful and measurable way to improve hospital-physician relations is to help physicians market their practices to new commercially insured patients. This not only builds loyalty with affiliated physicians, but also drives increased volume among your target patient audiences. The HealthGrades Connecting Point program is driving as many as 12 new patients per physician, per month, to physicians enrolled in the program by their affiliated hospital. Ninety-seven percent of those patients are insured, making this one of the most successful marketing programs available. Furthermore, hospitals participating in the program are seeing downstream revenue increases in the millions of dollars.

HealthGrades Connecting Point is simple – all you need to get started is a list of affiliated physicians. Supply this list to HealthGrades and let your physicians know that their profiles are highlighted to the millions of insured patients who have an immediate medical need and who are looking for a new doctor on HealthGrades.com.

MedCentral Health System in Mansfield, OH was losing volume as a result of patient outmigration. They partnered with HealthGrades to leverage their Specialty Excellence Award and position themselves as the premier provider of cardiac surgery in Ohio. In just a short year and a half, they experienced a 20% increase in open heart surgical volumes.

With 80% of Internet users looking online for health information (according to the Pew Internet & American Life Project), many hospitals are turning to this cost-effective medium to market to prospective patients. One New York City hospital in particular has effectively utilized the Web to increase patient admissions and grew revenues by $1.8 million in just one year.

Click here to read their story.

Making online marketing a part of your strategic marketing plan is a smart and economical way to promote your hospital and its achievements. In an era when marketing budgets are tightening or going away altogether, the internet offers, dollar for dollar, the best value in marketing. It’s also a surprisingly effective tool. Did you know that over 60 percent of people over the age of 18 use the internet for online health searches? How many of them can find your hospital in an online search? If you Google your key service lines and your city or region (e.g. hip replacement, Des Moines), does your hospital appear on page one of the search results? If it doesn’t, you are missing out on potential web traffic and patients. The art and science of boosting a Web site higher in search results is known as Search Engine Optimization or SEO. SEO is a very complex topic but here is one small way to get started. Make sure that your on-page content matches what consumers are searching for. For example, many hospital web pages talk about "cardiology." But many consumers search on terms like "heart attack" instead. Insert a few consumer-friendly phrases on each of your key service lines' web pages to link more effectively to the terms consumers are searching for.

HealthGrades' consultants can help evaluate your Web site and make recommendations on improving your online marketing. This suggestion is just a small part of the value you get when you engage with HealthGrades to leverage your distinctions.

Click here to learn more about how we work with hospitals to Improve Reputation, Increase Volume and Grow Revenue.

New Connecting Point Service from HealthGrades: The "new way" to market

Still marketing the "old way"? Now there's a new way to market to patients in your community at the exact moment they are choosing doctors; if they choose yours, that's a potential admission you didn't have before.

Signing up for Connecting Point, a new service from HealthGrades, allows your hospital to connect with the more than 180,000 patients choosing doctors each day on HealthGrades.com, driving new admissions to your hospital.

It works like this: HealthGrades.com has profiles of every practicing physician in the country, and right now, more than 7 million patients come to HealthGrades.com each month, making it the leading destination for patients choosing providers. Through Connecting Point, hospitals can make the profiles of their physicians free to these about-to-be-patients, and also add a "make an appointment" function.

The results are immediate, as hundreds or even thousands of patients begin making appointments with your doctors. And because 97% of these patients are insured, that's a stream of patients to your hospital that can rebalance your payer mix.

Dozens of hospitals are already seeing results. One New York City hospital is generating thousands of appointments with their physicians and projecting $1.8 million in new revenue as a result.

With Connecting Point, you're leveraging the Web to market "the new way" - to the specific patients in your community that are in need of medical care right now.

Want to learn more? Call 800-940-4179 or visit Healthgrades.com/hospital-solutions/connecting-point/.

On Tuesday, April 28, hear Jan Rutherford, HealthGrades, and John Steiner, Resurrection Health Care/Saint Joseph Hospital, talk about leveraging the Internet to strategically connect with patients and physicians at the Forum for Healthcare Strategists' Physician Summit.

