Case Study: Grady Memorial Hospital

Grady Memorial Hospital, also simply known as Grady, is the public hospital for the city of Atlanta. It was found in 1892 and is one the largest hospitals in the state of Georgia. Grady has become known for its amazing trauma service. As the hospital website notes, they are the region’s premier level I trauma center (Grady, 2016). While Grady excels at taking care of the critically injured, it still has areas that need some work.
Based on the data from Hospital Compare two of the measures that need some improvement are the patient experience and timely effective care, particularly the emergency department. These two measures are associated with the quality dimensions of timeliness and patient centerness. Timely and effective care can play

a major role in how patients perceive the care they receive in a hospital.

If patients constantly have to wait an excessive amount of time they will either leave before they receive care or could end up becoming sicker as a result. Donabedian’s three-element model structure, process and outcome have become the gold standard for defining quality measurement (Varkey, 2010). Structure relates to the health care setting, which includes the hospital policies, procedures and design. Process evaluates if the right actions were taken for an intended outcome and how well the actions were executed to achieve the outcome. Outcome focuses on the patient, it measures the patient’s condition, behavior, and response to or satisfaction with care (Varkey, 2010). Although each of these measures focus on different areas, they indicate areas that need improvement. Also, the measurement from structure and process plays an important role in the patient’s outcome. If the hospital has the right staff, equipment and

the staff performs the right course of treatment, then each patient will have the intended outcome. My chosen measures relate to structure and outcome. Poor structure in a hospital can mean not enough staff is on duty to meet the demands of their patients or the facility is not designed to handle the volume of patients. If patients do not feel they have received timely or the best care, this can affect how they perceive and rate a hospital.
As a public hospital, Grady treats many of the poorest patients in Atlanta. Many of these patients mainly seek care through the emergency department due to lacking insurance. Timely and effective care can mean the difference between saving someone’s life or potentially causing them more harm. The Hospital Compare data showed that Grady was worse than the national and state average in just about all areas. For further benchmark analysis, Grady was also compared to another local hospital, Atlanta Medical Center (AMC). AMC, like Grady, mainly treats poorer patients. Both hospitals are noted to have very high volume ERs, meaning they care for 60,000+ patients in the ER annually. The average time patients spent in the ER before they were seen by a health care professional is 110 minutes at Grady, for AMC it is 30 minutes. The national average is 33 minutes and the state average is 46 minutes. The amount of patients that left the hospital before being seen is 22% at Grady, whereas AMC is 2%. The national is 2% and the state is at 3%. The average time patients spent in the ER before they were admitted to the hospital as an inpatient is 637 minutes at Grady and 412 minutes at AMC. The national average is 338 minutes and the state average is 359 minutes.
The patient survey results revealed that both hospitals only have a 2 out of 5 star rating. The percentage of patients that reported their doctor “always” communicated well is 80% for Grady and 78% for AMC. The national rating is 82% and state is 82%. The amount of patients that they “always” received help as soon as they wanted is 53% for Grady and 58% for AMC. National and state were rated at 68% and 66%. Although both hospitals were lower than both the state and national percentages, Grady performed a bit better than AMC.
As health care cost rises and patients are expected to take more an active role in their health care external reported measures provides patients and their providers with information that will help them to make more informed care decision (Varkey, 2010).

A website like Hospital Compare presents patients and their providers with important information on hospitals. They can view patient satisfaction surveys and see how hospitals are handling important diseases like stroke and heart condition. Patients are able to choose a hospital that will provide them with the care they need and they can avoid hospitals that lag behind in key areas. Another benefit is that hospitals are held more accountable. It is bad business for any hospital to have low rankings. Externally reported measures allows the public to see how well a hospital is performing, which can equate to more business or a loss in revenue. These reports put a spotlight on hospitals and forces them to fix areas that need improvement. A major challenge to externally reported measures is the data. If the data is not collected correctly or lacks accuracy it can cause more harm than good. Information that is not accurate can cause a hospital its reputation. The hospital would have to spend time fixing the error and the public perception that the false report has caused. Benchmarking can be benefit in these reports as it allows health care facilities to see where they stand when compare to either national standards

or to their competitors. In the case of Grady, there were several areas that were right on par with national and state numbers, in those areas the executives at Grady can continue the processes they have put in place. The areas that showed a deficit can receive more attention so that the hospital can get them up to standards.
Grady has tough time in the last few years and has even faced the possibility of closing due to financial issues. The hospitals has begun to revamp itself and to improve in many areas. The quality measures from Hospital Compare shows the public that Grady has made great strides in many areas, but at the same time it shows areas that still need focus and improvement.