Quality Improvement Initiative to Reduce Clinical Variations

Subject: Nursing
Pages: 6
Words: 1672
Reading time:
7 min
Study level: Master

Summary

Healthcare facilities should eliminate clinical variations to ensure their patients receive the highest quality and safest health services. Reducing clinical variations also helps to reduce the cost of care on a national and organizational level. Unfortunately, clinical variations permeate various healthcare facilities. Clinical variations refer to the excessive use, minimal use, different use, or wastage of health care resources, services, and practices (McSweeney et al., 2020). Clinical variations have resulted in American healthcare being the most expensive in the world. According to research conducted in 2016 by the Institute for Healthcare Improvement, the expenditure by the healthcare sector accounts for 17.1 percent of the total national GDP (McSweeney et al., 2020). These figures were expected to rise to 20 percent by 2020. The need to reduce the cost of delivering health care gives rise to the need to contain clinical variations.

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For health care facilities to reduce clinical variations, they need to aim at offering the right care using the right or uniform procedure at a particular time. Broadly, health care professionals should set a uniform order of sets and clinical guidelines for certain procedures (McSweeney et al., 2020). Additionally, they should focus on reducing the number of tests and procedures involved in treating a particular illness (Vachon et al., 2015). Whenever possible, health care professionals should eliminate the gaps in care to deliver the right interdisciplinary care.

Moreover, health care professionals should look into other factors at an individual hospital level that raises the need to redesign the current healthcare systems. Some of the factors that should be eliminated include increasing the acceptance of a bundled payment. Also, hospitals should enable their patients’ easy access to Medicare services and reauthorization of the CHIP Act of 2015 (Becker’s Hospital Review, 2016). Other cost-saving initiatives that a health care facility can adopt include the readmission reduction program for 30 days and other programs offered by the CMS that aims at improving quality.

The results of the reduction of clinical variations have a lot of benefits to a clinical setting. The benefits include increased profitability, optimization of the staff members, reduction of operation costs, and improved engagement among physicians (Vachon et al., 2015). The most significant benefit is the improvement of the quality and safety of health services.

The QI Initiative to Reduce Clinical Variations

Health care facilities should reduce clinical variations for the clinical and financial benefits tied to the practice. The practice can be initiated by two drivers who are; shifting from the reimbursement that is based on fee-for-service to adapting the ones based on value. In addition, hospitals need to improve clinical outcomes, this can be achieved by reducing complications and hospital re-admissions (Wachman et al., 2018). This paper analyses an initiative by Unitypoint Health, a health care facility that serves western Illinois and southern Wisconsin that aims at reducing clinical variations.

Unitypoint Health is a health care facility that serves western Illinois and southern Wisconsin through its various branches. It is recognized as the thirteenth largest non-profit health organization and the fourth largest non-denominational health care facility in America (Health Catalyst, 2018). The leaders of the organization established the need to adopt an initiative that would help them reduce the cost of health care as well as increase the quality of care offered. However, they emphasized the need to recognize the strengths and weaknesses of their organization for successful implementation of the change. The organization adopted an initiative to elevate its readiness standards and change competencies as a way of reducing clinical variations.

While in search of the most effective practice, Unitypoint leadership identified the need to evaluate the strength and weaknesses of the organization before implementing change. The result of the evaluation indicated that the organization had a deficit in analytics, adoption, and best practice. Health Catalyst (2018) notes that after the evaluation of the findings, the Unitypoint Health team was able to set certain policies and design a plan to support the staff working towards improving outcomes.

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The healthcare facility implemented a policy that allowed expanded access to data that is drilled down to the regional level using analytics applications. The applications collected credible data from single sources which made it useful and accurate for the stakeholders to trust (Health Catalyst, 2018). Further, Unitypoint Health increases analytics capabilities by developing data sources, visualizations, and analyses that would help them assess and monitor priorities (Wachman et al., 2018). The increased analytics capabilities would also help them evaluate the progress and outcomes of the data. The initiative helped the organization identify the areas that were poorly performed to intervene appropriately. Also, it increased the use of operational leaders and improvement teams enabled them to achieve success.

Consequently, Unitypoint Health leaders recognized the need to create awareness of their decisions. This would help them to gain understanding and support in future projects. This action would help improve the adoption of the projects by leaders and various stakeholders (Health Catalyst, 2018). They planned to communicate the crucial decisions, the progress of various initiatives, and accomplishments in the organization. The organization further provided views by leveraging the drilled-down analytic application to offer valuable information to all stakeholders. The facility also emphasized the need to establish support for clinical and operational initiatives.

