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The Quality Institute
An Innovative Concept to Organize and Marshal Physicians
Clinical quality is emerging, appropriately, as the key criteria for selecting healthcare providers. The Consumer Disclosure Project, funded by the Robert Wood Johnson Foundation and supported by employers, insurers and foundations, has as its goal “By January 1, 2007, Americans will be able to select hospitals, physicians, integrated delivery systems, and treatments based on public reporting of nationally standardized measures for clinical quality – safe, timely and effective care – patient experience, equity and efficiency.”
CMS, the National Quality Forum and payers are other powerful forces driving in this same direction. Crude proxies for quality like volume and infrastructure are being replaced with specific and quantifiable outcome measures. Word of mouth and marketing are being replaced as provider selection factors with internet research and comparative evaluations.
No one is in favor of poor quality. Yet, most healthcare systems struggle to organize, focus and motivate clinicians to take the steps necessary to dramatically improve healthcare. Physicians often view these initiatives as another attempt to restrict their autonomy and authority as well as a tax on their time and income. Not unlike the era of managed care, those providers that get ahead of the curve will be the ones best positioned for success in this new era of clinical performance.
One emerging strategy to capitalize on this opportunity is the creation of a local “Quality Institute.” This is a distinct entity led by physicians and focused on improving clinical performance, patient and employee safety and consumer understanding and satisfaction. The organization is built around a cadre of physicians who have an interest in and commitment to scientific research, best practices, information sharing and improving performance. The mission is to accelerate and fund performance improvement and the result is both better healthcare and a competitive advantage in attracting and retaining clinicians and patients.
The concept is to create a separate non-profit entity, perhaps a division the health system, with a specific charge, for example: measuring, monitoring, improving and reporting clinical performance. It might assess current performance; provide tools and support for physicians; track the state of the art; disseminate information; organize and coordinate participation in “pay for performance” initiatives; and facilitate patient safety, satisfaction and outcomes initiatives in the hospitals. It could have full time staff (i.e. health statisticians, researchers), part time staff, perhaps shared with the system (i.e. medical executive director, CFO) and project participants (i.e. physicians, nurses, pharmacists, technicians). Funding could come from foundation grants, payers, pharmaceutical companies and contracts with the hospital.
This approach allows interested physicians to get involved in the leadership and setting the agenda for clinical performance and provides the health system, patients and payers with information they need to make an informed decision. The independence creates credibility, accountability, consistency and a budget and sources of funding. It also creates a vehicle to integrate and compensate independent physicians without creating legal entanglements or undesirable precedents.
There would still be a critical quality management role for the hospital and medical staff that might be separate from but coordinated with the Institute. This organizational model avoids some of the obstacles and barriers to quality improvement inherent in the traditional hospital-medical staff dynamic. This concept is not unlike how the PHO created an effective forum for many hospitals and physicians to work together for mutual benefit in contracting with managed care payers.
Each community and medical staff is unique and the mission, vision, structure and strategy of the Institute would have to reflect the market reality. The organizational development process can help motivate physicians and raise awareness of the opportunity. The resulting Institute can position physicians and the health system for improved performance, better reimbursement and increased market share.
Research demonstrates that poor quality care is expensive in terms of lost lives, sick time and cost. It takes far too long for the best ways to treat and prevent disease to become part of the standard practice of medicine. Rand reports that vulnerable seniors fail to receive recommended care two thirds of the time. The National Committee for Quality Assurance found that over 57,000 Americans die every year because they don’t receive the appropriate healthcare routinely practiced by the clinicians in the best performing health plans. This results in more than $1 billion in unnecessary hospital costs and 41 million sick days. The National Healthcare Quality Report indicated that 37 of 57 indicators of healthcare quality saw a trend of no improvement or deterioration.
Recent studies have also found that there are 15-20 errors per physician per year in the Family Practice setting (25% with patient health consequences), 40-60% of post-surgical infections are avoidable (1.3% surgical patients), there are 18,000 preventable heart attack deaths in hospitalized patients each year and there are 2 errors per patient day (1 life threatening error per patient) in intensive care units.
National consumer surveys illustrate the public’s concern about quality and safety. In fact, 47% say they are very concerned about an error when going to the hospital for care and 40% say that about going to the doctor’s office. About 58% believe there are fair and reliable ways to measure and compare hospital and physician quality and 44% favor insurance companies paying more to hospitals and medical groups shown to provide better care and less to those who have not (only 16% oppose). Only 24% of people believe hospital care and 35% physician care is a fairly or very good value.
The market is responding to these concerns and perceptions, US news provides a widely read report on the best hospitals, Solucient ranks the top 100 hospitals, healthgrades.com rates hospitals on the internet and several payers including Medicare and various state agencies are publishing reports on the quality of hospitals and doctors. Business coalitions and consumer and healthcare advocacy groups are uniting to provide usable comparative information on quality and safe practices.
A Quality Institute is a proactive strategy to enable a healthcare system to strengthen physician linkages and drive it to the next level of performance.
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