Mercy Medical Center in Sioux City, IA, had a perception problem. After conducting market research and finding that of the two hospitals in the market it was not the "preferred hospital," the staff engaged with HealthGrades to leverage Mercy's quality award to improve its public perception. Mercy successfully improved its reputation to become the preferred hospital and increased its market share for admissions by 16%.

To see more examples of how our expert consultants can partner with you to create exceptional results, click here.

Using Transparency to Help Patients Make Difficult Choices Quickly and Easily

A consumer-driven atmosphere is thriving in healthcare and the Web is where it's all happening. From the latest research on seasonal asthma to choosing the best hospital for bypass surgery to finding a new physician who specializes in geriatrics after relocating, consumers are turning to the Internet for answers that are just a mouse click away.

So, what does this mean for the hospital marketer? The age of printed brochures and highway billboards is over. Health consumerism demands that you invest in your hospital's online presence. Open the lines of communication. Engage the audience. Do it now. According to Harris Interactive, 70 percent of adults now use the Internet as a primary source of health information. Patients are showing the desire to have more control over decisions affecting the healthcare provided to them and their families. In fact, prospective patients are already spending based on the information you're currently communicating online.

"Pay-for-reporting and pay-for-performance initiatives are bringing even more national attention to patients' perceptions of their care and escalating the importance of caregivers to know what consumers are thinking and understand how patients define quality health care services," says Martina Dolan, author of Report Finds Medical Practices Improving Service, Consumer Satisfaction Rising on AboutHealthTrasparency.org.

Many insured patients searching online plan to visit a doctor within 30 days. This is the perfect opportunity to communicate your hospital's message and the value of your physicians to an engaged audience. Are you impacting decisions with your hospital's strongest value points?

To find out how many millions of prospective patients are searching for physicians and hospitals in your region, and to see the results that other hospitals are attaining though HealthGrades' Connecting Point™, click here.

Learn more about HealthGrades' Connecting Point™

HealthGrades today identified the nation's top-performing hospitals - America's 50 Best. Find out who is on the list.

These hospitals know how to weave clinical excellence into the fabric of their organizations. They represent the top 1% of all hospitals in the nation in clinical quality performance. In order to qualify for this top honor, America's 50 Best Hospitals had to maintain patient outcomes in the top five percent in the nation for at least the past six consecutive years.

These elite hospitals were found to have an approximate 27 percent lower mortality rate than all other U.S. hospitals and a complication rate that was eight percent lower.

Read HealthGrades' America's 50 Best Hospitals study and learn more about what it takes to be one of these top performers.

Target Patients Who Are Actively Searching for Doctors Online

The current economic recession is top-of-mind for hospital executives and marketers, with many wondering how to adjust marketing strategy to maximize revenues in current market conditions. Some have responded by cutting budgets-basically employing the same tactics, but less often. However, strategic targeting of key audiences is a far more effective way to spend limited resources.

"Now more than ever is a great time to take a hard look at where your customers are spending their time and money, and then working to align your budgets accordingly" says Aaron Kahlow, the founder of Online Marketing Summit (OMS) and author of a recent MarketingProfs article "Top 10 for Online Marketing Success in 2009."

So where are your prospective patients spending more time these days? Online.

According to Harris Interactive, 70% of adults now use the Internet as a primary source for health information. This is great news for hospital marketers with tight budgets because using online marketing tactics allow for more targeted customer segmentation and are more measureable than offline tactics like print ads, television ads and billboards.

One of the fastest and most effective methods is to get your hospital's message in front of patients searching for physicians online. Many of these patients plan to visit a doctor within 30 days. To find out how many millions of prospective patients are searching for physicians and hospitals in your region, and to see the results that other hospitals are attaining through HealthGrades' Connecting Point™, click here.

Learn more about HealthGrades' Connecting Point™

#4: A Culture of No Excuses

In hospitals where clinical quality is a top priority, there is no tolerance for denying the facts and making excuses when it comes to addressing poor outcomes. Yes, it is true that when first exposed to patient data showing room for improvement, physicians may initially attack the validity of the data and explain away what can be painful news. But top-performing organizations never accept excuses.

When hospital leadership makes a commitment to a "no excuses" policy on clinical quality, and holds everyone involved accountable for results, measurable, sustainable clinical quality improvement begins. Comparing data from multiple, independent sources and understanding that administrative data is a proxy for chart-reviewed data is one way to open a door for change in this regard. It is always easier to ignore the data or use common excuses, such as "our patients are sicker," but at the end of the day, this kind of attitude will not improve outcomes.

