The results of a nationwide survey of quality improvement professionals working in healthcare were released July 30, and underscore concerns among those professionals that the obstacles to dramatic quality improvement in healthcare delivery and operational processes are such that major changes need to be made to the ways in which quality improvement is executed in healthcare settings.
The survey of 323 quality professionals in healthcare was conducted by the Milwaukee-based ASQ, a global association of quality improvement professionals that works to support quality improvement across all industries . ASQ is best known as the sole administrator of the annual Malcolm Baldrige National quality Award; the association encompasses 90,000 members worldwide.
Among the 323 quality professionals in healthcare surveyed, when asked what things were “extremely important” to do right now in healthcare, 42.9 percent cited “reducing hospital readmissions”; 34.52 percent cited “creating efficiencies with existing clinical resources (staff and units) to maximize patient throughput”; 30.45 percent cited “implementing patient care coordination programs”; 30.0 percent, “changing medical malpractice laws”; 23.2 percent cited “improving data and analytics on ROI of medical products/technologies”; 21.29 percent, “improving supply chain management”; and 21.22 percent, “redesigning hospital care spaces to be more efficient.”
When asked to name quality improvement approaches that would “help healthcare organizations to cut costs and reduce waste,” survey respondents cited “increasing the use of quality and process engineers in healthcare settings” (29.68 percent); “focusing on Lean management principles” (29.68 percent); “implementing mandatory process improvement training for healthcare professionals” (29.22 percent); “creating financial incentives to deliver more efficient care” (27.12 percent); “forming or joining purchasing collaboratives and group purchasing organizations to leverage their buying power,” 19.14 percent; and “expanding the use of ‘medical technology’ (refers to procedures, equipment, and processes by which medical care is delivered),” 17.43 percent.
Meanwhile, when asked to name difficult “hurdles that healthcare organizations face in making changes to reduce costs,” 48.44 percent of those surveyed cited “The Affordable Care Act and its impact on how healthcare organizations set prices”; 26.14 percent cited “Medicare and Medicaid funding challenges”; 20.78 percent said, “modifying the model of reimbursement so healthcare and health maintenance is preferred over the sick-care, fee-for-service model that currently exists”; 16.29 percent said “lower reimbursement from health insurance exchanges”; 14.56 percent cited “fragmented, uncoordinated care”; 13.2 percent mentioned “persuading physicians to accept changes to the types of devices or supplies being purchased; while only 5.94 percent cited “not enough organizational bandwidth or resources.”
Shortly after the release of the survey results, Joseph M. Fortuna, M.D., spoke with HCI Editor-in-Chief Mark Hagland about the survey and about broader issues in healthcare quality improvement. Dr. Fortuna, the immediate past chair of the healthcare division of ASQ, is the CEO of PRISM, a Milwaukee-based non-profit consulting group working with hospitals and medical groups, to bring process and quality improvement skills, methodologies, attitudes. Dr. Fortuna practiced for years as an emergency physician, before transitioning into work as a corporate medical director, and then consulting work. Below are excerpts from that interview.
Let’s talk about your perspectives on the intersection between quality and healthcare delivery and operations.
Yes. What healthcare people don’t realize very often is that quality in healthcare has many domains. And certainly, many clinicians see it only in the clinical domain. But to really be a high-performing organization, you’ve got to look at the operational domain as well. Most of the errors occur in the operational realm and in support systems. And the culture in healthcare has not progressed to where Toyota is, except in a few organizations like Virginia Mason, to where everyone is looking to eliminate waste. And we’re mostly not doing that in healthcare. And those who are mostly don’t have the high-level skills needed to do that enterprise-wide and to make it a sustainable part of their culture. We don’t do that, and that’s what our organization, ASQ, is really passionate about.
Joseph Fortuna, M.D.
Among the survey results, it was notable that nearly one-third of ASQ members surveyed urged the hiring of professional quality and process engineers in healthcare settings.
I am very passionate about this issue. Many hospital leaders, including both administrators and clinicians, favor training clinicians in quality courses and then employing them as quality and process change leaders. And if you look at advertisements placed in media for people in healthcare, for quality directors, they’re almost always mandating a clinical background. Frankly, for my money, unless somebody is a process engineer first and then goes into clinical practice, those clinicians generally don’t have anywhere near the level of skill sets that process engineers have. Someone who takes a two-week course in Six Sigma and gets a green belt—that person doesn’t have the skill set needed to really create and sustain change.
So we really need professional-level process engineers working in hospitals and medical groups, then?
Absolutely; in fact, we’re developing a white paper on that subject right now.
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