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Eleven Health Care Leaders Identify Ten Strategies to Reduce Waste and Improve Care Quality 

WASHINGTON, D.C. – (June 5, 2012) – Collaborating under the auspices of the Institute of Medicine (IOM), CEOs and senior executives from eleven leading hospitals and health systems have developed a comprehensive checklist to promote high-value health care—care that delivers better results at reduced cost.

Released today, the CEO Checklist for High-Value Health Care is a Discussion Paper from the Institute of Medicine in which the authors present a Checklist of ten strategies that have proven effective in reducing waste and improving outcomes. The Checklist is available online at

The authors of the Checklist represent CEOs and senior executives from the following institutions: Cincinnati Children’s Hospital Medical Center, Cleveland Clinic, Denver Health, Geisinger Health System, Hospital Corporation of America, Intermountain Healthcare, Kaiser Permanente, Partners HealthCare, ThedaCare Center for Healthcare Value, Veterans Health Administration, Virginia Mason Health System.

The development of the Checklist occurs at an important time for health care in this country. As those who purchase health care—employers, families, and federal, state and local governments—continue to struggle with rising costs, they are increasingly seeking providers that can deliver high value care. This changing healthcare marketplace is forcing hospital and health system executives to focus both on providing the highest quality care and doing so at reduced cost.

Reflecting on the importance of this initiative, Institute of Medicine President Harvey Fineberg noted that “The CEO Checklist provides concrete strategies to deliver better health care at lower cost. The prominent health executives behind the Checklist, and others like them, are leading the way to superior care at reasonable costs. We can all learn from their example.”

The strategies outlined in the Checklist are unique in that they save lives and money. They describe a comprehensive approach to promoting high-value health care, and can serve as a blueprint for other hospital executives when considering their own efforts to improve the value of care delivered. Checklist items include:

  • Senior leadership that is committed, visible, and determined
  • Institutional culture of continuous improvement and real-time learning
  • Comprehensive IT systems for integrated, streamlined, and safe care
  • Evidence-based care to ensure the best care is delivered every time
  • Optimized resource utilization to reduce waste
  • Integrated care delivered in the setting most appropriate for the patient’s needs
  • Patient–clinician collaboration on care plans
  • Targeted resources for the sickest patients
  • Safeguards to reduce injury and infection
  • Internal transparency on performance, outcomes, and cost

To demonstrate the potential of each of the ten checklist items, A CEO Checklist for High-Value Health Care includes supporting case material describing the experiences of authoring institutions already working to implement these strategies, including:

  • Cincinnati Children’s Hospital Medical Center: Smoothing patient flow through the ICU has avoided $100 million in capital costs and reduced delays due to bed availability.
  • Cleveland Clinic: Internal transparency on quality spurred a 40% reduction in central line-associated blood stream infections (CLABSI) in the ICU, with $30,000 saved per avoided infection.
  • Denver Health: Lean improvement activities have reduced observed-to-expected hospital mortality and saved $158 million since 2006.
  • Geisinger Health System: The ProvenHealth Navigator medical home model decreased admissions and readmissions by 20% and reduced the total cost of care by 7%.
  • Hospital Corporation of America: Evidence-based perinatal services have reduced newborn complications helping HCA save $68 million annually and set new national benchmark levels for the industry.
  • Intermountain Healthcare: Evidence protocols for elective labor reduced inappropriate induction from 28% to less than 2%, saving $50 million dollars.
  • Kaiser Permanente: Early intervention protocols for community-acquired sepsis reduced mortality by roughly 60%.
  • Partners HealthCare: A home-monitoring program for heart failure patients reduced readmissions by roughly half, and has saved more than $10 million ($8,000 per patient).
  • ThedaCare: Patient-centered, team-based care at ThedaCare’s Collaborative Care Units has reduced the length of stay by 10 to 15 percent, improved patient satisfaction by 30 percent, reduced errors, and reduced the indirect and direct cost of care by 25%.
  • Veterans Health Administration: A system-wide prevention initiative for Methicillin-resistant Staphylococcus aureus (MRSA) has saved lives by reducing ICU infection rates by 62% nationwide.
  • Virginia Mason Health System: An intensive care management program for Boeing employees improved outcomes, improved the timeliness of care, and reduced costs by 33%.

