How to Generate ROI from Quality Improvement Efforts

The National Association for Healthcare Quality has set national standards for quality and safety.

The National Association for Healthcare Quality (NAHQ) has published a new report that includes ways healthcare organizations can generate return on investment from quality efforts.

Boosting care quality is one of the top responsibilities for CMOs and other healthcare leaders. Quality improvement is linked to patient safety and financial considerations such as generating revenue from pay-for-performance incentive programs.

A core element of NAHQ's work is the Healthcare Quality Competency Framework. The framework features eight domains: regulatory and accreditation, patient safety, performance and process improvement, health data analytics, quality review and accountability, quality leadership and integration, professional engagement, and population health and care transitions.

One of the primary strategies for quality improvement included in the new report is using the NAHQ Healthcare Quality Competency Framework to provide clarity in the field of healthcare quality.

"Before NAHQ created a quality competency framework, nothing existed in the industry to guide quality leaders and quality programs to achieve results through their people," says Stephanie Mercado, CEO and executive director of NAHQ. "As quality improvement was born in the industry, it was set up and structured at the local level. It was put together organically at the site-by-site level. Each one of the hospitals had their own homegrown quality system."

The healthcare industry has standards in many areas such as standards of practice and standards of care, but NAHQ has filled a gap in standards for quality and safety, according to Mercado.

"Until NAHQ developed the Healthcare Quality Competency Framework, we did not have a standard for setting up and structuring the work of quality and safety," Mercado says.

NAHQ's approach to helping healthcare organizations improve quality and safety is a step-by-step program aided by a NAHQ navigator that systematically helps healthcare organizations understand the level of work and type of work that their employees are doing, Mercado explains.

"We help healthcare organizations to visualize their competency-based performance through an assessment," Mercado says.

The next step is a peer-to-peer benchmarking analysis so a health system can see how their staff compares to each other, such as staff at hospitals within a health system. This benchmarking analysis also includes comparing a health system's staff to staff at other health systems.

The third step is helping a healthcare organization set goals for better quality performance, according to Mercado.

"We set a target for them to be at higher ground; and once we set that target, we deploy coaching, mentoring, and upskilling methods," Mercado says. "Then we reassess to see whether their people are working at higher levels. We want their work to be less variable."

Claire Lauzon-Vallone, RN, MBA, is vice president of quality and safety at CHRISTUS Health. Photo courtesy of CHRISTUS Health.

Generating results

CHRISTUS Health has made significant gains from working with NAHQ.

"What we saw in terms of return on investment was increased patient safety and quality of care as well as reduction of harm," says Claire Lauzon-Vallone, RN, MBA, vice president of quality and safety at CHRISTUS Health. "We saw mitigation of risk. We helped our people understand what they should be looking for."

Working with NAHQ has resulted in empowerment of CHRISTUS Health's quality professionals, according to Lauzon-Vallone.

"When you train them and provide professional enhancement and engagement, they feel more confident and engaged to make decisions locally," Lauzon-Vallone says.

Participating in NAHQ programs has generated financial gains, including more than $15 million generated annually from pay-for-performance incentive programs. The health system has also achieved a 50% reduction in serious safety event rates.

"We have seen cost avoidance as a return on investment," Lauzon-Vallone says. "We have had lower catheter-associated infections and lower central line infections. We have had less mortality and shorter length of stay. We have had penalty reductions in government programs."

CHRISTUS Health's hospitals have posted improvements in patient safety, according to Lauzon-Vallone. For example, with Leapfrog, the health system only had one hospital out of 28 that had an A grade. Now, it has 14 hospitals with an A grade.

"We started out with a lot of our national benchmarks not being where they needed to be," Lauzon-Vallone says. "Working with NAHQ has helped us kickstart our hospitals to get better performance for safety."