From HealthLeaders Media '09: Never-ending Quality Improvement

HealthLeaders Media Staff, October 19, 2009

In the ideal hospital of the future, quality improvement will be hardwired into the culture of the organization. Outcomes data will not only drive macro-level hospital changes, but also individual physician-patient interactions. Quality will extend beyond hospital walls into patient communities and include preventive health improvement and management, rather than only reactive treatment.

But there is a long road to better outcomes and quality for many hospitals, and everyone from employers to physicians to members of Congress is trying to figure out how to fix the flaws in the current system and get more value from the healthcare dollar.

Four healthcare leaders offered a glimpse at how the best hospitals and payers in the industry are making progress on improving outcomes in a panel discussion at HealthLeaders Media 09: The Hospital of the Future Now in Chicago on Friday.

The panelists offered five strategies for improving healthcare outcomes from the bottom up:

1. Make quality permanent. Shortly after being hired, every new staff member—from receptionists to physicians—at Monoroe Carell Jr. Children's Hospital at Vanderbilt goes through a three-day training session that focuses on the importance quality plays in Vanderbilt's overall mission. There is followup on a weekly and monthly basis, and the goal is to instill the importance of quality improvement into new employees from day one, said Kevin B. Churchwell, MD, CEO and executive director for the hospital.

"Quality has to become the foundation on which all all initiatives are built upon," added Jay Srini, chief innovation officer for UPMC Health Plan.

2. Seek the right outcomes. Panelists agreed about the importance of simplifying outcome measurement to avoid overwhelming staff and get at the core of quality improvement. For instance, although an organization may measure multiple indicators related to catheter- or ventilator-acquired infections, the goal for a wide range of measures can be boiled down to improving handwashing rates, said Churchwell. "That's one example of trying to simplify and get at the core measures of what really makes a difference."

St. Joseph Health System boils narrows nearly 300 indicators that are measured in its quality report to about 15 work processes in order to keep improvement achievable. "If we can't design reliable clinical work then the [outcome measurement] experience is moot," said Dan Varga, MD, chief medical officer for the system.

3. Include a broad community. "Know your community," advised Ken Anderson, DO, MS, CPE, chief quality officer for NorthShore University HealthSystem Medical Group. Leaders should focus beyond hospital walls to patient communities and at-risk populations. Quality isn't just about improving outcomes from procedures; it requires managing chronic conditions and improving health through behavior changes, the panelists said.

That can be particularly challenging for facilities with high-risk populations or in rural areas that are difficult to reach. Success requires partnerships with governments, schools, patients, and even other hospitals, said Churchwell. "You can say we're in competition at some level but we're really not. We're all in the business of taking care of patients. That's the most important thing to do and we can collaborate in doing that," he said.

4. Use technology to support, not drive, improvement. Top leadership teams use robots, telemedicine, EHR systems, and other health IT to better track outcomes and improve care coordination. However, they do not let technology become a solution in itself. For instance, decision-support tools can be valuable for physicians if used correctly, but alerts and guidelines can lead to an information overload—and will be ignored—if they are not delivered with thought to genuinely enhancing clinical care.

5. Get ready for integration. True integration extends across multiple stakeholders, including patients and employers, Srini said. New models like medical homes and accountable care organizations show promises, but it's important for leaders to continue innovating and looking for new solutions, panelists said.

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