Which of the following improvement efforts is the best example of increasing the efficiency of care?

To thrive in an increasingly challenging healthcare environment, undertaking quality improvement projects is more important than ever for healthcare systems to stay competitive and survive. To do that health systems need to be able to identify initiatives that will deliver the maximum impact for their organization.

Quality improvement initiatives can focus on clinical, financial, and operational and can have a significant impact on total costs of care, clinical outcomes, care variation, decision support, length of stay, and more.

Hospital systems across the country face many pressing problems: clinical variation, preventable medical errors, hospital acquired infections, delays in patient discharge, and dwindling cash flow.

Ensuring Quality Improvement Projects Deliver Return on Investment

Quality improvement is defined by the Centers for Medicare and Medicaid Services as “the framework used to systematically improve care.” Health systems that have access to data and analytics across their organization can quickly identify and prioritize quality improvement projects that will not only deliver a strong return on investment but also quantifiably improve care. Here are some excellent examples of effective, high-value quality improvement efforts.

Pharmacist-led Medication Therapy Management Reduces Total Cost of Care

Allina Health hypothesized that expanding the involvement of pharmacist-led medication therapy management (MTM) to a group of Medicaid patients covered by a shared-risk contract had the potential to improve patient outcomes and reduce costs. The organization leveraged its analytics system to demonstrate the impact of this initiative.

The analysis showed the following results:

• $2,085 mean total cost of care reduction per patient in the six months after the first pharmacist MTM encounter; over $590,000 extrapolated out over 283 MTM patients.
• 12 percent reduction in hospital admissions per 1,000 members and a 10 percent reduction in emergency department visits per 1,000 members.
• Statistically significant decreases in average medication count.

The analysis demonstrated the unique, positive impact of the pharmacist medication therapy management program on patient outcomes in a six-month period following the pharmacist MTM. This program is effectively reducing the total cost of care.

Optimizing Sepsis Care Improves Early Recognition and Outcomes

Sepsis is a major driver of mortality in the U.S.–it’s estimated that up to half of all hospital deaths are linked to the infection. Identifying sepsis early can be challenging, as the patient’s physical response presents a syndrome of non-specific symptoms which delay recognition, diagnosis, and treatment, resulting in increased mortality rates.

To combat this problem, Mission Health, North Carolina’s sixth-largest health system, implemented a comprehensive data-driven approach to facilitate early sepsis identification and standardize the treatment of sepsis. With that approach combined with evidence-based alerts, Mission Health gained insights into sepsis performance to drive improvements, including:

• 1 percent relative reduction in mortality for patients with severe sepsis and septic shock.
• 9 percent relative difference in mortality for patients who received the evidence-based protocols compared to those who did not.
• 4 percent relative reduction in emergency department (ED) length of stay (LOS) for patients with severe sepsis and septic shock.

This proven plan to improve sepsis outcomes and enhance care for patients with sepsis has laid the groundwork to move the early identification screening tools to the outpatient setting, including urgent care centers and physician offices.

Boosting Readiness and Change Competencies Key to Successfully Reducing Clinical Variation 

UnityPoint Health, a healthcare system serving Iowa, western Illinois, and southern Wisconsin, recognized the importance of reducing clinical variation and the need for strong physician champions and robust analytics to support improvement efforts effectively.

By consistently integrating information from a readiness assessment, an opportunity analysis, and expert resources, the health system was able to establish a prioritization and implementation approach to outcomes improvement that produced the following results:

• Variable costs were reduced by more than $1.75 million based on the deployment of interventions in sepsis alerts, order sets, and other clinical decision support tools.
• Reductions in LOS have allowed patients to return home earlier and spend more than 1,000 additional nights in their homes.
• 36 percent increase in sepsis screenings completed in the emergency department (ED).
• Sepsis order set utilization in the ED has increased by more than 185 percent.

The health system plans to continue identifying significant improvement opportunities aligned with its strategic planning cycle and the priorities identified by clinical and operational leadership.

