Historically, the principal driver of patient safety and quality efforts has been the fundamental desire for clinicians and administrators to “do the right thing” and prevent harm to their patients. Now, organizations thinking strategically are making quality improvement a central component of their business model. Why? Because they understand that quality is at the intersection of transformational cost management, increased government mandates, evidence-based medicine and consumerism.
“Bringing science to safety resonates with clinicians. They are naturally wired to respond to credible metrics and clinical expertise and when it comes to preventable harm, the human cost is unacceptable in their eyes,” said Evalynn Buczkowski, senior consulting director at Vizient. “Their shared goal is to have the right person do the right thing for the patient at the right time every time.”
While every hospital operates in a unique market with unique resources and demands, these three areas of patient safety and quality care must become part of their organization in order to compete in today’s market:
- Identify and fix process-related defects that can result in preventable patient harm and reimbursement penalties
- Embed quality, safety and reliability as a C-suite business imperative
- Optimize reporting resources to meet regulatory, market and internal needs with accurate data
Reducing preventable patient harm and financial penalties
In the world of growing regulatory and performance requirements, an organization’s quality and safety data — and the management infrastructure it reflects — hold the potential for significant bottom-line impact. Using sound data and a team of clinical and process improvement experts, hospitals can assess the current state and identify areas of need. This leads to prioritization and implementation of an action plan to improve patient safety and the quality of care on a rapid timeline.
For example, a large, Texas-based hospital system identified a key opportunity to improve performance (and avoid harm to patients) in one of the four hospital-acquired condition areas measured by CMS: prevention of central line-associated bloodstream infections (CLABSI).
“CLABSI is a complex but pivotal improvement opportunity with immediate and important benefits to patients and the organization,” said Buczkowski. “Vizient is often engaged to help health systems improve their safety and quality infrastructure to avoid financial penalties for poor outcomes.”
Vizient data and analytics helped narrow potential approaches to specific opportunities that would positively impact CLABSI rates. The data revealed that each CLABSI occurrence cost the system more than $27,000 in care delivery and resulted in nearly 16 avoidable days. Most importantly, CLABSI increased the mortality risk by 25 percent.
This evidence prompted both the system’s leadership and their clinicians to support a multifaceted CLABSI reduction approach. Nursing staff, infection control and supply chain personnel all played a role.
“Sharing the initial evaluation data with physicians gained their buy-in for new safety protocols and helped them understand CLABSI-related issues that floor nurses face,” said Buczkowski.
Ninety days after implementation, the hospital experienced zero CLABSI episodes and, in addition to the benefit of improved patient outcomes, also saved $2.9 million in avoided variable costs and more than 1,700 total avoided days.
Quality and patient safety starts at the top
A recent study published in the journal Health Affairs noted that national policies to improve health care quality have largely focused on clinical provider outcomes and, more recently, payment reform. Yet the association between hospital leadership and quality, although crucial to driving quality improvement, has not been explored in depth.
While there may not be hard data linking C-suite involvement with quality improvement, Vizient’s boots-on-the-ground experience sees a strong correlation.
“Addressing preventable harm requires evidence-based measures applied to systemwide efforts. In my experience, the greatest improvement in clinical outcomes is when these efforts and improvement teams are co-led by administrators,” said Buczkowski. “They set priorities, remove barriers and ultimately allocate resources to improving quality. Their involvement visibly demonstrates they value the teamwork, human talent and environmental factors that underpin a culture of quality and continuous process improvement.”
Data drives sustainable quality improvement
Hospitals generate cost, quality and safety data every minute of every day with every patient they treat. This data becomes the face of the hospital’s quality performance infrastructure — the most accessible view into how the organization approaches and improves outcomes of care.
“Every item of data carries a cost; to document, code, crunch, cleanse, gather, review, report and archive. Most health systems don’t need to generate more data than they already have. What they need help with is unlocking its value by making it actionable for clinicians, supply chain teams and administrators,” said Buczkowski.
Hospitals must learn how to leverage the data they are generating to effectively identify quality and safety initiatives, create baselines, monitor progress, provide feedback, and continue the cycle of performance improvement and cost management.
Improving patient safety and the quality of care is the intersection of transformational cost management, governmental mandates (including value-based purchasing), evidence-based medicine and consumerism. And even with the current uncertainty around health care, there is not a single reimbursement trend that points away from quality as the driver of financial viability.
Hospital leaders must spearhead quality initiatives and more effectively use the data they are generating to address areas that create preventable patient harm. By doing so, they will be able to improve patient outcomes, convert quality to currency and thrive under payment reform.