New initiative takes positive approach to quality management.

Quality improvement initiatives are being designed to help medical centers improve both their clinical and business outcomes and better serve their communities at the same time.

The greatest strength of these new programs is in their positive approach to quality management, according to UniHealth America senior vice president and chief medical officer Ed Geehr, M.D. "Instead of looking for failures in health care practice and trying to fix them, we're now looking at what is working best, and trying to emulate that."

In simplest terms, Dr. Geehr described the what he calls clinical benchmarking as "a method we've developed to identify who is doing the best work in various clinical areas, understand what it is they are doing to achieve their outcomes, and share that knowledge with the rest of the system."

"It is also important to note that physicians are highly involved with the clinical benchmarking process," Dr. Geehr said. A systemwide committee of physicians known as the Quality Improvement Council works with medical centers and corporate management to promote the exchange of ideas.

The program also gives the quality management process at medical centers a more strategic type of purpose, he adds. "Through this evaluation process, hospital management can better focus their facility's limited resources on the areas of greatest impact. With this approach, a balance of community, payor, and facility priorities can be achieved."

There are several steps in the benchmarking process. In the first, each medical center identifies its areas of strategic focus, based on an analysis of its current performance and a forecast of its future needs. Once they select their strategic focus and related goals, the medical centers work to obtain information about systemwide performance outcomes.

UniHealth America vice president Alberta Pedroja, Ph.D. reviews the clinical performance data from the medical centers, and analyzes it based on several performance indicators: the average length of stay and mortality for routine patient care, readmissions, trends over a two-year period, costs (when such data becomes available), and percentages of both minor and catastrophic illnesses.

Through this ongoing systemwide data evaluation process, UniHealth identifies benchmarks as they occur. If a database reveals a benchmark at one facility corresponds to a strategic interest at another, the staff collaborate with the two medical centers to examine the clinical process of care, and delineate the aspects that have resulted in the best outcomes. The key UniHealth person charged with this responsibility is Nancy Donaldson, R.N., DNSc., who will assist the centers in identifying their Best Practices, and then translate and transfer them from one facility to another.

In the last step of the process, data regarding the outcomes of the selected practices is carefully tracked, analyzed, monitored, risk-adjusted and interpreted by the receiving facility to ensure that the target practice improvements are effective and do in fact achieve outstanding clinical results.

An example of this process is an internal clinical benchmark which has been established for DRG-14 (Stroke) which provided a methodology to shorten lengths of stay without compromising clinical outcomes. During the data evaluation process, it was found that Complexity Of Illness-1 (COI 1) patients who were referred to a psychiatrist within three days of admission had shorter lengths of stay.

A multidisciplinary team of corporate and entity participants was convened to create hypotheses and design data collection methods to validate or refute the developed hypotheses. They concluded that early referral to a psychiatrist resulted in a shortened length of stay and a better clinical outcome.

Once an internal benchmark is validated, the next step is to present the information to colleagues systemwide at a special dissemination event.

At these sessions, an interactive dialogue encourages health care professionals from throughout the system to fully understand the clinical benchmarks. It is then up to each individual facility to decide how, or whether, to locally implement the clinical benchmark.

Another key to making the clinical benchmarking process effective is physician leadership at all levels of the organization. Besides Dr. Geehr, examples of this physician leadership at UniHealth include the heads of the many medical groups within the system as well as Artie Southam, M.D. President and Chief Executive Officer of CareAmerica Health Plans. In addition, a Quality Council of quality assurance and improvement physicians and paid medical directors have been meeting since 1992 to develop clinical quality management leaders within the physician community.

Goals include refining, translating, transferring, implementing selected processes, and quantifying the impact of the initiative on its clinical and cost effectiveness within the UniHealth America system. A key goal for the upcoming year involves expanding the initiative to medical groups. "We are now in the process of developing a set of performance measures that can help us to identify these benchmarks and best practices as well," Dr. Geehr said.

He commented he has been especially pleased with the response to the initiative from physicians. "Many have told me they really like the program's strategy, and find its clinically-based, non-threatening and educational approach refreshing."

Steve Kirk is with the UniHealth America News Bureau.