Authors

Stephanie Mercado, CAE, CPHQ

Executive Director and CEO
NAHQ

Anna Flattau, MD, MSc, MS

Enterprise Vice President
Jefferson Primary Care at Jefferson Health
Alumni Professor and Chair of Family and Community Medicine at Sidney Kimmel College of Medicine, Thomas Jefferson University

 

How does your health system define “success?” Does your quality programming reflect that definition? If not, it is time to recapture the vision of quality and inspire your teams in its pursuit.

Healthcare’s current environment of reevaluation, transition, and integration allows a fresh opportunity to move beyond conceptualizing quality initiatives as a matter of “compliance.” Now is the time to examine if our work truly measures and improves what matters in furthering human health and wellbeing within the communities we serve.

Shifting perspectives to address more meaningful metrics

Tactical, national, and mandated measures for quality often consume the allocation of resources for quality programs in healthcare systems. Narrowly defined quality metrics that are disseminated to clinical teams through a framework of compliance can discourage the passion and commitment of stakeholders and leave little resources available to reflect the true values and perspectives of clinicians, consumers, and communities on their most important needs for healthcare services.

Today’s transitioning environments provide an opportunity to move from a mindset of quality as compliance, to quality as the pursuit of excellence in care delivery. Strategic selection of the focus for quality must begin to address “measuring what matters” in a way that reflects the broader purpose of healthcare services in the hearts and minds of consumers and those delivering care.

Broader, human system perspectives are essential for this transitional time

Great, cross system, “macro metrics” feel to providers and consumers like a mirror that reflects what they value, need, and do. This includes analysis of delivery of care of a population across the boundaries of care delivery settings, care delivery teams, and time. A summative approach pushes us to see the big picture, redesign better and more effective care models, and deliver on a broader concept of quality. It also reflects the perspectives and expert insights of those on the ground level of understanding care and community needs. While metrics focused on specific encounters or episodes of care are still important as key management tools, this needs to be complemented with broader, comprehensive, or summative approaches to quality measurement. This “balanced scorecard” approach can better reflect the complex professional work of healthcare teams and create a focus on definitions of success that will shape how integrated clinical systems are designed and evaluated. Similarly, core considerations such as health equity can be centered in metrics design, thereby ensuring that ethical considerations are fully attended to by clinical and quality teams.

Getting from where we are to where we need to be with quality

Leadership and quality competencies must evolve to achieve a new and broader vision for quality performance. These competencies should include skills in facilitating large scale, cross system, summative initiatives that require the engagement and involvement of representative leaders from across the system and a strategic corralling of these efforts. Crucial insights for improvement are informed by the ground level and likely made at a system level, reflecting a broad scope of care through the experience of consumers and their care teams.

A balanced scorecard perspective for organizing systemwide quality programming incorporates patient-centered and system level metrics – reflecting your vision of healthcare effectiveness – as well as mandated and more narrowly defined metrics. This macro-focus as a major and visible component of quality efforts should be balanced with and complement micro level metrics. The realities of limited time and resources for performance improvement – or any other aspect of achieving excellence – require that the prioritization of quality efforts be strategic and make sense for the entire system.

It is important to assure that your quality team is inspired and ready to lead this exciting new approach to its work, which is rooted in the evolving competencies and skills such as those defined by the National Association for Healthcare Quality® (NAHQ)! Redefinition of “health system success” is the foundation of a re-energized quality strategy, and the changing landscape of healthcare compels that we move forward as a field.

 


Authors

Stephanie Mercado, CAE, CPHQ

Executive Director and CEO
NAHQ

Anna Flattau, MD, MSc, MS

Enterprise Vice President
Jefferson Primary Care at Jefferson Health
Alumni Professor and Chair of Family and Community Medicine at Sidney Kimmel College of Medicine, Thomas Jefferson University

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