The Importance of Quality Improvement in Advancing Health Care and Controlling Costs
Posted: August 1, 2023 | Category: News
By Mark Wendling, MD, Executive Director, Valley Preferred
“Quality is not an act; it is a habit.” – Aristotle
Health systems around the country have been working on addressing the rising cost of health care in the United States. Few have had much success. U.S. health care spending grew 9.7 percent in 2020, reaching $4.1 trillion or $12,530 per person. As a share of the nation’s Gross Domestic Product, health spending that year accounted for 19.7 percent.(1)
The most forward-thinking physicians, experts, and leaders have made the connection between health care quality improvement and waste reduction toward impacting costs. This connection, however, needs to encompass a multi-faceted and continuous approach to quality to be effective. The concept, in its broadest definition comprising value-based care, has become the most logical and urgent answer as affordable access continues to spiral out of control.
The QI solution matures
Historically, improving health care involved quality assurance – evaluating services and delivery – and quality control – basically a system that could verify whether a desired level of quality was maintained. These methods may have revealed shortcomings and indicated needed changes but failed to perform in a broader sense. They couldn’t necessarily determine effects on other parts of the organization, identify inefficiencies, or address the provider’s role in the process, all important aspects of true QI.
Fortunately, a new concept has overtaken the old. Health care organizations are now combining quality assurance with continuous quality improvement (CQI). It simply means that opportunity for improvement exists in every process on every occasion. CQI also includes the provider element: it requires a commitment to constantly improve operations, processes, and activities toward the ultimate goal of best patient care.
Something is wrong if workers do not look around each day, find things that are tedious or boring, and then rewrite the procedures. Even last month’s manual should be out of date. – Taiichi Ohno, Japanese industrial engineer, father of the Toyota production system
Organizations that take the pursuit of quality seriously and understand its connection to managing costs have initiated programs in which their own providers can participate. If a clinician sees an area that could use improvement, he or she is able to work with a QI team to bring their solution to fruition. Some have even instituted training that enables clinicians to benefit from expert guidance while developing their QI efforts. In this way, creating a “culture of quality improvement” endorses Aristotle’s view that quality is not a single act, but a habit.
Asking the right questions
One thing QI training emphasizes is not to jump to conclusions during a QI investigation. This takes some practice since physicians are expected to be authorities who “know all the answers.” “Medical school teaches you basically to recognize patterns, since there are only so many things that can cause certain symptoms,” says Grant Greenberg, MD, MHSA, MA, Chair, Department of Family Medicine, LVHN. “The contradiction is that medicine is not a definite field. There are types of problems we solve that don’t always have an obvious answer. We have to be able to take time to delve into the details, see what else is going on, and above all, ask the right questions that are directly related to the problem you’re trying to solve.”
If I had one hour to save the world, I would spend fifty-five minutes defining the problem and only five minutes finding the solution. – Albert Einstein, German-born theoretical physicist
As QI increasingly becomes a science, there are structured models to assist. The most common QI methodologies used in health care are PDSA, six-sigma, and lean strategies.
- PDSA, or Plan-Do-Study-Act, is an iterative, four-stage problem-solving model used for improving a process or carrying out change.
- Six Sigma is a set of management tools and techniques designed to improve the capability of the business process by reducing the likelihood of error.
- Lean strategies focus on producing more with less input. Thus, it seeks to eliminate waste throughout the entire manufacturing process.
Data is foundational to QI
In the methods above and in all others, data is essential in being able to ask the right questions. Fortunately, data analytics has evolved as a great asset for health care QI work. It encompasses collecting, tracking, analyzing, interpreting, and acting on an organization’s data for specific measures, such as clinical quality measures. Measuring a health system’s inputs, processes, and outcomes is a proactive, systematic approach to practice-level decisions for patient care and the delivery systems that support it.
Managing all that data includes ongoing measurement and monitoring. It enables an organization’s QI team to identify and implement opportunities for improvements to its current care delivery systems and monitor progress as changes are applied. Managing data also helps a QI team understand how outcomes are achieved, such as improved patient satisfaction with care, staff satisfaction with working in the organization, or an organization’s costs and revenues associated with patient care.
“Without big data, you are blind and deaf like a deer wandering into the middle of a freeway.” – Geoffrey Moore, American organizational theorist, management consultant and author
As the collected data is interpreted, it becomes a reliable and insightful gauge for altering approaches, changing operations, or finding another way to do something that has proved – through data – to have less than desirable results.
When data, efficiency, and performance come together
With data, organizations now can get a bird’s eye view of their processes, from how many unnecessary lab tests are ordered to which patients have not had their annual screenings. Acting on this information through QI can affect efficiency, cost, and ultimately, value provided to the patient. At the Heart Hospital, Hamad Medical Corporation (HMC), in Doha, Qatar, two physicians identified an area that needed improvement and found a way to change it with multidisciplinary, multi-level involvement.
Poonam Gupta, MBBS, MPH, CPHQ, CMQ, a physician and head of Quality Improvement, who works with Dr. Salah Arafa, a senior consultant interventional cardiologist, says teams throughout the hospital have seen an increase in communication, cooperation, and system thinking since value and quality improvement were made a priority in 2018. “We saw great results in one of our labs where we reduced waste by decreasing the amount of rejected blood samples sent for analysis,” she says. “Using the value management system-wide lens, our frontline staffs were empowered to view and address the issue from a whole-system perspective.” Instead of teaching themselves to work around the problem and allowing the waste to grow, or having several teams tackle the issue separately, those involved banded together to effectively resolve the problem without creating unnecessary conflict with the lab.(2)
“There are many experts on how things have been done up to now. If you think something could use a little improvement, you are the expert.” – Robert Brault, author
Physicians are integral to success
Once the data resources are in place and insights are found, the QI torch is handed to the clinicians to follow through on what they learn. It’s up to them to work with people “upstream,” before they become patients, encouraging adaptation of healthy behaviors and regular doctor visits. When illness or injuries occur, the entire system works with patients “downstream” to help them recover as effectively as possible and avoid readmissions to the hospital.
It’s data, efficiency, and performance that constitute effective QI work. Each time these elements come together in a well-thought-out QI effort, it’s another beginning of fundamental change in a health care system that is over-burdened with inefficiencies. As more organizations take on QI as a priority, the better chance we have of making health care more satisfying and affordable.