The value of a quality department is reflected by its impact on quality and safety outcomes to stop harm upstream and prevent it from reoccurring. In times of budget and workforce reductions, sometimes the quality department’s effectiveness is not readily seen for what it is: a monitoring and performance improvement arm of the health system for cost avoidance and achieving top decile performance in healthcare.
Irving, Texas-based CHRISTUS Health, one of the largest health systems in the country, took on the challenge of producing a robust quality management function. This initiative sparked a need to align with a validated professional organization to demonstrate how quality management can be strengthened to help the leaders in each hospital support evidence-based care for excellence in quality and safety outcomes.
CHRISTUS Health is a Catholic nonprofit health system with more than 60 hospitals in the U.S. — across Texas, Louisiana and New Mexico — as well as in Mexico, Chile and Colombia. The CHRISTUS health system is comprised of 260 clinics and outpatient centers with eight ambulatory surgery centers.
Over the past fi ve years, the health system has embarked on a journey to improve performance and quality, including upskilling and elevating the roles within the quality management department. This journey has included engaging with the National Association for Healthcare Quality (NAHQ). Through this partnership, CHRISTUS Health has adopted NAHQ’s industry standards for quality professionals; increased competencies of members of the quality team; and improved performance on multiple metrics.
To better understand CHRISTUS Health’s quality and safety journey and the critical role that quality professionals play, Becker’s Hospital Review spoke with Claire Lauzon-Vallone, RN, vice president of quality and safety at CHRISTUS Health. Ms. Lauzon-Vallone shared insights based on her organization’s experience working with NAHQ to transform, upskill and elevate the quality management role in patient care excellence.
A need for consistent, organizational quality management standards
The quality organization at CHRISTUS Health has been on a “zeroharm” journey using High Reliability Organization Principles for the last five years. At the outset of this journey, standardized system dashboards were built to help quality professionals spend more time influencing and improving quality of care versus building their own graphs and tables. These dashboards reflected performance to national benchmarks. As CHRISTUS’ national footprint grew, directors of quality for each hospital asked the system office to establish a standardized job description library, orientation onboarding outlines, recommended department structures with ratios, job-specific competencies and professional career ladders in quality that reflected the multi-factorial role of a quality professional.
Engaging with NAHQ
Previously, the value of quality professionals at CHRISTUS Health was, in some ways, misunderstood — particularly in how a quality professional brings forth a specific skillset that supports leadership in monitoring for variances and providing performance improvement methods to promote quality patient outcomes. This subject matter expertise can assess the organization for quality variances, identify contributing factors and barriers, put an action plan into place and evaluate the effectiveness of the solutions. In the past, this advanced level of quality management expertise was gained through informal methods of “train-the-trainer” or long-term studies in quality management. As CHRISTUS sought to achieve patient care excellence in all publicly reported scorecards, it began a long search for a validated method of assessing and training quality professionals across the enterprise.
As part of this initiative, CHRISTUS Health decided to work with NAHQ, as NAHQ delivers the Certified Professional in Healthcare Quality® (CPHQ) credential and represents quality leaders across the U.S. Ms. Lauzon-Vallone noticed NAHQ’s website had published a validated program: Workforce Accelerator®. It provided a comprehensive assessment of skills, eight domains of quality competency standards and a workforce assessment tool to help CHRISTUS better understand the level and type of work their staff were performing.
“With NAHQ’s Workforce Accelerator, I was able to defi ne the roles better for quality management professionals, standardize these roles and educate senior leaders on the eight competency domains that drive a strong quality management department,” Ms. Lauzon-Vallone said. “They liked the fact that I was using a nationally recognized organization in quality management with validated tools.”
Using the standards established within NAHQ’s Workforce Accelerator , CHRISTUS Health standardized all quality professional job descriptions throughout the organization, using the industry standard, twice-validated NAHQ Healthcare Competency Framework™. In addition, the framework was woven into each job description and all job-specific competency forms. The new competency forms supported onboarding and continual educational growth of each quality professional to maximize their skillset over time.
Getting leadership buy-in
Leaders at CHRISTUS understood the idea that achieving quality outcomes requires strong quality professionals. However, in the absence of clear and consistent standards, it hadn’t been easy to defi ne what this meant. With NAHQ and the eight domains of the Healthcare Quality Competency Framework, it became possible to define the desired competencies of a quality management professional; assess the organization’s team members; identify gaps; determine plans to close these gaps; and identify when credentialling via the CPHQ is required. “With the eight domains, I was able to say, ‘This is where the enterprise is now and this is where we need to be for achieving a successfully integrated quality management program in each hospital,’” Ms. Lauzon-Vallone said.
Leadership got on board because they saw the value of having consistent standards for quality professionals. They also saw promise in the idea that strong quality management professionals could help the entire organization achieve its quality goals. Quality as a discipline and quality professionals that lead the work are the connective tissue between setting goals and achieving them.
The value of quality management professionals is constantly reiterated when leaders across the enterprise regularly see scorecards reflecting quality metrics that trend toward goals and exceed goals to reach excellent performance. Quality professionals with strong competencies that use the NAHQ tools tend to help their organizations achieve quality goals, while those whose skills are not as refi ned often fall short in achieving desired metrics. “That’s how we continue to show them the value of working with NAHQ,” Ms. Lauzon-Vallone said.
Implementing NAHQ tools in phases
NAHQ tools, specifically Workforce Accelerator and Organizational Membership Subscriptions™, can be implemented in phases. CHRISTUS Health had some flexibility in its phased execution. The first phase was focused on director-level staff members, with some risk managers included. Phase two addressed the next level of managers. Each phase included a professional assessment that evaluated the level and type of work that was being executed at CHRISTUS based on the Healthcare Quality Competency Framework, as well as custom upskilling opportunities established relative to organizational goals and implementation of training and upskilling activities.
Results — including changes in metrics and culture
By adopting and using NAHQ’s Workforce Accelerator throughout quality management at CHRISTUS Health, the organization’s hospitals are exceeding the goals set for each fiscal year, Ms. Lauzon- Vallone said. But the successes realized go beyond improvements in metrics; the results include a change in the organization’s culture, the establishment of an enterprise quality management standard, and an elevation and upskilling of CHRISTUS Health’s quality management system. As more quality professionals have earned their CPHQ certifications, they are feeling more confident; finding that they have an important voice; speaking up; leaning in; and supporting leaders to facilitate and drive change for optimal patient quality of care.
Part of the cultural change is that the focus of the quality professional isn’t merely to look at metrics and report results but to translate the metrics into actions that improve care. Their role is “weaving quality management into the fabric of the organization,” as taught by Workforce Accelerator. “We’re looking at quality management through this new framework from NAHQ, to look at the problem and solve it better with sustained improvement,” Ms. Lauzon-Vallone said.
What’s next for CHRISTUS Health
Ms. Lauzon-Vallone said by using Workforce Accelerator, the next phase of CHRISTUS’ journey will be supporting its quality professionals to achieve their certifications. NAHQ showed that certified quality management professionals are more prepared in each framework domain to help leadership attain high levels of quality of care and patient safety. Certifications also help quality professionals maintain the Professional Engagement domain of the framework by remaining engaged in their professional growth and evidence-based practices. Additionally, NAHQ’s program has helped with quality professional recruitment because candidates can clearly see themselves in the articulated framework of the role and place it in their future career path.