THE
COMMONWEALTH
FUND
2003 Commonwealth Fund
International Health Policy Survey
of Hospital Executives
Cathy Schoen, Robert J. Blendon, Catherine M. DesRoches, Robin Osborn,
Elizabeth Raleigh, Phuong Trang Huynh, Alice Ho, and Kinga Zapert
Summary Chartpack
Contents
I. Introduction
4
II. Methods
5
III. System Overview
Chart III-1 Satisfaction with the Health Care System
Chart III-2 Two Biggest Problems Faced by Hospitals
Chart III-3 Quality of Hospital Resources
Chart III-4 Concern About Losing Patients to Competitors
Chart III-5 Preparedness for a Terrorist Attack
7
8
9
10
11
IV. Hospital Finances
Chart IV-1 Hospital Finances
Chart IV-2 Current Financial Situation in Hospitals
13
14
V. Capacity and Waiting Times
Chart V-1 Patients Wait Six Months or More to Be Admitted
for Elective Surgery
Chart V-2 Average Emergency Room Waiting Time
Chart V-3 Average Hospital Waiting Times
Chart V-4 Diversions of Patients to Other Hospitals Due to
Lack of Emergency Room or Hospital Capacity
Chart V-5 Delays or Problems with Discharge Because of
Limited Availability of Post-Hospital Care
Chart V-6 Waiting Times for Elective Surgery in the Past Two Years
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
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17
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Hospital executives
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VI. Improving the Quality of Care
Chart VI-1 Hospital Does NOT Have a Written Policy for Informing Patients
of a Preventable Medical Error Made in Their Care
Chart VI-2 Effectiveness of Hospital’s Program for Finding and Addressing
Preventable Medical Errors
Chart VI-3 Physician Support for Reporting and Addressing
Preventable Medical Errors
Chart VI-4 How Effective Would Electronic Medical Records Be in
Improving Quality of Care?
Chart VI-5 How Effective Would Computerized Ordering of Drugs Be in
Improving Quality of Care?
Chart VI-6 How Effective Would Standard Treatment Guidelines Be in
Improving Quality of Care?
Chart VI-7 How Effective Would Outcome Comparisons with Other
Hospitals Be in Improving Quality of Care?
Chart VI-8 How Effective Would Bar Coding of Medications Be in
Improving Quality of Care?
Chart VI-9 Effectiveness of Government Policies and Regulations
Designed to Improve Quality of Care
Chart VI-10 Opposition to Disclosure of Quality Information to the Public
23
24
25
26
27
28
29
30
31
32
VII. Staffing Issues
Chart VII-1 Staffing Shortages
34
Chart VII-2 Canceling or Postponing Scheduled Surgeries Due to Staff Shortages 35
Chart VII-3 Nurse Staffing Levels Compared with Two Years Ago
36
Chart VII-4 Strategies to Recruit and Retain Nurses
37
Chart VII-5 Rating Physician Morale
38
VIII. Information Technology
Chart VIII-1 If You Had New Funding to Invest in a One-Time Capital
Improvement to Improve Quality of Patient Care in One Area
of Your Hospital, What Would It Be?
Chart VIII-2 Major Barriers to Greater Use of Computer Technology
40
41
IX. Summary and Policy Implications
42
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
3
I. Introduction
The Commonwealth Fund 2003 International Health Policy Survey is
the sixth in a series of surveys designed to provide a comparative
perspective on health policy issues in Australia, Canada, New Zealand,
the United Kingdom, and the United States. The 2003 survey consisted
of interviews with a sample of hospital chief operating officers or top
administrators of the larger hospitals across the five nations. The survey
sought these executives’ perspectives regarding current resources and
efforts to improve quality of care. Comparative findings from the survey
were reported in the May/June 2004 issue of Health Affairs.*
This chartpack represents a summary of the survey findings and is
divided into the following sections:
•
•
•
•
•
•
System Overview
Hospital Finances
Capacity and Waiting Times
Improving the Quality of Care
Staffing Issues
Information Technology
* R. J. Blendon, C. Schoen, C. M. DesRoches, R. Osborn, K. Zapert, and E. Raleigh, “Confronting Competing Demands
to Improve Quality: A Survey of Hospital Executives in Five Nations,” Health Affairs (May/June 2004): 119–35.
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
4
II. Methods
•
Telephone survey of hospital executives in Australia, Canada,
New Zealand, United Kingdom, and the United States.
•
Conducted by Harris Interactive and subcontractors
from April to May 2003.
