H ow do you measure the quality of a hospital? Infection rates, mortality prices, national rankings, and industry accolades, taken together, can paint an impressionistic picture of performance. But a lack of standardized tools for data collection and analysis confounds practical comparisons. The New York State Department associated with Health, in acknowledging this limitation, reports that “indicators do not currently exist to measure how well hospitals treat every type of illness or patient that they care for. ” Instead, it describes quality more broadly as “doing the right thing, at the particular right time, in the right way—and having the best possible results. ”
Few institutions nationwide have embraced plus operationalized this particular credo like NYU Langone Hospital—Brooklyn within the southwest Brooklyn neighborhood associated with Sunset Park. The hospital’s performance metrics and accolades are unrivaled in the borough, and match or even best those of the top academic medical centers in the United States. But it’s the animating philosophy behind those metrics—and the culture it inspires—that explain the particular hospital’s extraordinary success and offer valuable lessons for other health systems.
Since 2016, when the 444-bed hospital, formerly known as Lutheran Medical Center, fully merged with NYU Langone Wellness, NYU Langone Hospital—Brooklyn has quietly set a new standard of care in a borough long strained by stark health inequities. The latest evidence of its transformation was documented inside a study published in JAMA Network Open in January 2022 showing a 33 percent drop in the particular mortality rate of patients hospitalized at NYU Langone Hospital—Brooklyn since the outset of the merger.
“To see that kind of rapid decline in just a few years is almost unheard of, ” says Robert I. Grossman, MD , CEO of NYU Langone plus dean associated with NYU Grossman School of Medicine. “It’s truly amazing. ”
Colliding with a crush of Omicron headlines, news of the hospital’s remarkable turnaround flew under the radar, but the significance looms large with regard to the future of medical center mergers and the delivery of healthcare to poor communities. In more meaningful terms, a thirty-three percent fall in mortality rates translates to thousands associated with lives saved.
The figure is particularly notable because NYU Langone Hospital—Brooklyn serves a community with the highest percentage of Medicaid patients in the nation. Lacking routine access to high-quality healthcare, and burdened with higher rates of obesity , diabetes , and high blood pressure , low-income patients with government insurance or no insurance at all tend to arrive in the hospital in worse health, experience more complications, and stay longer than patients with private insurance.
Although mortality rate was its primary focus, the study also showed the 39 percent reduction in central line infections, a 33 percent drop in catheter-associated urinary tract infections , and a higher likelihood of patients recommending the hospital or giving it a top-tier ranking.
These performance metrics stand apart in Brooklyn, where one in five residents live below the particular poverty line and hospitals have buckled under financial strain. In 2017, a new study by the healthcare nonprofit Leapfrog Group ranked Brooklyn hospitals among the worst within the nation. Today, NYU Langone Hospital—Brooklyn is the only hospital in typically the borough to earn Leapfrog’s “A” rating, as well as 5 stars, this highest score, from often the Centers for Medicare plus Medicaid Services. This year, your hospital became the first and only medical center in Brooklyn to receive Magnet® recognition with regard to excellence within nursing from the American Nurses Credentialing Center.
The hospital’s mortality rate doesn’t just outperform other Brooklyn hospitals; it’s among the exact lowest inside the nation when factoring in the proportion associated with patients who arrive along with advanced illness. Institutions that care for sicker patients typically have increased mortality rates, but NYU Langone Hospital—Brooklyn has proven the exception to the particular rule.
The particular dramatic transformation challenges an entrenched narrative that clinic mergers are bad for individuals. Most studies show that will as the hospital competition decreases, overall fatality increases in addition to patient satisfaction can furthermore decline. Martin Gaynor, PhD, an economist at Carnegie Mellon University who studies the consequences regarding hospital consolidation, told Typically the New York Times of which “evidence through three decades of medical mergers does not support the claim that combination improves quality. ”
So how did NYU Langone carve a different path? This JAMA Network Open study points to a confluence involving factors, but its success begins with some sort of core philosophy about quality—that is, about “doing typically the right thing, at this right time, in the right way”—and doing it consistently to deliver one high standard connected with care and even raise the bar for everyone, not just privately insured sufferers living in wealthier zip codes. “We began using the premise that we cannot accept any lower standards for the patients we care regarding in Brooklyn than the patients we care for throughout Manhattan, ” says Bret J. Rudy, MD , senior vice president together with chief with hospital operations at NYU Langone Hospital—Brooklyn and often the senior author from the study. “The goal has always been one standard for take care of all patients, no matter where they reside. ”
Dr. Rudy’s appointment to head the hospital’s administrative team in 2016 was the first in a long series of decisions by NYU Langone’s leadership that would underscore this guiding philosophy. Doctor. Rudy began his career as an adolescent medicine specialist at the College of Pennsylvania treating underserved teens together with HIV coming from Philadelphia’s poorest communities. “The abject poverty was stunning, ” Medical professional. Rudy recalls. “The kids in our care were wonderful but truly disadvantaged. So even though I was working at a good big academic medical center, I had to stay very connected to the community and additionally collaborate using community-based organizations. ” Dr . Rudy’s experience in Philadelphia burnished your career-long conviction that your cutting-edge care of an academic clinic can and should be extended to everyone. “It didn’t matter if you were on Medical planning and coming from West Philly or you were wealthy enough to fly in by another state because you wanted to see a particular professional, ” he says. “Every patient was treated equally. ”
Two Hospitals, One Standard
To ensure equitable not to mention measurable treatment at NYU Langone Hospital—Brooklyn, the health system’s senior management advocated intended for a full-asset merger that could result around an unified administration having shared goals and expectations. “The only way in order to deliver the exact same level of care on Brooklyn as we do during Manhattan was to put everybody on the same footing and compare everyone the same way, ” says Joseph Lhota , executive vice president and bassesse dean, chief of staff.
