What Premier’s QUEST Is Getting Exactly Right—and What It Means for Everyone

June 24, 2013
It was refreshing and encouraging to hear leaders from organizations that aren’t yet famous for their pioneering quality improvement work talk about how they had made dramatic strides in patient safety, care quality, cost-effectiveness, and efficiency. And their testimony only adds to the growing evidence that the quality revolution in healthcare is eminently doable—for everyone.

The testimony of executives from organizations not yet famous for their groundbreaking quality work adds to the evidence that the quality revolution is eminently doable—for everyone

Listening to Thomas Macaluso, M.D. and Tamera Parsons share their perspectives around their organizations’ participation in the QUEST program on March 19 at the Premier healthcare alliance offices in Washington, D.C., during a press briefing highlighting the results of five years of QUEST work, it was clear to me that this kind of work is exactly what every patient care organization in the U.S. needs to be doing right now in some form.

Macaluso, chief quality officer at Memorial Healthcare System of South Broward, based in Hollywood, Florida, and Parsons, vice president of quality and patient safety at the Johnson City, Tennessee-based Mountain States Health Alliance of Northeast Tennessee and Southwest Virginia, both come from organizations whose senior leadership cadres have absolutely embraced mission- and vision-driven continuous clinical performance improvement, and their commitment shows. Both executives were able to speak with great authority—and enthusiasm—about the improvements they’ve made in a variety of areas since their organizations became involved in the Charlotte-based Premier’s QUEST program, which now encompasses 33 hospital-based organizations nationwide. In particular, Dr. Macaluso spoke about his organization’s congestive heart failure readmissions reduction project, while Parsons spoke at length about her 11-hospital system’s work on reducing sepsis-based mortality.

As Macaluso explained it, “The project” at Memorial Healthcare System “began with an opportunity to identify different categories of strategies to help reduce avoidable CHF readmissions.” After considerable strategizing, and roll-up-their-sleeves work, he and his colleagues have been able to report that their system’s flagship hospital has reduced its avoidable readmissions rate for CHF from 36 to 23 percent. Meanwhile, Parsons was able to explain in detail the complex, but absolutely essential, series of steps that she and her colleagues at Mountain States have taken in order to seriously pursue mortality rate reduction, particularly around sepsis-related mortality.

What’s more, both agreed, leveraging health IT is an absolutely essential element in such clinical performance improvement work, through all phases, from the initial analytics-driven assessment of specific problems, to targeting specific processes, to working with individual clinicians and clinical teams to make changes, to further analyzing the results of such efforts—in brief, the “blessed cycle” of performance improvement work. And of course, their accomplishments to date are part of a much broader set of achievements among all the QUEST-participating hospitals nationwide.

In any case, what particularly impressed me about all this is that Macaluso and Parsons come, not from the dozen-ish most famous quality pioneer organizations around the country—we all know the names that get repeated over and over—but from organizations that are not yet well-known for their intensive improvement efforts. They also come from organizations with relatively average financial resources, rather than from among the most resource-endowed patient care organizations nationwide.

To me, this is yet more reinforcement for the truth—which only recently has begun to be fully appreciated and accepted—that every patient care organization in this country can in fact achieve dramatic, and sustained gains in clinical performance, and can significantly improve its patient safety, care quality, efficiency, cost-effectiveness, transparency, and patient experience.

But to do so, the leaders of patient care organizations nationwide will need the following core elements. First, they will need a senior executive and clinical leadership—both at the c-suite level and at the board of directors level—that is absolutely committed to moving forward, regardless of the obstacles and challenges. Second, they will need smart strategies, and in some cases, that will mean working with outside consultants; in any case, it will mean bringing together leaders within their organizations from every pertinent clinical discipline and operational sphere; failure to do so has been one of the major factors (along with lack of sustained senior executive support) in the failure or downsizing of such initiatives in the 1990s and early 2000s. Third, they will need to seriously and intelligently invest not only in enterprise-wide electronic health records and clinical information systems, but also in the most leading-edge analytics, business intelligence, data warehousing, and health information exchange capabilities available. Lack of such IS tools has been another contributing factor to failure of such initiatives in the recent past. Fourth, they will need to benchmark their efforts and results with other organizations around the country—thus the relevance of collaborative efforts like Premier’s. And fifth and most challenging, they will need to initiative a cultural revolution.

And of course, for many in healthcare, cultural revolution is the scariest of all those propositions. But without it, these kinds of efforts are doomed to fail, because they require energy to be sustained over long periods of time in order to maintain and continually improve on the kinds of results that the folks at Memorial Healthcare System and Mountain States have achieved.

But if there’s anything that the Premier executives and member organization leaders have shown through QUEST (as they did in the earlier CMS/Premier HQID project, which ultimately became the template for the new Medicare value-based purchasing program under healthcare reform), it’s that revolutionary change is in no way limited to those dozen-ish most famous hospitals and health systems whose names everyone knows. Indeed, Keith Figlioli, senior vice president of healthcare informatics at Premier, Richard Bankowitz, M.D., chief medical officer at Premier, and several others, will be discussing some of the QUEST achievements when they speak on a panel at the Healthcare Informatics Executive Summit in San Francisco next month. In short, there’s nothing magic about what those organizations are doing; and in fact, every patient care organization can participate in this revolution. So if there’s a single lesson I took away from the QUEST press briefing of last month, it’s that now is the time to make a move on all this—seriously, what’s stopping you?

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