#3: Physicians Who Work on Interdisciplinary Teams

When physicians come together to work across departments, the result is reduced variation in patient care and improved outcomes. When HealthGrades partnered with Ochsner Medical Center in New Orleans to ensure that the hospital's clinical outcomes matched caregivers' and administrators' perception about the level of care being provided, physician leadership was a key to success.

Performing "as expected" simply was not good enough for Ochsner's Dr. Hector Ventura and his team. While Hurricane Katrina slowed their momentum, in 2006 the Heart Failure team led by Dr. Ventura was back in action. When analyzing their baseline data and interviewing individual cardiologists, it became apparent that while each cardiologist had a Heart Failure (HF) order set in his head, there was not widespread use of a standardized order set that would ensure perfect care and help other members of the care team know the plan of care. Dr. Ventura, Section Chief for Heart Transplantation, stepped up to garner buy-in from his colleagues and also worked across departments — to Hospital Medicine (Dr. Steve Deitelzweig, Chair) where one order set was used by everyone. Now every patient, regardless of who the attending physician is, gets the HF order set upon admission.

#2: Board Engaged and Quality Outcomes Transparent to Board

When a hospital's board is actively engaged in reviewing quality measures and investing in clinical quality improvement, research shows that reduction in mortality and complications happens at a faster rate. HealthGrades Clinical Excellence senior consultants have found that, among client hospitals, board engagement is one of the primary factors for success in rapidly improving patient care.

Among HealthGrades' clients, the reduction in mortality and complication rates for those with engaged boards was statistically significant:

#1: The CEO Actively Participates in Quality Performance

Many hospital leadership teams profess to have made clinical quality a top strategic imperative, but few are taking the right steps to ensure real progress is made. HealthGrades consultants work with hospitals nationwide that span the spectrum on executive engagement. From their many years in the field they have identified that the #1 predictor of a hospital's ability to achieve and maintain top clinical performance is a CEO who actively participates in clinical quality improvement initiatives.

Here are some tips from HealthGrades Clinical Excellence Consulting group's senior leaders on what works and what doesn't when forming a culture that elevates clinical quality. The following are based on two real-world client examples:

What doesn't work:

• COO hired HealthGrades to drive improvement in Cardiac Service Line
• HealthGrades met CEO twice, briefly over course of 2 years
• Service Line Director assigned to lead clinical quality engagement
• Physicians allowed to argue about data
• Priorities not set
• Attendance at project meetings optional
• CMO, DOQ, Board would not meet with HealthGrades
• No improvement
• HealthGrades asked client to not renew engagement

What does work:

• CEO hires HealthGrades to support the quality mission
• Board of Directors are supportive
• Cardiac Surgeons and Interventionalists skeptical about third-party data
• CEO and CMO are engaged in all key meetings during every visit
• CEO actively assists with agenda development and ensuring physicians attend meetings
• A true culture of quality and change
• 11% reduction in bypass surgery mortality results over time
• HealthGrades is engaged for three years
• Contract signed with HealthGrades for Orthopedic Service Line

To learn more about how HealthGrades physician-led consultants partner with hospitals to achieve clinical quality improvement goals five times faster, visit www.healthgrades.com/cerc.

When Physicians Lead, Patients Win

In 2005, Ochsner Medical Center embarked on a journey to ensure that the hospital's clinical outcomes matched caregivers' and administrators' perception about the level of care being provided as well as the organization's vision for providing top quality care to New Orleans patients. Performing "as expected" simply was not good enough for the hospital. By partnering with HealthGrades Clinical Excellence Consulting group, the hospital was able to achieve a 62% reduction in risk-adjusted heart failure mortality by identifying and eliminating variation in care practices.

"Overall, the way that we care for patients with heart failure is the same whether you are on the hospitalist service or the cardiologist service, or whether you've had a heart transplant or not," said Dr. Sandra Kemmerly, Ochsner Medical Director for System Performance Improvement. "We would not have been able to drill down and uncover that without the help of HealthGrades."

Click here to download the full case study and watch a video to learn how HealthGrades and Ochsner were able to achieve these results.

