THA Bill Aston Award for Quality

Bill Aston Award for Quality

The Texas Hospital Association Bill Aston Award for Quality honors hospitals’ measurable success in improving quality and patient outcomes through the sustained implementation of a national and/or state evidence-based patient care initiative.

Sharon Beasley, 512/465-1030

2021 Award Winner, Academic Institution or Large Teaching Hospital/Health System
Baylor Scott & White Health, Baylor Scott & White Medical Center, Temple
Project: Solving High Utilization Patients

At Baylor Scott & White Health’s academic medical center in Temple, Texas, the same patients kept coming into the emergency department (ED) for urgent as well as primary and specialty care. At the Temple facility, these high utilizer (HU) patients were responsible for 1.2% of admissions in 2018 and 3.9% of readmissions in 2018. The health care providers at the Temple facility recognized that breaking the cycle of readmissions could improve the quality of and support better and more appropriate utilization of services in the right setting.

To address high utilizers, the Temple facility launched the Complex Patient Management Team (CPMT), consisting of caregivers with expertise in internal medicine, psychiatry, case management, pharmacy, nursing and social work disciplines.

The methodology used empirical data to select a subset of patients quarterly. The CPMT analyzed variables and created patient-specific action plans that applied to all current and future encounters. The process consisted of six steps: goal setting, defining the target by identifying previous quarter HUs, sharing information using lists in Epic, discovering HU motivators, developing patient-specific action plans, and implementing the plan consistently across ED, outpatient and inpatient settings. The primary metric for evaluating success was ED visits and readmissions by high utilizer patients.

The key takeaway from the project showed that using a multidisciplinary team in action planning for high utilizer patients can reduce their use of ED services and lower admissions. A baseline cohort of the top 20 high utilizers from December 2018–February 2019 showed an 8% reduction in ED visits and readmissions in the three months prior to identification of the first intervention cohort. Results far exceeded the CPMT’s goal of reducing HU ED visits and readmissions by 30%. From March 2019–May 2021, the average reduction in combined ED visits and readmissions across subsequent cohorts was 35.7%. Importantly, 143 patients out of 202 total (71%) patients served by the CPMT had a decrease in readmissions.

This data was reported to hospital committees, a system-level improvement team and the governing board. With this data, the CMPT sees future opportunities to provide at-a-distance consultation and CME activities to spread best practice.

photo of the BSW team
Members of the Baylor Scott & White Health Team, standing from left to right, front row: Katie Sciba, LMSW, CCM; Lydia Sutherlun, MD; Tresa McNeal, MD. Back row: Mike Averitt, DO; Joel Travnicek, PA; James Bourgeois, MD.

2021 Award Winner, Non-Research/Non-Teaching Hospital/Health System
Oceans Behavioral Health Hospital, Abilene
Project: Patient Health Questionnaire (PHQ-9)

Oceans Behavioral Hospital Abilene provides inpatient and outpatient mental health care to adolescents, adults and seniors. The hospital serves the Abilene community and surrounding rural areas, filling a critical gap in the local health care continuum.

As part of an organization-wide quality improvement initiative in 2020, Oceans Abilene began collecting, analyzing and reporting data related to their use of the Patient Health Questionnaire (PHQ-9) to screen for and measure depression levels in patients. The PHQ-9 is a screening tool associated with the Joint Commission’s National Patient Safety Goal for Suicide Prevention. In addition to diagnosing and monitoring the severity of a patient’s depression, the PHQ-9 also screens for the presence and duration of suicidal ideation. The use of this tool has been essential in ensuring patients leave treatment better than when they entered while providing a much-needed standardized quality measure for behavioral health care, which lacks many of the empirical tools used in physical health care.

Beginning in July 2020, Oceans Abilene administered 1,086 questionnaires to patients over the course of a year. The assessment showed that 595 of those patients (55%) were experiencing severe depression symptomology at admission. While the dataset was formatted to screen out initial scores of minimal depression, notably, all of the screened patients in Q1 and Q2 of 2021 reported a severity level of at least moderate depression or above, and only 5% (53) characterized initial depression levels as mild in Q3 and Q4 of 2020.