The clinicians in the organization increase their efforts in cleaning up and reviewing order sets and aligning workflow and optimizing EMR. At this phase, it was important to ensure the clinical teams were not overloaded with work by monitoring their engagement in workgroup teams (Health Catalyst, 2018). The assessment was done by a mid-tier workgroup team. In addition, the team would provide a list of projects to leaders with the hope that they would be implemented successfully to improve the quality of health care in the facility. Being aware of their goal to reduce variation, the leaders aimed at improving outcomes quickly and effectively. Resultantly, it would improve competence in best practices.

Evaluating the Success of the QI Initiative

Following the implementation of the QI initiative in Unitypoint Health, the organization targeted to improve practices for CAD/AMI diabetes, septicemia, and COPD. The organization prioritized each domain and created a relevant team. Health Catalyst (2018) noted that the team consisted of a change management agent and an expert in the clinical subject. However, some individuals who were equipped with the required skills played both roles. An analyst and a processes engineer were added to the team to create or maintain the analyst application, conduct the analysis, present the results, and measure the process. The team worked closely to improve measurement and reporting, clinical communication, and analysis.

Before the initiation of the projects, the teams were offered time to consider the multi-layered facets of the project. This would help them save time and increase their chances for successful execution (Health Catalyst, 2018). Moreover, the team spent more time planning based on the strength they were likely to face and the weaknesses they expected to create barriers that were perceived from the OIRA tool framework. The tool provided clear visibility at the departmental level. The team assumed slower processes at the initiation stage to help them avoid any foreseeable barriers or plan on how to overcome them throughout the process.

The improvement change leaders were committed to using the framework of competence and readiness and the information. The team spirit resulted in a shared framework that enabled teams to experience the benefits of analytics, leadership, and best practice (Wachman et al., 2018). The teams experienced progress in all three areas where leadership and analytics drive the best practice. The organization learned how the pieces fitted together and successful completion of the prioritized clinical domains.

Unitypoint Health selected various stakeholders for an on-site assessment to represent people from leadership, analysts, nurses, physicians, and other relevant stakeholders. The participants were ready and willing to participate in the assessment. They were all excited to participate as they were sure the information would be useful to the organization. To ensure adequate representation and opinions, 40 participants from various clinical and leadership departments engaged in the assessment. Among the participants, 20 were clinical staff, 12 were from the leadership department, and 8 served as the front-line or IT staff in the organizations.

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The participants provided various insights and outcomes of the quality improvement initiative. The participants from the leadership department confirmed that the facility was able to save an average of $1.75 million within six months of deployment of the initiative. The significant cause of the reduction of the cost was the introduction of der sets, sepsis alerts, and other clinical-based decision support tools (Health Catalyst, 2018). Also, they noted that a reduction in the length of patients’ hospital stays offered them an earlier discharge. This allowed them to spend more than 1000 nights in their homes as compared to earlier.

The clinical department participant was also excited about the initiative as they had experienced an improvement in their practice. They recorded that millions of clicks had been eliminated or reduced from their practice due to the deployment of new tools for sepsis screening (Health Catalyst, 2018). They also noticed an increase in sepsis screening by 36 percent in the ED within six months of deployment. There was the utilization of the sepsis order set in the ED by more than 185 percent. In other departments, some noticeable changes were an increase in placement in cardiac stents by 10 percent that occurred using the radical approach.

Recommendation of Additional Indicators and Protocols

I would recommend the application of Key Process Analysis (KPA) in Unitypoint Heath. The application would help deliver various insights into the size of health care processes provided, the variations that exist in the processes, and the impact that would result from their improvement (McSweeney et al., 2020). The healthcare facility would also identify significant opportunities for improvement throughout the year. However, the opportunities should be in line with the organization’s strategy (Becker’s Hospital Review, 2016). Also, the priorities should be identified by the leaders of the clinical and operational departments.

References

Becker’s Hospital Review (2016). What clinical variation means to a hospital’s bottom line: 4 insights from the C-suite. Web.

Health Catalyst, 2018. Boosting Readiness and Change Competencies Key to Successfully Reducing Clinical Variation. Leadership, Culture & Governance and Quality & Process Improvements. Web.

McSweeney, M. E., Meleedy-Rey, P., Kerr, J., Yuen, J. C., Fournier, G., Norris, K.,… & Rosen, R. (2020). A quality improvement initiative to reduce gastrostomy tube placement in aspirating patients. Pediatrics, 145(2). Web.

Vachon, B., Désorcy, B., Gaboury, I., Camirand, M., Rodrigue, J., Quesnel, L., & Grimshaw, J. (2015). Combining administrative data feedback, reflection and action planning to engage primary care professionals in quality improvement: a qualitative assessment of short-term program outcomes. BMC health services research, 15(1), 1-8.

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Wachman, E. M., Grossman, M., Schiff, D. M., Philipp, B. L., Minear, S., Hutton, E., & Whalen, B. L. (2018). Quality improvement initiative to improve inpatient outcomes for neonatal abstinence syndrome. Journal of Perinatology, 38(8), 1114-1122.