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World Class Healthcare Quality
Stage II Doing the Right Things |
Stage I Creating the Discipline |
Stage III Enabling World Class Care |
Strategy |
"Role" of Quality |
Principally a monitoring, reporting and compliance function Performed mostly at the local hospital level; some coordination and assistance provided by System |
Strategy drives selected patient care improvement initiatives |
Healthcare Quality Management (QM) functions integrated into care processes Competitive differentiator: "known" for quality QM viewed as an investment |
Peer Comparisons |
Perform regular "benchmark" comparisons with peers and "Top Performers" |
Targets |
Agree upon and set QM targets / establish priorities annually |
Agree upon and set QM targets / establish priorities annuallys |
Agree upon and set QM targets / establish priorities annually |
Infrastructure |
Technology as Enabler |
Use / modify existing financial and administrative data to measure outcomes |
Use "bolt on" tools to begin measure- ment of inputs and medical practice (e.g. DataVision, Apache, etc...) CIS, CPOE in development |
Full CIS including CPOE, EMR, bar coding, Decision Support Systems, etc... |
Pathways, Care Maps, etc. |
Primarily focused on "order sets" Some pathway / care map acceptance for limited conditions or care processes Hospitals in System independently develop "best practices" |
National sourced, evidence based pathways / care map culture beginning to evolve Sufficient resources to create data and conduct clinical analysis required to "sell" pathways to MDs Ability to compare clinical practices and outcomes to internal and external benchmarks |
National sourced, evidence based pathways / care maps in place for at least 80% of the most common DRGs; compliance at or above 80% Best practices developed across system using consistent guidelines Pathway behavior integrated into care processes, documentation, etc... Consistent and appropriate coding by physicians, coordinate with DQRS |
Process |
Leverage of "System" Strength |
Efforts primarily conceived and driven at individual hospital level |
Collaboration among some system members to accelerate pace of development |
Formal routine periodic collaboration among all member hospitals |
Research / Knowledge Sharing |
Research conducted primarily as individual hospital initiave Limited, informal, ad hoc sharing of knowledge across system |
Collaboration among some hospitals to research / share selected "best practices" |
System-wide "data mining" to identify opportunities for common improvement Aggressive "best practice" structure |
QI / PI Activity |
Individual hospital driven; focus mainly on service and cost effectiveness |
Inclusion of selected "pure quality" initiatives in PI agenda Focus on individual "high return" quality initiatives Techniques established for measuring ROI on quality (or COPQ) |
Full integration of PI and QM agenda ROI on full P/Q improvement agenda Significant understanding of quality improvement ROI at individual initiative level |
External Reporting |
External reporting performed primarily by individual hospitals Oriented toward governmental / regulatory compliance (JCAHO, CMS) "Data Strategy" defines type / amount of data gathered and required resource requirements Able to gather data and report Core Measures |
Migration towards satisfaction of regional "market" standards Use to secure "pay for performance" reimbursement rates Audit process ensures consistent data measurement across individual hospitals |
Ahead of local competitors in proactive demonstration of quality and patient safety vs. national standards Strategic Advantage attained; used to manage market share growth Understanding of relationship among metrics JCAHO "Survey Ready EVERY Day" |
Internal Reporting |
Agreement on Standardized Units of Measure for the System |
Table of Measures Static "dashboard" developed to measure and trend combined performance across key dimensions of Quality (Outcomes, Process, and Resource Utilization/Cost) |
"Dynamic" dashboard allowing "drill down" access to key performance drivers Understanding of relationship among metrics Statistical Process Control |
Influence on Care Process |
Combination of retrospective and concurrent review processes |
Information and decision process increasingly managed at "line" level |
Real-time decision support Expectation of "Evidence Based Medicine" analytical approaches to influence MD behavior / practice Proactive processes to improve out- comes (e.g. "error proofing," using FMEAs, etc. |
QM Initiatives |
Locally driven; System provides limited coaching, ideas for improvement initiatives, data/ analytical support |
QM initiatives based on ROI |
QM initiatives based on highest strategic needs of the overall organization |
Organization |
Structure |
Principally local organization structure to meet local needs Well defined roles, responsibilities and accountability System provides basic coordination and structure |
System helps establish overall and local goals and objectives, including objectives and timeframe for development of QM (ie "Stage" achievement and timing) Integration of QM / UR and PI organizations Well defined incentive structure |
Appropriate structure and sufficient human / other resources to achieve System strategic goals Built in accountability and incentive systems Integration and/or tight coordination of QM/PI/Risk Management and patient care processes System provides significant "value added" services Alignment between individual hospital committees and System - level oversight committee |
Culture |
"Attitude" Towards Quality |
PI and QM programs aimed at improv- ing quality; broad based participation Influence processes and infrastructure at the local level Compliance orientation |
Growing "Culture of Quality" across the system; broad based participation in initiatives that benefit the entire System |
Ubiquitous passion for quality Consistent dedication to deliver quality care among all constituents Quality is "Baked In" vs. "Bolted On" "Learning Organization" with effective healthcare quality knowledge management system |