NEJM Catalyst

NEJM Catalyst Practical innovations in health care delivery:

Ideas, solutions, and case studies to improve patient care and drive value in health organizations.

Health care delivery is undergoing a major transformation around quality, cost, and access. NEJM Catalyst brings health care executives, clinician leaders, and clinicians together to share innovative ideas and practical applications for enhancing the value of health care delivery. NEJM Catalyst brings insightful articles and real-life examples from a network of top thought leaders, experts and advisors to provide:

Practical innovations in health care delivery;

Impeccable quality and impact;

Active contributions from renowned authorities, thought-leaders, and advisors;

Independent and impartial curation; and

An exchange of ideas among executives and clinicians. NEJM Catalyst is produced by NEJM Group, a division of the Massachusetts Medical Society, located in Waltham, Massachusetts.

In this article, the authors discuss the creation of HealthLocator, a public, digital platform designed to address the c...
11/28/2025

In this article, the authors discuss the creation of HealthLocator, a public, digital platform designed to address the confusion and inconsistencies between hospital rating systems. HealthLocator aims to empower patients with transparent, data-driven insights on more than 5,000 U.S. hospitals, helping them make informed decisions based on reliable metrics.

Developed by the Mayo Clinic’s Kern Center, HealthLocator integrates three core domains — quality outcomes, patient experience, and patient safety — into a single composite score. These domains draw from publicly available U.S. Centers for Medicare & Medicaid Services (CMS) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data, spanning measures of readmissions, mortality, timeliness of care, patient experience, and hospital-acquired conditions, subsequently transformed into percentiles to more clearly present and interpret performance.

An unique complementary feature is the reliable excellence indicator, which identifies top-tier hospitals consistently scoring highly across all CMS measures through robust simulations. In addition, HealthLocator includes high-volume and high-6-month-survival indicators for surgeries and specialized care, using CMS claims data.

The novel 6-month mortality model adjusts for patient risk while avoiding the potential for methodological manipulation through inappropriate use of observation stays that are excluded from mortality measurement in other rating and ranking systems.

The Mayo Clinic plans to continually refine HealthLocator based on user feedback, with future updates focusing on personalization, outpatient and long-term care quality measures, expanded data sources, and broader stakeholder input via an external advisory board.

In essence, HealthLocator is not just another ranking system — it is a public service initiative rooted in peer-reviewed methods and designed to help patients find high-quality care while promoting accountability and improvement in health care delivery: https://nej.md/3L7D6XV

Length of stay (LOS) has increasingly been a focus of hospital operations as health systems try to allocate limited reso...
11/28/2025

Length of stay (LOS) has increasingly been a focus of hospital operations as health systems try to allocate limited resources and contain costs, especially those in value-based arrangements.

This article describes the design and implementation of a LOS reduction initiative at two large urban hospitals. Detailed in the article is the infrastructure created to support process improvement related to LOS across a variety of service lines, including hospital medicine, care management, laboratory, and patient logistics. A variety of the resulting programs and their outcomes are described, as well as contributing factors to their successes and challenges.

Key metrics explored include LOS; turnaround times for laboratory orders, thoracentesis, and paracentesis; ratio of patients geographically cohorted; utilization of clinical pathways; and volume of discharge delays.

The authors address investment in culture, process establishment and maintenance, fostering interdisciplinary collaboration, and timely and accurate data analytics, as well as their role in optimizing LOS: https://nej.md/483GomP

In response to rising concerns about violence against health care workers, beginning in 2021, Penn Medicine implemented ...
11/26/2025

In response to rising concerns about violence against health care workers, beginning in 2021, Penn Medicine implemented a high-tech weapons-detection system at hospital entrances. The prevalence of detected fi****ms represented an opportunity to engage with patients, families, community members, and hospital staff in efforts to promote firearm safety, not just at the hospital, but at homes within the community.

In this article, the authors report on the development of a firearm-secure-storage program implemented in partnership with hospital security at an urban academic hospital in Philadelphia. Promoting secure storage among firearm owners is a key strategy to prevent injury and death and was highlighted as a community risk reduction and education strategy in the 2024 U.S. Surgeon General’s advisory on firearm violence.

