A blind spot in healthcare quality work

With quality and safety underpinning nearly every aspect of healthcare work, one might assume hospitals and health systems have well-established ways of finding out what their total investments in quality and safety look like. Not so, leaders told Becker's

"There's not a single place on a book, in the ledger, [where that investment] is easily seen," Stephanie Mercado, CEO and executive director at the National Association for Healthcare Quality, told Becker's in a July interview. 

That is until the quality organization launched a resource in 2022 that gives organizations a firm sense of their total spend on quality and safety, as well as how they compare to other organizations — an idea sparked by Tony Warmuth, Cleveland Clinic's executive director of clinical transformation and a member of NAHQ's board. 

"We use data to drive improvements around clinical, operational and experience-related measures, but we really didn't have good data to benchmark our own operations within safety and quality," said Mr. Warmuth, who worked alongside other quality leaders to help NAHQ develop the tool, which at least 39 systems and 150 hospitals had submitted data to as of May. 

The resource involves a survey with questions to determine an organization's relative investment in quality and safety, and allows hospitals to see what their quality and safety spend is per adjusted discharge and per employee, among other denominators. 

Historically, it's been difficult to benchmark quality and safety investments because there are variations in how programs are structured across hospitals, health systems and integrated delivery networks. With that in mind, the benchmarking resource was designed to give hospitals an "apples to apples comparison," regardless of how their quality and safety program is organized. For example, if an organization incorporates patient experience into their quality and safety program, they can benchmark patient experience. If it isn't incorporated, "it didn't muddy the waters," because the component doesn't have to be benchmarked, Mr. Warmuth explained. 

"It [allows] hospitals to sort of a la cart select the components of their safety and quality programs and benchmark those directly, and that really never existed before this program," he said. 

Ahead of the budget process for 2024, Mr. Warmuth said Cleveland Clinic gave both its quality and finance teams access to the tool to help guide planning for individual quality and safety programs. 

While each hospital or system may use the tool differently, Ms. Mercado said most organizations are using it primarily to get their arms around their quality and safety investments, with peer-to-peer comparisons being secondary. 

"Putting that all together and knowing how it's working for your whole system is something that has been elusive until now," she said. 

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