Scaling the results already experienced within these institutions nationally has the potential to save thousands of lives and millions of dollars each year.

The CEO Checklist emerges from the work of the Institute of Medicine Roundtable on Value & Science-Driven Health Care and its Value Incentives Learning Collaboratives, extending insights addressed in the 2010 IOM publication on excess costs in the U.S healthcare system—The Healthcare Imperative. In this Discussion Paper, Roundtable members who lead hospitals and other care delivery organizations have partnered with other health care delivery leaders to share lessons learned about improving the value of care they deliver within their own institutions.

The Checklist Discussion Paper is part of a new category of IOM publications—Perspectives—which offer personal observations and opinions of leading experts on developments in health and health care. Perspectives are aimed at informing the discussion on pressing issues before the nation. As personal views, they reflect only the opinions of the authors, not the Institute of Medicine.

Organization Contacts:

Cincinnati Children’s Hospital: Terry Loftus ( | 513-636-9682)

Cleveland Clinic: Megan Pruce ( | 216-445-7452)

Denver Health: Julie Lonborg ( | 303-602-4968)

Geisinger Health System: Patti Urosevich ( | 570-204-1848)

HCA, Inc.: Ed Fishbough ( | 615-344-2810)

Intermountain Healthcare: Jason Burgess ( | 801-442-3217)

Kaiser Permanente: Keith Paulsen ( | 510-625-5667)

Partners HealthCare: Rich Copp ( | 617-278-1031)

ThedaCare Center for Healthcare Value: Sara McCarl ( | 920-659-7500)

Virginia Mason Health System: John Gillespie ( | 206-341-1509)

The Veterans Health Administration: Susan Poff ( | 202-316-6931)


Cincinnati Children’s Hospital Medical Center is a comprehensive, 577-bed pediatric hospital, ranked among the nation’s premier children’s hospitals, research centers, and pediatric residency training programs.

Cleveland Clinic, a not-for-profit, multispecialty academic medical center that integrates clinical and hospital care with research and education, is comprised of a 1,300-bed main campus, eight regional hospitals, 18 outpatient facilities, and both national and international locations.

Denver Health is Colorado’s primary “safety net” institution, providing over $453 million of care for uninsured patients this year and caring for almost one third of all Denver residents and 37% of Denver’s babies.

Geisinger Health System is a not-for-profit, fully integrated health services organization that serves more than 2.6 million residents in central and northeastern Pennsylvania.

HCA, Inc. HCA is one of the nation’s leading providers of healthcare services, comprising locally managed facilities that include approximately 164 hospitals and 109 freestanding surgery centers in 20 states and England. HCA is responsible for approximately 18 million patient encounters annually.

Intermountain Healthcare is a nonprofit system of 22 hospitals, physicians, clinics, and health plans serving the medical needs of Utah and southern Idaho.

Kaiser Permanente is an integrated managed care organization that has 9 million members, 37 medical centers and 431 medical offices throughout nine states and the District of Columbia.

Partners HealthCare is a non-profit, integrated health system founded by Brigham and Women’s Hospital and Massachusetts General Hospital and includes community and specialty hospitals, community health centers and other health-related entities. Partners is a principal teaching affiliate of Harvard Medical School.

ThedaCare Center for Healthcare Value is a non-profit organization that unites employers, providers and payers with the goal of creating a healthcare marketplace that rewards providers for delivering value.

Virginia Mason Health System is a Seattle-based integrated health services system including a 480 physician group practice, a regional network of neighborhood clinics, and a 336 bed acute care hospital.

The Veterans Health Administration is the largest integrated health care system in the nation, with over 53,000 licensed independent health care practitioners working across 152 hospitals and 812 community-based outpatient clinics to provide comprehensive care to more than 8.3 million Veterans each year.

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