Focusing on quality and safety to accelerate healthcare transformation

Achieving positive transformation in health care seems, now more than ever, extremely complicated. Barbara Davis, Senior VP of Client Success at CipherHealth, provides her perspective on the quality and safety agenda of hospitals and health systems in the US.

Davis has 30+ years of experience in Healthcare Quality and Lean improvement. Co-chair of the Patient and Family Advisory Council at SCL-Saint Joseph Hospital in Denver, Davis also serves as an affiliate faculty member of Regis University, Denver, CO.

Barbara Davis

What is the state of CMS’ quality and safety initiatives across the country?

It's interesting that the quality and safety initiatives began under the Bush II Administration. There was a realization that the federal government was paying a lot of money to providers for delivering poor quality care--that is, the overuse, underuse and misuse of healthcare services.

  • One of the areas of overuse was the rate of re-hospitalization in three diagnoses that are common in the Medicare population. To help reduce costly and unnecessary readmissions, providers were incentivized to work together to reduce readmissions and to improve the quality of care provided to Medicare patients.
  • Another long-standing topic of concern was the federal government's inability to use consumer assessments of healthcare, so the CAHPS program was created to measure the patient's experience in a variety of healthcare settings.
  • Additionally, safety problems that were both common and costly was the incidence of infections and pressure ulcers.

Along with others, these topics are foundational in the Medicare quality and safety agenda, and healthcare organizations are incentivized to participate-either through value based bonuses or withholds. They aren't going away.

The same concerns about cost, quality and safety during the Bush Administration exist today, except they are now "on steroids" as the baby-boomers become Medicare members. Medicare costs will continue to increase because 10,000 people per day turn 65 for the next 19 years. Another issue is the number of people in the U.S. who are "dual-eligible". About one-third of all Medicaid spending is for people covered by Medicare, and 11 million low-income dual eligible people would be impacted. Primarily, these costs cover long-term care for low-income people or those who have had to "spend-down" their resources to qualify for Medicaid. It is unfortunate that roughly half of the baby boomers have saved only $100,000 for retirement, and so they will rely on Social Security and health programs, such as Medicare/Medicaid.

How will patients' and their families' perception of value evolve as providers continue to focus on patient satisfaction and retention?

One of the essential elements of patient and family centered care is patient/family engagement in the design of their care. Patients and families will need to be even more involved in their care, take more responsibility for providing it and find ways to receive care using technology. Providers will need to deliver care to more patients while spending less money.

Given this fundamental change in how patients and families are involved in their care, I would guess we might see an increase in healthcare consumerism, advocacy, and demand for superior services. Michael Porter PhD, defined health care value as needing to be defined around the customer; value depends on results and is measured by the outcomes achieved, not by the volume of services delivered. For me as a patient to receive value-based care, I have to define what I need, so I have to be asked and the information I give them regarding my preferences needs to be considered in the mutual design of my treatments.

CMS has developed its Person and Family Engagement strategy (PFE) that supports its quality strategy goals--make healthcare affordable, develop healthier people and communities and better care. Two of the five fundamental principles guiding CMS actions are: co-create goals and encourage engagement and self-management.

In its article called "Harnessing Evidence and Experience to Change Culture: A Guiding Framework for Patient and Family Engaged Care", the authors at The National Academy of Medicine have identified a key engagement outcome for Better Health is improved patient-defined outcomes. In order to define the outcomes, patients need to be informed of the options, share in the decision making and set achievable "value" goals, with realistic outcomes. As patients and family members, we will all need to become more active in our care.

How can technology help make quality improvements affordable?

Healthcare has consistently relied on technology to deliver better value and higher quality. Consider the industry's adaptation of the CT scan and the MRI machines. These provide better information for a doctor's treatment. Consider the use of "smart" IV infusion pumps that help calculate the correct doses for patients. Or robot surgical tools that facilitate complex surgery using a minimally invasive approach. These technology solutions are patient centered and improve quality and safety.

Although healthcare has been quick to adapt patient focused technologies for patient care in healthcare settings, it seems to me that healthcare providers will now need to adopt technologies that help manage the patient in their own homes, describe treatment plans that family members can successfully execute at home, or provide care at long-distances. For example, as a member of a health plan, I can now ask for video visits instead of going into the physician's office. Healthcare providers will adopt these technologies because they work for them and their patients. Technology also helps improve the quality of the care provided while enhancing its affordability.

As a former Quality and Safety leader, what would be your top pieces of advice for other hospital leaders?

Be prepared. As a former VP of Performance Excellence, I would try to ensure my clinical and administrative leaders were informed of the changes and then we would develop a plan to meet the challenges of new regulations, laws, judicial findings, research, or technologies. We would conduct a SWOT analysis or build out scenarios with risks and benefits associated with them. We would find ways to anticipate and solve the problems. We also developed a communication plan so the front line associates would be informed and would be able to address any patient or family concerns about the topic. This was helpful to ensure alignment and helped empower the staff with relevant and timely information.

Review your data. I recommend using data to understand the clinical needs of your patients so segment the data in ways that help inform problem solving. The clinicians will be able to say what makes sense and what needs further review. Using data could help identify new tools or solutions.

Involve patients and family members. With all the news, the public may be panicking about how this will affect them. Find patients and family members who are interested in patient and family centered care principles and who are able to provide their input on key decisions about care design and their preferences.

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