As more hospitals cut their budgets, it's important for staff members who work in quality and patient safety to understand what points to illustrate when making a case for joining a new initiative, launching a new quality improvement program, or asking for increased resources in the name of patient safety.
Depending on the size of the facility, people in different positions may be in charge of determining how to divvy up the budget or advocate for how to best use existing resources. That decision will usually include some involvement from the chief financial officer or other members of the hospital's executive team.
"Realize that CFOs now are more abreast of the clinical issues, and not just a number cruncher as they were 10, 15, or 20 years ago," says John Domansky, CFO at Knoxville (IA) Hospital and Clinics. "There's a lot more of a balanced approach now in the CFO world than there was in the past."
How to make your case
Domansky, who makes financial decisions for a critical access hospital licensed for 25 beds, says that he is interested most in programs that will minimize the hospital's risk, and in that vein, he'll pay more attention to those programs emphasizing a proactive approach to patient care (e.g., arguing for a bar-coding program for medications to prevent potential medication errors). However, if a staff member from quality or patient safety is presenting an idea to him, he stresses that he is interested in the hard facts of why that program is necessary.
"Make sure they have all their facts—what are we avoiding?" asks Domansky. "What are we saving here? How can we potentially justify this? If it was your money, how would you spend it? Try to anticipate the questions ahead of time." Specifically, he points to data concerning the number of incidences of a specific error and information gained from any root cause analyses done.
That same sentiment was echoed by Corey Reeves, CFO of Gordon Hospital, a 69-bed facility in Calhoun, GA, owned by Adventist Health System.
"It's important to be well-prepared," says Reeves. "Come with having thought through multiple sides of the argument, so that they can talk through and show that they have thought through all that that entails, the value added." It's apparent to Reeves and other members of the leadership team when someone has not anticipated these questions and prepared answers for them, he said.
During the actual presentation, Reeves says that whatever the topic, he prefers when he is briefed on the topic at a higher level, and then can asked more detailed questions about the points he is interested in.
"I would suggest you always start out at a very high level, and allow them to ask questions, to dig down deeper, and be prepared to answer those," Reeves says. "I would say something short to get their attention, and if they continue to want more, you're prepared to give more."
Don't forget to relate it to costs
Think about patient safety and satisfaction, but also financial impact.
"Give to-the-point, financial impact—especially if it's a positive financial impact, that will get their attention and they'll want to know more and how that's going to happen," says Reeves.
Hospital leaders making decisions about what new initiatives to take on each year are faced with the task of prioritizing, often in a world where seemingly every potential project could keep patients safer. One hospital leader cautions those pitching initiative ideas to use "the right thing to do" as the sole reason for taking it on.
"Don't hinge your whole pitch on just 'the right thing to do,'" says John Kane, vice president for quality and patient safety at Catholic Health in Buffalo, NY. "There [are] so many 'right things to do.' It's a given that patient-centered care is the right thing to do, but you don't need to make the assumption that quality always costs more."
Kane recommends tailoring a proposal to focus on the "dark green dollars" at stake. This term, being popularized by the IHI, refers to the money that can be attributed directly to the bottom line.
"As reform is coming down the line and it's really centered on cost reduction, as well as waste reduction, we're finding issues that give you strong motivation to go out there and try and figure out how you can get a return on investment through quality," says Kane. By focusing on safety within the organization, Kane says it is possible to reduce costs.