Members Only

For These Departments, Quality Is Job No. 1

By Teddy Durgin

“Quality departments are critical to the success of any healthcare organization. Quality professionals focus on continual improvement in patient safety, implementing best practices for eliminating errors and monitoring and evaluating data for continuous improvement. These individuals are also responsible for reporting and benchmarking the organization’s performance against quality measures that relate to value-based reimbursement. Moreover, the quality department can drive higher levels of organizational performance by promoting a safety culture.”

So says Kate Conklin, MS, CHC, CPHQ, CPMSM, CPCS, FMSP, chief compliance and privacy officer for Texas-based GI Alliance. Such departments are even more top of mind than usual with Healthcare Quality Week running Oct. 20–26. NAMSS Secretary-Treasurer Alison Webster, MBA, CPCS, CPMSM, CPHQ, FMSP, is looking forward to the week and shares Conklin’s respect and admiration for the people who staff these departments and their importance in moving healthcare forward.

She remarks, “The quality department helps ensure that their organization provides safe, high-quality care and continually strives to improve the care and services provided to patients. Through the utilization of various quality improvement tools and in collaboration with healthcare personnel, the quality team facilitates and coordinates various strategic process improvement projects, identifies and recommends improvement opportunities, measures and tracks data-driven metrics to track progress, reports results, and uses comparative data for public reporting and other accreditation purposes.”

So, in what instances would a medical services professional (MSP) work with a quality department? The question was posed to both women. Conklin replied, “All patient care is done at the direction of a licensed medial provider, which is why MSPs should have a strong connection to the quality department. Physicians should be encouraged to be at the forefront of all quality improvement initiatives. The evaluation of individual physician competency and performance is a critical component for privileging that is delegated to the medical staff. This work cannot be done without two-way engagement between the quality professionals and medical staff, as much of the data needed to assess competency is collected by the quality department.”

Webster concurred, adding, “Medical staff peer review is a medical staff function. At my organization, we were able to redesign the peer review process, which is now facilitated through the quality department, the professional practice excellence team (PPET), to support peer review. This clinical team facilitates the ongoing professional practice evaluation (OPPE) and the focused professional practice evaluation (FPPE) for cause processes and supports the professional practice committee (PPC). Medical staff services continues to facilitate the FPPE for new privileges process. PPET and medical staff services are closely aligned and work together collaboratively to ensure all reporting flows up to the medical executive committee.”

Webster believes an optimal OPPE process should include data driven metrics, both specialty-specific and organization wide. Her organization’s quality/ PPET team have clinical backgrounds, whereas medical staff services pros are historically non-clinical. “So the quality [department] is better suited to working with practitioners in terms of developing clinical quality indicators and facilitating case review.”

For her part, Conklin believes an MSP should have a solid understanding of the quality metrics and goals of the organization “so they can help educate physicians and facilitate change management that may be occurring due to external value-based programs or internal quality goals. MSPs can assist with strengthening this relationship.”

Conklin went on to say that the most effective quality departments are headed by strong leaders who not just mandate change, but advocate for change. This advocacy starts with conversations with physicians about why a change is needed and includes them in the change process.

She stated, “Physicians embrace data and will certainly champion any initiative that improves the safety and quality provided to their patients if it is evidence-based with outcome data. The quality program should be sharply focused on the core values of the organization and the services it offers to patients. The Department should develop training and continuous learning on safety principles, which are accessible to everyone in the organization. Everyone has a part to play in quality.”

Webster picked up on that and added, “Communication and flow of information between the quality department and medical staff services is key and must be governed by federal and state laws which protect what information can be shared as a result of peer review. When practitioner issues are identified through peer review processes, it is important that medical staff services is kept informed and able to help navigate next steps, especially since decisions as a result of peer review may affect clinical privileges.”

Looking ahead, the same crystal ball question was posed to both Conklin and Webster: “How do you see quality departments evolving in the years to come?” The former answered, “There is a convergence happening with quality, patient safety, risk management, and regulatory compliance right now. These can no longer be independent functions. It takes a collective effort to provide the right care, at the right time, in the right setting, and getting reimbursed properly for the services. I do not believe we will see pay for performance or value-based programs going away, but we continue to see challenges in adoption … Today, healthcare professionals work in an increasingly stressful environment in balancing the best care with resources in a tighter margin. The more MSPs and quality professionals understand these challenges, the better they can provide the necessary support to ensure viability of the organization from quality, compliance, and financial perspectives.”

Webster, meanwhile, concluded, “As gatekeepers of patient safety, MSPs are in a unique position to partner with quality departments around practitioner performance and practitioner data initiatives. Quality departments and medical staff services can further collaborate by implementing continuous feedback loops that ensure standards of care are aligned. Together, they can develop targeted initiatives that enhance patient safety, streamline processes, and foster a culture of excellence within the healthcare organizations they serve.”