Healthcare Quality And Improvement Committee

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The Healthcare Quality and Improvement Committee is a collaborative technical committee between the ASQ Quality Management Division and the ASQ Healthcare Division.
Our Mission: “Be a resource for the effective foundational and emerging performance improvement methodologies relating to health and healthcare systems.” Team Objectives:
  1. Target higher levels of leadership, such as the CEO, CFO, CIO, CSO and others, with techniques to assist organizations to fit quality and performance methodologies into their overall strategy.
  2. Engage in research and application related to both the Quality Management and Healthcare sections of the overall QBoK as they apply to health and healthcare content.
  3. Use a holistic approach to system level value realization, explore the boundaries of performance and process methodologies such as Lean, Six Sigma, TQM and others to support the growing demands of health and healthcare at the global level.
  4. Reinforce the existing relationship between the Quality Management and Healthcare technical communities for joint member interest and industry segment content.
  5. Document and publish, using a range of media and social channels, the results of committee research and application, including activities related to all three published focused areas.
  6. Explore the overlap in customer segments and content between the Quality Management and Healthcare Divisions through joint study, research, writing, presentations and other deliverables.
  7. Expand the offerings in support of the customized Healthcare quality management system model with additional Monographs and tools supporting the improvement and sustainability of performance excellence in traditional healthcare institutions
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Areas of Focus
Maintenance and Support
Papers and Monographs
Expansion of Use
  • Identify new QMS pilots
  • Engage ASQ members as coaches for individual pilots
  • Register the QMS as an American National Standard
  • Propose conference sessions at appropriate venues to provide visibility of the HC QMS Model and associated monographs and papers
  • Generate new publications on the benefits of the QMS in healthcare
  • Develop Monograph 3 on QMS data analysis and basic implementation tools
  • Create additional papers QMS-related topics for HC/QM TC members
  • Seek out new, alternative publication venues
  • Seek and support new opportunities for QMS utilization, as suggested and chosen by Healthcare Quality and Improvement committee members, Technical Community and ASQ leadership

Improving Healthcare Monograph Series: Featured Content:
  • Assess and Improve your Healthcare QMS with these tools - Webinar recorded on May 20, 2021
    • With Pierce Story and Grace Duffy This talk will introduce the 10 quality system elements of an effective healthcare quality management system and tools to systematically improve the safety and quality of patient outcomes. In this informative 60-minute webinar, you will learn: the Healthcare Quality Management System model the 10 Healthcare Quality System Elements application of quality tools to improve healthcare systems and outcomes
  • 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.
  • 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.


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 on ASQ.org
News Quality Management Division 08/23/2020 5:52pm CDT
Added by Jerry Rice

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