Quality Improvement in Healthcare

With patients’ lives at stake, you would think that the healthcare industry would be in the forefront of using business efficiency principles to improve the quality of products and services. Unfortunately, this logical thought is wrong. There is more to quality improvement in healthcare than just telling everyone to be better.

For about 75 years, numerous industries have applied the principles of business effectiveness devised by W. Edwards Deming, who is best known for helping Japan's industries rebuild after World War II. His principles spurred industries to devise systems that focused more on improving the productivity of teams of workers than individuals, measured performance, and got the right data in the right format at the right time in the right hands. 

Deming believed that systems designed by management were responsible for 85 percent of an organization’s mistakes, while only 15 percent of mistakes were attributable to mistakes by employees. Applying Deming’s principles helped innumerable companies improve the quality of their products and services. The quality improvement concepts have been used to transform almost every major industry with significant results, the last industry with large amounts of data being in the healthcare realm.  

The healthcare industry has been so far behind other industries in adopting new technologies that research indicates it to be one of the final frontiers in shifting from a paper-based system to a digital communication system. It is well known that digital or electronic communication is more efficient, less costly, and more effectual in allowing doctors and patients to connect up and manage all types of care. However, many health professionals weren't able to move over to a digital system because the patient information wasn't readily accessible.

Fortunately, the healthcare industry has made more of a commitment to improve the quality of its services in recent years by adopting more business efficiency principles, including those advocated by Deming. An article found in TechTarget, explains how mobile technology such as e-mail, text messages, and other kinds of messages are used to inform doctors and other medical professionals as soon as possible that there are problems in treating patients. This means that corrective action to improve the outcomes of patients can also be implemented as soon as possible. Specifically, modern quality improvement in healthcare requires accurate, timely and readily available information through almost every phase of a quality and performance improvement initiative. 

One of Deming’s beliefs is that a company can’t improve its performance if it can’t measure it. Thus, he advocated a quality improvement system that included performance measurements. This belief can be applied to the healthcare industry, especially when focusing on the betterment of outcomes for patients.  In 2002, several organizations hired experts who produced the first “nationally standardized quality measures” for hospitals so they could quantify how successfully hospitals treated patients with acute myocardial infarction, heart failure, pneumonia, and pregnancy. By 2004, all of the USA’s accredited hospitals had to publicly report how successfully they treated at least two of these four groups of patients.

Hospitals that did not report the required information were penalized financially by the Center for Medicare and Medicaid Services. The new performance measurement and public reporting requirements dramatically improved medical care because hospitals increasingly directed resources to improve the quality of care received in their respective hospitals.

Initially, back in the 90's, it wasn't uncommon for hospitals to have performance rates that measured between 40 to 60 percent, with substantial variations throughout other hospitals. However, by 2009, hospitals had achieved very high levels of performance on many of specified measures and changed the wide variations when comparing hospitals.  Part of the substantial changes came due to mandatory reporting by all hospitals.

While performance has increased, so, too have costs. In fact, cost containment and risk of loss of reimbursements, are primary factor driving much of the effort to institute quality improvement systems.

Quality improvement in healthcare is a major issue, but many people in the industry have made the mistake of hiring medical professionals to devise quality improvement systems. Dr. Joseph Fortuna of the American Society for Quality explains that hospitals are beginning to hire chief quality officers, which shouldn't be doctors or nurses with minimal little training. It’s no longer about the old quality assurance state of mind, but a need to understand that real quality improvement starts much farther upstream. It’s the Deming approach of doing it right the first time, and that will make the meaningful changes.