Guide to quality improvement in healthcare

Aristotle once famously said, "Quality is not an act, it's a habit." What he meant was that slacking off on quality can have devastating consequences. For hospitals and health systems, this translates to a clear maxim: quality improvement can help avoid a host of operational and financial challenges.

Generally speaking, quality improvement (QI) is the process-based, coordinated, data-driven approach to improving the quality of a service or product. It operates under the belief that there's always room for improving operations, processes, and activities to increase quality.

In healthcare, the goal of QI is to improve the delivery of care to patients. 

Improvements are, to some extent, changes. Changes that make something better, more efficient, and safer. That said, it's important to note that while the concepts of improvement and change go hand in hand, not all changes lead to improvement. In simple terms, tweaking something doesn't automatically mean it's better than before.

That's why QI roots itself in measurement, goal-setting, and testing. It's about keeping a close eye on health systems and processes, assessing them, and making continuous improvements toward delivering care that’s safe, timely, efficient, equitable, and patient-focused (more on this a little later).

Much as quality improvement requires a quantifiable change of methods, it also needs you to shift your mindset. Rather than stubbornly sticking to the mindset of "that's our culture and there's nothing we can do about it," QI prompts you to remain humble and always have an open mind. It encourages everyone to actively seek opportunities for improvement and learning. 

QI is important for many reasons, and not simply for the sense that the targeted healthcare delivery system has an extra, intangible 'something' that sets it apart from similar systems. It matters because managing and elevating quality can create significant, sweeping change within a medical institution, attaining outcomes such as:

Saving patient lives

QI eradicates the very thing that causes needless loss of lives: errors. While it's true that to err is human, quality improvement constantly keeps staff and the systems they use in check. This greatly reduces the chances of committing a potentially fatal error.

Considerable cost savings

Good quality comes at a cost, but poor quality will always cut into your practice's profitability and will do so in many ways. For example, poor quality working practices will demand considerably more management input to correct and can cause a higher number of quality and safety issues. 

Similarly, poor quality healthcare processes can result in a waste of both time and money, directly affecting costs. QI cuts these inefficiencies out of your workflows, allowing you to scoop up savings through resource optimization, waste reduction, and improved operational efficiency.

Better preparedness in the event of large-scale emergencies

Such was the magnitude and speed of COVID-19 that it caught everyone off-guard. The medical systems that utilized quality improvement processes like analysis were able to respond quickly and effectively. A sharp focus on QI allows your team to learn from such events so that you're better prepared if a similar one occurs.

Facilitates team collaboration

Quality improvement brings together professionals from many and varied healthcare departments. Setting aside their differences, they work in unison to analyze data, identify improvement opportunities, and implement changes. 

This collaboration promotes a shared understanding of goals, enhances communication between multidisciplinary team members, and fosters a culture of teamwork. 

Not too long ago, QI efforts were focused solely on the giver of care, be that a physician, nurse, or any other medical professional. The modus operandi was that if the people closest to issues affecting care quality weren't given the time, permission, skills, and resources they needed to solve them, QI would lose its essence. 

Today, QI has shifted from being a “name and shame” game that placed the blame squarely on an individual. The consensus is that human error is inevitable, even among the most skilled professionals who adhere to the highest care standards. 

So rather than trying to identify and address incidents, QI now focuses on working conditions and the underlying processes. Put simply, it aims to expose failures in processes, not flaws in people.

With that in mind, here's what a typical quality improvement process looks like:

• First, QI professionals dive deep into patient records and other medical data.

• Next, they carefully assess the care processes in place.

• Finally, using the data they've gathered, they pinpoint areas that need improvement while also highlighting areas of excellence.

Gone are the days when QI professionals had to spend days on end manually sifting through data. With advancements in technology, not only can they hunt down and analyze vast amounts of data much faster than before, but they can also use it more meaningfully.

Chances are, you've already seen examples of QI in full swing, or perhaps you've executed some yourself, albeit unknowingly. When you utilize an EMR system to enhance medical record documentation or craft a well-thought-out strategy to reduce the number of hospital-acquired infections, those are excellent examples of QI efforts.

There are more impacts, of course. Other real-world examples of quality improvement in healthcare include:

• Enhanced communication and collaboration among cross-department teams

• Reduced readmission rates

• Minimized medication administration errors and adverse drug reactions

• Reduced wait times for appointments

• Improved sepsis care

• Streamlined registration process

When executed to perfection, a quality improvement process can help practice owners improve patient outcomes, achieve efficiency in the delivery of care, and reduce healthcare costs.  

Beyond that, solid QI practices and improved patient outcomes firmly put your practice on the road to success by:

Transforming how you are reimbursed for services rendered

With a robust QI process in place, adopting value-based payment models such as Next Generation ACO Model and Medicare Shared Savings Program will be relatively easy and straightforward. It's a move that the federal government greatly appreciates and rewards.

Enabling participation in the federal Quality Payment Program (QPP)

The QPP was created by the Medicare Access and CHIP Reauthorization Act (MACRA) and offers two payment pathways for physicians: alternative payment models (APMs) and the Merit-based Incentive Payment System (MIPS). Without a well-oiled QI process, which is essentially a commitment to quality, getting into the QPP is an impossible feat.

