Despite two decades of effort - targeting care processes, outcomes, and most recently the value of care - progress has been slow in closing the gap between quality and cost in the US healthcare system. It's time for a new approach focusing on healthcare quality as a business strategy, according to a special issue of the Journal for Healthcare Quality (JHQ), the peer-reviewed journal of the National Association for Healthcare Quality (NAHQ). The journal is published in the Lippincott portfolio by Wolters Kluwer.
Commissioned by NAHQ, the special issue shares insights from healthcare organizations leading the way toward a focus on quality as a business strategy. "For the past 20 years, the health care industry has improved and innovated, but it hasn't come far enough or fast enough.," commented Stephanie Mercado, CAE, CEO of the National Association for Healthcare Quality. "As you can see from the papers published in this issue, when quality is leveraged as a business strategy and the people doing the work have the competencies to deliver on quality and safety, we can accelerate our progress and achieve real improvement."
Quality as a business strategy for improving healthcare: Six innovative approaches
The special issue was assembled by Guest Editors Cathy E. Duquette, PhD, RN, NEA-BC, CPHQ, FNAHQ, and Nidia S. Williams, PhD, MBB, CPHQ, FNAHQ. It presents six invited papers illustrating the wide range of programs being implemented by interprofessional teams across the health continuum to improve the quality of care:
Improving Documentation for Stroke Patients. At Memorial Hermann Health System in Houston, Randi Toumbs, DNP, RN, MS, AGACNP-BC, and colleagues used standardized templates and trainee education to increase the accuracy of clinical documentation for stroke care. In addition to improving performance on stroke metrics, the program improved case mix index and expected length of stay - two factors with ad impact on reimbursement.
Assessing Costs of Pressure Injury. Shea Polancich, PhD, RN, of University of Alabama at Birmingham and colleagues tested a method to estimate the costs of hospital-acquired pressure injuries: a common and preventable complication. Despite challenges, the pilot study suggested that assessing the costs of adverse events can help in validating the return on investment efforts to improve the quality of care.
Bundled Payments for Joint Replacement. A study led by Tobin Lassen, MBA, MPH, of Cedar Gate, a value-based care performance company in Houston, found that mandatory participation in a Medicare bundled payment program for joint replacement does not improve patient outcomes. The researchers suggest that further study is needed to explore differences in the effects of bundled payment programs for patients in different settings.
Vertical Integration in Skilled Nursing Facilities. Research led by Tory H. Hogan, PhD, of the Ohio State University College of Public Health, Columbus, found that that vertical integration of hospitals into skilled nursing facilities reduced hospital readmissions for pneumonia - but not for heart failure. These mixed results suggest that vertical integration of care may have differing effects in different types of hospitals.
Reducing Unnecessary Phlebotomy. Valerie L. Strockbine DNP, RN, CPHQ, of The Johns Hopkins Hospital, Baltimore, and colleagues evaluated the use of a clinical decision support system (CDSS) to help reduce the rate of non-evidence-based phlebotomy testing. They found that the CDSS reduced the number of unnecessary tests and lowered costs, with the potential for further savings with more widespread introduction of the system.
Value Transformation Framework. Cheryl Modica, PhD, MPH, BSN, of the National Association of Community Health Centers (NACHC) and colleagues report on the development of a Value Transformation framework to provide an "actionable pathway" toward a value-based care approach at federally qualified health centers. The NACHC provides tools to help guide systems change toward the "Quadruple Aim" goals of improved healthcare outcomes, improved patient experience, improved staff experience, and reduced costs.
As a leader in healthcare quality, I know first-hand the value of leveraging quality as a business strategy. I've worked with countless individuals and together we've made patient care better, and saved millions of dollars. There is no question, a vital component of leveraging quality as a business strategy is the healthcare workforce that is ready to deliver on value."
Carole Guinane, RN, BA, MBA, CPHQ, President of the NAHQ Board of Directors
Cheryl, M. (2020) The Value Transformation Framework. Journal for Healthcare Quality. doi.org/10.1097/JHQ.0000000000000239.