In the Literature: At Intermountain, process improvement reduces inductions, cesareans, NICU admissions, and costs

This project was selected from among many reported in the peer reviewed literature. For a list of more articles on quality improvement, visit our resource bibliography.


James, B. C., & Savitz, L. A. (2011). How Intermountain trimmed health care costs through robust quality improvement efforts. Health Affairs, 30(6), 1185-1191. doi:10.1377/hlthaff.2011.0358 (abstract)


Intermountain Healthcare’s 23 hospitals and 160 clinics in Utah and Idaho


Intermountain set out to improve quality in multiple clinical areas by measuring, understanding, and managing variation among clinicians in providing care. The effort emphasized processes rather than outcomes of care because data from their robust clinical and administrative information systems revealed that outcomes were similar across providers while resource utilization varied markedly.


The initiative had four components: identifying key care processes, designing information systems to manage clinical and financial data together, implementing changes to allow departments to use the resulting data to encourage accountability and change, and aligning financial incentives so that clinicians would not suffer financially for providing better care.

The maternity department was one of the first to implement this process improvement approach, beginning with efforts to reduce elective induction. In addition to the information systems, Intermountain adopted a new policy requiring review of all planned elective inductions for medical appropriateness.


The proportion of all inductions that lacked strong indications for clinical appropriateness fell from 28 percent to less than 2 percent. This reduced the amount of time women collectively spent in labor by roughly thirty-one days per year, increasing the capacity of Intermountain to care for more women and newborns without additional beds or nurses.

The process improvement project also resulted in decreases in both NICU admissions and cesareans, and Intermountain estimates that the elective induction protocol reduces health care costs in Utah by $50 million per year. Intermountain also estimates the changes cost them more than $9 million per year in revenues, highlighting the need for payment reform to address this potent barrier to widespread replication.



Filed in Blueprint, Clinical audit, case review, or analysis of adverse events, Clinical controversies, Clinical practice guideline/policy change, Health information technology, Health information technology, In the Literature, Payment reform, Performance measurement, Performance measurement/reporting on Fri., Jul 29, 2011

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