John Muir Health: Case Study

Strategic Healthcare Group helps health system decrease blood utilization by 18% and save $1.9 million in costs while improving quality and patient safety.

John Muir Health is a combined 600-bed, two-hospital health system in Concord and Walnut Creek, California.  The system had an escalating blood budget of $6 million a year and a growing awareness of the safety and quality issues surrounding blood transfusion. Hospital leadership became determined to improve blood utilization. After trying unsuccessfully to reduce blood use on their own, Strategic Healthcare Group was engaged to optimize blood management practices and reduce inappropriate utilization of blood products throughout the health system.

As a result of their engagement with Strategic Healthcare Group, from 2007 to 2009 the hospital decreased blood utilization by 18% and saved $1.9 million in acquisition costs alone. “This is just the tip of the iceberg,” says Nicole Brocato, Executive Director for Quality Improvement and Clinical Research at John Muir Health. She cites decreased morbidity and reduced length of stay as two other huge benefits.

The process began with the Strategic Blood Management™ comprehensive audit and benchmarking process, which is designed to identify high-yield opportunities for improvement. “When they did the audit, we found a lot of opportunities from a safety, quality and cost point of view. While the costs get the attention of management, the safety and quality aspects get the attention of physicians,” says Roy Kaplan, M.D., Medical Director of Quality Management.

After the first year’s savings of $900,000, Strategic Healthcare Group helped John Muir build upon their comprehensive blood management program. This included helping the hospital system hire a Transfusion Safety Officer and a Blood Management Medical Director, two positions that have been integral to John Muir Health’s success. SHG supported the training and development of these positions by providing on-site peer-to-peer mentoring, a transfusion safety toolkit, and ongoing support as needed. Even factoring in the cost of these positions and the consulting fees for SHG, the hospital exceeded its financial savings goal by $300,000 with a net savings of $1.2 million, says Brocato.

Dr. Kaplan says the team from SHG made all the difference. “I’ve been very impressed with the people on the team, and their work product was excellent. Their presentation skills were good. They’ve motivated leadership across both hospital campuses to take action,” Dr. Kaplan says.

“Because SHG consultants are clinicians and content experts, they have a very realistic and achievable approach,” says Margaret Simor, Director of John Muir’s cardiovascular service line clinical operations. “We have found that they took the time to get to know our stakeholders across two hospitals. They helped us identify champions. They provided us with a structure for the program that takes best practices from their own clinical experiences and those of other clients. The program is not static. They share ideas. They provide support They deliver content that is tailored to John Muir Health and is meaningful to our real-world experience.” Simor adds, “They have presented us with high-quality deliverables in terms of our audit and implementation plans as well as a systematic approach to achieve the opportunities identified.” Simor concludes by saying “I have worked with many consultants over my career, and I find SHG’s approach to be the best by far.”

Brocato agrees. “There’s no way we would have been able to do this without Strategic. They encourage us and keep us on track. They’re very hands-on and supportive, but they don’t bulldoze when they come on site. They know their role. They’re also down-to-earth people who are fun to work with.” Dr. Kaplan says the external benchmarking and change management strategy was essential for success. “(SHG’s process) was very good for our organization. We will probably learn to accelerate change in other areas as well through the process,” he adds.

The Strategic Blood Management System™ uses an E4 Methodology- Evaluate, Educate, Engage & Empower- to shift the attitudes, behavior and culture of the organization toward better blood use within the first few months. Remarkably, hospital clients typically see a return on investment within three to six months of their engagement with Strategic Healthcare Group. Better yet, the sustainable approach, culture change and informatics tools hardwire the process and keep the savings going for years down the road.

Clinical data shows that a reduction in blood transfusion rates dramatically improves patient safety by reducing the number complications and the length of stay. Hospitals that reduce transfusion rates see substantial savings in the cost of patient care, in addition to the remarkable savings on blood purchase costs. While an estimated savings for reduced complications is difficult to accurately determine, experts say the real cost of adverse events may be approximately eight times as much as the blood costs.

Brocato says John Muir Health participated in research with the National Surgical Quality Improvement Program. The data (on a local and national level) confirmed that decreasing blood transfusions decreased patient morbidity. It also showed that increasing intraoperative transfusions from one unit to two units of packed red blood cells was associated with increased 30-day mortality, surgical-site infection, pneumonia, and sepsis in general surgery patients.

“This is the perfect example of saving money and improving outcomes and patient safety. Blood management is the poster child for cost savings and quality outcomes,” says Brocato, adding, “It doesn’t just save money, it is the right thing to do for our patients.”

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