2000 Salary Survey Results - Quality specialists blend craft with technical skills
2000 Salary Survey Results - Quality specialists blend craft with technical skills
While 50% of QI/TQM readers are either quality improvement managers or directors, according to feedback from the 2000 QI/TQM salary survey, their responsibilities are all over the place.
Judy Homa-Lowry, RN, MS, CPHQ, notes that some QI specialists oversee quality of care and service exclusively. Others are responsible for accreditation as well as quality. Some oversee case management, accreditation, and quality. Homa-Lowry is president of Homa-Lowry Healthcare Consulting in Canton, MI, and a member of the QI/TQM editorial advisory board.
Judging from repondents' credentials, they come well prepared for the work: 55% of respondents have clinical degrees, 25% have MBAs, and 100% have the CPHQ or a similar certification. But when they took their jobs, did anybody tell them that they would also have to play snoop and diplomat?
Perhaps those responding to the survey have discovered by now that they have got to be a busybody, like the neighbor who knows everybody else's business. But unlike that big-mouthed neighbor, quality specialists need to handle secrets with the finesse of a diplomat — or their access to inside information will disappear during a lunch break.
And more than anyone in the organization, quality specialists' duties require that they keep one eye on the patient outcomes data and the other on regulatory changes and compliance. Then they have to see that all those feed into the bedside care and support services. Easier said than done.
"The challenge is in looking at quality through the continuum and designing coherent processes through the organization," says Homa-Lowry. If a standard calls for interdisciplinary input, is the input coordinated into the totality of care from inpatient to outpatient?
If the organization fails to provide interpreters for non-English speaking patients, the institution is in a potentially liable position.
If the interpreters have large blocks of time in which they're not engaged with patients, however, the resources go to waste.
If the forms and checklists for advance directives are in place while patients endure unwanted treatment, or un-remitting pain, then haven't professionals missed the point of compliance?
Few of respondents' co-workers will freely hand them the data they need to accomplish such a tight degree of coordination. Either they don't have them or they can't figure out why anyone would need them.
"The communication channels for sharing data are as much a problem in big organizations as in small ones," says Homa-Lowry. A system of two or three hospitals and affiliated outpatient clinics might have disjointed communication among the components.
Snoop around
Small organizations tend to rely on word of mouth. So it's up to the quality specialist to go snooping and find out whether the information is in pharmacy or in utilization review.
The next challenge is to win access to the data from, for instance, the compliance, risk management, case management, or utilization management staff. "These are not always marriages made in heaven," Homa-Lowry observes. So here we go, back to diplomacy.
Never make a request empty-handed. Always bring a gift. It's not that hard to learn the interests and problems of departments you deal with. Invite them to help you find ways to reward them for extra data collection or reports. It's diplomacy, remember?
Homa-Lowry says that quality specialists also need basic skills in data analysis and information systems. Do you understand how to analyze processes at the departmental level and determine how they feed into the continuum of care? An initiative to reduce wait times in the emergency room, for example, probably involves changes in the radiology department and the lab.
Staying in the loop
Here's what we meant about being a busybody. "Quality managers should make sure there's a sharing of information among the risk management, case management, and compliance people," Homa-Lowry asserts.
With wide-ranging access to people and information throughout the system, she says, quality specialists are positioned to help providers design processes that comply with the standards of state and federal agencies, as well as those of the Joint Commission on Accreditation of Healthcare Organizations.
While it may appear that the regulations are based on bureaucratic whim, they usually represent a broad attempt to address a patient care outcome. "As quality professionals, we have to interpret the regulators' intentions to our co-workers. We have to show them how to put it all together — the forms and the checklists — and turn it into good hands-on care." It's a tough job, Homa-Lowry says.
Measuring the right data
Sometimes clinicians wonder why their outcomes don't improve even when they are in compliance with the regulations. Sometimes, they don't know what's important to measure. They measure the wrong things then wonder why compliance doesn't add up to better patient outcomes.
Checklists and forms are empty exercises unless they drive lower error rates and wait times and value for the dollar. "We have to integrate regulatory requirements and shape them into patient care processes and outcomes. Often times, when people see that a new approach isn't working, the tendency is to change everything," she says. This is where you can save resources by rescuing a slightly off-target solution from the scrap pile. "A good quality specialist will say, 'let's just try one little adjustment to see if that makes a difference first.'"
Never has the task of coordinating standards been so boggling. Eighty percent of those responding report they have been in this industry anywhere from 16 years to a quarter century or more.
In that time, the job of coordinating accreditation standards has become huge, observes Patrice Spath, consultant in health care quality and resource management with Brown-Spath & Associates in Forest Grove, OR. QI people are tracking new regulations from the federal agencies, their own states, and standards from the Joint Com-mission, she notes.
"How to keep track of these is a major challenge of the job!" she adds.
It could easily be a full-time responsibility in itself. Some of the respondents to this year's salary survey who work in large organizations oversee the staff that perform that job. Even if quality professionals have dedicated keepers of the standards, however, the standards by nature are a trap, baited and set: Mere compliance is a resource drain that some institutions can hardly manage. They're like the proverbial senior citizen who has to choose between food and medicine.
Not enough time or staff
There's barely enough time and staff to fulfill the prescriptive requirements, let alone time to blend compliance into better outcomes.
"Even in big organizations, sometimes we assume that a regulatory form will equal compliance. But how do we translate the regulation into hands-on patient care? How do we know what's important to measure?" asks Homa-Lowry.
This is where your blend of professional arts and skills comes into play. As quality professionals develop their roles within the organization, they will have the trust of people who will share the departmental problems that undermine better outcomes. It's the quality professional's key to the changes that will actually tie compliance activities to outcome improvements.
(Editor's note: In future issues of QI/TQM, we'll feature articles on how to manage the vast quantity of compliance information that affects QI initiatives and measures your organization.)
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.