CHRISTUS CEO Reflects on 10-Year Journey to Excellence with Help of Useful Data Metrics


Many practicing clinicians experience an "ah-ha" moment at some point during their careers—an incident which perfectly crystallizes the reason they became care providers. This epiphany came to Dr. Thomas Royer, CEO and president of CHRISTUS Health (Dallas, TX), during his third year of medical school, when a woman brought her 10-year-old son to him in the ER, to treat a worsening gall bladder infection.

"I couldn't believe that child's mother actually trusted me enough to take care of her pride and joy," he says. "It made me realize why health care is so sacred; people literally turn their lives over to us. From then on, I knew excellence in my profession was a necessity, not a luxury. And that's why it's so important for us to use metrics and I.T. systems to provide the very best care we possibly can."

At CHRISTUS, an organization consisting of over 40 acute and long-term care facilities, health care leaders have followed Royer's lead with its "Journey to Excellence" initiative. This undertaking involved a commitment to using data and metrics in order to document solid performance in four key areas: clinical quality, service quality, business literacy, and community value. A decade after the project began, CHRISTUS is celebrating a wide range of achievements affecting all areas of practice—including increased revenues, transparent governance processes, and a best practice program driven by a benchmark competitive evaluation process and Touchstone Award Program.

"We couldn't have made such incredible progress without our metrics," notes Royer. "Numbers prove how well you're doing, or how badly you're doing, and they initiate change quicker because you have facts and reasons driving the decision-making process."

Rolling with the Changes
For Royer, making useful metrics a priority in his practice was a journey in itself. Like many care providers, he was confident in his ability to administer quality care, without having to look back at the statistics.

"I made two critical mistakes in my early years practicing medicine. First, I worked with the wrong people too long and just expected them to do the right things. Second, I did too much without measurements," Royer admits. "I was blinded by the assumption that we were all administering quality care, and it took too long to prove we were doing the wrong things, because I had no measurable data to back it up."

With the health care industry rapidly changing—from declining reimbursements to the increasing demand for transparency among payors and patients—Royer knew CHRISTUS had to change along with it. Most importantly, the organization needed to develop more integrated, innovative, and patient-centric approaches to care delivery.

"One of our priorities was creating a brand identity for CHRISTUS, as one of the best health care organizations in the world," says Royer. "But to truly accomplish that, we needed to take the time for metrics, to prove we actually are as exceptional as we say we are, or to address honestly our areas of weakness."

Keys to Success: Transparency, Motivation, Integration
In order to validate its achievements, CHRISTUS saw the need to not only gather data and measure it, but to make it transparent to the community. According to Royer, transparency allows patient communities to base their medical decisions on proven clinical outcomes, quality of service, and cost of care.

"Transparency really means creating an environment of continuous learning, where you recognize where you are, as well as where you want to go in terms of quality," he says. "Using a balanced scorecard approach has been essential for us to focus on performance metrics, supported by our outcomes data."

Keeping staff throughout the organization focused and motivated has also helped CHRISTUS in keeping care delivery consistent across the enterprise. "We're all in this together, each hospital and each staff member lends a hand in this process,'" says Royer. "Our overall mission and values need to be lived every day. Each of our hospitals represent small islands of excellence, and as a ministry, we're gradually becoming a continent of excellence."

One of the special challenges for CHRISTUS was streamlining the data collection process for interconnectivity across its organization. To connect its information system and resources over eight regions, CHRISTUS chose to standardize its health care information system with MEDITECH's HCIS in 2007.

"CHRISTUS saw the obvious benefits of converting from two health care information system (HCIS) vendors to one integrated solution," Royer says. "Information management is a key part of our foundation, and getting all of our systems to talk to each other is absolutely essential."

Proven Data Brings Real Results
By making changes based on its measures, CHRISTUS has experienced not only improvements in performance, but also financial growth. Royer says CHRISTUS' success with all four key measurements have exceeded the 80th percentile, while assets have grown from $3.3 billion to $4.7 billion since 1999. In addition, net revenue during the past decade has also expanded from $1.9 billion to $3 billion. However, Royer says there's no chance leaders at CHRISTUS will become complacent.

"Nothing in medicine stands still—we all must continue to learn and work to enhance our data intercollectiveness," he explains. "I was once asked by a nurse from one of our hospitals if I'd be satisfied with a 99th percentile rating in all four of our key measurements. My answer? If your hospital was only 99% successful, how satisfied would you be if your child was in that one percent?"