The disturbing impact of the Covid-19 pandemic on the burnout of doctors and nurses is a pressing topic of conversation in the healthcare community right now. Less discussed, but equally worrying, is the significant impact of the pandemic on the quality of care provided by hospitals. As hospitals have faced increases in demand, capacity constraints, labor shortages and staffing issues, the effect on quality measures has been significant.
Data from the Centers for Disease Control and Prevention (CDC) shows an increase in gaps in health equity, substance abuse and healthcare-associated infections such as ventilator-associated events, infections of catheter-associated urinary tract and increased MRSA (methicillin-resistant Staphylococcus aureus bacteremia), among other issues. These impacts on quality performance should be generalized in the future.
Impacts on quality performance have a direct impact on hospital finances. For example, in February 2022, the government published its list of penalized hospitals which it estimated did not meet the seal of approval for patient infections and preventable complications. The penalties, a 1% reduction in Medicare payments over 12 months, are based on the experiences of Medicare patients discharged from hospital between July 2018 and late 2019, just before the pandemic began.
As we emerge from this health crisis, quality improvement (QI) initiatives must become a strategic priority for most hospitals as they get back on their feet. Your financial viability depends on it. As hospitals reprioritize their quality improvement initiatives in a post-Covid-19 world, their focus is likely to be twofold: first, to assess whether the many changes being made rapidly during the pandemic need to be formalized, even expanded; and second, to resume or accelerate existing quality improvement efforts that were underway even before Covid-19.
Given the urgency, hospitals cannot approach quality improvement as usual. Organizations must establish bold strategies and adopt innovative technologies that break down entrenched silos and enable rapid decision-making. It is important to note that quality improvement programs should not further burden staff, but rather support, guide and enhance the provider experience – a fundamental principle of the Quadruple Aim.
Five Principles of a QA Change Program
There is no one way to approach CI to ensure it is productive. But there are some fundamental principles that all healthcare organizations should keep in mind when designing a quality improvement program that is right for their context.
- Develop quality improvement action plans based on the best evidence.
Those who support quality improvement programs need to think and search through an evidence-based lens. A great use case is when an organization updates or revises its policies or procedures. The literature may show that there is insufficient evidence to support a proposed new guideline or policy.
There may also be better alternative tests that may trigger other approaches that may be more effective. Identifying evidence-based options can help you take action faster.
- Use technology to find the needle in the haystack.
Although CI initiatives should be evidence-based, it can be easy to get lost in the volume of literature. The amount of healthcare information published is staggering: some 2 million articles per year, by some estimates.
As in so many other areas of the hospital, technology can support how this work is done. Technology and natural language processing are now key to guiding a query through an evidence-based lens, directing users to next steps, and organizing volumes of literature into something that can be summarized and more easily processed immediately. .
- Recognize that CI programs cannot move forward without alignment.
While quality improvement programs can be driven at the departmental level, the most effective approaches are based on collaboration between clinical staff and health care workers.