Who's Responsible for Quality?

“Later, we figured out that was backward,” he says. “We moved away from doing quality to them to doing quality improvement with them.”

So ended the period of the model of quality improvement to model for performance excellence, Falvey said. “What I mean by that is that if we’re in the 95th percentile, that still means 5% of people aren’t getting what they’re supposed to be getting.”

So the clinical and operational teams are now responsible for the results, not the quality team.

“That changed the attitude and made the meetings different. Agendas began being sent by operational teams, and we were there to help integrate and bring in best practices,” he says. “We have a chart we track, and looking at the first six months, we went from mid-level to top performer by changing this notion of accountability.”

A lot of the work consisted of improved reporting, which supports efforts to improve processes, he says. They narrowed down the common order sets across the system and started a required box of things to track that have been put on all the order sets. If the physician decides to depart from the order sets, he or she must document reasons something wasn’t done.

Operationally, Aurora also shifted the roles of quality nurses from retrospectively looking at quality lapses to searching for them while the patient is in-house.

“It provides better patient care—that’s the key piece,” Falvey says. “It’s just a good sound way to run a health system.”