Attention to Quality

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Smart Business LA County
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It’s been a decade since the Institute of Medicine sent out shock waves with its report of widespread medical errors in America’s hospitals. While hospitals clamored to start measuring and improving patient quality and safety, MemorialCare Health System had started its journey years earlier by bringing together physicians, nurses and other clinicians to develop best medical practices that have been implemented at each of its hospitals.

To learn more, Smart Business turned to Barry Arbuckle, Ph.D., president and CEO of MemorialCare Health System and past chair of California Hospital Association.

What else triggered the attention to quality?

Quality has never been more important for health care providers. Employers are asking for it. Payers are demanding it. Pay-for-performance is emerging, while physicians are choosing hospitals known for high-quality care. External rating agencies are measuring medical outcomes and sharing results for all to see. Consumers are using the Internet and social networking to research and identify best health care practices. All are demanding information on health care value, quality and safety. And the market is responding with an explosion of information and public reports, and an increase in legislation and regulations.

What role does quality play among health care providers?

Quality and safety must be central to the mission of every health care provider — hospitals, physicians’ offices, home health services, ambulatory facilities and other settings. Scores of quality measures are being implemented. These include rapid response teams that quickly respond to declines in patient conditions, safeguards and quality control measures to reduce medication errors, and checklists to decrease surgical complications and injuries. That is because we know even one preventable death or complication is one too many.

How can health care providers implement quality initiatives?

Well before the Institute of Medicine’s first report, MemorialCare Health System decided to aggressively document our quality through extensive clinical outcome studies. Through teams of doctors, nurses and clinicians coming together from our hospitals, we pioneered and created best practice, evidence-based medicine and clinical guidelines that are able to identify best diagnostic, treatment and preventive techniques. Our teams focus on specific populations of patients or diseases, and develop guidelines that have become the standards of practice at all our Southern California facilities.

What is the result of best practice standards?

Spending many months identifying and implementing optimal clinical standards allows organizations to achieve outcomes that can surpass national and regional benchmarks for most diseases. It can result in extraordinary quality, proven treatments and comprehensive care that continually raise medical standards. An empowered and powerful network of clinicians and support staff work in the best interest of every patient. With bold goals and shared purpose, every health care team member is devoted to aligning safety and quality aims, offering support and continually learning from one another. Quality, safe health care and a passion for excellence remain MemorialCare Health System’s top priorities, keeping us clearly focused during challenging times.

How do electronic medical records fit into the quality mix?

Electronic medical records (EMRs) are critical to patient quality and safety. In earlier columns, we discussed how EMRs place a patient’s full medical history onto computers and information systems, which allows clinicians to better coordinate care through immediate access to secure patient data. This facilitates clinical workflows and handoffs. It also maximizes clinical quality through real-time decision support at points of decision-making and eliminates most paper used in patient documentation and education, since paper slows care and creates environments ripe for error. Efficient care delivery prevents unnecessary orders and diagnostic tests, reduces medical errors and improves patient quality, safety and health. MemorialCare is among the first to implement a fully integrated medical record linking inpatient, outpatient and emergency patient records.

What can employers do to ensure their work force receives highest quality care?

Query physicians and hospitals about their quality initiatives. Do they have best practice teams that collaborate to design and implement best practice tools, offer education and monitor outcomes and opportunities for further improvement? Are clinical outcomes documented and, if so, easily accessible? Have they implemented, or will they be implementing, electronic medical records in inpatient and ambulatory settings that interface with affiliated physicians? How intensive is their focus on supporting a strong culture of patient safety and vigilance? What procedures have they implemented to reduce hospital acquired infections and risk of complications? And what awards and recognition have they received for quality and safety performance?