I entered the healthcare industry in 2002, not long after the landmark quality report To Err is Human was published. During a presentation at the first educational conference I attended, airline captains, the alphas in the cockpit, explained to surgeons, the alphas in the operating room, that it was OK for someone to speak up about an imminent medical error.
“Why would a nurse or other team member put a physician’s ego over a patient’s limb?” I thought. Although I was too new to the working world and the industry to realize it, I had my first exposure to the thorny topic of healthcare quality, and it shaped my career.
A few years later, the push for healthcare quality improvement was in full force. I was tasked with coordinating a project to reduce secondary fragility fractures that improved process measures.
In my next role, I found myself on the front lines of healthcare improvement again, just as it was being put in the hands of clinicians. I led ongoing education efforts around pay-for-performance and maintenance of certification. My eyes were opened to the model of continued professional development and lifelong learning as the path to professional competence.
Six years ago, when I became CEO of the National Association for Healthcare Quality, I discovered that healthcare professionals’ competence was developed on the job because there were no formal training pathways for healthcare quality. And because quality was “everyone’s job,” outcomes varied greatly, introducing risk, waste and compromising improvement in patient care and system performance—all the things healthcare is trying to avoid.
Meanwhile, clinical disciplines were developing their own quality competencies, exacerbating variability in performance. Despite regulatory and compliance requirements at the clinical care delivery level, healthcare didn’t have employer or government requirements for standard training and certification in quality and safety. And it still does not.
How could there not be a clear, articulated educational pathway or competency standard for the healthcare quality profession?
Motivated to be part of this solution, the NAHQ developed and twice validated the industry-standard Healthcare Quality Competency Framework (eight dimensions, 29 competency statements and 486 behaviors stratified across novice, proficient and advanced levels). This work was built on more than 30 years of proven education and training leadership from the NAHQ and its industry-standard certification in healthcare quality, the Certified Professional in Healthcare Quality. The CPHQ is held by more than 12,000 individuals today. More and more employers are preferring or requiring it and healthcare graduate programs are recognizing it for credit.
Increasingly, health systems are implementing the competency standards with great results. Lifespan, the largest system in Rhode Island, trained its workforce and organized its quality efforts using the standards. With the support of the NAHQ and other methodologies, Lifespan saved $12 million in four years and is projecting another $7.4 million. Imagine how much could be saved if others followed their lead.
I’ve seen firsthand the opportunity to align all system employees—executive, clinical, administrative and other staff—on the same quality competencies. If we are to reduce variability in healthcare delivery, a step in that direction would be to first reduce variability in healthcare quality competencies among all industry stakeholders.
There is no silver bullet that will change healthcare. And there are no software solutions, consultant engagements or buzzwordy trends that can replace the need for an ongoing, organizational commitment to workforce readiness to deliver quality and value through healthcare quality competencies.
I’ve seen much progress in improving healthcare in the 20 years since To Err is Human but know we haven’t come far enough or fast enough. It is my sincere hope that when I look back after my next 20 years, that I see a workforce trained and aligned on industry-standard quality competencies that prepare them to provide the uncompromising care and value that patients deserve.