Quality has never been more important
for health care providers. Employers
ask for it. Payers demand it. Pay-for-performance is taking shape. Physicians
increasingly choose hospitals known for
high-quality care. External rating agencies
measure outcomes, sharing results for all to
see. Consumers use multiple media to
research and identify best medical practices.
And there’s an explosion in information
accessibility and public reports and an
increase in legislation and regulation.
Smart Business learned more from Barry
Arbuckle, Ph.D., president and CEO of
MemorialCare Medical Centers and chair of
the California Hospital Association Board of
Trustees, about what health care organizations are doing to improve quality measures.
What role does quality play among health
care providers?
Quality and safety must be central to the
mission of every provider — from hospitals,
home health services and long-term care
facilities to physicians’ offices, ambulatory
facilities and other settings. That’s because
we know even one preventable death or
complication is one too many.
How can health care providers implement
quality initiatives?
We have an example close to home. More
than a decade ago, MemorialCare Medical
Centers began aggressively documenting our
quality through extensive clinical outcome
studies. Through teams of doctors, nurses
and clinicians from our six hospitals, we created best practice, evidence-based medicine
and clinical guidelines that identify the best
diagnostic, treatment and preventive techniques. Physician-led teams focus on specific
populations of patients or diseases and develop and refine guidelines that support delivery
of care at the bedside. These more than 300
guidelines have become standards of practice at all our facilities. We also are identifying
bold goals to reduce mortality, attaining superior compliance to key measures of care,
improving early response to prevent patient
emergencies, reducing hospital acquired
infections and complications and improving
the experiences of patients and families.
What is the result of best practice standards?
Spending many months identifying and
implementing optimal clinical standards
allows organizations to achieve outcomes
that can surpass national and regional benchmarks for most diseases. It can result in
extraordinary quality, proven treatments and
comprehensive care that continually raise
standards. An empowered and powerful network of clinicians and support staff work in
the best interest of every patient. With shared
goals and purpose, every staff member is
devoted to aligning safety and quality aims
and learning from one another.
How do electronic medical records fit in?
Electronic medical records (EMRs) are
critical to patient quality and safety. In this
Smart Business February 2008 column, we
shared how EMRs place a patient’s full medical history onto computers and information
systems, allowing clinicians to better coordinate care through immediate access to
secure patient data. This facilitates clinical
workflows and handoffs. It minimizes waste and inefficiency of manual and paper-based
processes, maximizes quality through real-time decision support at points of decision-making and eliminates most paper used in
patient documentation and education.
Efficient care delivery prevents unnecessary
orders and diagnostic tests, reduces medical
errors and improves safety.
How will quality impact financing?
It already has. In late 2006, a major credit
ratings firm announced that credit ratings
will be incorporating quality measures and
specific metrics into the assessments of credit quality for health care organizations — a
critical breakthrough in understanding and
evaluating how hospitals operate. With outcome indicators and benchmark data growing abundant, analysts are integrating quality
measurements into rating activities and ensuring a culture of quality and safety.
Before too long, all health care organizations will be submitting quality measures to
rating agencies, just as we submit financials.
Favorable clinical outcomes and low complication rates as well as zero events of avoidable patient harm and 100 percent performance on critical quality policies will be carefully studied by rating agencies and payors.
What actions can employers take to ensure
their work force receives quality care?
Query local physicians and hospitals about
their quality initiatives. Do they have teams
that design and implement best practice
tools, offer education and monitor outcomes
and opportunities for improvement? Are clinical outcomes documented and easily accessible? Are they implementing EMRs? How
focused are they on supporting a strong culture of patient safety? Do they document
their goals to significantly improve quality?
What procedures have they implemented to
reduce infections and the risk of complications? And what type of awards have they
received from external organizations for performance in quality and safety?
BARRY ARBUCKLE, Ph.D., is president and CEO of MemorialCare Medical Centers (www.memorialcare.org) and chair of the California
Hospital Association. Reach him at [email protected] or (562) 933-9708. MemorialCare Medical Centers include Saddleback
Memorial Medical Center in Laguna Hills and San Clemente, Orange Coast Memorial Medical Center in Fountain Valley, Anaheim
Memorial Medical Center, Long Beach Memorial Medical Center and Miller Children’s Hospital in Long Beach.