Health care organizations are always engaged in some sort of clinical quality improvement activity, but many struggle to understand the actual impact of their effort. This presents a challenge to C-suite leaders, who may be asked to fund an initiative without having clear evidence that it will result in performance improvements commensurate with the level of resources invested.
To allocate scarce resources in the most impactful way, an organization needs to be able to measure the effectiveness of a given initiative in real time to see what is actually making a difference. To do this, Arcadia partnered with a Health Care Controlled Network (HCCN) covering 124 sites and 650,000 patients on the development of Arcadia Launchpad, a platform to track the near-real time performance of quality initiatives and share blueprints for successful initiatives across sites.
A platform like Launchpad will best support organizational success when paired with strong leadership support. In Arcadia’s work with healthcare organizations across the country, we have found that leaders also need to consider the following when investing in clinical quality initiatives:
Data quality before all else.
Arcadians are passionate about data quality because we see it as fundamental to the success of any initiative. If the data are not right, providers will not trust quality reports and progress will be noticeably slower.
Leaders should budget enough time for data validation, as data quality within the EHR will directly impact success. Most importantly, know what data are needed to measure improvement and assess and mitigate data quality risks early on: How dirty is your problem list? Do providers currently voice concerns about report accuracy?
Engage cross-functional leadership in governance.
Many quality initiatives require collaboration between multiple areas, so a leader championing quality initiatives should engage as many cross-functional teams as possible – starting at the C-suite and working across the organization – to get a true multi-disciplinary perspective. Measuring and managing performance is extremely difficult, so engaging these stakeholders early in the process will help leaders counter skepticism and navigate the inevitable bumps in the road.
Leaders should work to ensure engagement at every level of the organization, particularly among the QI team members and the staff directly responsible for executing the initiative.
In organizations with multiple sites, or networks comprised of multiple organizations, building cross-location engagement can be a challenge. Leaders should feel comfortable starting with the one or two sites that are most engaged, and building on their success over time.
Use data to determine attainable – but high impact – goals.
In any cross-functional governance body, there will be many opinions about QI goals. Leaders should leverage data to bring the team to agreement, reviewing performance on measures and the associated costs of poor measure performance. For example, colon cancer screening is very often a measure with poor performance and high associated costs.
Leaders should also think strategically about their patient panel and their organizational capabilities to determine where they can realistically effect change. For example, if a mobile unit is under-utilized, it might be immediately deployed for screenings in high-density areas. Alternatively, an organization may choose to implement efforts that strategically position it to achieve longer-term goals.
Think about QI capacity.
Consider the actual effort required to execute a given initiative, and the realistic capacity of a QI team. In the absence of automated tools to support performance measurement, tracking by hand can take significant time. It may be worth investing in technology or other IT support to maximize the contributions of the QI team.
Optimize external partnerships.
Sometimes an organization can make better progress by forming an external partnership with a public health department or other community-based entity. Leaders should look for opportunities to piggyback on existing community efforts or collaborate with other organizations to extend the reach of a given quality initiative.
Measuring performance is truly difficult – as is improving it. Health care leaders who invest in data quality, governance, and cross-functional collaboration will be more likely to succeed in maintaining organizational engagement over time.
Jennifer Polello, MPHA, MCHES, PCMH CCE and LuAnn K. Kimker RN MSN, CPHIMS, PCMH CCE have worked with organizations across the country on effective clinical quality initiatives. They will be presenting their work with the health care coordination network Community Health Best Practices at the IHI 17th Annual Summit on Improving Patient Care in the Office, Practice, & the Community in March 2016, and have contributed to the related whitepaper Managing Change and Disruption in Population Health.