•
Sample of largest hospitals in each country:
– 200+ beds in UK and the US
– 100+ beds in AUS, CAN, NZ
•
Final hospital sample size of:
– 100 in AUS, 102 in CAN, and 103 in the UK
– 28 in NZ
– 205 in the US
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
5
III. System Overview
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
6
Chart III-1. Satisfaction with the
Health Care System
Somewhat satisfied
Percent
100
75
4
16
12
50
8
93
77
76
Very satisfied
4
82
47
25
0
AUS
CAN
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Hospital executives
7
Chart III-2. Two Biggest Problems
Faced by Hospitals
Percent naming:
AUS
CAN
NZ
UK
US
Inadequate funding
58%
62%
57%
39%
10%
8
—
—
—
60
Staffing shortage
45
60
54
64
47
Inadequate/ overcrowded/
outdated facilities
32
39
54
42
7
Indigent care/ uninsured
—
—
—
—
17
Malpractice costs
6
—
—
—
11
Inadequate reimbursement
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
8
Chart III-3. Quality of Hospital Resources
Base: Hospitals that have the facility
Percent rating as
“only fair” or “poor”:
AUS
CAN
NZ
UK
US
Intensive care unit
9%
13%
10%
11%
5%
Operating rooms or
theatres
7
20
13
17
5
Emergency room or
department facilities
21
48
30
17
20
Diagnostic imaging
equipment or other
medical technology
13
19
21
18
3
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
9
Chart III-4. Concern About Losing Patients
to Competitors
Percent “very concerned”
they will lose patients in
next two years to:
AUS
CAN
NZ
UK
US
Other hospitals
16%
4%
7%
4%
19%
Free standing diagnostic
or treatment centers
6
6
4
4
55
Free standing ambulatory
or primary care centers
7
3
0
3
51
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
10
Chart III-5. Preparedness for
a Terrorist Attack
Percent
Somewhat prepared
Very prepared
100
75
18
25
25
63
61
28
43
50
58
25
62
46
0
AUS
CAN
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Hospital executives
11
IV. Hospital Finances
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
12
Chart IV-1. Hospital Finances
In The Past Year:
AUS
CAN
NZ
UK
US
Had a surplus or profit
35%
9%
11%
7%
71%
Broke even
25
22
7
61
6
Had a loss or deficit
40
70
82
32
23
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
13
Chart IV-2. Current Financial Situation
in Hospitals
Insufficient to maintain current levels of service
Percent
Allows for some improvements*
100
75
81
75
63
57
50
25
30 32
11
2
4
8
0
AUS
CAN
NZ
UK
US
* Does not include percent reporting sufficient to maintain current levels of service.
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
14
V. Capacity and Waiting Times
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
15
Chart V-1. Patients Wait Six Months or More
to Be Admitted for Elective Surgery
Very often
Percent
Often
100
75
50
22
25
12
14
0
AUS
21
9
22
CAN
35
22
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
1
US
Hospital executives
16
Chart V-2. Average Emergency Room
Waiting Time
Base: Hospitals with an emergency room or department
Percent reporting an average wait of two or more hours
100
75
46
50
25
58
23
39
17
0
AUS
CAN
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Hospital executives
17
Chart V-3. Average Hospital Waiting Times for…
Base: Hospitals who perform the procedure
A Breast Biopsy for a 50-Year-Old Woman with an
Ill-Defined Mass in Her Breast but No Adenopathy
Percent of patients
having to wait:
Less than three weeks
Three weeks or more
AUS
CAN
NZ
UK
US
74%
70%
48%
73%
93%
15
21
44
20
2
A Routine Hip Replacement for a 65-Year-Old Man
Less than six months
54
43
25
15
92
Six months or more
39
50
65
81
1
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
18
Chart V-4. Diversions of Patients
to Other Hospitals Due to Lack of
Emergency Room or Hospital Capacity
Very often
Percent
Often
50
25
5
15
9
0
AUS
9
4
CAN
4
7
0
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
15
US
Hospital executives
19
Chart V-5. Delays or Problems with
Discharge Because of Limited Availability
of Post-Hospital Care
Very Often
Often
Percent
75
50
30
24
19
25
15
34
24
0
AUS
CAN
28
7
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
25
US
Hospital executives
20
Chart V-6. Waiting Times for Elective Surgery
in the Past Two Years
Percent
Gotten Longer
Gotten Shorter
100
86
75
44
50
25
11
21
9
18
29
27
8
14
0
AUS
CAN
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Hospital executives
21
VI. Improving the Quality of Care
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
22
Chart VI-1. Hospital Does NOT Have a
Written Policy for Informing Patients of a
Preventable Medical Error Made in Their Care
Percent saying hospital does NOT have such a policy
100
75
50
50
50
36
18
25
8
0
AUS
CAN
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Hospital executives
23
Chart VI-2. Effectiveness of Hospital’s
Program for Finding and Addressing
Preventable Medical Errors
Percent
Somewhat effective
Very effective
100
75
13
22
4
24
24
67
70
50
66
58
25
71
0
AUS
CAN
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Hospital executives
24
Chart VI-3. Physician Support for Reporting
and Addressing Preventable Medical Errors
Percent
Somewhat supportive
Very supportive
100
75
17
21
59
59
7
50
25
57
35
30
54
56
0
AUS
CAN
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Hospital executives
25
Chart VI-4. How Effective Would
Electronic Medical Records Be in
Improving Quality of Care?
Percent
Somewhat effective
Very effective
100
75
50
25
43
45
40
35
50
68
39
CAN
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
43
19
0
AUS
46
UK
US
Hospital executives
26
Chart VI-5. How Effective Would
Computerized Ordering of Drugs Be in
Improving Quality of Care?