Allowing you to participate in the public reporting of physician performance

Make no mistake, patients, payers, and healthcare providers are constantly checking to see how practices are performing on healthcare quality performance. They are flocking to reporting websites, report cards, or similar tools to compare provider performance on matters of healthcare quality. Surely you wouldn't want to be absent on such platforms. QI provides the pathway to get there.

Putting you in pole position to earn ABFM Performance Improvement (PI) activity credit

As you well know, receiving this credit isn’t necessarily a cakewalk. A well-executed QI process helps you earn it by demonstrating the incredible work you’re doing to deliver impeccable care.

Helping you earn the skills needed to apply for and complete a bevy of national recognition programs

From the iconic Patient-Centered Medical Home (PCMH) program to the prestigious Diabetes Recognition Program, these meaningful rewards are only given to deserving candidates. Having a QI process running portrays that you've invested in a model of care that puts patients first and where continuous care improvement is a priority, and that's precisely what organizers want to see.

Quality improvement (QI) isn't something you can just advocate for and not back up with deeds. For the process to work, you need to embed the importance of quality into your practice's culture from the get-go. 

Implement procedures and systems that support your QI initiatives—that may mean creating a well-balanced QI team, holding frequent QI meetings, and making QI progress and results readily available to staff members and patients alike.

If you're considering rolling out a QI program, think about the following before you hit the ground running:

How will you pinpoint areas in need of improvement?

Implementing a QI program on a whim is possibly the worst thing you can do for your practice's bottom line. The whole thing will certainly hit a brick wall, and you'll lose your precious resources. So take the time to understand what opportunities exist for improvement.

Carefully analyze your existing data, paying particular attention to patient records. Your organizational operations could also be sabotaging your care delivery endeavors to some extent, so don't turn a blind eye to them either. Once that's done, use the data you have to establish a baseline for patient outcomes.

You might ask, "Can I use Electronic Health Records (EHRs) to garner the data I need for QI?" You can, but those alone won't get the job done. 

Initially, EHRs were thought to be the final piece in the patient-centered care jigsaw, but they've since fallen short. Instead, most focus on better billing, documentation, and boosting ROI. To be on the safe side, look at data and trends from across the entire care continuum. Dive into EHRs, outcome studies, and other data sources to closely track the health, outcomes, overall wellness, and costs of individual patients.

How will you know which areas to prioritize?

Next, set clear and measurable goals in the areas you identify as direly in need of improvement. Ideally, your goals should revolve around these key areas:

• Safety: Avoiding harming patients with the care that’s intended to help them

• Accessibility: Giving patients access to the correct care at the right time in order to get the best results

• Effectiveness: Using scientific knowledge to provide services to everyone who could benefit and refraining from providing services to those who are unlikely to benefit (this involves avoiding underuse or misuse)

• Patient-centeredness: Providing care to patients that’s responsive and respectful of individual patient preferences, values, and needs and making sure that clinical decisions are guided by patient values

• Timeliness: Reducing harmful delays and improving waiting times for those who receive and those who provide care

• Efficiency: Avoiding waste, for example, waste of supplies, equipment, energy, and ideas

• Equitability: Providing care that’s the same for everybody—doesn’t vary in quality due to characteristics like ethnicity, gender, socioeconomic status, and geographic location

Over and above, make sure the goals you set are the right ones for your practice. No two healthcare organizations are the same, and what worked for someone else might flop badly for you. Clearly identify how each goal aligns with the facility's vision and strategic plan so that if there are any misfits, you can remedy them instantly.

How will you know whether the process is working?

Once you've set your QI goals, commit to evaluating them on a continuous basis.

In healthcare, the Plan-Do-Study-Act (PDSA) cycle has emerged as a reliable way to accelerate any QI initiative. First, you plan a change, you execute it, then you observe and analyze the results, and, finally, you act on what you've learned. This way, you can discern which changes are effective and which ones are not.

How will you communicate the results?

Don't keep your QI efforts to yourself. Share the progress and results with your physicians, staff, and even patients. Recognize and award those who have made an impact on your progress. Trivial as this might seem, it plays a pivotal role in the long-term success of your quality improvement endeavors.

Perfectly planned, well-implemented QI programs are essential for healthcare organizations looking to properly address patient needs in today’s world. When your care delivery systems and processes are performing at their absolute best, the chances of having unhappy patients or a sinking bottom line are nearly zero. 

No matter how you look at it, quality improvement in healthcare isn't just important for the continued survival and growth of your facility; it's mission-critical.

Quality measurement is an important prerequisite for any quality improvement process. In the famous words of Peter Drucker, “you cannot manage or improve that which you cannot measure.” 

Before you begin to make improvements in healthcare, you first need to know if there are any opportunities for improvement. If yes, analyze and measure them accordingly to see which ones need prioritizing. Then act on them.

The best way to evaluate the quality of healthcare systems is to keep a close eye on two fundamental areas: your practice operations and your patient population. Studying your operations helps you uncover areas for improvement, and scouring through your patient records is an effective way to understand their risk. 

It's easy to think of QI as an activity solely reserved for the practice owner, but that's a skewed perspective. When the practice owner, physicians, nurses, staff, and even patients join hands to improve the quality of care delivery in whatever ways they can, everyone benefits. 

The facility gets an operational revamp, the owner enjoys immense cost savings and a happier team overall, the staff are better placed to drive top-notch care, and, importantly, the patient receives care that is safe, convenient, affordable, and holistic. It’s a true win-win situation.