Watch HealthGrades' new video, featuring St. Luke's Episcopal Health System, Ochsner Health System and Good Samaritan Health System, and then find out how many lives and dollars you can save by engaging HealthGrades' physician consultants. Within the top echelons of hospital governance, a group of leaders have emerged who are daring to make clinical quality the core strategic imperative for their organizations. For them, investing in clinical quality improvement is not optional; it is critical to the survival of their organizations. These visionaries see a day fast approaching when any hospital that is not providing the highest quality care at the lowest cost will be forced to close its doors.

Presented by: Dr. Richard May, MD, HealthGrades' Senior Physician Consultant

When: Tuesday, June 16, 11 a.m. to noon MT
Where: On the Web
Cost: Free

New payment models, such as Medicare's much debated "bundled payment" system, aim to drive providers to provide higher quality care at a lower price. But they also pose a new set of challenges for hospitals and physicians who must work together much more closely to achieve high quality simultaneously with optimal financial results.

Dr. Rick May, HealthGrades' Senior Physician Consultant and orthopedic surgeon provides an in-depth analysis of how the demand for value is driving quality reporting and how various payment systems could impact your organization. Dr. May will outline specific ownership, integration and transparency strategies that hospital and physician leaders must embrace now to maximize performance in the future.

Dr. Marigene Hartker, MD, HealthGrades' Senior Physician Consultant

Tough economic times mean tough choices for hospital leadership. Visionary executives know that opportunity is always present in the midst of rocky financial markets. While competitors are scaling back and curtailing quality improvement programs, the best hospitals know that now is the time to invest to achieve world-class care and put the competition far behind them. Dr. Marigene Hartker recently presented a special free webinar entitled "Engaging Physicians", based on her work with St. Luke's Episcopal Hospital/Texas Heart Institute. The webinar outlines how executive teams can make the first and most powerful step towards building an award-winning cardiac care program - working with physicians. In this program, Dr. Hartker outlines specific steps that your hospital can take now to ensure physician leaders fully support and work towards your vision for becoming the best of the best.

Originally Web Cast on April 16, 2009.

View and Listen to seminar

Podcast: Listen to Dr. Marigene Hartker discuss the subject with Dr. David Pate, MD, JD, and chief executive officer of St. Luke's Episcopal Hospital and Dr. Joseph Knapp, head of Cardiac Services at St. Patrick Hospital and Health Sciences Center/The International Heart Institute of Montana.

Dr. Rick May, Senior Physician Consultant, HealthGrades' Clinical Excellence Research & Consulting

Each month our senior consultants tackle the questions that you've always wanted to ask about clinical quality improvement, giving you frank, direct answers from the field that you would not get anywhere else.

Imagine a new technology that can cut your surgical mortality and complications in half. Now imagine that it's simple to implement and costs virtually nothing. Sound too good to be true? Not according to the New England Journal of Medicine and Dr. Atul Gawande. The best-selling author is one of a team of physicians who looked at using a simple surgical checklist to improve outcomes. (See Haynes, et al. A Surgical Checklist to Reduce Morbidity and Mortality in a Global Population. NEJM 2009;360:491-499.)

Their results were astounding. Mortality was cut in half from 1.5% to 0.7%, and complications were reduced from 11% to 7%, all by getting their staff to ask a standard set of questions before, during, and right after surgery. "Use of the checklist involved both changes in systems and changes in the behavior of individual surgical teams."

Dr. Gawande spoke at IHI this year and noted that, on average, it takes 17 years for new clinical research to become clinical practice. Often, the hard part is not knowing what works, but making it work in your hospital. Here are some tips that will help you implement the checklist now, not 17 years from now:

• Make sure everyone, from the physicians to the nurses to the transporters, understands the science behind the changes being considered. Present the clinical data to the whole team, multiple times if necessary, and let each member talk about the results.
• Encourage the team to come up with a way to implement the surgical checklist that works for the team and your hospital. Every OR is unique and the team needs to go through the exercise of finding its own solutions. This will help the team own the system and the results.
• Monitor the team's progress. Let the members know daily or weekly how often the checklist was done properly and completely.
• Reward the process and the outcomes. Give all the team members something for helping to create the process, something else for hitting the process goals, and something huge when outcomes improve.

