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At the core of California’s health care safety net are public hospital systems, delivering nearly half of all inpatient care and millions of outpatient visits to uninsured residents each year. But can these institutions adapt to the changing environment under health reform, given financial pressures from providing uncompensated care, infrastructure deficiencies stemming from inadequate capital, and challenges resulting from a clinically complex patient population?

Since 2004 the California Health Care Foundation, working with the California Health Care Safety Net Institute (SNI), has provided more than $4 million in grants to public hospital systems to support efforts to improve operations. Most of California’s 19 public hospital systems have participated in at least one CHCF-sponsored improvement process over the last decade, and some have participated in many.

Individual projects have focused on patient experience, scheduling systems, disease registries, and population management, but hospital and clinic staff report that learning management skills from the improvement process has been as valuable as the outcomes of the interventions themselves. Appreciating the need for further skill development, the foundation has begun funding Lean management training to help public hospitals prepare for the changes ahead. Sophia Chang, director of CHCF’s Better Chronic Disease Care program from September 2003 to May 2013, reflects on lessons learned over 10 years of funding performance improvement in public hospitals. Ruth Brousseau conducted many of the evaluations described in the article.

The complete GrantWatch article is available free of charge on the Health Affairs site through the External Link below.