Making Quality Improvement a Reality

All hospitals want to be quality leaders. They all want to have the best outcomes at the lowest cost. 

One of the biggest challenges in implementing a quality improvement strategy is figuring out where to begin. Most of the quality improvement efforts hospitals currently focus on are centered around mandatory monitoring regulations (CMS and otherwise). This tends to be effective for specific measures, but tackles only a small piece of the puzzle.  

Hospitals need to know where to get the most bang for their buck. Examining cost, volume, and variation in care delivery are crucial. The problem is most hospitals lack sophisticated analytical capabilities to assess this data accurately. Substituting surrogate measures like severity of disease (usually more costly in general) are often employed, but can be misleading.

Key process analysis (KPA) is a helpful tool hospitals can use to prioritize focus and allocation of resources. KPA utilizes the Pareto principle (also called the 80/20 rule), where roughly 80 percent of the opportunity for quality improvement lies within 20 percent of care processes. There are many “usual suspects” that tend to occur across different hospital systems (i.e. heart failure and sepsis); however, some unique players tend to emerge when data is accurately evaluated.
 
Hospitals unaware of their true variable costs (not charges or reimbursements) can think a particular service line is profitable based solely on the fact that it’s high volume. The harsh reality is that a high volume, costly service does nothing but subtract revenue from a hospital’s bottom line quickly. It’s no longer an effective strategy to make up for losses with volume.
 
Physicians need to be wary of this phenomenon as well. For example, a high cost surgeon who performs a tremendous volume of procedures can’t hide behind that volume when costs become transparent. Suddenly, what used to be an advantage becomes a liability to the hospital. The financial safety net is removed and the surgeon is left exposed. Physicians need to be conscious of their costs and recognize that superior patient outcomes are actually more often tied to lower costs.