The health care industry as a whole is experiencing a relentless emphasis on outcomes, costs, transparency and safety. Hospital and health system leaders must respond to external pressures over which they have little control, while addressing internal issues that affect organizational performance.
Hospitals exist to serve community needs. Attending to customer preferences and stakeholder interests, while monitoring both the external environment and the internal environment, will effectively position proactive organizations to create value and achieve sustained competitive advantage in the marketplace.
The AHA Quality Center brings together multiple resources to help accelerate hospitals’ improvement efforts. Our intention is to assist hospitals to achieve better outcomes, to improve operational performance, to enhance safety and to increase satisfaction. This in turn will result in more affordable health care. Numerous factors influence a hospital’s performance and its contribution to the community in terms of service delivery, outcomes and health status. The Quality Center has identified eight areas related to organizational performance that both individually and collectively have significant impact on hospital performance. These are the “Eight Dimensions of Quality.” This article will introduce the eight areas and pose a few questions that will allow leaders to begin to assess where you are in your journey. In subsequent columns readers will have the chance to hear in more depth from experts in the field on individual dimensions of quality.
Effective leadership is essential if hospitals are to make the system-level changes that will dramatically improve quality of care and patient safety. Hospital leadership must be skilled at articulating a vision for quality improvement; cultivating change leaders within their organizations; aligning incentives across administrative, medical and clinical staffs; and managing all aspects of change. Development of these leadership skills is crucial if hospitals are to “raise the bar” of hospital performance. Some of the questions that leaders should be able to answer include:
Hospitals that improve quality and patient safety see correspondingly improved business performance. Organizations that improve processes get better outcomes. Improved outcomes are often accompanied by reduced length of stay, decreased readmission rates, lower health care associated infection rates and better medication administration. Removing waste, eliminating defects and reducing variability translates into higher customer satisfaction and lower costs per episode of care. Improved quality will better position the organization to compete in the existing environment in which emphasis on outcomes, costs, transparency and safety will only increase. Leaders should be able to answer:
Improving hospital patient safety and quality of care requires the full participation of the medical and hospital staffs. To achieve this participation, hospital leadership must cultivate an environment that engages both groups. Engaged physicians and staff feel an attachment to their jobs and the hospital they work for. When appropriately engaged, they will act in the best interest of their hospital and will be willing to invest effort in meeting hospital performance goals. Leaders should be able to answer:
Effective hospital leaders establish a clear vision and direction for hospital performance improvement. Improvement depends upon the development of a comprehensive performance measurement and reporting system. Performance measurement and reporting systems can be used to identify areas within a hospital in need of improvement, track progress over time, publicly report performance, and produce data reports useful for continuous quality improvement. It is important that performance measurement not be viewed simply as a regulatory requirement, but rather as an indispensable function for motivating behavior necessary to maintain and/or improve quality and patient safety. Some of the questions that leaders should be able to answer include:
Health information technology (HIT) can play a major role in improving outcomes for patients and the financial performance of health care providers. Investment in HIT has become more compelling because of technical advancements that improve functionality and ease of use, as well as pressure and incentives from consumers, government and regulators. Leaders should be able to answer:
There is a growing recognition of the critical role that culture and communication play in ensuring the delivery of safe, quality health care. When a culture of safety and quality has been established, it can be observed in the values, attitudes, perceptions, competencies and patterns of behavior of staff throughout the organization. Executive leadership is essential to promoting culture change. Leaders must visibly demonstrate their own commitment to quality care and patient safety and provide the resources needed to achieve results. Because change is often difficult, the messages relayed to staff about patient safety, staff engagement, open communication, and blame-free error reporting must be consistent and sustained over time. Leaders should be able to answer:
Patient- and family-centered care can be defined as health care that establishes a partnership among practitioners, patients and their families, both ensuring that care delivery respects patients’ wants, needs and preferences and providing patients with the education and support they need to make decisions and participate in their own care. Patient- and family-centered care is associated with improved clinical outcomes, increased market share and patient loyalty, increased patient safety and higher employee satisfaction. Leaders should be able to answer:
Hospitals that want to begin or enhance a quality improvement program have numerous proven strategies and methodologies to choose from. Often they search for projects that deliver the greatest impact at the lowest cost. Prioritization of quality improvement efforts should be informed by the hospital’s external environment, including national health care quality priorities, payer concerns, community needs and regulations. Within each organization, methods for identifying and prioritizing areas in need of clinical quality improvement should be data-driven. Leaders should be able to answer:
Steve Mayfield is the AHA’s senior vice president of quality and performance improvement and director of the AHA Quality Center. Future articles will allow content experts to expand on these issues. Visit the AHA Quality Center at www.ahaqualitycenter.org to explore these and other topics.