The Top Six Examples of Quality Improvement in Healthcare
Hospital systems across the country face a number of pressing problems: clinical variation, preventable medical errors, hospital acquired infections, delays in patient discharge, and dwindling cash flow. While health systems need to consistently innovate in order to tackle these problems, many quality improvement projects fail to deliver on ROI.
While there are many different definitions of quality improvement, the Health Resources and Services Administration (HRSA) defines it as “systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups.” In addition to a practical definition, health systems need a roadmap to help guide successful quality improvement projects forward.
Health Catalyst has focused on helping health systems identify, prioritize, and succeed in tackling quality improvement projects since 2008. With the right evidence, analytics, and methods, providers and improvement teams can transform healthcare, improving the quality of care delivered to the patients they serve and the bottom line. Health Catalyst offers a roadmap to use best practice, adoption, and analytics together to drive outcomes improvement. This article provides examples of quality improvement in healthcare that may help others in their journey.
Clinical Examples of Quality Improvement in Healthcare
Healthcare systems working to improve clinical quality face the difficult challenge of aligning changes across the organization. But health systems can learn from successful clinical quality improvement projects and implementing key principles of their success. Below are three successful clinical examples of quality improvement in healthcare covering a wide range of issues facing many health systems today.
1. Pharmacist-led Medication Therapy Management Reduces Total Cost of Care
The first example is a recent project to improve patient outcomes and reduce cost where Allina Health leveraged their analytics system to demonstrate the impact of their pharmacist-led medication therapy management (MTM) in reducing the total cost of care.
In order to reduce medication-related adverse events the health system initially considered expanding the involvement of pharmacists performing medication therapy management (MTM) to a group of Medicaid patients covered by a shared-risk contract. Before making this decision and developing a comprehensive business plan, the health system wanted to better demonstrate the unique impact pharmacists were making on patient outcomes. The health system leveraged its analytics platform and Health Catalyst professional services to perform a comprehensive analysis. The analysis showed the following results:
- $2,085 mean total cost of care reduction per patient in the six-month period after the first pharmacist MTM encounter; over $590,000 extrapolated out over 283 MTM patients.
- 12% reduction in hospital admissions per 1,000 members and a 10% reduction in emergency department visits per 1,000 members.
- Statistically significant decreases in average medication count.
The analysis demonstrated the unique, positive impact pharmacist medication therapy management program is making on patient outcomes in the six-month period following the pharmacist MTM. This program is effectively reducing the total cost of care.
2. Optimizing Sepsis Care Improves Early Recognition and Outcomes
The second example of a clinical quality improvement project deals with an issue well-known to hospital systems. Sepsis is a major driver of mortality in the U.S.–it’s estimated that up to half of all hospital deaths are linked to the infection. Identifying sepsis early can be challenging, as the patient’s physical response presents as a syndrome of non-specific symptoms, which delays recognition, diagnosis, and treatment–all of which increases mortality rates.
Mission Health, North Carolina’s sixth largest health system, had previously implemented evidence-based sepsis care bundles. However, their processes for identifying patients with sepsis and initiation of care was fragmented and varied widely across the system, negatively impacting outcomes. By using a comprehensive data-driven approach to facilitate early sepsis identification and standardize the treatment of sepsis, including the addition of evidence-based alerts, Mission Health gained insights into sepsis performance to drive improvements. Using this comprehensive approach for early recognition and treatment, they achieved substantial improvements in sepsis outcomes, including the following:
- 1% relative reduction in mortality for patients with severe sepsis and septic shock.
- 9% relative difference in mortality for patients that received the evidence-based protocols compared to those who did not—the evidence-based protocols substantially reduce mortality.
- 4% relative reduction in emergency department (ED) length of stay (LOS) for patients with severe sepsis and septic shock.
- Four percent relative reduction in ICU LOS for patients with severe sepsis and septic shock admitted from the ED.
The health system will continue to use this proven plan to improve sepsis outcomes and enhance care for patients with sepsis and they are laying the groundwork to move the early identification screening tools to the outpatient setting, including urgent care centers and physician offices.
3. Boosting Readiness and Change Competencies Key to Successfully Reducing Clinical Variation
This example of clinical quality improvement in healthcare comes from UnityPoint Health, a healthcare system serving Iowa, western Illinois, and southern Wisconsin. System leaders recognized the importance of reducing clinical variation and the need to have strong physician champions and robust analytics to effectively support improvement efforts. However, they also realized that without understanding organizational strengths and weaknesses related to adopting change and improving outcomes, they would struggle to successfully implement initiatives that delivered the desired benefits and sustained improvements over time.
By consistently integrating information from a readiness assessment, an opportunity analysis, and expert resources, the health system was able to establish a prioritization and implementation approach to outcomes improvement that produced the following results:
- Variable costs were reduced by more than $1.75 million based on the deployment of interventions in sepsis alerts, order sets, and other clinical decision support tools.
