Succeeding as a Safety Net (Part 1 of 3): Ronald Reagan UCLA Medical Center

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RRMC-thumb1Earlier this week, we began a look at the difficulties facing safety-net hospitals as they struggle to meet the needs of their patients, while simultaneously trying to live up to federal quality metrics. It’s a tough juggling act, since many safety nets are focused on care that isn’t necessarily a top priority for the government.

However, as Cheryl Clark points out in a recent HealthLeaders Media article, there are a few safety nets that have managed to succeed in spite of the federal quality metrics. These safety-net organizations believe that CMS’ demands are within reach.

First, there’s the internationally known and respected Ronald Reagan UCLA Medical Center in Los Angeles, a 520-bed facility that “draws from…’a melting pot’ of uncountable ethnicities around Los Angeles…where nearly one in five patients is self-pay or Medicaid,” Clark writes.

David Feinberg, MD, MBA, president of the UCLA Health System and CEO of the UCLA Hospital System, said, in spite of his organization’s world-famous medical accomplishments, “five years ago, if you asked patients to rate UCLA on a patient experience score of one to 10, we were in the 30th percentile, and our emergency department was in the 17th. Basically, we could save your life, but two out of three people would never come back.”

To turn this around, he and his staff began an outreach campaign in which they simply listened to what their patients had to say about the quality of care UCLA was providing.

What were some of the things they learned? Patients were unclear as to the hospital’s authority structure, they felt the facilities were dirty, the food lousy, and the providers arrogant, he said.

This led to a full-on effort to turn Ronald Reagan UCLA’s patient satisfaction scores around. As part of this, the entire executive team made themselves available both in-person and over the phone to patients. Ronald Reagan UCLA also reevaluated the standards it applied to new hires and began training veteran workers on patient-satisfaction skills.

“Some of this strategy has worked,” Clark reports. “According to Hospital Compare, 80 percent of patients give Ronald Reagan UCLA a nine or 10 on a scale of zero to 10, compared with the California average of 67 percent and the national average of 69 percent. And 83 percent would definitely recommend the hospital, compared with 69 percent statewide and 70 percent national.”

However, Ronald Reagan UCLA continues to fall short in many important areas. If you ask Feinberg, he thinks the scores are “still terrible” and readily acknowledges the reasons his staff gives, such as “We can’t be as good as other hospitals because we don’t have a new building. Or because we have residents and trainees. Or because we take care of really old, very sick patients. There are hundreds of excuses.”

“We definitely get more right now than we used to. But we have such a long way to go. And when you have cancer, I don’t care if you’re a safety-net hospital or the Taj Mahal,” he concluded.

Nevertheless, the organization continues to improve, even as a safety net. In our next post, we’ll look at another safety net that was struggling to achieve federal standards and is now succeeding in a very big way.

In the meantime, what has your hospital, safety net or otherwise, done to improve its quality scores? What has worked, and what hasn’t worked?

-by Pete Fernbaugh

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