The authors describe a scalable design process, leading to the development of several firearm-related initiatives, including a firearm-storage-device distribution program that featured a pilot randomized controlled trial to compare self-reported secure storage adherence rates among those who accepted a free cable-lock device and those who received their choice of a free cable lock or lockbox (all chose the lockbox).

After some development and iteration, phase 1 of the program evolved from free hospital-based cable lock distribution and on-site firearm storage to program participation via a QR-enabled poster at hospital security entrances. Interested visitors and patients could scan the QR code on the poster, respond to survey questions, and share shipping information to receive a free locking device.

Findings suggest that the hospital setting provides a scalable platform for firearm-secure-storage programs; that recipients prefer lockboxes over cable locks; and that device distribution improves secure storage rates among firearm owners. This initiative highlights the potential for health systems to contribute to injury prevention through innovative partnerships with security staff and easy-to-adopt safety solutions embedded in routine hospital operations: https://nej.md/480WkG7

Health systems experience significant variation in business and clinical outcomes within and between operating units. He...
11/26/2025

Health systems experience significant variation in business and clinical outcomes within and between operating units. Here are the 24-month results of a large-scale, post-merger deployment of a clinical operating system (cOS) across Prisma Health, an 18-hospital health system.

The cOS is a branded and tech-enabled management system that defines the daily work across all clinical environments. Implementation of this cOS was associated with improvements in efficiency, patient experience, team engagement, safety, quality, and financial performance across all care settings.

The overarching goal of a cOS is to simplify the essential workflows and work environment of the clinical team. This experience suggests that implementation of a highly visible and holistic cOS can have transformational clinical, business, and human impacts in a short period of time within a large and complex health company: https://nej.md/49oD203

How Penn Medicine navigated complex information technology challenges involved in processing electronically faxed patien...
11/25/2025

How Penn Medicine navigated complex information technology challenges involved in processing electronically faxed patient information to improve workforce well-being and patient care, and the decision-making process in choosing whether to build digital tools internally versus partnering with third-party vendors: https://nej.md/4oWDFCA

Penn Medicine launched its homegrown technology platform, called coordn8, in October 2022. It automates the processing of electronic faxes received from other providers and health systems and integrates them into Penn Medicine’s electronic health record, significantly reducing administrative burden.

The platform has processed more than 370,000 faxes, saving the health system more than 8500 hours of staff time to date. Staff satisfaction improved markedly according to surveys, rising from 35% to 60%. The freed capacity was redirected to higher-value clinical tasks.

This clinician-driven initiative demonstrates how automating repetitive high-volume tasks such as patient identification and record indexing can reduce workforce burden, enhance the accuracy and timeliness of filing electronic faxes, and create a scalable system that minimizes manual effort, streamlines workflows, and ensures timely access to critical patient information.

Gender inequity remains a systemic issue in academic medicine. Female physicians have lower salaries and are leaving aca...
11/25/2025

Gender inequity remains a systemic issue in academic medicine. Female physicians have lower salaries and are leaving academic medicine at higher rates than male physicians.

After correction for rank and years in rank, the salaries of female faculty in 2020 were below the median and lower than their male counterparts in the Department of Pediatrics at UC Davis Health.

To address gender inequity, close the gender pay gap, and improve physician retention, the Department of Pediatrics at UC Davis Health assessed gender pay equity using z scores based on rank and specialty and implemented several measures (the gender equity bundle), including starting assistant professors at the 50th percentile salary for rank; providing compensation linked to rank/years in rank; adjusting productivity metrics for childbearing, sick and family leave; raising the bar by using general pediatrics benchmarks for specialties with lower salaries; advancing more women into leadership positions; and, finally, implementing a lactation support program.

This program utilized lactation value units, a financial incentive to support lost work relative value units for lactation holds, and additional documentation time for both outpatient and inpatient pediatric physicians for up to 2 years from childbirth. The department adopted a formulaic approach to salaries based on rank and years in rank under an aligned funds flow methodology.

With these measures, the salary z scores of all faculty improved, and the mean difference in salary z scores between male and female staff decreased: https://nej.md/4pgrnoD

The number of on-market, digitally enabled health solutions is increasing steadily; if and how they fit within the healt...
11/24/2025

The number of on-market, digitally enabled health solutions is increasing steadily; if and how they fit within the health care ecosystem, however, is unclear. Their role in health care depends on their health protection and health improvement value, but objective data on their value is rarely available.

