The Institute of Medicine describes healthcare quality as "the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Each patient may rate the quality of the care they receive in a different way: the care was accessible and affordable; their illness was successfully treated or cured; they felt respected; caregivers were compassionate; the clinicians were professional and highly skilled. Organizations that meet any or all of these criteria will likely earn the patient’s trust and loyalty, leading to future return visits —and referrals to family and friends.
But how does an organization rate its efforts to enhance quality? Besides the quality standards necessary to meet regulations and receive reimbursements, how much does your hospital or health system know about its quality improvement program? Perhaps it’s time to take a closer look at the quality of your QI program and how you can maximize its impact on your patients and your business.
Quality care as a fundamental driver
Since quality is tied to both patient satisfaction and (in the US) reimbursements, improving quality should be a foundational goal of your hospital or health system. For large hospitals, those with more than 50 licensed beds and not in rural areas, QI programs are required. Quality oversight is mandated for healthcare facilities to participate in federal programs in the US. Typically, a QI Committee and a Board Quality Committee oversee the program. These groups focus on quality measures, outcomes, patient safety, and regulatory quality requirements based on state and federal requirements.
There are a variety of names used for QI programs:
- Performance Excellence (PE)
- Performance Improvement (PI)
- Performance Improvement and Safety
- Continuous Quality Improvement (CQI)
- Quality Improvement
Many of these use Six Sigma®/Lean Six Sigma methodologies to improve processes and eliminate waste. They focus on ROI and high-profile projects aligned with the hospital’s or health system’s strategy and organizational goals. These QI programs look at end-to-end quality across all departments, including patient safety, patient satisfaction, infection control, laboratories, clinics, patient care areas, security, and support.
A hospital’s nursing department may have a separate quality program, in which it’s responsible for its own evidence-based practices (EBP) and Magnet Recognition Program®. These programs may or may not report up through hospital quality programs.
Measuring the quality of QI initiatives
With sophisticated quality improvement programs, healthcare organizations set performance goals for their PE or PI departments. These assess cost avoidance, cost savings, pay-for-value metric performance, operational measures, and growth. However, hospitals without a culture of quality (or well-established QI processes) may never ask how well their quality improvement is working.
There are also specific issues that can thwart QI efforts. Today’s Hospitalist points to insufficient leadership engagement, lack of appropriate, actionable data, and cultural implications of projects as some of the problems that can negatively affect quality improvement. The system is broken if projects are done inefficiently, redundantly, or result in recommendations that won't improve quality.
What is the single most significant factor that can alert hospitals and health systems that their QI program could be more successful? An increase in reportable events. From the World Health Organization to the National Quality Forum to individual US states, guidelines for reporting adverse events are in place to increase patient safety. But healthcare facility administrators can look at their reportable events metrics to see that quality is headed in the wrong direction.
Evaluate, then upgrade your quality improvement program
Once you’ve diagnosed your QI deficiencies, consider how you can cost-effectively address them. First, determine if quality improvement is driven from the top down and throughout the entire organization. If the board and C-suite executives aren’t vocal and visible CQI proponents, they should be! Next, examine the culture of your hospital or health system. Is it open to change and growth, or is your staff hesitant to try something new?
When QI teams see that their recommendations are actually incorporated into the hospital’s best practices, they embrace the idea of quality improvement…a trend that can be contagious. Team members are also more likely to commit to a hospital or health system with opportunities to initiate and implement improvements. Give your trainees the chance to choose QI or EBP projects that speak to their passion, strengthening their engagement and education. If you have a pipeline full of QI projects, identify those most critical to a department or the facility as a whole and get teams excited about seeing them to fruition.
Finally, automate your QI, EBP, and research projects from beginning to end. Using an application such as Ovid® Synthesis Clinical Evidence Manager, your projects benefit from a standardized process, useful templates, and easy access to up-to-date clinical data. In addition, by improving communication and collaboration, your team members have more time to focus on project topics and outcomes instead of manually pulling all the pieces together.
Oxford Learner’s Dictionaries say “excellence” is synonymous with “quality.” So as you undertake quality improvement to become or remain the hospital that provides excellent care, be sure that your QI program is equally outstanding. Then, when it realizes its full potential, the results will speak for themselves.
Learn how a streamlined workflow solution can improve your quality improvement programs and maximize your efforts to improve patient care and outcomes.
