Uncovering The Pathway To Clinical Quality Improvement

by William C. Mohlenbrock, M.D. and Thomas M. Kish

The economic challenges of the past decade have placed hospitals under unrelenting pressures to reduce costs while maintaining quality.  With most of the stray dollars already found, any further cost cutting initiatives will likely bring with them the danger of compromised quality of care.

What healthcare organizations need to successfully respond to these challenges are new tools and new thinking with which they can maintain or increase their clinical quality and efficiencies.  And more than ever before, physicians are the key.  The next stage of improvement must be a collaborative effort among physicians, clinical staff members and executives, working together to develop innovative ways to improve patient care.

This imperative for physician and hospital collaboration is felt most acutely in those hospitals whose medical staff members are coming to the administration and requesting to become hospital employees.  The burden of office overhead, personnel management and loss of ancillary services is driving physicians to the role of becoming employees. But herein lies an opportunity for innovative hospitals.

To take full advantage of physicians’ integration within the hospital, the enterprise must become as data-driven in its clinical arenas as it is in its financial endeavors.  Timely, accurate and accessible data brings with it an immense power for clinical process improvements and enhanced efficiencies.  By allowing physicians to direct process improvements, the hospital can reduce the misuse and/or overuse of hospital resources, obviate costly errors and control variations in care delivery that compromise medical outcomes.

On the organizational side, aggregated information can be analyzed and compared to industry norms.  Using comparative data, clinicians can facilitate incremental, continual and ultimately transformative reforms in resource utilization and clinical outcomes.  What’s more, measurements exist that can quantify the financial benefits of clinical improvements, creating a system that actually pays for itself.

In the clinical environment, comprehensive information gathering begins with the physician.  In order for a new era of quality improvement to be successful, new solutions must be implemented that are faster, easier for clinicians to use, and more easily integrated than paper charts.  Thankfully technology is proving to be a terrific partner in this regard.  New and increasingly affordable electronic charting alternatives exist that can not only be implemented in hours or days instead of weeks or months, but also interface with enterprise-class data systems for analysis.

Such clinical systems have been shown to lower costs and raise quality of care through bi-directional information sharing.  Knowing what tests have been ordered by colleagues and having access to the results give physicians the ability to avoid duplicate lab charges and make diagnoses more rapid and reliable.  The reduction in redundancies conserves the hospital’s resources, saves purchasers’ money and ultimately lowers premiums.

But more needs to be done.  Perhaps the most exciting new frontier for data-driven improvement comes at the organizational level, where the Index for Clinical Excellence (ICE) is an emerging standard for quality improvement.  Developed in 2008 to support value-based clinical decision-making, ICE is a compilation of hospitals’ and medical staffs’ services and quality outcomes, trended over a three-year period.  ICE examines clinically and financially reliable indicators and provides powerful insights into the performance of an individual hospital and its medical staff.  By comparing internal data to ICE’s industry-standard statistics, hospitals and MDs can identify specific areas for quality and cost efficiency improvements.

Five industry standard metrics comprise the ICE standard: Resource Consumption; Risk-Adjusted Morbidity Rates; Risk-Adjusted Mortality Rates; Reductions in Variation; and the NHQM (National Hospital Quality Measures).  ICE uncovers statistically significant clinical variations and provides insights as to initiatives for clinical and financial improvements.

Collaborative, physician-directed, best practice improvements are the healthcare industry’s best insurance against the externally mandated cost containment alternatives that are the hallmark of third-party payers and proposed government-based reforms.  As history has proven, advancements in the healthcare field rarely come from outside the profession.  It’s up to providers to be proactive in addressing their well publicized quality and cost problems.

ICE, electronic charting and other data-driven initiatives can facilitate clinically reliable analysis of hospital medical records information.  These tools, which allow results to be reviewed in consumer- and purchaser-friendly formats, will make collaborative partnerships between stakeholders, clinical quality improvement and medical cost containment a reality.

William C. Mohlenbrock, M.D. is Chief Medical Officer and Thomas M. Kish is President of Verras, LTD., a firm focused on delivering to healthcare organizations proven, quality-of-care technology that easily identifies and employs best practices for improving clinical excellence through physician directed process improvement.  They can be reached at bmohlenbrock@verras.com and tkish@verras.com.