Percent
Somewhat effective
Very effective
100
75
55
50
25
38
51
64
61
60
33
24
28
32
0
AUS
CAN
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Hospital executives
27
Chart VI-6. How Effective Would
Standard Treatment Guidelines Be in
Improving Quality of Care?
Percent
Very effective
Somewhat effective
100
75
56
59
46
43
48
39
41
50
50
46
50
25
0
AUS
CAN
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Hospital executives
28
Chart VI-7. How Effective Would
Outcome Comparisons with Other Hospitals
Be in Improving Quality of Care?
Percent
Somewhat effective
Very effective
100
75
38
22
36
33
33
50
51
25
65
57
48
55
0
AUS
CAN
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Hospital executives
29
Chart VI-8. How Effective Would
Bar Coding of Medications Be in
Improving Quality of Care?
Percent
Very effective
Somewhat effective
100
75
36
50
25
41
52
46
52
28
32
30
62
31
0
AUS
CAN
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Hospital executives
30
Chart VI-9. Effectiveness of
Government Policies and Regulations
Designed to Improve Quality of Care
Percent
Somewhat effective
Very effective
100
75
4
5
4
50
5
25
63
2
38
71
57
41
0
AUS
CAN
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Hospital executives
31
Chart VI-10. Opposition to Disclosure of
Quality Information to the Public
Percent saying should NOT
be released to the public:
AUS
CAN
NZ
UK
US
Mortality rates for specific
conditions
34%
26%
18%
16%
31%
Frequency of specific
procedures
16
5
4
13
15
Medical error rate
31
18
25
15
40
Patient satisfaction ratings
5
2
0
1
17
Average waiting times for
elective procedures
6
1
0
1
29
25
10
25
9
29
Nosocomial infection rates
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
32
VII. Staffing Issues
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
33
Chart VII-1. Staffing Shortages
Percent reporting “serious”
shortages of:
AUS
CAN
NZ
UK
US
Nurses
23%
30%
11%
22%
31%
Pharmacists
26
33
14
27
14
Specialists or consultant
physicians
11
26
7
17
16
Trained managerial staff
5
12
0
6
3
Lab technicians
3
9
0
17
4
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
34
Chart VII-2. Canceling or Postponing
Scheduled Surgeries Due to Staff Shortages
Percent reporting having to cancel or postpone 10%
or more of scheduled surgeries due to staff shortages
50
26
25
21
24
14
14
0
AUS
CAN
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Hospital executives
35
Chart VII-3. Nurse Staffing Levels
Compared with Two Years Ago
Percent
Situation is worse
Situation is better
75
50
48
41
28
25
24
40
36
36
25
25
15
0
AUS
CAN
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Hospital executives
36
Chart VII-4. Strategies to
Recruit and Retain Nurses
Percent saying they use:
AUS
CAN
NZ
UK
US
Sign-up bonuses
16%
24%
4%
8%
60%
Tuition reimbursement
75
51
54
NA
97
Recruiting from other
countries
57
30
86
88
35
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
37
Chart VII-5. Rating Physician Morale
Poor
Only fair
Percent
50
7
3
25
2
28
15
0
AUS
CAN
NZ
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
26
20
7
UK
US
Hospital executives
38
VIII. Information Technology
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
39
Chart VIII-1. If You Had New Funding to
Invest in a One-Time Capital Improvement to
Improve Quality of Patient Care in One Area
of Your Hospital, What Would It Be?
Percent saying:
AUS
CAN
NZ
UK
US
Electronic medical records/IT
35%
47%
46%
38%
62%
Emergency room/OR/
Critical care facility
26
18
4
22
13
Basic hospital/patient facilities
17
14
21
22
3
9
16
11
10
3
Diagnostic equipment/
medical technology
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
40
Chart VIII-2. Major Barriers to
Greater Use of Computer Technology
Percent saying major barrier:
AUS
CAN
NZ
UK
US
High start-up costs
84%
84%
93%
69%
71%
Projected maintenance
costs/insufficient technical staff
49
42
32
52
27
Lack of uniform standards within
industry
49
35
50
31
44
Doctors’ resistance to change
20
21
18
8
39
Privacy concerns
20
26
7
8
17
Lack of training
11
12
4
9
15
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
41
IX. Summary and Policy Implications
•
Shared concerns across countries around financial health,
waiting times, quality of basic services, staffing shortages.
•
Challenge to maintain current levels of service and financial
constraints may limit the ability of hospitals to make quality
improvements.
•
While attention is being given to patient safety, there remains
substantial room for improvement.
•
Majority of hospital executives endorse public disclosure of
quality data and quality initiatives.
•
Nurse shortages are a concern but there is guarded optimism
that they are not getting worse.
•
Information Technology is an investment priority but hospitals
cite common barriers to moving forward.
•
Cross-cutting issues offer opportunities to learn from varying
approaches within different country systems.
2003 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Hospital executives
42