With rising costs, increasing regulations, and growing numbers of patients, hospitals and clinics must struggle to make ends meet while still providing effective medical care. Quality management programs seek to improve efficiency and patient outcomes, but they are only effective if supported by diligent, regularly updated information.
The Value of Variations
Diligent quality management in healthcare allows health administrators to identify variations in patient outcomes and the cost of care. Although there are exceptions, standardization is associated with excellence in the healthcare industry. If all caregivers performing a particular procedure are achieving the same costs and outcomes, odds are that they have all adopted the most efficient processes available. Conversely, if caregivers are performing the same procedure but generating very different costs and/or patient outcomes, the caregivers who have higher costs or worse outcomes are likely not using optimal methods. Thus by gathering data and identifying procedures with the highest outcome variations, administrators can determine where quality management in healthcare efforts are best spent.
Studying variations in healthcare outcomes often yields instant savings for hospitals. Say that a group of physicians perform heart surgeries at a median cost of $30,000 per procedure. One surgeon, however, is performing the same procedure at a cost of $50,000 and performs 20 of these surgeries per year. If that surgeon can reduce his or her costs to the level of the group of physicians, the hospital will save $400,000 a year, giving it more resources to improve the quality of care for other procedures. Heart surgery would thus be an ideal field on which to focus quality management efforts. This is generally an effective way to cut costs, but it doesn’t always work, which is why you must rely on other areas.
Though caregivers’ processes are important, they alone cannot determine variations in the cost and outcome of procedures. A heart surgeon may generate higher costs not because he or she is less efficient than other surgeons but because they treat more complex or more advanced heart conditions. Likewise, if a surgeon achieves worse outcomes than others, it may be because those patients waited longer for treatment. To optimize quality management, physicians, nurses, and other caregivers must be directly involved in the data gathering process, providing qualitative feedback to complement raw facts and figures. Even if some caregivers are clearly less efficient than others, they should have a say in how to improve their processes; imposing changes on them won’t take into account the nuances of their responsibilities.
Besides allowing individual caregivers to explain and improve their outcomes, caregiver collaboration is also important on a collective level. Hospitals that institute quality management in healthcare programs must choose which departments and procedures to focus on first. Say that a hospital finds similarly large variations in heart surgery, diabetes, and hypertension outcomes. Talking to the caregivers who perform each procedure will allow administrators to determine which of these areas will yield the largest and quickest results. If caregivers who handle diabetes have successfully implemented similar quality management steps in the past, but other caregivers have not, the diabetes caregivers will be the most receptive to new suggestions. The hospital should thus focus on them first, addressing heart surgery and hypertension caregivers only when it has diabetes caregivers as an example.
Finally, caregiver collaboration allows hospitals to address communication problems. Though medicine is often presented as an exact science, there remain significant discrepancies in medical terminology. The distinction between “diabetes” and “prediabetes,” for example, varies from caregiver to caregiver, and different definitions may explain reported differences in diabetes outcomes. Allowing caregivers to get involved in data collection makes it easier for hospitals to clear up differences in definition and establish consistent terminology.
The impact of good information isn’t limited to clinical settings. Given the rapid growth of chronic diseases, one of the most effective ways to improve outcomes and cut costs is to educate patients on how to remain healthy throughout their lives. To educate patients effectively, however, caregivers must have reliable data on diseases and patient outcomes, use consistent terminology, and present information in a format patients can understand. Collaborative data gathering is thus crucial to quality management in healthcare both inside and outside the hospital.