Health systems nationwide face common challenges in maintaining and improving quality and access. Workforce shortages, rising costs, and uncertain regulatory environments demand innovative ideas to address opportunities for improvement. And when solutions are developed, they must be tested on a meaningful scale to proveties and care settings.
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HCA Healthcare’s almost 190 hospitals, more than 2,600 care sites, and around 47 million patient encounters annually are much more than a measure of size. They represent robust opportunities to study care, identify best practices, test innovations and implement change throughout one of the largest healthcare delivery systems in the U.S
“We’ll do a pilot in one division, which is usually 10 or 15 hospitals,” explained Michael Cuffe, MD, executive vice president and chief clinical officer at HCA Healthcare. “If the solution works and we see with absolute statistical certainty that it is having the desired impact on patient care quality, we can roll it out with great confidence.”
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Leveraging scale to inform best practices
The complex nature of essentially every aspect of healthcare can make it difficult to take a promising idea and implement it outside of a single department or facility. Whatever it improves and by how much, leaders take something of a gamble when replicating it elsewhere to see if positive results in one test market will hold up across widespread patient populations, clinicians and care settings
HCA Healthcare’s scale is an advantage when it comes to addressing these challenges. Millions of encounters across diverse care settings contribute to a robust database that identifies opportunities by spotting patterns, evaluating outcomes and assessing anomalies, an asset that smaller organizations cannot replicate
“Variations in data can be identified at hospital, unit and physician levels,” Dr. Cuffe explained. “If it’s a best practice we can learn from it, and if it’s a negative outlier we can talk to people, advise them and bring in experts if needed to improve.”
HCA Healthcare’s culture includes a deeply held belief that patients should have access to the same high standards of care wherever they live. The organization’s scale enhances its ability to rectify unwanted variations, then spread those approved practices across markets
For instance, Enhanced Surgical Recovery (ESR) combines evidence-based approaches to nutrition, pain management and early mobility to improve surgical recovery. HCA Healthcare implemented the approach in the treatment of more than 140,000 patients, giving leaders an opportunity to evaluate its effectiveness at a scale few health systems could match before deciding whether it should become a systemwide standard
“We studied it in what everyone else would consider an entire system and it really worked,” Dr. Cuffe said. “It reduced complications and length of stay, and helped people recover better from surgery with significantly less narcotic use for pain management. We brought together a team of surgery leaders, adopted it as a best practice and standard, and then rolled it out broadly.”
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Using data to improve systems of care
Large collections of data are only as valuable as the meaningful improvements they drive. The goal is not simply to collect data, but to translate it into better care. For HCA Healthcare, information gathered across millions of patient encounters serves as a tool for identifying opportunities, testing solutions and measuring the impact of change.
“We effectively have one of the nation’s largest hospital databases,” Dr. Cuffe said. “We provide evidence-based guidelines, promulgate them through change management and then track adoption.”
HCA Healthcare’s large, diverse patient population and systematic approach to improving care enables pivotal research into important areas like infection prevention. Through large-scale, pragmatic clinical studies, including the REDUCE MRSA, ABATE Infection and Mupirocin-Iodophor Swap Out trials, researchers studied methods for reducing infections among hospitalized patients. Tactics developed informed operational practices and established protocols that were rapidly adopted across HCA Healthcare, and also were adopted as best practices across the healthcare industry.
“We had already broadly adopted the practice of using mupirocin in the nose and chlorhexidine baths to reduce MRSA in acutely ill hospitalized patients,” Dr. Cuffe recalled. “We had done the research, presented the abstracts, knew the results and understood how important it was before the manuscript even came out.”
While HCA Healthcare has developed a sophisticated augmented intelligence (AI)-enabled data ecosystem, Dr. Cuffe emphasizes that technology alone does not improve outcomes. Data systems and technology must align with evidence-based guidance, measurement and advanced analytics to support clinician workflow
The organization developed and began using Sepsis Prediction and Optimization of Therapy (SPOT) in 2018 to identify sepsis more quickly. The tool uses algorithms focused on patient vital signs, labs, nursing reports and other data to help identify sepsis approximately six hours earlier than previous, more manual screening methods largely performed only at nurse shift changes. The adoption of SPOT and its early alerting workflow has significantly reduced time from sepsis onset to clinical action, improving sepsis outcomes across HCA Healthcare and establishing groundwork for sepsis care practices nationwide.
