Healthcare Quality And Improvement Committee
| Our Mission: “Be a resource for the effective foundational and emerging performance improvement methodologies relating to health and healthcare systems.” | Team Objectives:
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Areas of Focus
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Maintenance and Support |
Papers and Monographs |
Expansion of Use |
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Improving Healthcare Monograph Series:
- Monograph 1: A Hospital-Based Healthcare Quality Management System Model
- Monograph 2: Assessing Your Healthcare Quality Management System
- How Well Is Your Healthcare Quality Management System Performing? by Grace L. Duffy, Susan Peiffer, and Pierce Story
- This article explains how a quality management system model can provide a solid foundation for healthcare organizations. It also details the importance ongoing self-assessments of existing gaps and how to address them to ensure improvement.
- Finding Solutions to Quality Issues That Affect the Healthcare Industry by Susan Peiffer, Gary Kollm, Sheri Graham-Clark, Romain Denis, Grace L. Duffy, Vicente “Alberto” Araujo, and Pierce Story
- Providing healthcare services that not only address patients’ existing needs but also improve general health and well-being—regardless of their differing needs and expectations—requires a complex mixture of approaches and tools.
- How Predictive Analytics Will Prevent the Cost of Harm: A Practical Approach for Hospital Management by Douglas B. Dotan and Kerry J. Koski
- The technology is available today to use predictive analytics for preventing patient harm and avoiding the subsequent negative financial impact. “An ounce of prevention is worth a pound of cure”—this mindset is a must for any hospital to reach high reliability given the complexity of today’s healthcare setting. Failure to recognize preventable adverse events (PAE) has a significant impact on a healthcare provider’s bottom line. In reviewing the 2014 National Medicare inpatient Diagnosis-Related Group (DRG) reimbursements (CMS. gov, 2014). It is clear that even a 1 percent penalty translates into a $3.5 billion unfavorable financial impact to the industry. Such cost can be avoided by integrating predictive analytics into hospital management systems, a logical next step in the continual improvement of patients’ safety and quality of care.
To achieve this next step and ultimately a healthier population, hospital leadership must create and sustain a “Just Culture” environment where organizational core values are demonstrated everyday by everyone. This requires a systematic approach of utilizing available information technology with evidence based clinical pathways to anticipate threats of PAEs and mitigate the likelihood of occurrence. Improving the readmissions penalty, which will reach an all-time high (Rau, 2016) of +$500 million in FY 2017, should justify an industry-wide focus on prevention.
- The technology is available today to use predictive analytics for preventing patient harm and avoiding the subsequent negative financial impact. “An ounce of prevention is worth a pound of cure”—this mindset is a must for any hospital to reach high reliability given the complexity of today’s healthcare setting. Failure to recognize preventable adverse events (PAE) has a significant impact on a healthcare provider’s bottom line. In reviewing the 2014 National Medicare inpatient Diagnosis-Related Group (DRG) reimbursements (CMS. gov, 2014). It is clear that even a 1 percent penalty translates into a $3.5 billion unfavorable financial impact to the industry. Such cost can be avoided by integrating predictive analytics into hospital management systems, a logical next step in the continual improvement of patients’ safety and quality of care.
- SBAR For Leadership Communication In Healthcare And Other Industries by Kelly L. Podgorny
- The concept of SBAR (Situation, Background, Assessment, Recommendation) is a communication tool that was introduced by the American military in the 1940s. It was later targeted specifically for nuclear submarines where concise and relevant information was essential for safety. Since then, the SBAR communication tool has been used in a variety of industries, including healthcare.
- Healthcare Performance Excellence: A Comparison of Baldrige Award Recipients and Competitors by Ronald C. Schulingkamp and John R. Latham
- What does the Malcolm Baldrige Health Care Criteria for Performance Excellence (HCPE) have to do with quality healthcare and a great patient experience? In the 2015 Quality Management Journal Vol. 22, No. 3, Ron Schulingkamp, Sc.D. of Loyola University New Orleans and John Lathan Ph.D. of Leadership Plus Design Ltd. addressed this issue in a paper titled, Health Care Performance Excellence: A Comparison of Baldrige Award Recipients and Competitors.
“The most important finding in this study was that Baldrige recipients provided care equal to or better than competitors while at the same time providing a better patient experience.” (p.6)
Hospitals today face pressures from a variety of stakeholders to improve performance across a comprehensive scorecard, which has become the basis for Centers for Medicare & Medicaid Services (CMS) Value-Based Purchasing (VBP) program. The VBP program is part of the Affordable Care Act (ACA) and is important in a practical sense because it has an effect on the hospital’s financial performance. The ACA created the VBP program to transition Medicare toward integration and alignment between payment and quality. The performance measures in the study are part of the VPP program (Table 1). The VBP program rewards hospitals for improving the quality of care by redistributing Medicare payments so that hospitals with higher performance in terms of quality receive a greater proportion of the payment than do the lower performing hospitals. The VBP program goal is to transform Medicare from a passive payer of claims based on volume of care to an active purchaser of care based on the quality of services its beneficiaries receive. The study investigates relationships between the effective application of the Malcolm Baldrige HCPE and healthcare organizational performance. There have been many studies on the value of implementing the Criteria for Performance Excellence, but due to the lack of comparable contexts and common performance measures, analysis of the differences in performance between Baldrige Award recipients and non-recipients has been limited. This study focuses on the common context of healthcare organizations in the same geographic region along with common metrics to analyze the impact of effective HCPE application.This study compares 34 Malcolm Baldrige National Quality Award Health Care recipients (2002-2011) to all 153 competitors in their geographic markets using standard CMS performance measures to determine if there is a relationship between the effective use of the HCPE as an organizational excellence framework and the performance of healthcare organizations.
The study results identifies Baldrige Award recipient hospitals had higher mean values representing higher performance than the non-Baldrige Award recipient hospitals in 37 of the 39 (95 percent) study measures. The HCAHPS patient survey measures results were the most significant findings in this study.
The final HCAHPS patient survey question, “Patients would definitely recommend the hospital”, was perhaps the most critical performance measure in the study and is considered a critical question relating to customer loyalty, which is an important aspect of the profitability and sustainability of any organization. The hospitals using the HCPE have transformed their organizations from a narrow focus on clinical outcomes to a more holistic approach to healthcare quality in all respects, including the patient experience.
- What does the Malcolm Baldrige Health Care Criteria for Performance Excellence (HCPE) have to do with quality healthcare and a great patient experience? In the 2015 Quality Management Journal Vol. 22, No. 3, Ron Schulingkamp, Sc.D. of Loyola University New Orleans and John Lathan Ph.D. of Leadership Plus Design Ltd. addressed this issue in a paper titled, Health Care Performance Excellence: A Comparison of Baldrige Award Recipients and Competitors.
Members of the Healthcare Quality and Improvement Committee are:
| Grace Duffy | Eugene (Gene) M. Barker |
| Pierce Story | Gregory Gurican |
| Alberto Araujo | Kelly Podgorny, DNP, MS, CPHQ, RN |
| Cathy Fisher | Christopher Kim |
| Cheri Graham-Clark MSN, RN, PHN, CPHQ, CPHRM, ASQ SSBB | Lynn Louis Loynes |
| Christine Bales | Maureen Washburn |
| Denise Robitaille | Ron Schulingkamp |
| Donna Gillespie | Rowenachona Sano |
| Douglas B. Dotan | Sue Peiffer, MS-MT (ASCP), MHA, CSSBB |
| Douglas C. Wood | Susan Gorveatte |
| Tammy Allen |
Historical Perspective: Healthcare Quality and Improvement Committee
Additional Resources
Attached files
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