Quality improvement efforts are built on uniform practices and data elements.
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| Sarah Shillington |
After years of implementing piecemeal performance improvement initiatives, health care organizations are beginning to recognize the need for a more consistent approach. As a result, standardization, in which institutions systematically develop and apply uniform practices to achieve efficient and reliable care throughout the organization, is emerging as an important trend in performance improvement.
Fragmented care-delivery and documentation systems are among the most common causes of inefficiency and a major contributor to inconsistent practices and policies. But by pursuing standardization on four levels—at the point of clinical input, in workflow, with performance metrics and at the corporate level—hospitals and health systems can eliminate these issues. As variations in data, care processes and performance metrics across departments and facilities decrease, the ability to accurately measure—and improve—performance increases.
Standardized Inputs: Uniform Data
Collecting, reporting and acting on quality information starts with standardized inputs. This requires creating consistent data sets that are uniformly summarized for maximum utility. “Without standardization of data elements across many source systems—including billing, laboratory, pharmacy and clinical systems—the accuracy of measures and the timeliness of reporting will be less than optimal, and the costs of measurement and reporting will be considerable,” stated Carmela Coyle, senior vice president, policy, for the American Hospital Association, in her April 2007 letter to the National Coordinator for Health Information Technology for the Department of Health & Human Services. At this level, this means standardizing relatively simple data elements such as temperature, classifications such as allergies, and data structures such as discharge summaries.
But this isn’t as simple as it sounds. Standardizing across an organization means stepping outside of the “siloed” model of care to look at the bigger picture of a single, integrated health care organization. Only uniformly consolidated data sets support generating outcomes that are comparable across various areas.
Collaboration among clinicians and administrative leaders and a clear vision are the keys to developing a system with uniform data. Generally, a standardization initiative that crosses organizational or regional boundaries will require a unified clinical team working together toward the goal of merging each region’s best practices into one. Clinical leadership should be brought together as a cohesive group to arrive at decisions on standardizing the data from across the continuum of patient care, including data from medication nomenclature to uniform pain scales.
Standardized Care Processes: Streamlined Workflows
Similar to consistent content, standardizing caregiver workflow creates a uniform platform for measuring and improving performance. It also reduces variability of care and documentation time. Ultimately, caregivers will have more time for direct patient care, medical errors will be reduced, patient safety will increase and clinical outcomes will improve.
Following are examples of estimated improvements in care efficiency resulting from workflow standardization:
- 60 percent to 80 percent reduction of preventable adverse drug events
- 32 percent reduction in order management and dispensing time, or 1.15 FTEs
- 55 percent to 65 percent reduction in physician report transcription turnaround time
- 20 percent decreased nursing documentation time
Standardized Metrics: Managing Pay for Performance
Standardized information systems and care delivery protocols are increasingly being used to respond to pay-for-performance initiatives. Everyone in health care is familiar with the Centers for Medicare & Medicaid Services’ 10 quality measures and the intent to link reports on those measures to the payments hospitals receive for each discharge. What everyone doesn’t know is how to ensure their institution can comply with this plan.
Compliance will be particularly difficult for multi-entity organizations that have not yet standardized content, care-practice processes, policies and procedures. In effect, they will be comparing apples to oranges when it comes to performance data. By contrast, health care organizations that have tackled the challenge of standardization can make comparisons with relative ease. These organizations are able to routinely assess pay-for-performance indicators, catch problems early, and make corrections quickly and broadly.
These capabilities are more than sufficient incentive to standardize across the organization to accurately capture, subsequently report and continually improve the quality of care provided. As momentum toward pay-for-performance increases, organizations that have standardized will be positioned for success.
Corporate Standardization: Build One, Deploy Many
Beyond the individual facility, health care organizations find substantial financial value in creating a corporate-level standard for content, care practices, policies and procedures, and processes surrounding new technology tools. This corporate standard can be replicated and deployed across multi-hospital systems with only minor modifications. This approach aims to achieve variation of less than 20 percent in processes, policies, procedures and system build. It also creates a consistent framework for:
- Improved financial performance
- Accelerated technology implementation and rapid deployment
- Decreased upgrade and maintenance efforts
- Enhanced competitive position and strategic alignment
When clinical workflows are consistent and standardized clinical content is leveraged, financial performance improves as installation, deployment and post-deployment savings are realized. By creating a corporate or hospital-specific data standard to be applied universally, subsequent system activations can be replicated. The installation time savings for a single nursing unit is approximately six to eight weeks and four to six months per facility for a multi-facility organization.
Mercy Health Partners, a five-hospital system with more than 1,000 beds in southwest Ohio, realized important benefits through its medication safety standardization initiative. The organization reduced its pharmacy formulary from 6,000 items to 2,500 items, resulting in a resource cost avoidance of 1,320 hours for installation of the pharmacy system. Additionally, medication safety system build and testing time saved an estimated 18,000 hours of resource time, translated into a savings of 8.65 FTEs across five facilities.
Typically, the more facilities included in the organization, the greater the savings. As estimated from ten health systems’ standardization results over a three-year period of time, savings in testing and troubleshooting of 30 percent for a single entity equates to a savings of 30 percent to 80 percent for each additional facility. Moreover, standardized technology advancements and care delivery processes combine to achieve efficiencies that impact the bottom line going forward. For example, clinicians can move from unit to unit or facility to facility with minimal training and achieve better efficiency and quality of care.
Health care organizations that rise to the challenge of standardizing data, care processes and performance metrics in order to measure and improve clinician performance will reap dual rewards: They will achieve sustained regulatory compliance and improved financial results while also leading the field in patient safety.
Sarah Shillington is vice president of McKesson Clinical Consulting Services, McKesson Corp., Alpharetta, Georgia.
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This article first appeared on March 19, 2008 in HHN's Magazine online site.
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