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Leadership for Quality and Safety

Leadership for Quality and Safety. David B. Nash, MD, MBA The Dr. Raymond C. and Doris N. Grandon Professor of Medicine and Chairman, Department of Health Policy www.jefferson.edu/dhp. … all hospitals are accountable to the public for their degree of success…

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Leadership for Quality and Safety

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  1. Leadership for Quality and Safety David B. Nash, MD, MBAThe Dr. Raymond C. and Doris N. Grandon Professor of Medicine and Chairman, Department of Health Policy www.jefferson.edu/dhp

  2. … all hospitals are accountable to the public for their degree of success… If the initiative is not taken by the medical profession, it will be taken by the lay public. 1918 Am Coll Surg

  3. Imperatives of the New Century • Accountable for the health status of defined populations • Global Budgets/Targets • Incentives to actively manage clinical care • Incentives to provide a coordinated continuum of care • Incentives for continuous quality improvement • The demand for value

  4. The Seamless Continuum of Care Community Patients Preventionand Wellness Primary Care AcuteCare ChronicCare RehabilitativeCare SupportiveCare • Rehab Units • Physical Occupational Therapy Centers • Recovery Centers • Home Health Centers • Hospices • Home Health Agencies • Hospitals • Nursing Homes • Home Health Agencies • Occupational Health • Wellness Centers • Physician Offices • Physician Groups • Physician Groups • Hospitals • Ambulatory Surgery Centers

  5. Effective Efficient Safe, etc. Greater Market Sensitivity Performance Comparison (Apologies to Tom Lee and Arnie Milstein)

  6. Definition of Quality Institute of Medicine “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

  7. FIGURE 5-1 Making change possible.

  8. Current Rules Care is based primarily on visits Professional autonomy drives variability Professionals control care Information is a record Decision making is based on training and experience Ten CommandmentsCrossing the Quality Chasm New Rules • Care is based on continuous healing relationships • Care is customized according to patient needs and values • The patient is the source of control • Knowledge is shared freely • Decision making is evidence-based Don Berwick 2002

  9. Current Rules “Do no harm” is an individual responsibility Secrecy is necessary The system reacts to needs Cost reduction is sought Preference is given to professional roles over the system Ten Commandments (cont.d) New Rules • Safety is a system property • Transparency is necessary • Needs are anticipated • Waste is continuously decreased • Cooperation among clinicians is a priority Don Berwick 2002

  10. A need for unified governance NoAmerican Quality Improvement Community Certify Performance Measures Implement Performance Measures NCQA AQA, HQA CAHPS NQF JCAHO CMS Plans Multiple Public and Private Sector Stakeholders 100 different P4P Programs PricewaterhouseCoopers Source: Tooker/ACP

  11. Hospital Accountability for Quality External Forces • Leapfrog • CMS, the MMA, the OIG • National programs like Premier • Employer-based Pay for Performance • State-based error reporting

  12. Medical Staff Structure • Anachronistic; referral pattern preservation • Not agile; who is in charge for CPOE? • Limiting privileges needed, not expanding • New drugs and biotechnology products

  13. Needed: Physician Leadership • Home-grown vs. new managerial class • What is the skill set? (ACPE) • Cross Cultural agents

  14. Tools for Physician Leaders • Treatment standards and protocols • Leapfrog criteria • Hospitalist programs • Technology – CPOE, ambulatory EMR • Practice Profiling • Safety culture engineering • External benchmarking

  15. Governance Support for the Leadership Standards • Put quality and safety on every agenda • Ask to see a dashboard of quality and safety indicators • Support investment in system improvements that will improve safety even in light of weak financial ROI • Link executive compensation to quality and safety improvements

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