Lastly, remember the words of my department Chairman in my Orthopedic Surgery residency. He once told me that performing great surgery was easy. He said, "All you have to do is do the same damn thing the same damn way every damn time."

Read more about how HealthGrades' Clinical Excellence Research & Consulting helps hospitals achieve five-star performance five times faster than the national average.

Ochsner Cuts Sepsis Mortality 38 Percent

By Sue Bond, Senior Consultant, HealthGrades' Clinical Excellence Research & Consulting

Each month our senior consultants tackle the questions that you've always wanted to ask about clinical quality improvement, giving you frank, direct answers from the field that you would not get anywhere else.

Clinical quality is a top priority for physicians and staff at Ochsner Medical Center (OMC), where an interdisciplinary team recently decided to tackle the problem of reducing mortality from sepsis, a life threatening condition caused by infection.

Ochsner's overall approach to improving patient care is through rapid cycle tests of change which are implemented by multidisciplinary teams. This became the heart of the strategy to reduce sepsis-related deaths at the hospital. Preliminary discussion on how to improve care for sepsis patients began in the summer 2007 between the Department Chairs of the ICU and ED, when it was felt that the organization's risk-adjusted mortality for Sepsis could be reduced. Each department has a quality champion, and in this case the champions were Dr. Leo Seoane of the Critical Care Department and Dr. Erik Sundell in the Emergency Department. These two physicians quickly emerged as the team leaders. Even though there were departmental, specialty, and organizational issues to overcome, Seoane and Sundell picked up the ball in the fall of 2007 and sprinted to the "goal" line with their team.

Hospital representatives were identified from the following departments: nursing, medical informatics, performance improvement, clinical pharmacy, nutrition, respiratory, nursing education, and nursing informatics. The first official multidisciplinary team meeting, led by Drs. Seoane and Sundell, was held in January of 2008. The Administrative Sponsor was Dr. Sandy Kemmerly, Medical Director for Performance Improvement. The team Facilitator was Susan Rodriguez, RN, MSHSA, from the Performance Improvement Department.

An early, critical decision point was determining who would insert the central line. There was concern that treatment goals would be delayed if someone other than the ED physicians were responsible for line placement. So Dr. Sundell trained all the ED doctors in the PreSep catheter insertion technique and validated their competency. Bethany Jennings, ED Nurse Manager, trained all the ED nurses in monitoring the values. The Critical Care Department decided that a fellow would respond to the ED to help get patient treatment started in a timely manner.

The next critical step in the process was developing an evidence-based order set. By March - just two months after the initial multidisciplinary meeting - the first draft order set was ready for review and feedback. By May the team and Ochsner's Therapeutics Committee had approved the final order set which would help drive standardized, evidence-based care.

In addition, comprehensive data collection on every single case of sepsis was undertaken. For each case in which the patient's goals were not met within 6 hours, personal feedback was provided to the attending physician by Dr. Sundell or Dr. Seoane. The value of this type of personal and timely feedback cannot be under estimated. Rapid communication of the data to all involved physicians and nurses truly was a key component of success.

Dr. Seoane took on the role of educating the Critical Care physicians to ensure complete compliance with the new order set and protocols. This was completed by September - as was ICU Nursing education.

The results speak for themselves. By the end of September 2008, as compared to performance in 2007, OMC had achieved the following outcomes:

38% reduction in risk-adjusted mortality
57% reduction in raw mortality - 31 LIVES SAVED!
24% increase in appropriately recognizing principle (admitting) diagnosis of Sepsis
81% patients meeting goals at 6 hours (up from 33% in June)

The entire multidisciplinary team continues to meet monthly, and a subgroup also meets monthly to review metrics on goal attainment, antibiotic timeliness, and order set usage.

While achieving these results could not have been realized without the efforts of everyone on the team, the leadership of Dr. Sundell and Dr. Seoane is to be admired and replicated in hospitals nationwide. These physician leaders, along with Dr. Kemmerly as team Sponsor and Dr. Joseph Bisordi, System CMO, made sure to thank their colleagues and staff along the way; and as was stated in a recent team meeting: "Failure is not an option."

Read more about how HealthGrades' Clinical Excellence Research & Consulting helps hospitals achieve five-star performance five times faster than the national average.