Quality Challenges from Within: Findings from the HealthLeaders Media Industry Survey 2010

No doubt about it, the past year was a demanding one for healthcare providers and organizations. Not only did they have to grapple with a slow economy, they had to second guess what among all the shifting federal health proposals might survive. These issues appeared challenging to those individuals—including chief quality officers, chief nursing officers, and other healthcare executives—who are in charge of leading quality and patient safety efforts at their organizations.

In our HealthLeaders Media Industry Survey 2010 released this week, quality leaders again ranked the category "quality/patient safety" as their organization's No. 1 priority this year—just like in the previous year. This year, 65% selected this category, but it represented a 19-point drop from the last year's 84%.

While patient experience/patient satisfaction was a strong second place as a priority this year (54%), two cost-related categories moved into third and fourth places. "Cost reduction," in third place, was cited as a priority by 29%—up from 19% the previous year's. And "reimbursement" was in fourth place, sited by 23%—up from 13%.

To get perspective on the survey findings, I spoke this week with Rulon Stacey, PhD, president and CEO of the Poudre Valley Health System based in Fort Collins, CO. PVHS, a 2008 Malcolm Baldrige National Quality Award winner, includes two hospitals and a network of clinics and care facilities in Colorado, Nebraska, and Wyoming.

Economic problems brought on by the recession—and the impact on their healthcare organizations—appeared to be on the minds of those surveyed this year. Out of 151 quality leader respondents, more than three-fourths (76%) said it weakened their organization's financial position. Nearly 18% said it did not affect their organizations, while 6% said it improved their financial position. [See Question 11.]

Nearly a third (35%), though, thought their leadership was highly effective and another third (38%) thought their leadership was slightly effective regarding the recession and economic crisis. [Question 10.] Morale, however, has taken a hit, more than 81% saying morale had been weakened at their organizations because of the recession.[Question 12.]

"We've had tougher years. It wasn't our best year, but it wasn't our worst year either," Stacey says. The key became anticipating an economic downtown. "When people would call me last year and ask how are you addressing the recession, the financial challenges, my answer is we started for that 10 years ago."

"We started a process that allows us to get information to make changes—to be quick to address issues in the market using data- driven solutions," he says. "I feel like we were prepared for last year—before it got here. We had our costs under control when we took the inevitable hit in revenue and the inevitable increase in bad debts."

As for strategies that would prove effective in dealing with the economic crisis, nearly half (45%) thought it would be slightly effective to support physician alignment, while 18% said it would be very effective. Revenue cycle enhancements also got a nod with 49% calling them "slightly effective" and 16% saying very effective. [Question 13.]

One of the major challenges facing health systems today is "how are we going to integrate with physicians and health plans," Stacey says. "How are we going to create a truly integrated clinical structure that will allow us to share information, improve quality, and decrease costs as a collective—not just physicians working alone or hospitals working alone."

Tougher to anticipate was the potential impact of healthcare reform and new regulations on providing quality care at their organizations. For the next three years, nearly two-thirds (63%) of those responding expected that "ever-changing government regulations" to present a major challenge to their organizations; and a third (34%) thought it would be a moderate challenge. [Question 29.]

"I think another issue that we're facing is simply the uncertainty of where the health reform issue is going to go. An important part of leadership in healthcare is strategic planning, envisioning and preparing for the future," Stacey says. "The organizations that have been successful in the past have been those that have been able to determine where the industry is going—and then get ahead of that."

"But when the industry is so fluid, and the future is so uncertain based on so many political barriers, it's hard to predict the future—and it's hard to get ahead of the future. "It's hard to be an effective leader at a time like this," he says. The uncertainty tends to "drive mediocrity through everything—and that's not helpful either."

In terms of implementing best practices, more than half (53%) say that represents a moderate challenge, while 18% viewed it as a major challenge, and 24% as a minor challenge.

"Obtaining the information actually is hard," says Stacey. Organizations often spend a lot of time trying to find out how they can get the best outcomes. This means tapping into resources nationally—and even internationally. "It's just tough to find forums where the best organizations are explaining what it is that they do."

In the area of patient safety, getting hospital staff and physicians to comply with an organization's quality and safety goals was seen as a moderate challenge by nearly half (47%) of those responding; nearly a quarter (25%) viewed it as a major challenge.[Question 29.]

Stacey notes that when it comes to patient safety, it's important to have a process in place "where we can identify . . . and address those problems, because if we can't identify the areas where we have the greatest opportunity for improvement, then those areas continually become problems," he says.

"The process we have is where we measure everything: We know when an indicator falls out of an acceptable range and then we're able to respond quickly enough to address that so it doesn't become an issue down the road."