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April 12, 2024

Potential CMS measure shows divide over quality training standards

Leaders at Kaiser Permanente, Northern California participated in NAHQ’s Workforce Accelerator program to improve their quality competencies and standardize their responsibilities across the health system’s region.

Hospitals may soon be required to provide set quality training to staff as part of a Medicare reporting program, but health systems and advocacy organizations are split on whether the standardization of quality-related skill sets is necessary to improve patient care.

Healthcare workers in quality roles are generally expected to know how to comply with regulatory requirements, improve care outcomes and assess trends in patient safety data.

However, the lack of formal training in care quality has led to gaps in staff experience and different perceptions of their duties. As the Centers for Medicare and Medicaid Services considers a measure to standardize this training, some health systems already require staffers to seek specialized certifications while others keep quality training optional.

Many quality-focused staff positions were created on the fly in response to external mandates and regulatory requirements, so standards and expected skill sets for these positions vary widely from hospital to hospital, said Stephanie Mercado, CEO and executive director of the National Association for Healthcare Quality.

“From the front lines to the board and C-suite, people have been trained differently or not at all in quality and safety,” Mercado said. “But they're all working together to achieve quality and safety. So we have a largely uncoordinated workforce at present.”

Hospitals are increasingly asking quality and safety workers to pursue certifications to solidify their ability to lead care improvement initiatives, said Patricia McGaffigan, vice president of the Institute for Healthcare Improvement.

At Chicago-based Northwestern Memorial HealthCare, for example, every employee receives a $1,000 education budget, which staffers can use to obtain a mandatory Certified Professional in Healthcare Quality certification from NAHQ.

Since the IHI debuted its Certified Professional of Patient Safety program in 2012, more than 5,000 individuals have earned designations, McGaffigan said. The IHI also offers certification through its patient safety executive and chief quality officer professional development programs.

“We don’t want to certify people in things that are not a part of the day-to-day work," McGaffigan said. "They have to be important and frequently used task and knowledge areas.”

Last year, CMS began considering whether to add the Patient Safety Structural Measure to its Hospital Inpatient Quality Reporting Program. If adopted, the measure would require facilities to report whether they are implementing patient safety curriculums for all clinical and non-clinical staff — including C-suite executives and board members — and conducting regular assessments of key quality competencies or skill sets as part of the program.

The American Hospital Association said limiting hospitals to training staffers a single way would be premature, as there is not yet evidence of improved patient outcomes stemming from standardized education.

“There are regulations from CMS that already exist and make it clear that hospitals need to articulate their quality assessment and performance improvement plan and the roles of everybody in their organization in implementing that plan,” said Akin Demehin, senior director of quality and patient safety policy at AHA. “The challenge is figuring out the level of expertise that each person in an organization needs to have in order to deliver high quality and safe care.”

Some systems have found standardized training helpful in getting quality-focused workers on the same page.

Kaiser Permanente of Northern California has tapped into NAHQ’s Workforce Accelerator program — which identifies quality areas where staff are less proficient and offers them educational resources — to ensure the system's quality training is uniform and comprehensive.

Dozens of quality directors, clinical leads, supervisors and managers at Kaiser Permanente of Northern California have participated in the program. Each participant receives on-demand video modules based on their educational needs and attends quarterly check-ins to track progress on their quality competency goals, said Robin Betts, vice president of safety, quality and regulatory services for Kaiser Foundation Health Plan and Hospitals in Northern California. Staffers also take part in group sessions to apply their education to real-life situations involving ethical or safety issues.

Upon joining the program in 2022, the Oakland, California-based health system found its quality-focused workers' performance varied widely in areas like patient safety, process improvement and professional engagement. New 2024 data show the majority of staff working in quality roles are now more knowledgeable about and proficient at all their responsibilities, Betts said.

At the start, only four executives across the health system reported being responsible for population health and care transitions. Two years later, 13 executives who oversee care quality report advanced knowledge of their population health and care transition duties. Likewise, Kaiser Permanente went from 38% of quality and safety workers with a baseline proficiency in data acquisition, analysis and reporting activities to 57%.

But Dr. Brian Stein, chief quality officer at Chicago-based Rush University Medical Center, said standardized quality training is not the best option for every system, as not every facility has the same needs or staff positions

Hiring staffers already skilled in care quality issues, with clinical experience and with data know-how, has been the main focus for Rush and is more important than having a certification, he said. A lot of training for those in quality roles happens on the job at the three-hospital system, he said.

Quality-focused staff can choose to use funding from the health system to seek training and certification courses from organizations like the Institute for Healthcare Improvement based on the demands of their roles, Stein said. However, this professional development isn't mandatory.

Since the health system has quality-focused staff working in so many different spaces, from performance improvement to quality analytics and value-based care, it doesn’t always make sense for everyone to have identical levels of experience or training, Stein said.

“We have a really good tradition of quality, and we've had people stay around for a long time,” he said. “We’re not having rapid turnover in this space.”