Quality improvement tools and tactics – What’s new from the world’s best

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What are the global leaders in healthcare doing to maintain their cutting edge? How do they continually top benchmarks in clinical indicators and patient experience and stay ahead of competitors?

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With 375 of the 414 Magnet accredited hospitals, 14 of the 19 Malcolm Baldrige quality award winners and 15 of the 17 Honour Roll hospitals as clients, Press Ganey is in a unique position to provide insight into what makes these organisations, such as The Cleveland Clinic and Johns Hopkins Hospital, the best of the best.
The short answer: an unwavering commitment to ensuring the patient is at the centre of all strategy development. Sure, everyone has this mantra on the wall in the hospital foyer, but high performers truly execute patient-centred care. It starts with the CEO as the agent of change and cascades throughout the organisation. Many strategies are employed, but two new tactics are now being embraced by high performers:

1. Benchmarking clinical indicators, not just as a score card, but as a driving factor in improvement, being average is just not acceptable; and


2. Immediate patient feedback and service recovery – before a patient leaves hospital.

Benchmarking of Clinical Indicators
By accessing an international database for examining relationships between nursing and patient outcomes, high performers use NDNQI to deliver evidence to support the importance of investments in nursing strategy. As the leading nursing quality improvement program, NDNQI (managed by Press Ganey) advances the vital efforts of nurses to help achieve higher quality, more coordinated care through a robust international database of 18 nursing-sensitive quality indicators and leading job satisfaction and practice environment RN surveys. The evidence for patient outcomes is overwhelming. Participants in NDNQI have recorded improved patient outcomes:

• 87% reduction in infection rates (over 2 years)


• 59% reduction in hospital acquired pressure ulcer rates (over 2 years)


• 17% reduction in injury falls (over 4 years)

“At a time when the health care industry is moving from volumebased care to value-based care, the ability to understand nursing quality indicators and retain valued nursing staff has never been more critical,” said Christy Dempsey, Chief Nursing Officer at Press Ganey. Nurses are at the forefront of the mission to reduce the adverse impacts of medical treatment and systemic breakdowns in care delivery.
Why do High Performers Utilise NDNQI?
Participating hospitals use NDNQI to measure nursing quality, improve nurse satisfaction and strengthen the nursing work environment. NDNQI features measures to monitor relationships between quality indicators and outcomes. With powerful unit level data, NDNQI assists high performers in action-planning and intervention for specific units needing improvement.
Recognised as a leader in performance improvement for over 30 years, Press Ganey partners with more than 11,500 health care organisations worldwide, (including over 500 in Australia and New Zealand), to create and sustain high-performing organisations. Press Ganey sought feedback from 106 million patients in 2014, data used to focus the development of leading-edge solutions that truly impact on the patient experience. In keeping with this mission Press Ganey acquired NDNQI, the recognised gold standard for nursing quality data and a proven solution that addresses the vital role of nursing in coordinated models of care. Since acquisition in June 2014, the database has increased to over 2,000 hospitals internationally, including 98% of Magnet accredited hospitals and is the largest provider of unit-level clinical performance data to hospitals. High performers continually challenge their own performance and NDNQI facilitates this process.
Participation in NDNQI is as simple as going to: solutions@pressganey.com.au and requesting access to an on-line registration process.
Patient feedback in real time for focused improvement tracking and immediate action
To drive performance, high performers do not wait until negative or sub-standard experiences have occurred to learn from them. They obtain real-time feedback to drive immediate intervention while the patient is still receiving care. This means targeted information — focusing on specific issues in specific areas — to allow for real-time action with specific patient cases, as well as identifying root causes to reduce recurring problems.
Many high performers have chosen Press Ganey’s Point of Care™ solution because it provides healthcare organisations with immediate feedback from patients and their families, empowering staff to action important interventions immediately and address concerns in real time, before it is too late and the patient has left their care.
Press Ganey’s Point of Care™ solution is a significant leap in technology from other systems available in the industry. The unique alerting function electronically notifies the right staff as soon as a negative response to a question item is submitted. For example, if patients don’t understand their medications, pharmacy can be alerted to proactively respond and address medication safety and education for the patient prior to discharge.
Insights from Press Ganey’s Point of Care™ solution complement scientifically robust, post-visit patient experience surveys and broader analyses of the entire patient experience, building upon those for more focused evaluation.
High performers use various forms of performance measurement metrics that they use to monitor the success of their Point of Care™ solution. Developing multiple ways to measure the desired behaviours and utilising a layered approach creates the greatest opportunity to capture a well-rounded picture of their processes.
An example is purposeful patient engagement or rounding, which is a validated best practice for improving the inpatient experience. A consistent approach to measure and monitor patient engagement activities can ensure effectiveness, give patients an expanded voice and allow for service interventions to ensure expectations are met.
Patient Engagement Example: What Gets Measured Gets Done
Managers and/or leaders at high performing facilities visit their units and departments to see how patient care is being delivered and ask patients directly if they are receiving, not just excellent clinical care, but also compassionate, connected care, the real key to improving the patient experience.
High performers also use PG’s Point of Care™ solution to conduct regular audits of care like hand hygiene practices, track measurements and share results with staff so that they can see improvements. Other important metrics they track for validating patient engagement are the number of call lights that are being tracked, number of patient falls and even discharge call processes. They then watch their scores improve as communication is becoming more and more effective.
A key benefit of the Press Ganey Point of Care™ solution is that it is housed in the ‘cloud’, so no special, expensive devices need to be purchased and patients and families can use their own smartphones or tablets to confidentially give feedback without having to go to a single gadget at the nursing station, a kiosk or download any app.
To get more information on the Press Ganey Point of Care solution
contact: solutions@pressganey.com.au or visit www.pressganey.com.au
By Terry Grundy, Managing Director, Press Ganey Australia and New Zealand