The idea of quality improvement was first introduced by Dr. Edwards Deming decades ago. The now called Deming Principles outline 14 points for total quality management and quality improvement. It’s from these basic ideas that the idea of Clinical Quality Measure Tools was derived and expanded on.
The 14 Edwards Deming basic principles of quality improvement are:
- Create constancy of purpose for improving products and services.
- Adopt the new philosophy.
- Cease dependence on inspection to achieve quality.
- End the practice of awarding business on price alone; instead, minimize total cost by working with a single supplier.
- Improve constantly and forever every process for planning, production, and service.
- Institute training on the job.
- Adopt and institute leadership.
- Drive out fear.
- Break down barriers between staff areas.
- Eliminate slogans, exhortations, and targets for the workforce.
- Eliminate numerical quotas for the workforce and numerical goals for management.
- Remove barriers that rob people of pride of workmanship, and eliminate the annual rating or merit system.
- Institute a vigorous program of education and self-improvement for everyone.
- Put everybody in the company to work accomplishing the transformation.
Now as mentioned earlier, denim principles of quality have been improved upon using clinical quality measure tools for better results in the healthcare industry. In other to apply these effectively, healthcare organizations need to:
Prioritize measures that truly impact patient care
We all work to keep patients safe and improve their outcomes. Thankfully, we see trends in required measures shifting from process to outcome measures to align with this focus. Outcome measures, like mortality and readmission rates, are important. Additionally, patient safety measures, such as surgical site infection (SSI), Catheter-Associated Urinary Tract Infection (CAUTI), and Central Line Associated Blood Stream Infection (CLABSI) are part of multiple pay-for-performance programs with considerable visibility. When complications arise, a surgery or procedure can end up with a different DRG depending on coding, and contribute to decreased reimbursement through both the CMS Value-Based Purchasing and Hospital-Acquired Condition (HAC) Reduction programs, and most importantly, worsen a patient’s satisfaction and health outcomes. Performing poorly on patient safety measures means not doing well by patients and leaving dollars on the table. So continue including patient safety and patient harm measures on your organizational scorecards, but be aware of how your internal goals align with benchmarks and thresholds identified in the pay-for-performance programs.
Have a line-of-sight to reimbursement
Financial considerations need to be monitored in addition to those related to quality and safety. We learn this from the adage “no margin, no mission.” It’s important to look at the alignment of measures across programs, understand the reimbursement tied to each one, and then make informed decisions about which ones to support the most.
To further illustrate the importance of certain measures from the financial perspective, consider the HAC Reduction program that says CMS will reduce payments by one percent for hospitals performing in the worst quartile with respect to certain infection and patient safety measures. Additionally, these same hospitals are involved in the Value-Based Purchasing Program, a CMS program funded by a two percent reduction in participating hospitals’ DRG payments and redistributed based on quality performance. For sizeable health systems, this can add up to millions of dollars when adding up measures across inpatient programs like HAC, value-based purchasing, and readmissions.
Having tools available to show not only clinical performance on quality measures but also the projected payment impact of that performance, allows an organization’s clinical and finance teams to work together to make informed decisions on prioritization of improvement efforts. There are some principles that apply in every situation without the need for a variation such as respect for people. In the healthcare industry respecting health, practitioners are essential as their work involves a lot of patient interaction and most importantly life and death situations. If employees are happy it affects the quality of service. In healthcare, a drop in quality of service could lead to life-threatening situations. Care should be taken.