Because the itis services are used across the

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Because the IT/IS services are used across the national health system, any upgrades or updates to the software must be done system-wide. For example, the hospital must send a request for hardware or software upgrades to the national system’s IT/IS staff. Other Environmental Context Local Competition The city’s competitive market consists of a safety net hospital and four major hospital systems, including HAU Care. Historically, the four major hospital systems operated in different niches of the city and surrounding areas, but over the past 5 years they have increasingly competed with one another and with physician groups. Central is geographically located in an area with residents of relatively high socioeconomic status. Two of the other regional systems have hospitals close by, while the third is not considered a major competitor. Historically, the city was a relatively high-utilization and high-cost market. Employers and purchasers either were less concerned about costs or were unable to work together to press providers to become more efficient and effective. The city is also home to major pharmaceutical and medical device companies. Additionally, it is the base for several major factories whose workers have union health benefits. HMOs are lightly represented in the S tate’s health insurance market. Funding and Payers Many factors have led purchasers in the State market to put more pressure on providers to compete and become more efficient. Some of the major factors include the presence of larger, national insurance firms such as Anthem and speculation about the impact of national health reform on payer mix and payment levels. Central’s largest payer— a private insurer bases reimbursement on quality metrics performance. As a result of volume and revenue decreases due to the U.S. economic recession, Central had to lay off 30 staff members in 2008. Since then, all of the regional ODS’s have been on a capital freeze. Although the hospital maintained a strong bottom line through 2010, there continues to be
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65 a region-wide hiring freeze to support other hospitals in the system. Nevertheless, the hospital was one of the few hospitals in the city that gave incremental raises and bonuses in 2010. Lean and Quality Improvement at the Organization In this section, we discuss the history of both Lean and quality improvement at Central. Exhibit 2.3 outlines the overall timeline for Lean and quality improvement initiatives. The specific activities noted in the timeline will be discussed throughout this report. History of Quality and Efficiency Improvement Efforts at the Organization Historically, quality improvement at the hospital began at the department level, with limited organization-wide efforts. A hospital-wide quality safety committee exists; one committee member noted that the structure of the committee shifted in the last few years from focusing on quality reports to being more action oriented. Further, the committee is making an effort to use Rapid Cycle Improvement (RCI) report-outs and other quality reports across departments. These
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