“We study implementation and workflow just as deeply as we study formulation of a new tool, because there is always a human in the loop that must be considered,” Dr. Cuffe said. By combining data, technology research and workflow implementation strategies, new knowledge is translated into better bedside care
Supporting the workforce through technology and standardization
Workforce shortages combined with rising patient acuity continue to challenge healthcare organizations everywhere, and the answer is not simply adding staff. HCA Healthcare is creating workflows, technologies and support systems that help every team member work more effectively, in such a way that more time is spent on patient care
Timpani is an AI-driven staffing platform that was developed internally and is now used at nearly 80 HCA Healthcare hospitals. It helps nurse leaders forecast staffing needs and optimize schedules, taking into account expected patient demand, staff skill sets and individual scheduling preferences. This allows leaders to better match the right caregivers with the right patients at the right time, improving workforce planning and reducing administrative burden.
Nurse handoffs presented another opportunity to use scale to drive improvement. This is when a nurse transitions critical, patient‑specific information to the next nurse at shift change—helping ensure continuity, safety and seamless care. The sheer volume of these transitions created opportunities to identify best practices and improve consistency across the organization
“Handoffs are a point of safety risk in healthcare, whether it be when patients come into the hospital or check out of the hospital, or otherwise between doctors and nurses within the hospital,” Dr. Cuffe said. “And we’ve got 22 million nurse handoffs a year.”
In partnership with Google Cloud, HCA Healthcare has been developing and piloting an AI‑powered application that supports the handoff process. Built with direct input from bedside nurses, these nurse‑designed language models consolidate notes, lab results and physician communications into an interactive, easy‑to‑review summary
“Our design centers around co‑creation at the bedside and human‑in‑the‑loop validation, ensuring the technology supports, rather than replaces, clinical judgment,” Dr. Cuffe said. “Amid a nurse shortage, it is helping give nurses more time and improve patient safety at the same time.”
Another example of how HCA Healthcare is supporting clinicians is through ambient clinical documentation. These tools use speech recognition and natural language processing to capture the patient-clinician conversation and generate a first‑draft clinical note for the physician to review
A core principle of the organization’s approach with ambient documentation is that the physician remains the final author of the record. Physicians and clinicians review, edit and approve the draft documentation to ensure that accuracy, clinical intent and accountability are fully preserved
Developed with intensive feedback from frontline clinicians, these tools have shown meaningful results. Physicians experienced reductions in documentation burden, regained time for direct patient care and benefited from strong change‑management support, including peer learning, templated training and iterative product updates that built trust over time
Standardizing processes and using technology to reduce complexity has made day-to-day nursing and physician practices safer, easier and more consistent, all with a strong focus on patient outcomes
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Building resilience for healthcare’s future
Workforce shortages have made organizations think beyond immediate operational needs and invest in long-term solutions. HCA Healthcare has made workforce development a priority, through growth of its Galen College of Nursing—one of the nation’s largest nursing schools—to 25 campuses, and expansion of its graduate medical education programs to become the largest sponsor of physician residency and fellowship programs in the country, with more than 365 accredited programs and 85 teaching hospitals across 16 states.
“We’ve gone from almost no graduate medical education residents and fellows to now more than 6,000,” Dr. Cuffe said. The initiative is also designed to connect workers to the communities in which they are trained.
“If they train in Dallas with us, they often will stay in Dallas,” he added
Scale has also played a role in HCA Healthcare’s response to disasters and mass casualty events, such as hurricanes and the 2017 Las Vegas mass shooting event, which sparked the mobilization of its reed. Nurses regularly travel from outside markets to regions struck by severe weather events, relieving local caregivers while emergency operations and other teams coordinate logistics to support affected communities
Scale as a catalyst for change
Scale serves a broader purpose within HCA Healthcare. It is a platform for learning, developing and testing new approaches, measuring outcomes and spreading proven practices across diverse markets, care settings and communities. Whether improving surgical recovery, reducing infections, developing technology or strengthening workforce pipelines, the overall goal remains the same: delivering better care to patients
“Our ability to identify what needs to change, make those changes when needed, and implement and track them for results and data is pretty good,” Dr. Cuffe said. “For us, scale also confers both the privilege and obligation to continue advancing healthcare beyond our own system.”
For all the discussion of scale, data and technology, HCA Healthcare’s central focus is not growth. Rather, it is ensuring that patients and communities have access to the best and latest in care, services, technology, processes or procedures, no matter where they are
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