Managing Outcomes Helps a Children’s Hospital Climb in Renown

Correction Appended

CINCINNATI - Although it is nearly 2,000 miles from Boise, Idaho, Cincinnati Children's Hospital means to make a visit here worth a patient's journey.

Jacqueline Swan and her son, Matthew, 8, who has a rare disorder of his large intestine, at Cincinnati Children’s Hospital.

Articles in this series are examining new approaches to addressing common shortcomings in the nation's health care system.

Dr. Albert Peña with his patient Matthew Swan at a clinic in Cincinnati Children’s Hospital.

Not content to play a regional role, the Cincinnati Children's Hospital Medical Center has emerged as a national name in pediatric medicine, drawing patients from distant cities like Boise.

Over the last year, 26 percent of its 14,300 pediatric patients have come from outside the Cincinnati area, compared with 19 percent five years ago.

Reasons for the hospital's national renown include its market-niche focus on certain rare or complex conditions. A medical-team approach coordinates the efforts of the various specialists who handle each child's case.

There is also diligent attention to quality and efficiency, inspired by a chief executive from a manufacturing background.

And then there is a distinction that might seem unremarkable if it were not so infrequent in American health care: Cincinnati Children's Hospital rigorously tracks how its patients fare, both in the hospital and after they leave.

Many hospitals might claim to offer high-quality care. But they often have only the vaguest notion of how well their patients are doing, aside from a few basic measures like whether they survive surgery.

Cincinnati Children's is among the relatively few medical centers that meticulously collect a wide range of data, to let the hospital see whether patients are getting good, effective care - and to look for ways to improve.

By precisely tracking how many patients develop surgical infections, for example, and why, Cincinnati Children's has been able to identify ways to reduce that number by more than half - to 42 last year compared with 95 in 2005.

By carefully charting measures like the range of joint motion achieved by juvenile arthritis patients, to cite another example, the hospital is trying to identify the most effective therapies and adopt them as standard treatments.

And demonstrating the value of dealing with the practical aspects of a patient's medical condition, Cincinnati Children's can point to data showing that 95 percent of children with severe intestinal abnormalities who complete its bowel-management program are able to leave wearing normal underwear.

One recent beneficiary is Matthew Swan, an 8-year-old from just outside Boise with a rare congenital disorder affecting his large intestine. After treatment at Cincinnati Children's, Matthew for the first time in his life is able to attend school full time.

Identifying specialties where it can excel, and pursuing them with a business-minded operational rigor, helped the nonprofit hospital take its place among the nation's best pediatric centers. It now vies for patients with the likes of Children's Hospital Boston, affiliated with Harvard, or the Children's Hospital of Philadelphia.

Lacking the prestige of other well-known pediatric centers, Cincinnati Children's had to learn to compete on something else, said Dr. Charles Homer, the chief executive of the nonprofit National Initiative for Children's Healthcare Quality. "The something else is quality."

The hospital's national emergence has been led by James M. Anderson, a former corporate lawyer who ran an industrial valve maker before becoming the hospital's chief executive in 1996. The goal, he said, is to make "the experience you have in Cincinnati Children's to be so much better an experience you want to come here."

The strategy's success can be measured in the hospital's operating revenue, which has grown by about 50 percent over the last three years, to just over billion for fiscal 2006. The figure includes the mounting research grants pulled in by some of the top medical specialists whom Mr. Anderson has recruited from around the country.

"Cincinnati Children's is a good example of a provider moving voluntarily down the path towards value-based care delivery or value-based competition," said Michael E. Porter, a Harvard Business School professor.

He is an author of the book "Redefining Health Care," which argues that hospitals should compete on the basis of their proven success in treating particular medical conditions.

The competitive strategy at Cincinnati Children's evolved about six years ago from a period of soul-searching as Mr. Anderson sought a strategic mission for the hospital.

Correction: September 18, 2007

An article in Business Day on Saturday about efforts by the Cincinnati Children's Hospital Medical Center to compete nationally for patients misspelled the surname of the physician in charge of quality improvement at the hospital. She is Dr. Uma R. Kotagal, not Kotogal.