Reports From the Field

Making Quality Real for Physicians

Journal of Clinical Outcomes Management. 2017 May;24(5)

References

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With accurate reports in place, we leverage all staff levels, from practice assistants to clinicians, whenever possible to improve by evaluating the performance data and setting goals. We use plan-do-study-act (PDSA) cycles to iterate performance improvement plans and tailor our efforts to the unique staffing levels and patient populations of each division [14,15]. For example, we have worked for years on improving blood pressure control among chronic kidney disease patients in our renal division. Initially, our first PDSA cycle involved mostly education and data sharing. When improvements were not seen, we did another PDSA cycle adding a brief form for physicians to fill out in the clinic for patients who had at least 3 blood pressure measurements that were not at goal. The sheet clearly displayed the 3 elevated blood pressures and asked the provider to note that day’s blood pressure as well as if the medication was adjusted or if the patient is not taking the medication(s) prescribed. Data from these worksheets informed efforts to focus on non–office-based blood pressure measurements [16]. Through a grant the renal division was able to give free blood pressure cuffs to patients for at-home monitoring.

In an effort to improve influenza and pneumococcal vaccination rates, we worked closely with front-line clinicians and staff to create improvement strategies tailored to the patient population and clinic staffing structure in 4 divisions: allergy (order and document flu vaccinations for asthma patients), rheumatology (point-of-care standing pneumococcal paper-orders for immunosuppressed patients), infectious diseases (a nurse-driven influenza protocol was implemented for HIV patients), and pulmonary (letters sent to chronic lung disease patients asking them to bring documentation of prior pneumococcal vaccination to their next visit). We saw increases in vaccination rates across all 4 divisions using varied approaches to reach our goals [17].

Meaningful Use

Our team was responsible for ensuring that the DOM succeeded in the federal government’s MU program. Millions of dollars were at risk to the hospital and to physicians based on performance on various MU metrics. The hospital made this a priority and set a goal for 90% of eligible providers to successfully certify in Stage 1 as meaningful users in the first year of MU.

To meet MU requirements, we categorized metrics by those requiring physician effort and those relying on clinic staff effort. We worked with division and departmental leadership to develop and implement an approach to improve performance on each metric. Monthly emails were sent with the current performance data, explanations of low-performing metrics, and actions to take for improvement ( Figure 2 ). This information was reinforced at faculty presentations.

While working with the clinics to achieve meaningful use, we recognized that a range of staff members played a critical role in helping physicians meet MU metric targets. We worked with the clinic and departmental administrative leadership to set up a one-time bonus payment in 2013 to all DOM clinic staff, including medical assistants, licensed practical nurses, practice assistants, for appreciation of their significant efforts to help the physicians and the hospital achieve their MU goals. As health care delivery continues to rely more heavily on highly functional teams, acknowledgment of the efforts of non-clinical staff in helping front-line clinicians in achieving MU can help promote teamwork around a common goal.