Building a Departmental Quality Program: A Patient-Based and Provider-Led Approach

Abstract

Quality improvement in health care today requires a comprehensive approach. Improvement efforts led by patients, payers, regulators, or health care providers face many barriers. Obstacles include selecting measures with clinical value, building physician acceptance, establishing routine and efficient measurement, and resolving competing clinical demands and work flow impediments. To meet these challenges, the Brigham and Women's Hospital Department of Medicine created a grassroots quality program guided by four main principles: improvement is led by frontline clinicians who select measures important to their patients, performance measurement is automated and accurate, appropriate resources are provided, and interventions are system based and without financial incentives for individual providers. The quality program has engaged the department's physicians from the start. Given the flexibility to define their own metrics according to their patients' needs, clinicians have selected measures related to prevention and wellness, which are often based on national standards. The central quality team facilitates measurement and reporting while providers focus on patient care. The subsequent production of meaningful, actionable data has been instrumental in building physician acceptance and in providing clinicians the opportunity to evaluate and monitor performance. The program's largest challenges have been in capturing meaningful data from electronic systems. The program's system-based focus encourages providers to develop solutions within the existing framework of clinic resources, primarily targeting work flows and processes, while minimizing large expenditures on additional staffing.

Improving Influenza and Pneumococcal Vaccination Rates in Ambulatory Specialty Practices

“…Increasing adherence to guideline-based recommendations on vaccinations has remained a challenge for decades. At our institution, the Department of Medicine has established a Quality Program (DOMQP) to work with all clinical divisions to create clinical quality metrics using billing and electronic medical record (EMR) data and to formulate performance improvement plans [ 1 ]. One clear focus of the DOMQP over the past few years has been to improve vaccination rates for influenza and pneumococcal disease across several of our divisions.…”

The Value of Negative Results in Quality Improvement

“…QI must be embedded within the culture of care delivery as a continuous effort at the level of individual hospital and clinical systems to be effective. 1 Maintaining engagement among staff for continuous QI is challenging, 2 and there is significant interest in ensuring that investments have positive results. Thus, sharing negative results is crucial.…”

Improving Quality and Safety of Care Using “Technovigilance”: An Ethnographic Case Study of Secondary Use of Data from an Electronic Prescribing and Decision Support System

“…Without good evidence about how well systems and individuals are functioning, organizations may be misled as to the quality of their services, fail to recognize and reward excellence where it exists, or miss opportunities to identify and remedy weaknesses (Francis ). Yet producing intelligence that is credible, timely (Bradley et al ; Pronovost et al ), close to the point of care (Weiner et al ), and actionable (Szent‐Gyorgyi et al ; Whippy et al ) continues to pose frustrating challenges. Some challenges relate to the practical difficulties of obtaining good‐quality data; others relate to how data can best be turned into intelligence and then used to inform effective action.…”

“…The secondary use of electronic health records (EHRs) to generate information on quality and safety offers a promising means of addressing at least some of these problems (Szent‐Gyorgyi et al ). The primary purpose of EHRs is recording information about the care of individual patients, though they are increasingly complemented by prescribing and decision‐support software.…”