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Achieving a 360-Degree Understanding of Quality

Analysis  |  By Cathy Duquette and Stephanie Mercado  
   December 13, 2021

The industry has tended to be so focused on what needs to be improved in healthcare, that we have not given enough attention to systemically addressing how these improvements will be made.

While quality has been a healthcare priority for decades, we are still not where we should be as an industry. The industry has tended to be so focused on what needs to be improved in healthcare, that we have not given enough attention to systemically addressing how these improvements will be made. Without digging into the root issues impacting quality, we will continue to put out proverbial fires without achieving meaningful change. And, without doing this systematically, we will drain resources and minimize our impact.   

Healthcare delivery is a complex operation that relies on a diverse group of stakeholders from a variety of clinical and nonclinical settings, who often have no common training, skills, or even shared vocabulary. Delivering high-quality care requires a holistic, 360-degree perspective to keep patients at the center of care and improve outcomes and experience. Now is the time to systematically leverage our workforce and the profession of healthcare quality to take our quality ambitions—and our care for each individual patient—to the next level. 

Understanding the impact and role of the quality professional 

To comprehend the full scope of requisites needed to advance quality ambitions, it is important to first highlight the strong reliance on quality professionals across the healthcare system. These professionals are already essential to meeting internal demands around process improvement and patient safety. Healthcare quality professionals are expected to set robust measures of success and to ensure the right work is done to leverage opportunities and resolve issues identified.  

Cathy Duquette, PHD, RN, executive vice president for quality and safety and the chief nursing executive at Lifespan. Photo courtesy of Lifespan.

Healthcare leaders are increasingly counting on their staff to deliver better outcomes as safely and efficiently as possible. They need a resource to connect the many dots required for this work to continuously move the organization forward. While all healthcare stakeholders contribute to quality, it is the quality professional's core role and skill set to lead the workflows and multi-stakeholder collaborations that drive toward quality goals and aspirations. 

Lifespan's commitment to quality workforce development pays off and further readies its team for a crisis  

Advancements around improving quality, as well as improving understanding of this space overall, have been significantly supported by the work of the National Association for Healthcare Quality (NAHQ). The organization has focused on elevating and defining quality workforce competencies while underscoring the role and value of quality professionals.  

Stephanie Mercado, CAE, CPHQ, executive director and CEO at the National Association for Healthcare Quality (NAHQ). Photo courtesy of NAHQ.

As an early adopter of the healthcare competencies developed by NAHQ, Lifespan offers a relevant case history of the real-world impact of this work. Until NAHQ defined and validated standard competencies for quality professionals, there was not a clear pathway for education and training for the Lifespan quality team. Formalizing the use of these competencies helped them understand where in-house quality professionals required additional training and learning so they could be positioned for success. 

As Lifespan and other healthcare organizations continue to evolve and collaborate with others across the healthcare system, it is critical to recognize that certain challenges cannot be solved alone. A healthcare quality team leads cross-office, cross-department and even, at times, cross-organization work to reduce variability, identify gaps and issues, and continue making progress toward quality goals. A focus on training against the quality workforce competencies can ensure they are fully equipped to rise to each occasion. 

Lifespan's quality professionals stepped up during the pandemic to make healthcare better 

As quality professionals know, healthcare delivery is interdependent. During the pandemic, quality professionals demonstrated not only their integral roles on a healthcare team when stakes are high—but also where their leadership is essential. 

At Lifespan, the quality and safety team led command center roles including logistics and supporting and facilitating operations. Lifespan's quality and safety team also dug deep into actual command center operations by managing day-to-day issues planning and resolution. It was crucial for the team to determine, in advance, what might go wrong with new COVID-19 procedures so those processes could be done correctly the first time around—and so significant public health and safety risks could be mitigated. These quality professionals undertook daily design projects for processes that were never tackled before and used time-tested tools like Failure Mode and Effects Analysis (FMEA) to identify the best protocols as rapidly as possible. 

Quality professionals focus on improvement as a way of life. They have the perspective and experience to tie the disparate functions of our healthcare system and practitioners together. They step in as a resource when the scope of change or input needed from stakeholders goes beyond frontline leaders' departments or skillsets.  

The 360-degree understanding of healthcare that they bring to this work offers one critical answer to the "how" of improving quality, care, and outcomes for patients and populations.  

Preparing your workforce for day-to-day challenges, and the increasing crisis-culture we experience, is a core necessity to running a strong business and delivering high-quality, safe care. Healthcare leaders should take full advantage of their quality team and further leverage their human potential by skilling and upskilling this workforce.

Editor's note: Cathy Duquette, PHD, RN, is the executive vice president for quality and safety and the chief nursing executive at Lifespan, an integrated, academic health system in Rhode Island. Stephanie Mercado, CAE, CPHQ, is the executive director and CEO at the National Association for Healthcare Quality.

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