What is Health Care Quality Improvement?

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In a short period, United States hospitals have saved patients $4.1 billion by improving service delivery. [1] The savings, derived solely from safety enhancements, is one of many operational characteristics hospitals seek to improve. As health care reform falls into place, producing robust information stores, hospital administrators are taking a closer look at their internal processes using big data innovations that have arrived with perfect timing. With this information and organized teamwork, health care leaders are piloting the sweeping changes desired by many patients and public health advocates.

Clarifying Health Care Quality Improvement

Caregiving organizations enhance service quality via steady, continuous tasks that produce measurable improvements. [2] They measure their success according to patient and population outcomes and satisfaction produced by current procedures. Organizations continuously change their policies and procedures to improve performance using varying practices, with most employing four core concepts, which are:

  • Data analysis
  • Ongoing quality improvement processes
  • Patient centered caregiving
  • Teamwork

Organizations vary in size, from small local clinics to national care provider networks. Quality improvement initiatives work best when geared toward an individual organization’s resources, procedures and current services. Clearly understanding current policies and procedures makes it easier for organizations to identify improvement opportunities. Consequently, health care enterprises evaluate resources in tandem with procedures to accurately measure performance.

Improving Quality in a Complex Environment

Caregiving organizations use process mapping to outline their practice and processes. The map visually represents organizational service sequences and processes, while revealing possible improvement opportunities.
Organizations optimize their clinical practices using process maps to achieve positive outcomes called critical pathways. Similar to process mapping, the care providers create critical pathway maps for each organizational service.
Together, the process and critical pathway maps along with medical field best practices help care providers improve organizational performance. The tools help care providers meet patients’ needs and expectations, such as:

  • Cultural sensitivity
  • Evidenced based service delivery
  • Information accessibility
  • Patient engagement
  • Safety
  • Service coordination

Successful health care quality initiatives serve as an outline for other organizations, which use this information to improve critical pathways. By comparing the maps to best practices throughout the medical field, organizations discover improvement opportunities.

Improving Quality Through Teamwork

Quality improvement is a team effort. Health care leaders harness the combined knowledge, skills and perspectives possessed by individual team members, a talent critical to implementing successful changes for complex services and processes. By gathering the team’s collaborative input, leaders access foreseeable issues and viewpoints regarding a specific process or discipline. Additionally, a fully invested and supportive team nurtures a common, creative mindset and resourceful thinking.

This environment naturally solicits active contributions from the entire caregiving team, with each contribution originating from a distinct perspective. This team approach leads to a synergistic effort among staff members. Health care leaders also implement a formalized quality improvement infrastructure, which supports team members with guidance and resources. This practice keeps team member efforts aligned with organizational priorities and objectives.

A Foundation Built on Data

Empirical data clarifies real issues and increases improvement productivity, while eliminating waste caused by misdirected initiatives. This information establishes an organization’s current performance as well as a reference point for improvement. The metric also allows organizational leaders to measure and compare quality improvement initiative performance and make sure team members sustain enhanced service levels. Among large organizations, empirical data helps leaders duplicate quality improvement initiatives across business units and geographical branches.

What Quality Improvement Means to Care Providers

Quality improvement initiatives help organizations increase community welfare as well as patient satisfaction and outcomes. [3] Large providers typically focus on improving organizational performance and primary care safety. Many organizations implement a primary care medical home (PCMH) framework to meet this objective. Quality improvement is central to the PCMH service delivery model. However, each PCMH pursues initiatives relative to their needs, which may include activities such as:

  • Diabetes management
  • Patient identification
  • Patient monitoring
  • Preventative service delivery

While health care organizations increasingly institute PCMH frameworks, they seek new talent skilled at managing ongoing quality improvement initiatives. For these initiatives, care providers are hiring executive talent to manage tasks such as:

  • Data analysis and exploitation
  • Identifying improvement opportunities
  • Long term performance tracking
  • Planning and implementation

Using external and internal information, health care executives educate and train organizational members. The executives also meet with consultants to discuss emerging best practices, utilize data analysis to compare organizational performance to professional peers and identify improvement and employee coaching opportunities. The health care executives deliver the coaching continually through regular training, organizational meetings and digital learning resources, such as Sermo, Doximity and Orthomind.

Forces Supporting Health Care Quality Improvement

Patient satisfaction is an increasingly important metric. [4] The measurement helps organizations meet the new standards mandated by universal health care reform, which encourages improved performance with financial rewards. Additionally, a more informed public demands improvements in health care service delivery.

Combined influences have moved health care service quality to the administrative forefront. The Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey provides organizations with detailed patient experience feedback. Health care organizations exploiting the resource foster a work atmosphere focused on quality improvement. The survey identifies organizational strengths and weaknesses, which leaders use to develop service quality improvement strategies.

The Centers for Medicare and Medicaid Services (CMS) uses a revised CAHPS survey to measure service quality. The service publishes the survey results online for public review with correlating “star ratings.” The National Committee for Quality Assurance (NCQA) requires health care providers to submit CAHPS survey results to receive accreditation and insurer reimbursements. Many states require care providers to collect and report CAHPS survey results for reimbursement through the Children’s Health Insurance Program (CHIP).

The government requires insurers participating in the new Health Insurance Marketplace to poll clients with another CAHPS iteration called the Quality Health Plan (QHP) survey. In the near future, the Health Insurance Marketplace will publish QHP survey results on its website and incorporate the findings with the CMS star rating system. Other new concepts, such as accountable care organizations (ACOs), also rely on the CAHPS to determine their remuneration shares.

The CMS also manages the Physician Quality Reporting System (PQRP), which builds on the results gathered from CAHPS surveys. Eventually, legislation requires all primary care providers employing more than two practicing physicians to collect and report PQRP survey results from patients.

Beginning in 2017, The CMS will publish the results on the Physician Compare Website and adjust care provider payments accordingly. In 2019, to qualify for disbursement under new payment models physicians must submit survey results similar to the CAHPS survey. These models include merit based payment incentive systems (MIPSs) and alternative payment models (APMs). The CMS is still developing the outline for the new models as stipulated by the Medicare Access and CHIP Reauthorization Act (MACRA).

Financial analysts predict that the global health care information technology market will grow from $7.4 to almost $25 billion, a more than threefold between 2016 and 2021 due to legislation and big data innovation. [5] During this period, they also predict that the United States will experience more growth than any other nation and simultaneously improve health care service quality at reduced costs. Patients, legislators and insurers support the sweeping reforms engineered to improve health care quality in the United States. This growth and spending suggests that hospitals and physicians will aggressively seek talented professionals as guides through America’s latest health care revolution.

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[1] Becker’s Healthcare
[2] Health Resources & Services Administration
[3] Agency for Health Research and Quality – Quality Improvement in Primary Care
[4] Agency for Health Research and Quality – Section 2. Why Improve Patient Experience?
[5] Market Watch