Simple measures result in big quality improvements

Staff reminders, report cards are effective

When it comes to improving quality, sometimes the simplest and least expensive measures work best, reports Earl Kurashige, RN, project manager for Qualis Health, a nonprofit health care quality improvement organization based in Seattle.

Simple tools such as chart stickers and reminders can make a big difference in helping hospitals meet the Centers for Medicare & Medicaid Services (CMS) and the Joint Commission on Accreditation of Healthcare Organizations’ quality indicators, he notes.

"We suggest simple reminders to prompt hospital staff to start paying attention to certain issues so that topic can be discussed with the patient," says Kurashige.

Qualis holds regional meetings with participating hospitals in the state of Washington and asks them to share their methods for successfully improving quality.

Sometimes driving improvement for a certain measure may be as simple as a sticker on the chart reminding the physician to write a prescription for an ACE inhibitor.

"Stickers that go on the chart are a very inexpensive way of reminding the staff of the quality initiatives. The staff who take care of the patients are very busy and have a lot of work to do. They may forget to do certain things, like cover smoking cessation with patients who need it. These reminders are simple, inexpensive, and effective," Kurashige says.

Qualis supplies hospital staff attending the conferences with pre-printed chart stickers that contain reminders for smoking cessation, mammograms, and immunizations and encourages the hospitals to print their own to remind staff of quality measures they are tracking.

"The stickers are very inexpensive. They can be printed for any quality initiative," he explains.

Hospitals that belong to VHA Inc., an Irving, TX-based health care cooperative, share order sets, patient educational materials, clinical pathways, and other processes used to improve quality, says Carolyn Scott, director of collaborative services and CEO work groups for clinical excellence at VHA.

"Most organizations have something they do really well, and we help them share their methods with each other," she says.

Developing standardized order sets goes a long way toward process improvement by ensuring that the quality indicators are met, Scott explains.

"It’s not that the physicians don’t know how to write an order, but it’s a lot easier when they just check the boxes or draw a line through what they want or don’t want done," she adds.

Here are some other tips from Scott and Kurashige on simple ways to improve quality:

  • Post data on the unit.

Scott suggests posting information such as the time it took to get a heart attack patient to the cardiac catheterization lab or on thrombolytic therapy.

"If you can posts those numbers in the cath labs or emergency departments [ED], that helps drive improvement. It sets the bar within your own organization," she says.

By following this suggestion, many hospitals have been able to reduce the time it takes to get patients to the cardiac catheterization lab, Scott explains.

"By merely posting the data, an awareness of the process is created. The ED and cath teams then begin to work on improving the times to these important, life-saving interventions," she says.

The strategy works in other areas of the hospital where you’re trying to improve a process, Scott adds. The posted information should show where the hospital is with regard to meeting the quality indicators and where it wants to be.

"Many studies show that posting the results is one of the most effective ways to drive improvement. Once the staff realize it is an issue, they can analyze where the problems are and bring all the departments involved together to strategize how to fix the problem," she says.

  • Issue reminder cards to physicians and nurses.

Qualis prints out reminder cards for physicians and nurses about the importance of the quality indicators and the steps they should take.

The laminated cards fit easily in a pocket and outline the quality indicators with a description of why it’s important to comply with them.

  • Issue physician report cards.

Physicians respond well to hard-and-fast data, Scott points out.

"Physician report cards are an effective way to drive improvement. When you can show them their data and be able to back up the data, it’s very effective," she says.

  • Celebrate success when you meet your goal.

"When the staff have done something well and improved a process, you should celebrate it. This will let those involved know that their efforts are recognized and valued. It helps with sustaining the momentum in the improvement activities," Scott says.