Healthcare Quality: Who is in charge and why?

Every healthcare organization has a quality department. It is usually focused on Quality Assurance and its purpose is ensuring compliance with the regulations as outlined by the various regulatory certifying bodies that oversee your organization. It is often staffed by people not actively engaged in clinical workflows or who are not clinically trained at all. But is obedience to all regulatory mandates your organization’s definition of “quality”?

Think about it this way. Regulatory and billing agencies can easily become your default strategists for what is important to your organization and how it defines quality performance if that is your only approach. Smooth, effective workflows and maximizing clinical interaction face time with minimal distraction for charting are what is important to your clinical workforce and healthcare customers. It is not to regulatory agencies. Does maximizing obedience to charting regulatory process steps as mandated for quality or billing mandates make your organization high quality? Or is the price for that “burn-out”. Or as I refer to it, organizationally imposed workforce injury.

Another way to approach this is taking a broader look at information management strategies.

There are 4 broad categories of data.

1. Regulatory (Joint Commission, NCQA, HRSA, CMS)
2. Grant or Contractual (payer contracts or grant deliverables)
3. Organizational Oversight (board scorecards or revenue/ margin/overhead)
4. Operational performance (visit volumes, screening rates, visit access, records completion)

Some data types fit all 4 categories. An example would be vaccination rates. JC,NCQA and HRSA will all want them. It can be applied to payer contract performance or a board scorecard. It could be segmented down to individual clinics or provider work teams as a clinical/operational metric.

Every single data category has common features.

1. It can be segmented down to divisions, programs, clinics or individual staff members. Or rolled up to whole organization aggregate summaries.
2. It can be applied to individual customers as performed or the above-mentioned work units who performed them. 

3. They can be pulled into a central data storage with other elements and made available via your organization’s website.
4. They can be displayed with or without attached PHI (personal health identification)

Maximizing the use and reuse of measures across multiple categories allows them to be reapplied for the purpose of regulatory compliance, grant or contractual performance, program or departmental operational monitoring, or individual staff member scorecards. Using the exact same data from the 4 major categories with a different segmentation strategy or PHI viewing permissions makes it possible for the same measure to be used as a clinical work list, a grant measure, regulatory compliance and a corporate scorecard all from one web-based source.

Once those measures are available for the entire organization to view and/or potentially interact with, another new opportunity for quality becomes available. If what is important to your organization is getting these things done and it is easy to see what has been done and what needs to be done, the new opportunity is that you can redistribute work by shifting scorecard displays, and attention to and responsibility for any measure. How often have you told your workforce that you can take work from them to reduce their burden?

The most important thing we need to do as healthcare organizations is to do healthcare, and do it superbly. What has happened in todays “quality” world is we do regulatory process superbly and the healthcare is mediocre and expensive. The healthcare is less important than the charting of the healthcare. Right now, billing and regulation is in charge and the reason why is because we made it about the money, not the caring. The price of this is burn out of our workforce and a massive price escalation in the cost of care. What we did is allow healthcare “quality” to become subverted and redirected at making compliance more important that compassionate high value health.

Recovering, redistributing, making information more accessible and repurposing measurement allows a more even equitable distribution of workload and a clearer picture of global quality (not just regulatory). Performance monitoring and resource redistribution is an easy way to begin taking back control and more rationally realign work and resources.

Most healthcare “quality” departments are run by legal or compliance staff who bear no burden for the extra work they often redundantly create. The measures they use to access quality are often difficult for the entire workforce to access, much less verify or see segmented down to the events they describe. But if the data underneath each measure is collected and stored on the front end, it can be reviewed or be acted upon on the back.

Simple realignment, redisplay and distribution of your information platform can make these gaps clearer and easier to identify and let your workforce spend more time on caring and less on complying. That is what needs to be in control and why it is important.

STEVE TIERNEY, MD, Senior Director of Quality Improvement

Steve Tierney is Senior Director of Quality Improvement for South central Foundation’s Malcolm Baldrige Award-winning Nuka System of Care. Steve joined SCF in 1995 as a primary care physician. He became one of the key physicians who helped lead the transformation to a relationship-based customer-owned health care system. He also played a key role in developing the robust data mart that helps SCF’s integrated care teams interpret complex data for internal comparisons and external comparisons against HEDIS benchmarks, where the organization scored in the 90th percentile for many of its services. Steve is trained as a family physician and an acupuncturist. He received his medical degree from the Uniformed Services University in Bethesda, Maryland. He still maintains an active family medicine practice in SCF’s Anchorage Native Primary Care Center. Steve presents nationally and internationally on transforming primary care, data integration, clinical quality program design, and complementary medicine integration efforts.