This all-in approach is atypical among hospital consolidations, in part because it incurs substantial risk. Lutheran Medical Center’s higher population about Medicaid individuals and its lower reimbursement prices would make it challenging to generate the surplus revenue needed to reinvest in staff, modern facilities, and new technology. Moreover, a full-asset merger stood to jeopardize NYU Langone’s top rankings, since the particular institution would absorb Lutheran Medical Center’s troubling performance data. Most hospital mergers divide administrations, operationally creating two separate hospitals. That configuration, inside effect, creates a firewall, so if metrics lag at one hospital, typically the decline won’t impact those at this other healthcare facility. In the case of NYU Langone Hospital—Brooklyn, “their metrics would be our metrics, ” says Dr. Grossman. “Their results, our own results. ”
The implications were debated among senior leadership and also the Board of Directors. “We were concerned, absolutely, ” Doctor Grossman explains. “As an institution, we had spent a decade making the quality standards some in the best within the country. To suddenly merge by using an institution that had poor quality meant thinking long as well as hard regarding how it would affect us. In often the end, the answer was pretty simple. We said, ‘We’re going to fix it. ’”
Andrew W. Brotman, MD , executive perversité president and vice dean for clinical affairs plus strategy, main clinical officer, says your literature on hospital mergers reflects some dominant model at the exact expense from uncommon alternatives. “When research say that mergers are bad for people, what they’re really referring to is a model in which a health system puts its name on a fabulous hospital, raises the costs, and does not do much else, ” says Doctor. Brotman. “That’s not what we do. It wasn’t about transferring patients to be able to Manhattan or even filling beds. We set out to create an important high-quality health care system for southwest Brooklyn—and we performed it. It really is a different philosophy. ”
By 2017, NYU Langone hadn’t just absorbed Lutheran Medical Center’s metrics, this understood them in granular, real-time detail. One year after the merger, it experienced installed the electronic wellness record, Epic, throughout NYU Langone Hospital—Brooklyn, including 22 inpatient in addition to outpatient locations. Representing an $80 million investment, Epic would unify a patchwork of record keeping systems, including paper records, to monitor some 1 . 7 million patients. That includes its Family Health Centers at NYU Langone , a network of a lot more than 40 Federally Qualified Health Center clinics with a longstanding history of serving underserved and immigrant communities through southwest Brooklyn. The Family members Health Centers at NYU Langone offers primary care to even more than 100, 000 affected individuals and accommodates over 600, 000 visits each year.
