Ambitious clinical quality goals set
Leaders at Vanderbilt University Medical Center recently set long-term clinical quality goals for the institution. This added push for systematic quality improvement is a component of elevate, the wide-ranging VUMC improvement effort that started last November.
Leaders have settled on three major quality goals:
• reduce preventable deaths to the lowest rate in the nation
• eliminate medication errors
• perform in the top 10 percent of the nation on publicly reported quality measures.
Each of the goals is a three-year target that will translate into a series of intermediate targets. Compensation for approximately 350 VUMC clinical leaders will depend in part on how well various areas of the Medical Center do in meeting the goals, said Harry R. Jacobson, M.D., vice chancellor for Health Affairs. The program to evaluate and eventually compensate these leaders according to achievement of quality targets gets under way in July.
“We have the world's most innovative clinical information systems, a deep roster of quality and safety experts and an outstanding faculty and staff, so we fortunately already have in place the elements that would be needed for a broad-based demonstration of quality improvement that could serve as an example for the nation,” Jacobson said. “It's time to see exactly what quality gains can be accomplished when a new level of analysis and the utmost coordination and communication are applied in the design of clinical systems throughout our medical center.”
The goal of eliminating medication errors has raised a few eyebrows, said F. Andrew Gaffney, M.D., chief quality and patient safety officer.
“It sounds like a tall order, but it's been shown that the best results come from designing systems to produce zero faults or as close as possible to zero,” Gaffney said. “It's not about telling people to work harder. We'll reorganize our medication process from start to finish until we've made it as reliable as we absolutely can.”
To track progress in reducing preventable deaths, Vanderbilt will use data from University HealthSystem Consortium, which provides comparative data on almost all of the academic medical centers in the country, said John Bingham, director of the Center for Clinical Improvement. Gaffney and Bingham said there is as yet no definitive method for measuring medication errors.
Vanderbilt clinical teams also will focus on scores of quality measures reported to the public by CMS (Centers for Medicare and Medicaid Services), JCAHO (Joint Commission on Accreditation of Healthcare Organizations) and the Leapfrog Group for Patient Safety, a coalition of some of the nation's largest employers.
While most of the public measures have to do with standards of treatment, there are also some outcome measures in the set. They include pregnancy outcomes, surgical site infection rates, and standards of treatment for heart attack, congestive heart failure and pneumonia. There is also Leapfrog's 30-item list of safe practices, including things like computerized physician order entry, prevention of wrong-site/wrong-patient procedures, verbal order read-back, hand hygiene and use of standardized abbreviations and dose designations.
“None of our other clients is approaching quality improvement with anything as bold and thorough as the effort we're seeing at Vanderbilt,” said Kathy Matney, a coach with the Studer Group, the consulting firm engaged to assist elevate.
“Reaching a clear agreement about quality goals was an important step,” Gaffney said. “Now the requirement is to understand all the processes that affect these quality measures. For the most part, we know what needs to be done. The challenge comes in executing the necessary changes and making them stick.”