Added March 29, 2019

The Shifting Dynamics in Healthcare. Part 2

From a healthcare administration perspective, how do we define what ‘quality’ represents, is it solely business based?

Is quality exclusively about the patient?

What about surgical outcomes, patient access, inpatient efficiency? Is quality something that can be measured?

How can taking steps to access internal quality, motivate an organization toward healthcare improvements leading to growth?

“If you cannot measure it, you cannot manage it.”

Paul Drucker

By acknowledging quality is the most important measure above speed, cost and every other item in between, we can begin to define how it fits within a value-based healthcare program. (VBH)

As we have discussed in part 1 of this series “Fee for Service or Value Based” the VBH model assesses the patient healthcare experience, the efficiency of the provider, the clinical processes and positive health outcomes. Implementing quality initiatives for higher reimbursement rates is a major point of focus but should not be the only factor when looking into ways that improve the delivery of healthcare; quality should encompass the whole sphere.

 

Setting the Stage with Quality Focused Initiatives

Getting buy-in across the organizational board regarding the meaning of “Quality” is the first step. Administrators need to be open-minded as there are differing opinions among staff and physicians based on knowledge and experience. In whatever way an organization chooses to define the meaning, aim for it to be measurable, and to not only revolve around patients but also consider the provider needs because they are the back and bones of healthcare.

While different measures can focus on certain aspects within health care delivery, together they provide a more comprehensive picture of the quality of healthcare within the organization, and the data gathered enables a way to be consistent and accountable. Some quality measures recommended from the Centres of Medicare and Medicaid include:

• Positive and Negative health outcomes
• The Clinical processes
• Patient safety
• Efficient use of available healthcare resources
• Proper and effective care coordination
• Patient engagements
• Population and public health
• Comprehension of adherence to clinical guidelines
• Physician assessments

As we step into the value-based world, VBH model is guided by the pursuit to improve patient health and wellness. Organizational quality aims should also mirror this ideal and consider implementing initiatives which also aid and support the specialists and primary care providers.

The Agency for Healthcare Research and Quality (AHRQ) recommends a base of three types of measures known as the Donabedian model. This model outlines three different quality measures.

• Structural measures: Identifies healthcare providers capacity, systems, and processes. It measures the proportion of certified physicians, data gathering technology, and physician-to-patient ratios.
• Process measures: These indicate what a provider has done to maintain or improve patient health outcomes, an example of this is the percentage of people who received preventive services and the length of time a patient waited to be seen.
• Outcome measures: The impact of healthcare services and intervention, such as results of care, surgical complications resulting in infection or death, etc. Risk adjustments are typically included to account for factors out of the hospital’s control.

Practice Makes Perfect

The sharing of ideas and high-level strategy discussions are good to get things laid on the table but does not provide enough evidence alone to bolster quality improvement within healthcare. Actual hands-on care while working together as a team puts into motion the quality aims and supplies real-time evidence of the direct impact of the strategies, measures, and protocols being put into practice. Hands-on care also encourages feedback from the team of physicians and employees to the administration, which encourages the open channel of communication.

Understanding the Worth of Physicians and Practitioners

At the very heart of the healthcare system are the physicians, and as we talk about the quality of care in the industry physicians are crucial. “They also continue to drive healthcare economics, directing 87% of personal spending on healthcare, nationwide.” Physician Relations gives precedence to their value and the impact they have within the success of an organization and upon the healthcare system.

As administrators seriously consider a physician’s insights on quality it is critical to remember leaders and physicians face each other from different perspectives, values, and experience.

Some of the differences in perspective stem from the administration and management viewing the scene from top-down structures and physicians are naturally free individualists, resisting reigning in from management. Administration tends to focus on budgets and community while physicians promote care over cost and the patient, over the community.

As an open-ended question, how can we harmonize the two perspectives together?

 

Physician Relations

• What support does the provider need to enable them to work at peak performance and not succumb to physician-burnout?
• What are the needs of sub-specialty providers?
• How can we avoid addressing the providers with too much “volume”?
• What can be done to improve access for providers?

Without considering these pertinent questions and working through the solutions, administrators will find it harder to recruit physicians especially in the next 5 years with the alarming shortage of primary care providers; Health organizations will be unable to adequately take care of patients and will experience a lack of growth.

Understanding the physician’s perspective is the first step to achieving internal quality goals.

 

Standing Out Through Technology Advances Enabling Quality and Connectivity

Connectivity through technology is a crucial tactic when implementing initiatives for healthcare quality, positive patient-care outcomes, and business growth. New applications for smartphones, connecting to remote care management programs for chronic patients, Mako Robotics, the da Vinci Surgical System, all these technologies begin internally and are designed to improve physician/patient relations and health.

In the case of remote care management programs, the technology not only addresses the patient but accommodates the primary care provider’s needs, which in turn benefits the organization.

• Multiple dynamic care plans
• Real-time patient feedback
• Care team coordination
• Measures patient engagement and outcomes

Ultimately, Healthcare systems are becoming smart, so looking for ways to partner with companies who offer high-tech programs will equip organizations with the best tools as healthcare transitions not only to value-based but technology-driven too.

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/What-is-a-Quality-Measure-SubPage.html

https://www.ahrq.gov/talkingquality/measures/types.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911723/

https://www.staffcare.com/11-methods-to-maximize-physician-alignment-improve-hospital-physician-relations/