Systematic, Data-Driven Approach Lowers Length of Stay and Improves Care Coordination

At Memorial Hospital at Gulfport, the hospital was faced with declining revenue due to changes in Medicare and Medicaid reimbursements. By reducing LOS, hospital leaders knew they could also improve financial, operational, and clinical outcomes by decreasing the costs of care for a patient, while also minimizing the risk of hospital-acquired conditions.

By adopting a systematic, data-driven, and multi-pronged approach, Memorial has achieved significant results in one year, including:

• $2 million in cost savings, the result of decreased LOS and decreased utilization of supplies and medications.
• Three percent increase in the number of discharges occurring on the weekend.

The Quality Improvement Journey

Healthcare systems working to improve care, reduce expenses, and improve the patient experience face many challenges, including the need to align changes across many levels of an organization. But the process of identifying, prioritizing, and implementing these changes can be improved with the right tools, process, and people. Once these things are in alignment, health systems can tackle clinical, financial, and operational quality improvement projects and make incredible strides in the clinical, financial, and operational health of the organization.

Health systems can deliver better outcomes, improve patient experience, and save lives through quality improvement projects that reduce clinical variation, preventable medical errors, hospital acquired infections, delays in patient discharge, and improve the bottom line.

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Additional Reading

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The QI process is grounded in the following basic concepts:

• Establish a culture of quality in your practice. Your practice’s organization, processes, and procedures should support and be integrated with your QI efforts. The culture of a practice—attitudes, behaviors, and actions—reflect how passionately the practice team embraces quality. The QI culture looks different for every practice, but may include establishing dedicated QI teams, holding regular QI meetings, or creating policies around your QI goals.

• Determine and prioritize potential areas for improvement. You will need to identify and understand the ways in which your practice could improve. Examine your patient population (e.g., to identify barriers to care, frequently diagnosed chronic conditions, or groups of high-risk patients) and your practice operations (e.g., to identify management issues such as low morale, long patient wait times, or poor communication). Use established quality measures, such as those from the National Quality Forum, Agency for Healthcare Research and Quality, and the Quality Payment Program to guide your efforts.
• Collect and analyze data. Data collection and analysis lie at the heart of quality improvement. Your data will help you understand how well your systems work, identify potential areas for improvement, set measurable goals, and monitor the effectiveness of change. It’s important to collect baseline data before you begin a QI project, commit to regular data collection, carefully analyze your results throughout the project, and make decisions based on your analysis.
  
• Communicate your results. Quality improvement efforts should be transparent to your staff, physicians, and patients. Include the entire practice team and patients when planning and implementating QI projects, and communicate your project needs, priorities, actions, and results to everyone (patients included). When a project is successful, celebrate and acknowledge that success.
  
• Commit to ongoing evaluation. Quality improvement is an ongoing process. A high-functioning practice will strive to continually improve performance, revisit the effectiveness of interventions, and regularly solicit patient and staff feedback.
  
• Spread your successes. Share lessons learned with others to support wide-scale, rapid  improvement that benefits all patients and the health care industry as a whole.
   

Quality improvement models present a systematic, formal framework for establishing QI processes in your practice. Examples of common QI models include the following:

• Model for Improvement (Plan-Do-Study-Act [PDSA] cycles): The Institute for Healthcare Improvement’s Model for Improvement combines two popular QI models: Total Quality Management (TQM) and Rapid-Cycle Improvement (RCI). The result is a framework that uses PDSA cycles to test interventions on a small scale.
  
• Six Sigma: Six Sigma is a method of improvement that strives to decrease variation and defects.
  
• Lean is an approach that drives out waste and improves efficiency in work processes so that all work adds value.

Quality improvement tools are standalone strategies or processes that can help you better understand, analyze, or communicate your QI efforts. Examples of QI tools include run charts, process maps, and fishbone diagrams (ihi.org).

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