10 Tips for Establishing Quality Improvement Programs

By Carrie Vaughan for HealthLeaders News, September 27, 2006

The drive to measure the quality of healthcare delivery is not limited to large urban systems and academic medical centers. Private and public funding sources, as well as employers and consumers, increasingly expect their healthcare providers to participate in quality improvement programs and to report the results back to them. Beyond outside pressures, hospitals regardless of size can’t improve what they aren’t measuring, experts say. “You really need to understand where your facility does things well and what areas need improvement,” says Ira Moscovice, Ph.D., director of the University of Minnesota Rural Health Research Center.

Here are 10 tips to help small rural hospitals get quality improvement programs off the ground and poised for success.

1. Make it an organizational priority Make sure quality improvement is part of the hospital’s mission statement and strategic plan. It also should be embedded into the culture so that everyone in the organization bears responsibility, says Terry Hill, executive director of the Rural Health Resource Center in Duluth, Minn.



2. Create a non-punitive culture Hospitals need to support quality improvement in a non-punitive environment. This kind of leadership should come from the top and permeate down throughout the whole organization, says Moscovice. For example, change “incident” reporting to “opportunity for improvement.”



3. Promote teamwork Hospitals need to make teamwork a central part of their work culture, says Tim Size, executive director of the Rural Wisconsin Health Cooperative, which is owned by 30 rural hospitals across the state. Develop small quality action teams and promote stronger physician-nurse relationships.



4. Start with national measures Start with the kinds of measures that are being collected nationally. Heart attack, heart failure and pneumonia are some of the conditions with a good sample size that rural hospitals can start analyzing, says Moscovice. Hospitals should also make sure they can meet the reporting requirements of third-party payors, government agencies and organizations that are studying quality.



5. Individualize the measures It is important for hospitals to personalize quality measurement beyond what’s required at the national level. For example, a rural facility that serves a large elderly population will want to track quality indicators related to respiratory and pulmonary conditions, says Steve Mayfield, senior vice president for quality and performance improvement at the American Hospital Association. “It is really important for hospitals to individualize this. That is how you can get buy-in at all levels of the hospital--from the board, the CEO, the administration and clinical staff,” adds Moscovice.



6. Utilize the right data Hospitals often collect a ton of information, send or store it somewhere--then don’t use it as part of decision-making processes. Hospitals not only should evaluate what they are currently collecting, but they also must do a better job of collecting crucial information, then actually using that information for critical decisions, advises Hill.



7. Collect and report information regularly Improving quality means measuring, analyzing and reporting information. “We need to institutionalize this, and part of that process is developing regularity for it,” says Moscovice. Public reporting initiatives are crucial, as well. Historically, when rural hospitals haven’t participated--justly or not--the public sees that lack of participation as a black mark on smaller facilities’ quality of care, he says.
   
   
8. Invest in information systems Rural hospitals need to invest in statistical analysis tools and management information systems that support quality improvement. But hospitals don’t have to buy a costly electronic medical record system just to measure and report quality. “EMRs can improve the point of service and the capture of information, but you can do it without all those expensive technologies,” says Mayfield. Hospitals should continue to upgrade their capabilities internally, however, so that they can switch to EMR systems down the road, adds Moscovice. In the meantime, make sure all the key clinical and administrative players have regular access to computerized information from the pharmacy and other areas of the facility.



9. Establish networks One of the best strategies for small rural hospitals--especially critical access hospitals--is to join forces with other small facilities rather than taking on quality initiatives by themselves. These networks enable small rural facilities to share their experiences and pool resources to facilitate quality improvement activities, says Hill. Additionally, small hospitals can benchmark their information against their peers because they are not just collecting their own data, says Moscovice.



10. Ask the experts Small rural facilities should take advantage of the assistance available to them. Numerous organizations, including state hospital associations, the AHA Quality Center, the state offices of rural health, and quality improvement organizations, can offer expertise along with educational and analysis tools to assist rural hospitals with quality improvement initiatives.


To read about the obstacles facing rural hospitals, see last week’s story, The Challenges of Measuring Quality in Rural Hospitals.

Carrie Vaughan is editor of HealthLeaders Media Community and Rural Hospital Weekly. She can be reached at cvaughan@healthleadersmedia.com