The Importance of Sustaining Quality Initiatives in Times of Crisis

By Paula Brandon

The coronavirus public health emergency will have a long-lasting impact on the finances and care delivery processes of hospitals across the United States. The pandemic has also emphasized the significance of clinical quality, and patient and staff safety, as well as adherence to best practices.

On March 27, 2020, the Centers for Medicare and Medicaid Services (CMS) granted exceptions and extensions for certain deadlines to help healthcare providers care for and protect their patients and staff. This decision is important to hospitals because of the financial implications associated with the quality metrics that influence the CMS Value-Based Purchasing (VBP) program. Achieving or exceeding baseline benchmarks not only maximizes CMS reimbursements and incentive payments through the VBP program, but helps organizations manage overall costs by improving patient outcomes and reducing lengths of stay.

Some of the quality measures driving the VBP calculations and determining reimbursement payments are hospital-acquired infection rates, patient experience scores, readmissions, mortality and complication rates, and efficiency. Although CMS’ actions reduced the burden on hospitals by offering a suspension of reporting while lessening the impact of the VBP program, this did not lessen the expectation for hospitals to provide quality care. In fact, the pandemic has made focusing on quality measures even more important in an effort to determine the impact of COVID-19 on patient outcomes.

Every day, healthcare providers work toward the ultimate goal of saving lives and providing optimum patient care. Safe, effective, and high-quality care influences care outcomes, facilitates a safe hospital environment, promotes efficiency, and provides data to identify opportunities for improvement. All of this is achieved via a sustained focus on quality and quality measurement during times of crisis.

A new paradigm in healthcare delivery

Since COVID-19 arrived and created an unanticipated new paradigm in healthcare delivery, much effort has been spent on trying to reduce the spread of the virus. This has placed significant demands on hospitals and healthcare providers, who have had to fluidly reassess processes and outcomes of care delivery as the immediate situation continues to shift. As the pandemic continues to modify healthcare delivery, it is critical to determine what has been effective and what has not. Healthcare professionals must continue to measure existing quality indicators and determine other quality indicators that are important to evaluate.

Improving patient care quality during the COVID-19 crisis

Improving quality of care during the pandemic requires a back-to-basics approach with an emphasis on continual improvement. Determining and communicating current performance levels on relevant quality measures is imperative to identify the benefits of the care delivered or pinpoint opportunities for improvement. Identifying new measures that will assist in determining progress toward combating and containing the spread of the coronavirus is also important.

Take action to improve quality

  • Confining quality discussions to the C-suite or the boardroom is not helpful. Communicate the measures, data, and progress toward targets to all staff and providers to drive improvement and determine what is working.
  • Post measures, goals, and progress on quality measures in breakrooms and on the internet to promote staff engagement.
  • Provide staff with a suggestion box (physical or virtual) to help them feel they can make a difference in the organization. Progress often occurs when informed staff and providers offer ideas for new approaches or restructured processes. The ultimate goal is to change structure or process to improve patient outcomes.

Remember that if the organization’s quality initiatives are implemented simply to meet regulatory requirements and not designed to affect patient outcomes, streamline processes, or standardize care according to best-practice guidelines, clinicians will not value the initiatives, which will make them ineffective.

Ultimate goal of quality improvement

Achieving the best outcomes for the most patients while reducing costs can be achieved if a quality program is dynamic, interactive, and focuses on driving excellence by sharing information and encouraging organizationwide participation.

In the final analysis, quality in healthcare should not be about reporting numbers or meeting metrics. It’s about changing the organization’s culture such that quality and safety become foundational, forming a mantra for every employee.

A robust quality program that is responsive in crisis situations such as the COVID-19 pandemic provides information and data, and facilitates adaptation to meet patient needs. Most importantly, it makes a difference in the outcomes of the patients served and will help maintain the organization’s clinical and financial viability.

Paula Brandon is vice president of quality and clinical support at Plano, Texas–based Community Hospital Corporation.