Even in health­care, qual­ity is free

By fo­cus­ing on pa­tients, their sat­is­fac­tion and your in­come will im­prove

Modern Healthcare - - OPINIONS / COMMENTARY - Wil­liam M. Jen­nings

As the health­care in­dus­try pre­pares for the im­ple­men­ta­tion of the Pa­tient Pro­tec­tion and Af­ford­able Care Act, known af­fec­tion­ately or de­ri­sively as “Oba­macare,” the is­sues that pre­oc­cupy top hos­pi­tal and sys­tem man­agers range from cost­cut­ting to in­creased pa­per­work and per­haps most im­por­tantly, main­tain­ing pa­tient sat­is­fac­tion and ex­cel­lent care dur­ing an era of di­min­ish­ing re­sources.

In our zeal to look for ef­fi­cien­cies, we can’t com­pro­mise safety and qual­ity. The Amer­i­can pub­lic al­ready has some pre­con­ceived no­tions about what the fu­ture may hold, and there’s an anx­i­ety that per­vades the in­dus­try.

A re­cent Ras­mussen Re­ports poll showed that 47% of those sur­veyed be­lieve the U.S. health­care sys­tem will get worse over the next two years even though 78% rate “the over­all qual­ity of the health­care they re­ceive as good or ex­cel­lent.”

In the pop­u­lar mind, cost-cut­ting is as­so­ci­ated with only one thing—less qual­ity. But it doesn’t have to be. In fact, to bor­row a phrase from a pop­u­lar man­age­ment book pub­lished 35 years ago, “qual­ity is free.”

That may sound pre­pos­ter­ous, but it’s not. Man­age­ment con­sul­tant Philip Crosby ded­i­cated his ca­reer to prov­ing the suc­cess of the adage, and in the process, he changed the way U.S. com­pa­nies did busi­ness.

The con­cept that qual­ity is free ap­plies to health­care just as much as it ap­plies to the man­u­fac­tur­ing sec­tor. Quite sim­ply, when you fo­cus on the pa­tient and never change your fo­cus, pa­tient sat­is­fac­tion goes up, em­ployee sat­is­fac­tion goes up, physi­cian sat­is­fac­tion goes up, er­rors go down, re­work goes down, ef­fi­ciency im­proves and in­come im­proves be­yond that which you spent on the jour­ney.

Bridge­port Hos­pi­tal has proof of its suc­cess, and has met­rics to back up that as­ser­tion.

In Wash­ing­ton, a com­monly used term is “bend­ing the cost curve,” and Bridge­port did that last year by re­duc­ing its cost per unit of ser­vice by .5%, from $11,780 in 2011 to $11,714 in 2012. The vol­ume in­creased 5% year over year and was the high­est vol­ume

In the pop­u­lar mind, cost­cut­ting is as­so­ci­ated with only one thing—less qual­ity. But it doesn’t have to be.

in­crease in re­cent his­tory at the hos­pi­tal.

When you re­ally im­prove ser­vice, the economics will fol­low. Pa­tient sat­is­fac­tion at Bridge­port in­creased 20 per­centile points, physi­cian sat­is­fac­tion in­creased from the 53rd per­centile to the 86th per­centile, and em­ployee sat­is­fac­tion in­creased from the 75th per­centile to the 86th per­centile. Th­ese three ser­vice mea­sures all im­proved at the same time the hos­pi­tal “bent the cost curve.”

Of course, Bridge­port is not in the busi­ness just to pro­vide ser­vice; its mis­sion is the busi­ness of im­prov­ing health­care. Key clin­i­cal mea­sures have im­proved as costs de­creased.

The ob­vi­ous ques­tion is “How could this hap­pen?” The ex­pla­na­tion is a sim­ple one. Hos­pi­tal man­age­ment en­gaged the team thor­oughly in the mea­sures and was com­pletely trans­par­ent about what it wanted to ac­com­plish.

As a key part of the ef­fort, man­agers em­pha­sized ac­count­abil­ity. Ev­ery depart­ment de­vel­oped seven mea­sures of qual­ity that were pub­li­cized on posters not just in their break room, but also in pub­lic ar­eas.

The de­part­ments picked qual­ity mea­sures that were cho­sen by their staff mem­bers. How well they per­formed was also made pub­lic.

Even at the board of di­rec­tors level, Bridge­port em­pha­sized the im­por­tance of trans­parency, with a pro­gram de­vel­oped by the vice pres­i­dent of qual­ity. I told him that if the staff was re­quired to mea­sure its per­for­mance, the ad­min­is­tra­tion should be re­quired, too.

As a re­sult, he pro­duced a one-page bal­anced qual­ity score card of clin­i­cal met­rics with such mea­sures as “emer­gency room turn­around times,” “mor­tal­ity rates” and “blood­stream in­fec­tions.” The qual­ity score card, which is never more than a page long, is read at ev­ery board meet­ing, ev­ery staff meet­ing, ev­ery med­i­cal fo­rum and ev­ery man­age­ment meet­ing. We re­view the re­sults and com­pare our per­for­mance in th­ese ar­eas with national or state bench­marks, which­ever is more ap­pli­ca­ble.

In ad­di­tion, as part of our qual­ity ini­tia­tive, we hold a daily safety hud­dle at 8:15 a.m. Ev­ery leader in the hos­pi­tal, some 100 peo­ple, gather in the med­i­cal li­brary for 15 min­utes, and they re­main stand­ing while we ask our­selves cru­cial ques­tions.

How many days since a se­ri­ous safety event? How many days since the last em­ployee in­jury? Have there been any pa­tient safety con­cerns in the last 24 hours, and are any ex­pected in the next 24 hours? Was there a great catch that pre­vented an er­ror from oc­cur­ring?

This safety hud­dle has raised the vis­i­bil­ity of pa­tient safety and con­trib­uted to the pos­i­tive trend at the hos­pi­tal. The prac­tice is some­thing we stole straight out of the man­u­fac­tur­ing world.

So Crosby was right, qual­ity is free—even in health­care. We have proof.


Wil­liam pres­i­dent M. Jen­nings & chief is

ex­ec­u­tive of­fi­cer of

Bridge­port Hos­pi­tal in

Con­necti­cut and ex­ec­u­tive

vice pres­i­dent of Yale New

Haven Health Sys­tem.

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