Over the course of treatment, which averaged 9.91 days for all age groups, the average PHQ-9 score fell from 19.52 at admission to 3.67 at discharge – an 81% reduction in depression symptomology.


  • The percentage of patients reporting severe levels of depression fell from 53% at admission to 1% at discharge.
  • At discharge, only 9% of patients characterized their depression as moderate or moderately severe – compared with 39% of patients at admission.
  • 90% of patients were discharged with the lowest level of mild to minimal depression.

To ensure continued improvement in quality measurement and patient safety, PHQ-9 outcome information is reviewed by the medical staff's Quality Assessment and Performance Improvement Committee on a regular basis. Updates and suggestions for change are considered in the committee and then presented to the Governing Board for full approval.

photo of Texas Health Resources team in Dallas, assembled in a labyrinth in a courtyard
Members of the Oceans Behavioral Health Team, standing from left to right: Danny Miller, Stacey Sanford, Alexandra Walters, Sydne Valentine, Chris Stephenson, Terry Burke, Kenzie Gilchrist, Tana Barron, Rick Walters, Edwin Akwanga and Britany Leggett. Seated from left to right: Kelli Garrett, Chasidy Tomlin, Kirk Hancock and Alyssa Holden.

2021 Award Winner, Rural Hospital Member
Peterson Health, Kerrville
Project: Zero Harm

In 2018, the Leadership Team and Quality Council of Peterson Health reviewed the publication Leading a Culture of Safety: A Blueprint for Success. This publication prompted Peterson Health’s ZERO Harm and Just Culture journey, and their first safety vision was created and approved by Peterson Health Leadership and medical staff.

The team identified the following goals for the project:

  1. Implement an evidence-based approach to identify systems issues that lead individuals to engage in unsafe behaviors;
  2. Maintain individual accountability by establishing zero tolerance for reckless behavior;
  3. Focus on correcting system imperfections; and
  4. Analyze each event to distinguish between human error, at-risk behavior and reckless behavior.

Within Peterson Health’s Just Culture, all workforce (clinical and nonclinical) are empowered and unafraid to voice concerns about threats to patient safety and workforce safety. While everyone is held accountable for actively disregarding protocols and procedures, the reporting of errors, lapses, near misses, and adverse events is not only encouraged, it is expected.

Their online event reporting system was revised to include an option for directors to select which behavior they identified in response to the event. This is done with the staff member to help them feel supported and held accountable at the same time.

The Zero Harm and Just Culture journey for Peterson Health has been effective in demonstrating both a reduction in harm and improved Culture of Safety. Their Culture of Safety survey results over the last several years have demonstrated a significant trend of improvement. When their journey began in 2018, their positive response rate related to a non-punitive response to error was at 60%. Improvement trended over the next three years to an all-time high of 90% in their FY 2021 survey results.

Patient Harm, as measured by the AHRQ PSI 90 measure, has also trended positively over the last three years. Harm rate per 1,000 discharges has decreased from 4.8 in FY 2019 to 1.3 in FY 2021. To this day, the entire organization continues to put Zero Harm and Just Culture at the forefront of everything they do.

photo of Peterson Health’s Quality Services Team
Peterson Health’s Quality Services Team, from left to right: Barbara Stehling, RN, Director of Quality Services; Elaine Ivy, RN, Patient Safety/Accreditation Coordinator; and Pam Burton, RN, Infection Prevention Supervisor.

Across the state, THA-member hospitals are championing innovative quality and patient safety initiatives that are showing measurable success in improving quality and patient outcomes. In keeping with THA’s initiatives to promote quality and patient safety in Texas hospitals, THA established the Bill Aston Award for Quality in 2010. The award honors hospitals that have distinguished themselves through measurable success in improving quality and patient outcomes through the sustained implementation of a national and/or state evidence-based patient care initiative that involves physicians, hospital governing board members and staff.

