We are in the midst of a true evolution of how hospitals will approach creating a culture of quality. The drivers for process improvement and management of resources have traditionally been more concerned with full occupancy and risk management, but now many external forces are raising quality improvement as a potential core competency for our nation’s hospitals.
With the push of the Institute for Healthcare Improvement (IHI), Leapfrog, and even Medicare, hospitals now must grapple with a culture change—one in which measurement and reporting of outcomes and processes will become, if not truly job one, at least in the top five. The fact that a hospital’s revenue stream through pay-for-performance (P4P) bonuses and its reputation by public reporting are at stake only serve to create a real immediacy in the coming years.
A recent SHM survey of the leaders of hospital medicine groups (HMGs) has shown that, once again, hospitalists find themselves right smack in the middle of quality improvement.
More than 41% of hospitalist leaders report that their HMG has a quality incentive program. This is even more prevalent at hospitals participating in P4P programs, where 60% of HMGs have quality incentives to align priorities. It is a hallmark of hospitalist groups to place a particular emphasis on the process and system improvement necessary for true measurable quality improvement. Many times, this improvement takes time away from direct and billable patient care.
Pointing to the relatively early stage in the adoption of P4P, this same survey reported that only 29% of HMGs were working in hospitals that participated in P4P programs, while 56% report their hospital did not have any P4P programs in place.
As we enter 2007, it is clear that while a small percentage of hospitals have embraced P4P the majority of hospitals are—at best—on the sidelines or still in planning mode. But those who are active in P4P have engaged their hospitalists to help them meet their goals. And everything that is coming out in the literature commonly read by the hospital C-suite promotes the promise of more reimbursement from the insurance industry and Medicare, leading to the conclusion that P4P and rewarding performance will increase in the near term.
What Can SHM Do for You?
Positioning hospitalists to play a key role in quality improvement, SHM has launched a number of initiatives and partnerships to provide hospitalists with the tools they need to help their hospitals to succeed.
As a framework of tools, SHM has now built six Web-based Quality Improvement Resource Rooms in VTE, Heart Failure, Stroke, Glycemic Control, Care Transitions in the Elderly, and Antibiotic Resistance. These practical tools and references are now available on the SHM Web site (www.hospitalmedicine.org) as are, in many cases, a comprehensive workbook that helps hospitalists to be the leaders of quality improvement change at their hospitals.
SHM realizes that, while this approach may work for the savvy, experienced quality improvement (QI) implementer, most young hospitalist leaders need a more personal, hands-on approach. With this in mind, SHM has launched its Mentored QI Implementation project. Centered around VTE prevention and supported by funding from Sanofi-Aventis, two senior hospitalist mentors will each work with 15 HMG leaders to take them step by step through the process of implementing a quality improvement process in 2007 and 2008.
To take this hands-on, supportive approach to the next level SHM (with support from a Kettering Foundation grant) will add the capability for on-site consultation—sort of a QI SWAT team that can show up at your hospital and work shoulder to shoulder with hospitalists and other members of the healthcare team to develop and implement processes that will improve patient care.