While no single approach is right for every hospital, there are a few fundamental tenets that all healthcare organizations should keep in mind as they design a quality improvement program.
The concerning impact of Covid-19 pandemic on clinician and nurse burnout is an urgent topic of conversation in the healthcare community right now. Less widely discussed, but just as concerning, is the significant impact of the pandemic on the quality of care that hospitals deliver. As hospitals have navigated sudden surges in demand, capacity constraints, workforce shortages and staffing challenges, the effect on quality measures has been material.
Data from the Centers for Disease Control and Prevention (CDC) shows an increase in health equity gaps, substance abuse, and healthcare-associated infections such as ventilator-associated events, catheter-associated UTIs and increases in MRSA (Methicillin-resistant Staphylococcus aureus) bacteremia, among other issues. These quality performance impacts are expected to extend far into the future.
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Quality performance impacts result in a direct hit to hospitals’ finances. As one example, in February 2022 the government released its list of penalized hospitals that in its estimation didn’t hit the quality mark on patient infections and avoidable complications. The penalties—a 1% reduction in Medicare payments over 12 months—are based on the experiences of Medicare patients discharged from the hospital between July 2018 and the end of 2019, right before the pandemic began.
As we make our way out of this health crisis, quality improvement (QI) initiatives should be elevated as a strategic priority for most hospitals while they regain their footing. Their financial viability depends on it. As hospitals reprioritize their quality improvement initiatives in a post-Covid-19 world, their focus will likely be twofold: first, to assess whether the many changes made rapidly during the pandemic should be formalized—and perhaps even expanded; and second, to resume or accelerate existing QI efforts that were underway even before Covid-19.
Given the urgency, hospitals can’t approach QI in a “business as usual” way. Organizations must establish bold strategies and adopt innovative technologies that break through entrenched silos and enable rapid decision making. Importantly, QI programs should not further burden staff – but instead support them, guide them, and improve the provider experience, a core tenet of the Quadruple Aim.
Five tenets of a QI change agenda
1. Build QI action plans based on the best evidence.
Those supporting QI programs must think and search through an evidence-based lens. An excellent use case is when an organization is updating or revising their policies or procedures. The literature may show there is insufficient evidence to support a proposed new guideline or policy.
There may also be alternate best evidence that can trigger other approaches that may be more effective. Pinpointing the options based on evidence can help get to action faster.
2. Look to technology to find the needle in the haystack.
Although QI initiatives should be centered in evidence, it can be easy to get lost in the volume of literature. The amount of healthcare information that is published is staggering—some 2 million articles annually, according to some estimates.
As in so many other areas of the hospital, technology can support how this work gets done. Technology and natural language processing now hold the key to guide a query through an evidence-based lens, prompt users on next steps, and organize the volumes of literature into something that is summarized and more immediately actionable.
3. Recognize that QI programs cannot advance without alignment.
While QI programs can be driven at the department level, the most effective approaches rely on collaboration across the clinical staff and frontline workers and the leadership and sponsorship of executive management.
The trigger points for improvement may be at a departmental level. But it is crucial that interdisciplinary teams work collaboratively so they are on the same page when it comes to the best practice in applying changes.
4. Use technology to drive a consistent framework.
A decentralized approach to QI can increase staff engagement and improve retention. At the same time, decentralization can also open the door to a wide variety of staff backgrounds and experience, which may impact quality and sustainability.
The right technology solution can help ensure that all professionals in a healthcare environment use the same standardized evidence-centered frameworks without undermining individual creativity. The ideal technology should support collaboration capabilities, provide built-in guidance, prompt users on next steps and auto-format outcomes.
5. Ensure transparency.
For most hospitals there is not a single, granular view of the status of all QI initiatives that enables hospital leadership to see which individuals or departments are involved, where there might be unintended duplication, and where efforts are gaining traction.
When there is an overall view of all QI initiatives, often the individual QI efforts are not uniformly tracked, which means reporting to the executive team on progress can be time-consuming or incomplete. The lack of transparency can also create waste; but perhaps more importantly, it can stall progress that has a direct line to quality measures.
Hospitals face a balancing act today as they navigate the full impact of Covid-19, staffing shortages and financial pressures, as well as a renewed agenda for QI programs. The next phase of recovery will not only require vision but an entirely new way of planning and implementing these QI initiatives.
Starting with an evidence-based approach and incorporating thoughtful tactics to engage staff, boost morale and secure buy-in will be crucial to making sustainable change happen. Change won’t happen overnight. But by combining an evidence-based methodology with technology, hospitals can make a significant impact on quality scores and hospital performance in a short amount of time.