Healthcare quality is foundational to achieving the overarching goals of every care provider: improving population health, enhancing patient experiences, controlling costs, and more. Yet we are not where we need to be – and sustainably achieving quality and safety goals continues to be just outside of our reach. Why?
New research from the National Association for Healthcare Quality reveals that people working in healthcare define quality very differently from one another. They use a range of terms like compliance, utilization management, safety, equity, population health, value. When stakeholders see quality differently and see each effort to advance quality as separate and distinct, it’s no wonder we are not further along in this quest for quality.
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Why the disconnect? Quality evolved organically over the years without a clear standard. This has led to where we are today, where five generations of people work in a wide range of quality roles, from the quality department to the front lines to the C-suite. They are trained differently – or not at all – in quality and safety, yet they are expected to work together toward shared goals.
Here lies the problem – and the opportunity. The time has come to reject the notion that quality can be homegrown. It’s time for leaders to become aware of and solve for this disconnect by aligning their workforce toward a quality and safety competency standard.
Why change is urgent
The healthcare industry is experiencing an existential threat today that cannot be overstated. Challenges are increasing in scope and size; NAHQ’s research reveals that we are facing a convergence of three major issues.
Care: Ensuring patient care is reliably safe is not improving enough. According to the 2022 Health and Human Services Office of the Inspector General report on adverse events in Hospitals, one in four Medicare patients admitted to hospitals experience an adverse event, and 43% of harm events are preventable.
And that is just in acute care settings, which are reasonably well contained. As healthcare delivery becomes more complex with new primary care models and Medicare Advantage models bringing care to additional settings, it will be more challenging to achieve consistent, high-quality care.
Cost: Healthcare costs are escalating unsustainably. Until now, one of the main “solves” for this has been to try to do more with less. But the sharply increasing influx of Medicare beneficiaries who will require care over next two decades will challenge this strategy greatly.
The workforce cliff: The healthcare industry is already facing workforce shortages. What’s coming is exponentially more precipitous.
Today in the U.S., we have seven working-age people for every retired person. In 15 years, it’s estimated the ratio will be four to one – a reduction of roughly half. The drop will hit the healthcare industry especially hard because, along with the shrinking workforce, the number of seniors is ballooning.
Imagine this situation playing out in our already stressed health systems? When care, cost and cliff converge, then what?
How quality is achieved
Addressing today’s challenges is hard. Tomorrow will be harder. Unification toward a shared vision for quality and safety and alignment to an industry standard is imperative.
For most areas of healthcare, self-regulation is the hallmark. Successful models exist, such as The American Nurses Association Scope and Standards of Practice and the rigorous standards of the American Board of Medical Specialties. These provide a framework for clinical success and ensure that everyone knows what is within each profession and each specialty’s scope of practice expectations.
Surprisingly, until 2018, the same type of standards for healthcare quality did not exist. In order to establish universal standards, NAHQ spearheaded creation of the Healthcare Quality Competency Framework. The framework was developed over a 10-month period by an oversight committee guiding six work teams and then validated twice in the field with 1500 healthcare quality professionals and leaders.
The goal now needs to be broad implementation of that standard. Early adopters are leading the way on this and have already embraced the competency framework with successful results.
Kaiser Permanente Northern California committed to evaluating their quality leaders and teams with the framework, redefined quality roles and then deployed upskilling and reskilling plans to fill gaps. The results were an increase in performance levels across all participants.
Lifespan in Rhode Island committed to educating nurses, physicians and frontline staff on the significance of safety and quality processes. After implementing standardized training to more than 10,000 employees, Lifespan saw positive advancement on all measured areas within their Culture of Safety survey and, for the first time in six years, the system received no hospital-acquired conditions’ penalties, providing $1million of cost savings.
These examples, and many others, serve as effective models for how to build coordinated, competent workforces at a system-wide level, based on industry-standard competencies for quality. And we’ve only just begun. The pressures of care, cost and workforce cliff are mounting; sustainable solutions are urgently needed. It’s time for the healthcare industry to uniformly adopt a national competency standard and systematically advance quality and advance healthcare. And we must do it now.
Stephanie Mercado is CEO of the National Association for Healthcare Quality.
