Seeing through the Looking Glass to fix healthcare quality
By Thomas Day
In a prior article, we noted what “Should-Not-Happen Events” cost a typical 200-bed hospital. So the question now becomes: “How can I reduce these events at my hospital?” The answer seems easy – it’s just a matter of funding quality management departments adequately, right? Ummm, well, maybe not. Traditional quality management functions ensure that your hospital is a safe environment for healthcare, and that most cases proceed without problems.
However, the most expensive off-quality cases can happen from specific events – and from specific hospital process failures. You can see this by looking at the Quality Percentile rankings (AHRQ results) for facilities in comparison to what they spend for traditional quality management functions. In the chart below, the more spent on traditional quality management (further to the right) should correspond to better quality (further up), or fewer “Should-Not-Happen Events.”
However, that’s not what you see below – it’s as if we need to go through the Looking Glass to see the world of quality as it really is. On the other side, what we do see is that out of thousands of cases, a relatively small number of problems – five to seven percent of the total – along with a handful of physicians – five to ten percent – cause millions of dollars of off-quality spending. To address this problem requires more than the traditional solutions – they require such things as Performance Improvement campaigns or the steady monitoring of hot spots. But more on that next time.
Thomas Day is president of HMC.
Each circle represents a hospital with the size of the circle representing the total $ spent on Quality Management. The vertical scale measures quality performance---the best performers having a higher aggregate percentile ranking. The horizontal scale measures quality spending per adjusted admission.
