A large number of healthcare organizations are making tremendous improvements in the quality of care and cost reduction; however, many find it difficult to sustain their advances. Sustainable quality improvements in healthcare requires more than just reacting to specific problems or events. It entails evaluating the processes to understand the underlying deficiencies, the areas most in need of improvement and the options available for making changes that profoundly impact efficiency. Ronald D. Snee with the American Society for Quality, stated, "The time to focus on sustaining improvement gains is well before the initiative is launched." Effective processes are designed with sustainability as a key component.
More than 75 years ago, Dr. William Edwards Deming established that quality improvement initiatives are essentially achieved through managing processes. Since that time, the theories and methodologies he developed have been used to affect profound and lasting change in the vast majority of industries throughout the world. The healthcare system, though multifarious, is fundamentally the same as other industries. It is comprised of a multitude of interconnected processes. By evaluating each of them individually, areas that require attention may be identified and appropriate measures put in place. Although this may seem a daunting task, following Pareto's principles, improving 20 percent of the processes will attain 80 percent of the results. One of the core components of process management is organization. An example of a project underway that focuses on this aspect of quality improvement is the Real Time Locator System (RTLS) under development by the Veterans Administration. RTLS improves the ability for healthcare providers to obtain needed resources. The RTLS will track equipment and supplies to eliminate time wasted searching for these items and enable healthcare providers to use that time to improve the quality of patient care.
Quality improvement requires setting goals that can be measured with meaningful data. Performance measurements should drive behavioral changes consistent with the organization’s quality objectives. A few examples of data that may be used to measure quality improvement include:
Data used to gauge performance is becoming more accessible as many healthcare providers transition to the performance based reimbursement systems being implemented by the Centers for Medicare and Medicaid Services. These systems include measures of patient experience such as overall care experience, health risk reductions, surgical complication rates and hospital readmissions. The data will precipitate quality improvement initiatives that will significantly improve patient outcomes.
Strong leadership is essential to lead organizational change; however, sustainable improvements necessitate the support of the process owners. Moreover, engaging the clinicians who are knowledgeable of the process provides a more informed perspective on the changes that should be implemented. Their familiarity with the patient care process enables them to better identify areas that are most in need of improvement and from which the greatest benefit may be derived. It is through actively involving everyone in the quality improvement process that they gain an understanding of its purpose and their application. Consistent reinforcement of these concepts will establish accountability for processes as well as responsibility for improvement.
The clinicians responsible for improving and sustaining processes require real-time data to assess the quality of care concurrently with patient treatment plans. This enables them to correct deficiencies and errors to produce positive outcomes for the patient during care rather than after the fact. Additionally, providers need access to data on coordinated care administered by other healthcare professionals. The Centers for Medicare and Medicaid Services (CMS) have made some advances in data sharing pharmacy providers in recent years, but many providers have had difficulty integrating these systems with clinical data sources to provide meaningful information.
Sustainable quality improvement involves change throughout the entire organization. Providers at all levels will need training to understand the benefits of quality improvement systems as well as the various tools available to bring about positive changes. Quality and business objectives must be aligned to support effective continuous improvement. Management's role in quality improvement is vital. Proper allocation of resources is essential to process management. Monitoring and measurement must be implemented to gather data that facilitates decision making regarding appropriate actions. A commitment from clinicians to take responsibility for these actions is critical to improving quality as well as sustaining it.