Quality in Healthcare... We Have All Heard It

As costs increase and reimbursements decrease there are ways to reduce costs, improve efficiencies and improve the quality of care to meet regulatory requirements. The landmark report from the Institute of Medicine, “To Err is Human: Building a Safer Health System,” illustrated to the mass public the hidden dark secret of healthcare problems related to quality and safety that is present within hospitals. Since this report, many quality concepts and improvement tools began to flow into the processes and systems within healthcare faster than any other industry in an effort to improve and measure quality.

Countless errors in healthcare occur because of faulty systems, processes and lack of alignment. These problems can be prevented by a redesign of processes and a focus on quality as the driver. Leaders within healthcare need to instill the concept of quality as a core function of performance. Improving quality and eliminating errors requires a cohesive message and approach to guide an organizational culture dedicated to improvement and quality. In order to do improve quality, it is important to understand the meaning. “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge,” as defined by the Institute of Medicine in a healthcare context is quality.

Increased pressures on quality and process improvements have led many organizations to look beyond to methods that reduce costs and improve quality. These methods include: Six Sigma, lean, balance score cards, statistical process control, and total quality management. Some argue that it is often too difficult to propose a cookie-cutter solution such as Six-Sigma into healthcare. To date, there has been little documentation on how these concepts have impacted quality within a healthcare context over a period of time. Many organizations adopt these quality initiatives without a strategic approach to manage or align these initiatives in a way that would benefit its customers and stakeholders. In 2008, a survey by the American College of Health Care Executives asked CEOs nationwide what their top concern amongst their institutions is. The No. 2 concern was safety and quality, and two-thirds voiced that their issue of quality was related to redesigning care processes. So, after a decade since “To Err is Human” was issued, why is there still such a concern about quality and patient safety?

Healthcare organizations in general are known to be complex; there are competing priorities, initiatives and stakeholders with a lack of focus and cohesiveness on its mission. Healthcare consists of multiple services, and among those services are different management styles and approaches. The difference between one management style to another can add to the complexity of the already conflicting structure of a business and a provider of services. Each leader within an organization will have a distinctive understanding of quality and management. Additionally, degrees of variance can occur between department initiatives as well as interdepartmental initiatives. Quality initiatives are impacted by the clinical setting, patient expectations, and the severity of the illness. Furthermore one can contradict the other because of a lack of cohesiveness which directly impacts the patient. Healthcare organizations must have a common understanding of the definition of quality, analyze their current status and align their quality goals to the mission to the meet the needs of the stakeholders.

One of the key components critical to the success of the mission is to ensure the organization is meeting the patient’s needs by providing quality care. In conjunction each organization needs to have a value proposition that is supported and adhered to by the organization to fulfill the needs of the stakeholders. The focus needs to be on the customers and creating a culture where everyone plays a part in the quality equation.

SIPS HealthCare Consults focuses on a revolutionary concept that aligns the aspirations of an organization to effectively manage its financials and performance derived by its strategy. Each organization has a strategic approach in managing and adding value; however there is often friction between the stakeholder’s needs and competing hospital initiatives. Individual leadership in management has inconsistent priorities which directly impact the value provided to stakeholders. We embrace and empower a holistic management philosophy that requires cultural change, time and a strong commitment. It is designed to provide every stakeholder an ethical framework of making decisions and maximizing customer value (Value = Quality/Price).

We propose that the executive leadership develop a culture of improvement that incorporates the organizational commitments and concepts related to continuous learning. There are many stakeholders that need to be considered when evaluating relationships, such as patients, residents, clients, visitors, communities, boards, professional alliances, co-workers, supplier colleagues, personnel and physicians. Each one of these relationships is critical to maintain for the success of the vision and mission. For example, medical staff, supportive staff and the front line personnel must be engaged since they are powerful partners in the development and implementation of the patient safety and quality strategies. Additionally, medical staff should communicate and interact with patients, families, communities and with the hospital itself. Information and communication portals are essential in the quality equation.

The role and responsibilities of the executive team in relation to the concept of quality and healthcare management is not illustrated and it should be. Without a strong executive team that supports and provides a quality agenda, quality management will not succeed in the organization. The executive team’s performance also needs to be defined by the delivery of the value base management culture change and it’s affect on satisfaction of the employee, patient, board and the community.

Amanda Chawla, MHA, is vice president of operations for SIPS HealthCare Consults.