We hear it everywhere now, but what are we doing to improve the quality of care? While we see and hear of breakthroughs in pharma, medical devices, and methodologies. Yet medical errors are one of the leading contributors of death, according to research performed by Johns Hopkins Medicine, causing approximately 250,000 deaths each year. Quality care goes beyond just saving lives – it helps patients achieve and maintain the best health possible so that they can work, take care of their families, and increase both the quality and length of life. The Institutes of Medicine (IOM) define quality care as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Patients want to receive high quality care and clinicians want to provide it, of course, but sometimes the distractions of a busy practice can interfere with practitioners’ focus on quality care. Other distractions come from dealing with new technology, retention issues, and , and Fostering a clinician culture focused on quality care helps eliminate medical errors and ensures patient safety.
1. Start community buy-in. Establishing collective buy-in from Director to CNA, requires not just the obvious stakeholders, but delivery to everyone who steps into the facility. Create a vision for quality by setting shared goals for performance, messaging, sharing the narratives of those patients positively affected by going above and beyond, etc.. Ex: Set a goal to improve vaccination rates for all patients, for example, by encouraging clinicians to review patient vaccination history at every visit. Or start with a sanitation program that is committee driven.
2. Foster a patient-centric environment. How often do you use exit interviews, surveys, suggestion boxes, and other means to help clinicians learn about the patients’ perspectives of care ? Most facilities solicit the feedback, but then it disappears into a secret data file that is too taboo to mention. Reporting of the interviews, surveys, and suggestions fosters a culture of quality care within the facility. While the term “journey” is often over used these days, nothing could be more important to the quality of care then to focus on the patients’ journey before, during, and after treatment.
3. Lead with evidence. Provide evidence-based care and create an environment that allows clinicians to keep up on pertinent changes in medicine. This may be through population health resources, or through sharing approved methodologies. Many use Dr. David Sackett’s definition of an evidence-based practice, which is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient.” Keeping abreast of all this new information is not easy. In fact, a primary physician would have to read about 15,000 articles from 90 journals each year to keep up – that works out to about 40 articles each day. While reading that amount of information would severely affect patient flow, allowing clinicians time to learn about the newest, most effective protocols available will greatly increase quality care.
4. Recognize and reward safety. Patient safety is the cornerstone of quality care. In fact, the Institute of Medicine (IOM) considers patient safety “indistinguishable from the delivery of quality health care” and defines quality as ““the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Focus on patient safety by creating a culture where healthcare professionals speak up if they witness a patient safety issue. Twenty percent (20%) of healthcare workers interviewed in a recent survey said they would not speak up if they saw a problem and, in another survey, 60 to 80 percent (60-80 %) of those interviewed said they knew a surgeon was making an incision in the wrong place but did not say anything.
5. Quality data must be gathered and protected. Gather information about the quality of care provided in a facility and share this data with clinicians. Data is the cornerstone of quality care, in that it reflects how well current care is working, measures the effects of changes to care, and documents successful care. Provide the data in actionable formats that help shape how clinicians provide care. This information can include data about:
- Adherence to clinical guidelines
- Care coordination
- Clinical processes
- Efficient use of health care resources
- Health outcomes
- Patient engagements
- Patient safety
- Population and public health
6. Part of quality is access. Improve systems that affect patient access. Integrate systems that reduce patient wait times so that clinicians can start treatment early, when it is most likely to be effective. Improve communication between the patient, clinician and insurance provider to improve patient access to new avenues of care. Facilitating patient access to their lab results, x-ray interpretations, and other medical information can improve quality care by encouraging patient participation in that care.
7. Make the patient a part of the team. Use a team approach, especially when the process or system is complex. A team approach creates a culture in which all participants share the responsibility of quality care. Team members improve quality by double checking diagnostic test results and prescriptions. Using a team approach also improves coordination of care with other parts of the larger health system.
8. Balance the carrot and the stick. Reward clinicians who focus on providing quality care. Consider performance-based payment initiatives, public recognition of positive patient survey results and patient outcomes, or extra vacation days as rewards for improving the quality of care. Programs that pay for performance can reward and encourage doctors and clinicians for putting the patient at the center of the health care experience. Rather than a system that pays providers based on the number of patients they see, payment focuses on incentives based on how well clinicians treat patients. At the same time, expectations must be clear as to what is at stake, and how the reputations of those serving at a facility are intertwined.
These eight strategies help foster a culture focused on quality care. Integrating these strategies into practices, charts, even order sets, can improve the overall culture of quality that results in happier, healthier, and more engaged patient populations. Pulse Clinical Alliance provides strategy sessions, focus groups, and training on improving quality assurance programs, and employee boards. We create cultural thermostats that provide leadership tangible indicators on the strengths and weaknesses of a health systems culture.