From the Editor RobFromberg_2012_r1 

Robert Fromberg, Editor-in-Chief

This month, my healthcare finance reading transported me back to the 1980s and 1990s.

At that time, I was writing about quality improvement in health care. I wrote about concepts such as continuous process improvement and total quality management; improvement methods like Plan-Do-Check-Act and FOCUS-PDCA; indicators of structure, process, and outcome; and setting priorities for improvement.

At that time, process improvement projects tended to be narrowly defined. Administrative processes were easier to tackle than clinical processes, clinical improvement tended to focus on issues such as patient throughput that didn't necessarily address clinical protocols, and true clinical improvement tended to focus on correcting problems rather than overall improvement.

Process improvement never stopped being important, but in an environment that demands improved value, it is once again in the spotlight. HFMA's Value Project has identified process improvement as one of four key capabilities necessary to drive value. The project's recently released report The Value Journey points out, "The crux of the changes that providers will need to make to transition to the emerging payment environment lies in care delivery." The report mentions old stalwarts such as Plan-Do-Check-Act. However, the report broadens the traditional scope of process improvement considerably to include cross-department and cross-location projects, links among care teams to improve population health, and engaging patients and other stakeholders.

Likewise, some familiar quality-improvement concepts emerge in this month's hfm cover story, "Delivering Value to Multiple Stakeholders: 2013 and Beyond" by Michael Nugent. The author encourages use of metrics that address outcomes, rather than the more easily captured structure and process metrics. He also calls for a more forward-looking, value-enhancing version of performance improvement that takes a broader, more collaborative approach.

In offering examples of this broader approach, Nugent describes how organizations are:

  • "Mapping out how patients receive value along the continuum of care, from diagnosis to discharge and follow-up"
  • "Creating lower-cost substitutes (for example, replacing high-cost surgical procedures with lower-cost interventional radiology services)"
  • "Actively sharing cost/benefit information with patients prior to expensive surgery (such as customized, video-based decision aids for patients with knee pain)"
  • "Providing timely feedback to patients on their health status, cost of care, and potential health outcomes to influence healthy choices

In a 1998 article, Stephen Shortell and colleagues called continuous quality improvement "a beautiful rose growing in an unruly garden filled with weeds," the unruly garden being the U.S. healthcare system and the weeds being "misaligned incentives, professional entrenchments, competing priorities, organizational inertia, and lack of adequate information systems, to note a few" (Milbank Quarterly, 76/4). It's gratifying to see the core benefits of quality improvement blooming in an environment that needs them more than ever.

Publication Date: Monday, December 03, 2012

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