The healthcare industry is perpetually in motion and adapting to new challenges and seeking opportunities to improve and innovate in search of quality excellence is required. Organizationally, quality must be a strategic priority to focus on embracing and becoming a learning organization using continuous process improvement and transformational leaders. Prioritizing quality enables healthcare organizations to make evidence-based and data driven decisions while integrating patient and staff well-being into the organization’s core values. Quality excellence has a direct and indirect correlation to positive financial outcomes.
National Quality Strategy: Navigating the Healthcare Landscape
A cornerstone of quality-driven healthcare is the National Quality Strategy (NQS), a roadmap designed to help healthcare organizations navigate the ever-evolving healthcare landscape. NQS, established by the Centers for Medicare & Medicaid Services (CMS), provides a comprehensive framework that underscores the significance of quality, safety, equity, and patient-centered care. NQS encourages alignment across quality reporting and value-based payment programs, accelerating the path towards value and addressing upstream drivers of health.
The NQS has set critical goals, encouraging a broader vision for quality and safety. It establishes quality as a foundational component across a patient’s care journey, ensuring optimal care and outcomes, regardless of age, background, or service delivery. In addition to NQS, other agencies such as National Quality Forum (NQF), and Agency of Healthcare Research and Quality (AHRQ) and regulatory agencies such as DNV and the Joint Commission establish quality and safety standards. An example of an organizational priority for the Joint Commission is to support health equity. The focus of health equity aims to address disparities by ensuring equal access to quality of care.
Public Reported Data and Transparency Used to Drive Quality
The CMS Star Rating and The Leapfrog Hospital Safety Grade are two significant barometers of healthcare quality. Medicare hospitals are rated from one to five stars by CMS, focusing on overall quality, safety, readmissions, patient experience, efficiency of care, and more. The Leapfrog Hospital Safety Grade, on the other hand, provides a letter grade (A to F) to hospitals based on over 30 processes and outcome measures. Public reporting is used to establish the baseline and comparison for hospitals to continuously strive for improvement to maintain or enhance their scores. In addition, public reporting gives patients information to be better consumers of healthcare and thus, their scores can impact a hospital’s reputation and patient’s trust.
Quality Metrics Collide: Ensuring Compliance
Quality leaders face the complex task of helping to prioritize and educate on various quality metrics, often with overlapping measures across multiple programs. The Hospital Value-Based Purchasing Program, Hospital-Acquired Conditions Reduction Program, and Hospital Readmissions Reduction Program each have their own set of quality measures. Managing and aligning these measures is pivotal to demonstrating high-quality care, streamlining reporting, and ensuring transparency. In addition, patients may be associated with many metrics. To begin to focus on overall quality excellence, it’s vital to identify and explore the intersections between these metrics for opportunities for improvement. Patient experience measures are a great example of removing silo thinking and connecting metrics with a patient and staff-focused approach to quality improvement.
The Financial Impact
In addition to defining, communicating the outcomes, and connecting the various quality metrics, quality leaders must collaborate with finance and c-suite to be able to paint the financial impact. Hospitals continue to struggle to maintain their profit margins and quality leaders must be able to clearly state areas of profit and areas of risk for now and in the future. CMS programs such as value-based purchasing and readmission penalties have a direct correlation to finance. Other market payors may have to pay for performance programs that correlate to publicly reported data, such as CMS and Leapfrog, and others may have their own that directly impact their reimbursement. In addition to a direct financial impact, there may be indirect financial factors to consider such as a legal impact, especially with never events, consumers walking away based on public reporting information, and inability to recruit and retain key employee positions and providers. Employees and providers want to work and practice in an environment that provides quality care to patients and want to work in a learning organization where their opinion and ideas are welcomed.
In the era of change and innovation, healthcare quality is central to the future of healthcare delivery. It emphasizes safety, equity, and patient-centered care, ensuring the well-being of communities and individuals. Quality aligns with the common goal of securing a path toward providing safe, equitable, and patient-centered care and must be an organizational strategic priority.