- Reductions in length of stay have allowed patients to return home earlier and spend more than 1,000 additional nights in their homes.
- Millions of clicks have been reduced for clinicians based on deployment of new sepsis screening tools.
- 36% increase in sepsis screenings completed in the emergency department (ED).
- Sepsis order set utilization in the ED has increased by more than 185 percent.
The health system plans to continue identifying large improvement opportunities aligned with its strategic planning cycle and the priorities identified by clinical and operational leadership.
Financial and Operational Examples of Quality Improvement in Healthcare
Financial challenges are increasingly threatening the future of healthcare organizations. In order to thrive in an increasingly complex environment, financial and operational improvement projects are more important than ever. But, health systems need to tackle the right projects at the right time for their organization. Below are three excellent financial and operational examples of quality improvement in healthcare.
4. New Generation Activity-Based Costing Accelerates Timeliness of Decision Support
The first example comes from UPMC, an academic medical center affiliated with the University of Pittsburgh. Health system leaders recognized that the common denominator to addressing threats to sustainability is to fully understand and effectively manage costs. To address this, they implemented activity-based costing (ABC), facilitated by the Health Catalyst CORUS™ Suite, to deliver detailed and actionable cost data across the analytics environment, and support service line reporting, contract modeling, and clinical process improvement. They used this capability to effectively drive cost savings and improve clinical outcomes in many of its service lines, including Surgical Services, Women’s Health, Orthopedics, and Cardiovascular.
Through its analytics platform and best-of-breed, ABC models, UPMC is improving quality and safety, reducing costs, and increasing value across service lines. An efficient accounting closing process delivers timely and accurate information to guide decisions and operational adjustments. Taking these steps led to the following improvements:
- Three-day reduction in time to close.
- Monthly preliminary results are typically reviewed within one business day, affording more time for validation and analysis.
- Executives receive financial data up to three days sooner.
- Reduction of 3.5 FTEs needed to complete the monthly close.
- Reduced 60 human touchpoints and opportunity for error.
- Multiple months of data can now be run simultaneously.
- Provided support for new data-driven governance structure.
5. Systematic, Data-Driven Approach Lowers Length of Stay and Improves Care Coordination
The second example comes from Memorial Hospital at Gulfport. The hospital was faced with declining revenue due to changes in Medicare and Medicaid reimbursements. Hospital leaders knew additional methods of providing more efficient and cost-effective quality care were needed to maintain long-term success. Improving and reducing length of stay (LOS) improves financial, operational, and clinical outcomes by decreasing the costs of care for a patient. It can also improve outcomes by minimizing the risk of hospital-acquired conditions.
Hospital leaders embraced the challenge of reducing LOS to lower costs and lessen risk for its patients. By adopting a systematic, data-driven, and multi-pronged approach, Memorial has achieved significant results in one year, including:
- $2 million in cost savings, the result of decreased LOS and decreased utilization of supplies and medications.
- 47-day percentage point reduction in LOS.
- Improved care coordination and physician engagement have successfully reduced LOS.
- The 30-day readmission rate has remained stable.
- Three percent increase in the number of discharges occurring on the weekend.
6. Clinical and Financial Partnership Reduces Denials and Write-Offs by More than $3 Million
The last example of financial and operational quality improvement projects comes from The University of Kansas Health System. Despite previous initiatives, The University of Kansas Health System’s claim denial rate of 25% was higher than best practice (five percent). System leaders realized that, in order to provide its patients with world-class financial and clinical outcomes, it would need to engage differently with its clinical partners.
To effectively reduce revenue cycle and implement effective change, the health system needed to proactively identify issues that occurred early in the revenue cycle process. To rethink its denials process, it simultaneously increased organizational commitment, refined its improvement task force structure, developed new data capabilities to inform the work, and built collaborative partnerships between clinicians and the finance team. As a result of its renewed efforts, process re-design, stakeholder engagement, and improved analytics, The University of Kansas Health System achieved impressive savings in just eight months, including:
- $3 million in recurring benefit, the direct result of denials reduction.
- $4 million annualized recurring benefit.
- Successfully partnered with clinical leadership to transition ongoing denial reduction efforts to operational leaders.
The Quality Improvement Journey
Healthcare systems working to improve care, reduce expenses, and improve the patient experience face many challenges, including the need to align changes across many levels of an organization. But the process of identifying, prioritizing, and implementing these changes can be improved with the right tools and, process, and people. Once these three things are in alignment, health systems can tackle clinical, financial, and operational quality improvement projects like the examples covered here and make incredible strides in the clinical, financial, and operational health of the organization.
Everyone involved in improvement projects from doctors and nurses, to data analysts and administrators are busy with other projects. Quality Improvement projects typically mean additional work everyone involved. However, health systems have the ability to improve care, patient experience, and save lives through quality improvement projects that reduce clinical variation, preventable medical errors, hospital acquired infections, delays in patient discharge, and improve the bottom line.
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