The digital record-keeping system meant the fact that hospital physicians seeing individuals referred via the Loved ones Health Facilities at NYU Langone—and other NYU Langone locations—would have instant access to their patients’ medical histories, enabling faster, more seamless care. It also meant that clients could schedule appointments using their mobile phones and receive text messages alerting them to upcoming appointments. “It doesn’t matter how rich you are or perhaps where you come from, everybody in this country has a smartphone, ” says Lhota. “If you send somebody a text message and tell them that they have an scheduled appointment, they’re more likely for you to make that appointment. ”
Building upon Epic, NYU Langone installed its signature suite of clinical dashboards that tracks more than 800 performance metrics and places the data from the fingertips of every clinician in the program. “Having entry to real-time data that will be accurate and even actionable is usually critical, ” notes Dr . Rudy. “I probably use the dashboards 10 times a day. ”
Often the dashboards brought transparency together with accountability to help everyone, and additionally served as a valuable tool for standardizing care. “If every doctor does what they alone think is right, the care will be variable, ” states Joseph M. Weisstuch, MD , chief medical official of NYU Langone Hospital—Brooklyn. “We’ve standardized our treatments and set an expectation that will everyone might fall in collection because it is the right way to take care associated with patients. This requires buy-in and people who are usually committed to making things better to get patients, not really just pertaining to themselves. ”
Backed from the dashboards, leaders were empowered to manage to the information and help to make objective choices that will directly serve affected individuals. “When you tell the surgeon of which his or her infection rate is twice as large as somebody else’s, that’s a powerful statement, ” adds Doctor Grossman. “We’re a new metric-driven organization, and there’s only one source of truth: the dashboard. ”
But analytics, as powerful as they may be, are only as good because the people that can act on all of them. In 2015, Lutheran Healthcare Center relied heavily on a network regarding part-time doctors who attended at some other hospitals. Its Level 1 Trauma Middle , critical care units, and neonatal intensive proper care unit had been all outsourced to contractors. “If some sort of voluntary physician brought a patient into the surgical or maybe medical ICU, for example , they would remain the patient’s primary caregiver instead involving deferring in order to the expertise of a good dedicated ICU team, ” explains Medical professional. Weisstuch. “That arrangement is definitely never within the best interest of the patient. ”
NYU Langone replaced most consulting doctors with personnel physicians. Clinical chiefs have been replaced through NYU Langone veterans who else understood the particular transformational changes that got helped bring the institution back from typically the brink connected with bankruptcy in 2007 to be able to become one of the top-ranked private hospitals in this nation. “Scores of doctors had privileges at three, four, five, six different hospitals not to mention weren’t particularly invested in any one these people, ” describes Dr. Brotman. “We transitioned that, so now a lot more than 75 % of NYU Langone Hospital—Brooklyn’s doctors usually are full-time. That will alone was a dramatic change. ”
Along with plummeting death rates, patients were discharged sooner, and they were less likely for you to wind up back again in often the hospital. “The longer a person stay in your hospital, the higher your risk of contamination and the exact longer you’re away from your family, ” notes Dr . Weisstuch. “Our focus can be on getting patients safely through their health crisis and home as soon as possible. ” Today, the average length of stay and the 30-day readmission rate with NYU Langone Hospital—Brooklyn are one of the shortest in New York City.
Rather than moving Brooklyn persons to their Manhattan campus—a consolidation tactic commonly used by other Brooklyn hospitals the fact that have resources in Manhattan—NYU Langone has built important new service lines. The Brooklyn hospital now offers reconstructive breast surgery, spine surgical treatment, robotic surgical procedure, advanced endoscopy, and advanced bronchoscopy, amongst other core services. “Why should people have to travel to Manhattan? ” asks Doctor Weisstuch. “Why should anyone living inside Sunset Park lack convenient access to state-of-the-art robotic medical procedures, advanced breast surgery, sophisticated reconstructive surgical procedures? ”
Among an extensive list of infrastructure improvements, the particular hospital has generated a new electrophysiology suite to assess cardiac subjects; a brand new interventional radiology collection where biopsies, diagnoses, and also therapies will be precisely guided with real-time imaging; brand new operating rooms; and Perlmutter Cancer Center—Sunset Park , a state-of-the-art ambulatory cancer center run by NYU Langone’s distinguished Perlmutter Cancer Center , offering radiation therapy as well as infusion remedies. This season, that will complete construction of a hybrid operating room that combines a traditional operating room with an image-guided interventional radiology package to allow for more complex procedures.
“We’re careful with sources across typically the system, ” says Dr. Rudy. “But if there is a technology that’s expensive but standard of treatment, we ignore the finances and put in the regular of attention. We make sure all of us do that will based on good clinical info. ”
Built to Last
NYU Langone’s deep investments in facilities, technology, and faculty yielded huge dividends during this darkest days of often the pandemic. Your newly bolstered hospital acquired the experience and staffing resources to deliver the ideal possible health care to your community disproportionately impacted by COVID-19. It weathered the problems with all the assistance of innovative supply chain and services teams, top clinical specialists with the latest knowledge about interventions plus best practices, some passionate frontline staff, and a nationally recognized Vaccine Center that inoculated more than 62, 000 patients in addition to members with the local community. “The employees at Lutheran Medical Middle would have fought like hell for their men and women, ” states Frank M. Volpicelli, MARYLAND , chief of medicine at NYU Langone Hospital—Brooklyn. “I have no doubt about of which. But it would certainly have been immeasurably harder without your systems and even resources for the larger system. ”
That insight holds true with or without the exact pandemic. The exact lessons gleaned from NYU Langone Hospital—Brooklyn about how to help build on an historic community hospital together with make the idea durable meant for decades to come can become applied to additional health techniques endeavoring to improve attention in underserved communities. “It’s been years of really hard work, ” says Doctor. Volpicelli. “We’ve done a lot more than throw money on problems. We’re here to build a sustainable model designed for delivering care and attention to underserved populations that can be replicated around the country. So , yes, we could simply take revenue out of NYU Langone’s commercially funded population throughout Manhattan and additionally spend it here in order to make the metrics better. But that is not a sustainable model. All of us intend to serve this local community for the long haul. ”