In particular, lower-performing systems in some cases had made changes recently that were likely to enhance quality—but the changes hadn't taken yet. And in other cases, the processes and policies appeared to be in place on paper, but the passion and commitment from the organization toward them seemed lacking.
"Every single leader of a high-performing system who we interviewed was passionate about making their system one where each patient received safe, high-quality care in each encounter," the researchers noted. Many had been aiming for this goal for years, and were part of a system where this goal was encompassed by everyone. All did acknowledge quality and safety failures, but they could see the progress their organizations were making towards achieving their quality and safety goals.
Systems with a strong cultures related to quality and safety demonstrated the following:
- A shared, system wide commitment/focus on achieving the system's quality and patient safety goals. For example, "system management is as important in achieving quality goals as is physician compliance with evidence based guidelines." So complying with evidence based guidelines becomes not just a physician responsibility but a system responsibility as well.
- A system board that is very engaged in quality and safety, such as being directly involved in setting the system's strategic goals for quality and safety and in frequent monitoring (at least monthly) the hospitals' progress toward achieving these goals.
- Extensive opportunities and vehicles for hospitals to collaborate and share best practices for improving quality and safety.
- Transparency around reporting performance both internally and externally. Teamwork needs to be emphasized to improve quality and safety, along with shared accountability for good outcomes.
- Having a mindset of perfect care and dramatic increases or stretch goals as compared to incremental improvement.
With all this in mind, perhaps the answer to the question posted at the beginning is actually "j," as in recognizing that "joining together at all levels is important to meeting quality goals."
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Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at firstname.lastname@example.org