The late W.W. “Bill” Aston was an exemplary leader who worked tirelessly to improve health care for the people in his community. He served on the Baylor University Medical Center board for 25 years and on the board of Baylor Health Care System from 2005 to 2010. In 2010, THA established the Bill Aston Award for Quality through an endowment from Baylor Health Care System.

“Mr. Aston was a strong advocate and champion for providing the highest level of safe, quality, compassionate care for all patients throughout the Baylor Health Care System,” said Joel Allison, president and CEO of Baylor Health Care System. “He will be remembered for his commitment to quality. He wanted nothing but the best. He always wanted excellence, and he constantly reminded us it’s about putting the patient first.”

Bill Aston

Hospitals or health care systems that are active institutional members of THA are eligible for this award. Nominated projects must demonstrate improved outcomes in patient care and be related to a national or state standard for improved patient care. Projects must demonstrate ongoing involvement by both physicians and trustees.

Selection Criteria
Applicants will be evaluated on the following criteria:

  1. A maximum of three Bill Aston awards may be awarded each year: one to an academic institution or large teaching hospital member; the second to a non-research, non-teaching member; and the third to a rural hospital member.
  2. The project/initiative submitted must demonstrate and document improved outcomes in patient care. Metrics might include reductions in specific infection rates or readmissions for specific diagnoses or increased compliance with specific protocols. Consideration will include the rate or delta of improvement.
  3. The project/initiative should be related to a national or state standard regarding improved patient care. Any clinic or nationally recognized issue, identification of an institutional problem or challenge, or team decision based on clinical factors or indicators is ideal.
  4. The project/initiative must have documented sustained effectiveness; a minimum of one year of improved performance/outcomes is required. The project/initiative must have been initiated in the last three years.
  5. Preference will be given to projects/initiatives that have been replicated and sustained within the entrant facility.
  6. The project/initiative must demonstrate the ongoing involvement of physicians.
  7. The project/initiative must demonstrate an ongoing role for the hospital governing board. For example, regular reports or educational activities related to the project for governing board members could demonstrate the board’s involvement.

Selection Process
The selection committee is composed of one member of the Texas Healthcare Trustees board, one member of the THA Board of Trustees, the THA president/CEO, one representative of the TMF Health Quality Institute, and one representative of the previous year’s winners. Hospitals represented on the selection committee are ineligible to receive the award during the member’s committee tenure. Hospital representatives serve one-year terms.

The honorees will be featured in THA publications and recognized at the THA Annual Conference and Expo.

Step 1. Complete the nomination form.

Step 2. Attach up to 15 pages of supporting documents, including a one-page summary and program description.

Step 3. Be sure all materials are completed and SUBMITTED by the posted deadline.

Questions? Contact Sharon Beasley at or 512/465-1030.

2020: Dell Children's Medical Center – Austin, Texas Health Resources – Dallas and UT Health Tyler

2019: Catholic Health Initiatives – Texas Division (Houston), Shannon Health System (San Angelo) and Houston Methodist The Woodlands Hospital (The Woodlands)

2018: Dell Children's Medical Center of Central Texas (Austin), Texas Health Harris Methodist Hospital Hurst-Euless-Bedford and Hill Country Memorial Hospital (Fredericksburg)

2017: Parkland Health & Hospital System (Dallas), Texas Scottish Rite Hospital for Children (Dallas) and Rankin County Hospital District

2016: Baylor Scott & White Medical Center - Carrollton

2015: Children's Health (Dallas), Doctors Hospital at Renaissance (Edinburg) and CHI St. Joseph Health Madison Hospital (Madisonville)

2014: JPS Health Network (Fort Worth) and Texas Health Resources (Arlington)

2013: St. David's Medical Center (Austin) and The University of Texas Medical Branch (Galveston)

2012: Methodist Health Care System of San Antonio and Medical Center of Lewisville

2011: Memorial Hermann Healthcare System (Houston) and South Texas Health System (Edinburg)

2010: The University of Texas MD Anderson Cancer Center (Houston)