A patient safety bill agreement announced this week by New York Gov. David A. Paterson now requires the names of doctors charged with misconduct to be made public. Also, these physicians now will be given just one day from the time formal charges are made to provide office records to investigators. The bill was created in response to the case of a Long Island doctor who put patients' lives in danger by practicing improper infection control.
A recent HealthGrades study has found that best-performing hospitals offer higher quality of maternity and cardiovascular care for women than poor-performing hospitals. The study shows that top-performing hospitals report much fewer maternal complications than lower-performing facilities, and that mortality rates for women treated for cardiovascular disease have dropped in recent years.
Nebulous. That's how Eric Dobkin, MD, chief quality officer at Crozer-Keystone Health System describes the responsibilities of a hospital quality officer in this month's HealthLeaders magazine.
Infection control, clinical outcomes, and compliance with The Joint Commissions' standards are common tasks assigned to a quality officer, but often, the responsibilities don't end there. CQOs hear about it when the hospital noise level is too loud or the cleaning staff misses a spot on the hallway floor.
"You could make the argument that quality should only be measured by the outcomes required, or you can look at the food served in the cafeteria," says Dobkin, who also serves as the vice president of patient safety for the five hospital system in Delaware County, PA. "They all fall into the rubric of quality."
While the role may be nebulous, the growing importance of hospital quality isn't, evidenced by the number of hospitals—big and small—that are bringing quality responsibilities to the executive table by creating the chief quality officer role.
"Patients, regulatory agencies, the government—they're all demanding quality, says Beka Warren, RN, chief quality officer at The Memorial Hospital in Craig, CO. "In the past, what has been important to the board of trustees is the financial component. If we were doing well financially, we were considered to be doing well. [Today] in this hospital, we look very much at the quality things that are going on."
And just as a CEO has a chief executive who deals with the financial, he or she also should have an executive to oversee quality. But appointing just anyone to the position is ill-advised, Dobkin and Warren say. To be a good CQO, a person must work well with numbers, make sense of statistics, and be optimistic. They must always strive for excellence and be able to lead, even when they encounter resistance.
"It's your job to inspire a hospital to more than what's easy," Dobkin says. "Part of a CQOs job is to educate everyone—from the board to the C-suite to the staff level—about what quality and patient safety are all about."
But perhaps the most important thing that a CEO should remember when hiring a quality officer is that assigning an executive to oversee quality doesn't mean he or she can wash her hands of that responsibility. At The Memorial Hospital, CEO George Rohrich makes daily rounds and meets with his executive team to discuss what he observes on these rounds. He remains on the front lines of the 25-bed hospital's quality improvement efforts, and talks about it often with staff at all levels.
There’s no question that quality is important to him, Warren says, and his emphasis shows the importance of it.
Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
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As a hospitalist, Philip Vaidyan, MD, saw patients on nearly every floor and in a variety of units. He soon found he was spending too much time moving among patients or answering pages from another area of the hospital. Then Vaidyan learned about a growing number of hospitals that reduced these frustrations by assigning hospitalists to specific units of the hospital. These hospitals, including SSM St. Mary's Health Center in St. Louis, say the move has nearly eliminated wasted travel time and given physicians more time with patients, families and staff. The hospitals also hope better access to physicians will lead to better communication, and allow treatment to begin sooner.
A bill passed by the Louisiana Senate will allow two doctors to remain on St. Bernard Parish's hospital commission while also being employed by the Franciscan Mission. The Mission is competing with Ochsner to operate a still-to-be-built hospital in the parish. However, while the doctors can serve on the St. Bernard Hospital Service District Commission, they will not be allowed to vote on any issue involving the Franciscan group. The bill now heads to Gov. Bobby Jindal.
SSM Healthcare-St. Louis recently announced another round of departures, another example of hospitals facing increasing pressure to improve care while cutting costs. In addition, quality directives from managed-care companies and the government are coming with slight, if any, increases in payment. St. Louis Post-Dispatch columnist Mary Jo Feldstein notes that one source of the economic problems facing hospitals is that as health plans raise the patients' portion of their medical bills and more families have fewer dollars to spend, some might be holding off on care. The problem is worsened as outpatient and testing services continue to grow and sends more patients out of the hospital for care, Feldstein says.