To manage the growing interest and uncertainty surrounding these solutions, UnitedHealthcare launched a pragmatic quality improvement trials process in 2021. The company’s aim is to fill the objective data gap and ensure that its digital formulary is based on evidence and value.

Since its inception, the authors have honed this process and expanded the portfolio of quality improvement trials. Results inform which solutions are included in UnitedHealthcare’s benefits as well as the structure of that inclusion: https://nej.md/44hFDFo

Severe flooding in Rio Grande do Sul, Brazil’s southernmost state, highlights the devastating impacts of climate events,...
11/24/2025

Severe flooding in Rio Grande do Sul, Brazil’s southernmost state, highlights the devastating impacts of climate events, including urban destruction, disrupted health care services, and widespread water and food insecurity.

In April and May 2024, torrential rains over the course of about 3 weeks submerged buildings, displaced millions, and led to significant economic and health consequences, such as outbreaks of leptospirosis and dengue. Hospitals in the region faced serious challenges, with many ceasing operations due to infrastructure damage and supply shortages.

At Moinhos de Vento Hospital in Porto Alegre — a city with about 1.3 million residents within a metropolitan region of about 4.3 million — the hospital’s Environmental Sustainability Office has implemented active climate awareness through mitigation strategies over the years. These preexisting initiatives, coupled with adaptive solutions at the time of the flooding, ensured sustained operations during the crisis; without such attention to climate change–related risks, other hospitals endured damage and more severe care delivery disruption.

This case study underscores the urgent need for health care institutions to adopt climate mitigation and adaptation strategies relevant to the climate impacts faced in their location, whether it is flooding, air quality, or extreme temperatures, among others.

Barriers such as competing priorities and financial constraints can hinder progress. Yet, the economic burden and the health-related impact of unpreparedness are substantial: https://nej.md/4r5tVYn

Out now - the December 2025 issue of NEJM Catalyst Innovations in Care Delivery: https://nej.md/3JPDnyl (link in bio)
11/21/2025

Out now - the December 2025 issue of NEJM Catalyst Innovations in Care Delivery: https://nej.md/3JPDnyl (link in bio)

This article examines vertical integration involving physicians. The authors argue that health care has largely ignored ...
11/20/2025

This article examines vertical integration involving physicians. The authors argue that health care has largely ignored industry’s troubled experience with the strategy. They then articulate the conditions favorable for vertical integration and find that health care has ignored these factors as well. Advocates and policy makers have encouraged integration without much supporting evidence.

The authors summarize the track record as caveat venditor (seller beware) and caveat emptor (buyer beware). It is not clear that physicians should sell their practices to outside firms. It is also not clear that most physicians (with the exception of those who are equity holders) benefit from doing so.

Furthermore, it is not clear that buyers do well with the physician practices that they acquire, have an exit strategy when the practices do not do well, or that they can survive the financial and regulatory threats facing them. Other parties may profit from vertical integration, but buyers and sellers do not.

Physicians have other options, such as organizing themselves, advocating, unionizing, and leading their colleagues: https://nej.md/4o1qMGo

A survey of NEJM Catalyst’s Insights Council shows a sharp rise in use of weight loss medications in recent years, prope...
11/20/2025

A survey of NEJM Catalyst’s Insights Council shows a sharp rise in use of weight loss medications in recent years, propelling change in perceptions of obesity and how to address it: https://nej.md/3X4eMc3

The December 2025 issue of NEJM Catalyst Innovations in Care Delivery marks a milestone in bringing robust content to ou...
11/19/2025

The December 2025 issue of NEJM Catalyst Innovations in Care Delivery marks a milestone in bringing robust content to our readers. Read or listen to the letter from our editors to get a peak at what's inside: https://nej.md/4i23cYw

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Innovations in Health Care Delivery

Health care delivery is undergoing a major transformation around quality, cost, and access. NEJM Catalyst brings health care executives, clinician leaders, and clinicians together to share innovative ideas and practical applications for enhancing the value of health care delivery.

Since December 2015, NEJM Catalyst has brought together a network of health care leaders to share insightful ideas and real-life examples of innovations in health care delivery, in the form of articles, case studies, quarterly events, and monthly surveys of our Insights Council.

NEJM Catalyst is produced by NEJM Group, a division of the Massachusetts Medical Society, located in Waltham, Massachusetts.