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Effective Quality Improvement

Fundamentals in quality improvement are often missed. Take, for example, a healthcare project to reduce readmissions to the hospital within 30 days for a given population of patients or members. I have had the most effective efforts after following some basic principles for engagement. 

 

First: Assess a problem area.  And baseline it. This is generally a known problem area. You could do an assessment to determine what the problem is. You could benchmark against other systems or organizations. Determine where your problems might be. This can often start with a common measure of some kind that is used to measure readmissions. 

 

Second: Once you know your baseline. You have a starting point. In this second phase, you choose your measures and make your plan. You should choose a handful of measures, no more than three or four. Should you be measuring readmissions in a healthcare environment, you should chose one or two process measures, an outcome measure and a balance measure.

 

• The outcome measure should or could be your ultimate goal or the telltale sign that what you're doing in your project is achieving the preferred outcome. For readmissions in healthcare, this could simply be readmissions for patients within 30 days. 
• Process measures should measure some new intervention or change in process that you've implemented with regard to the problem you're trying to solve. Process measures in this example could be something like setting up an appointment for a patient within 2 - 3 days following a discharge announcement. It could also be checking a system for discharges consistently every day (as a second measure). You should also create a plan to implement the new processes you plan to put in place. 
• A balance measure is great for silencing the critics, or acknowledging your error with your project. In a project like this, that might be identifying a drop in revenue from sick patients (which might create an opportunity with a patient panel from a particular payer you might be benefitting for increased reimbursement), or perhaps if you're a Direct Primary Care provider, might be an indicator of reduced expense for your patients.  

 

Third: After you have determined your measures, you set out to do what you planned to do. This is your opportunity to make your mark and test the scenario. You can start small with a small population, figure out a way to identify the success of that cohort. You may need to mark that cohort somehow, in this example, perhaps you have a custom marker on that patient group (in this healthcare example). 

 

I've implemented this process and had amazing success with it. If you need assistance, we can provide help to get you through your project along with technical, clinical and evidence based tools to be successful. 

 

- David Smith