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Methods to the Madness

January 1, 2007
by Mark Hagland
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When it comes to quality improvement methodologies, CIO leadership will be essential.

The term "quality improvement" has become omnipresent in healthcare during the past couple of years. But how many patient care organizations have put their money and effort where their collective mouths are? Michele serbenski

One group of executives and clinicians who've done so in a big way are those at Bronson Healthcare Group, an integrated health system in Kalamazoo, Mich. Indeed, Bronson's flagship hospital, Bronson Methodist Hospital, received the Malcolm Baldrige National Quality Award in 2005 from the Baldrige National Quality Program, administered by the National Institute of Standards and Technology, Gaithersburg, Md., a division of the U.S. Department of Commerce.

Among the achievements the Baldrige Program cited in awarding Bronson Methodist Hospital its award: the hospital's Medicare mortality rate decreased from 4.8 percent in 2002 to 3.5 percent for January-July 2005; patient satisfaction improved from 95 percent in 2002 to nearly 97 percent in 2004; and the hospital was included in Fortune Magazine's "100 Best Companies to Work For" in 2004, 2005 and 2006.

Of course, such national recognition doesn't come to just any organization. The staff and clinicians at Bronson have been working for several years at systematically improving every aspect of the organization's business, from clinical care quality to patient satisfaction to operating efficiency.

"The key thing the Baldrige criteria does is to cause you to formalize and define your approach to everything, and to integrate tactics," says Michele Serbenski, executive director, corporate effectiveness and customer satisfaction, for parent Bronson Healthcare Group. In other words, to take a strategic and systematic approach to quality improvement.

Mac mcclurkan Meanwhile, says vice president and CIO Mac McClurkan, information technology is inevitably an important facilitator of change. "It's not about technology, it's not about bits and bytes, it's about process," McClurkan emphasizes. "That being said, if you do have technology in place, it's important to demonstrate that you have a well thought-out process for selecting, implementing, maintaining, securing, and using the technology. That's something very central to the strategic role of the CIO, and it's very central to what Baldrige is all about."

IT, CIOs, in spotlight

Industry experts say that the kinds of systemic improvements being made at Bronson are creating a model of organized quality improvement across healthcare, something that is desperately needed in a field that still acts like a cottage industry rather than one of the largest and most important sectors of the American economy.

With purchasers, payers and consumers all demanding greater accountability for quality; with an accelerating emphasis on patient safety; and with healthcare inflation surging, many agree that only systematic approaches will move patient care organizations significantly forward in key areas. And whether healthcare organizations are using Baldrige Award criteria, Six Sigma, Lean Healthcare management, Total Quality Management or some other technique or combination of methodologies, CIO leadership, through the strategic use of IT, will be essential to facilitating major change.

Just ask Charles Stokes, president of North Mississippi Medical Center (NMMC) in Tupelo, Miss. He and his colleagues were overjoyed to learn on Nov. 20 that their organization had received the Baldrige Award for 2006.

In order to succeed at systematic quality improvement, Stokes advises, "Make sure that your change initiative is directly tied to your mission and vision, and that it is data-driven. In the absence of data, any opinion will do. And CIOs have to be involved in it. The systems are too complex and the data is too important for them to sit on the sidelines. Our focus has been on five critical success factors: people, service, quality, financial strength and growth. The reason I think we were a recipient was because of our ability to focus on those five areas and produce measurable results in every one. Baldrige provides a framework for us to be able to focus on things that are important."

And, he quickly adds, only an objective, data-driven approach, one championed and co-led by an organization's CIO, can succeed over the longer term.

In fact, the organization's self development of an electronic medical record (EMR) was very much on the minds of the Baldrige award committee. Not only was the EMR's development cited as an achievement in itself, it was seen as a facilitator of quality improvement.

"At NMMC, a care-based cost management approach has provided cumulative gains of $11.1 million since 1999, largely as a result of reducing practice variations and medication complications," noted the committee. And, it added, "Debt has decreased from 26.7 percent to 21.8 percent in 2006 (year to date)."

Not surprisingly, the second of three national winners for 2006 (across all industries) is also an organization that has focused very strongly on systematic quality improvement. And it, too, is in healthcare. It is the San Diego-based Premier Health Alliance, which has achieved notoriety for its co-sponsorship of the Hospital Quality Incentive Demonstration Project with the Centers for Medicare and Medicaid Services (CMS) in the pay-for-performance sphere (see Healthcare Informatics' November 2006 cover story, "Catching the P4P Wave").

Setting a quality course