Quality and Excellence in Healthcare: Best Practices

Quality and Excellence in Healthcare: Best Practices

Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

April 30, 2014

Private Hospitals Association of the Philippines, Inc.

Greetings and Salutations

Thank you, (Name of Introducer), for the kind introduction which I am confident will build a bridge between the audience and yours truly, thereby facilitating the communication processes that go with my talk.

Greetings! (Good morning!)

Before anything else, I like to thank the organizers of the Private Hospitals Association of the Philippines for inviting me to be one of the speakers in this Mindanao Regional Management Seminar.  I consider the invitation an honor and a privilege.  Thank you.

Introduction

I was asked to give a 30-minute talk with the title of “Quality and Excellence in Healthcare: Best Practices.” Given this title and in consideration of the theme of the Regional Management Seminar, which is “Setting the Bar of Excellence in Healthcare,” I came out with the following outline for the main contents of my talk.

  1. Aiming for best practices in quality and performance excellence in hospitals / medical centers
  2. How to aim for best practices in quality and performance excellence in hospitals / medical centers
  3. Examples of best practices in quality and performance excellence in hospitals / medical centers

Some delimitations and specifications of my talk and some operational definitions and usage of terms in my talk:

  • I changed the word “healthcare” in the title to “hospitals” and “medical centers” for focus reason as I assume that my audience consists of owners and administrators of hospitals and medical centers.
  • “Hospitals” and “medical centers” will be used interchangeably.
  • When I speak of “hospitals” and “medical centers,” I am referring to the private ones, not governmental.
  • I will not longer mention nor discuss the reasons why hospitals should aim for quality and performance excellence.  I assume all of us know the reasons and there should no longer be any debate on this.
  • I will start right away with the concept of aiming for best practices in quality and performance excellence in hospitals, then how to aim, and then examples.
  • I will use the definition of ISO for “Quality” which is defined as “degree to which a set of inherent characteristics fulfils requirements.” Degree: refers to a level to which a product or service satisfies. So, depending upon the level of satisfaction, a product or service may be termed as excellent, good or poor quality product or service. Inherent characteristics: those features that are a part of the product or service and are responsible to achieve satisfaction. Requirements: refer to the needs of customer, needs of organization and those of other interested parties (e.g. regulatory bodies, suppliers, employees, community & environment).  The expectations that may be stated, generally implied or obligatory.
  • I will use the definition of Baldrige and Philippine Quality Award for “Performance Excellence” which is defined as an integrated approach to organizational performance management that results in (1) delivery of ever-improving value to customers and stakeholders, contributing to organizational sustainability; (2) improvement of overall organizational effectiveness and capabilities; and (3) organizational and personal learning.
  • I will define “Best Practice” as a formally documented method or technique that has been institutionalized in the hospital and that has consistently shown performance excellence results at least if not yet proven superior to those achieved with other means and which can be or better, is being used as a benchmark by other hospitals.

 Aiming for Best Practices in Quality and Performance Excellence in Hospitals / Medical Centers

“Setting the Bar of Excellence in Healthcare or Hospitals,” the theme of this seminar, theoretically means putting the standard of excellence in hospitals at a certain level in the continuum of excellence or defining the standards or criteria of excellence.  Setting the bar may either be raising or lowering, it but usually raising, when one is talking of bar of excellence.

There are various levels of excellence. The rating scale or categorization varies from one evaluating organizations to another.  One categorization is low, medium, high, and highest levels of excellence.  Another categorization is gold, platinum, and diamond levels with the diamond being the highest level being used by Accreditation Canada International.  Another categorization is Center of Safety, Center of Quality, and Center of Excellence previously used by PhilHealth.  Still another categorization is the one being used by the Philippine Quality Awards: Level 1, Recognition for Commitment to Quality Management (just beginning quality journey; planted seeds of quality and productivity); Level 2, Recognition for Proficiency in Quality Management (achieved significant progress in building sound process); Level 3, Recognition for Mastery in Quality Management (demonstrated superior results; role model in the Philippines); Level 4, Philippine Quality Award for Performance Excellence (highest level of excellence; national and global role model).

All hospitals should continually aim for the highest level of quality and performance excellence.

If a hospital has a documented “Journey towards Excellence” program with at least some positive evaluation results, then that hospital can say or boost that it has one “Best Practice” and this “Best Practice” is considered to be the Parent, either Mother or Father, Best Practice.

To give examples, Manila Doctors Hospital has this graph depicting its “Journey towards Excellence” (see Graph).  With the presence of positive results in terms of being accredited by ISO in 2005, Accreditation Canada International in 2010, and PhilHealth Benchbook as a Center of Excellence in 2010 over a planning-implementing span of 15 years complemented with other projects on quality and performance excellence, MDH can say or boost it has the Parent Best Practice, which is a programmed Journey toward Excellence.

Ciudad Medical Zamboanga has this graph depicting its “Journey towards Excellence” (see Graph).  With the presence of positive results in terms of being accredited by PhilHealth Benchbook as a Center of Safety in 2010 then Quality in 2010 and lately, 2013, being given the Level 1 Philippine Quality Award within 10 years of existence, with plans to move up to PQA Level 4 and be accredited by an international hospital standard organization, CMZ can say or boost it has the Parent Best Practice, which is a programmed Journey toward Excellence.

MDH and CMZ have set the bar of quality and performance excellence and they are still continually aiming for the highest level.  Aiming for the highest level of quality and performance excellence does not just mean getting additional and more external reputable standard-bodies to give them accreditation certificates and awards but more importantly, the strategy should be to have more documented specific best practices in the hospital aside from the Parent Best Practice.

As I have defined earlier, “Best Practice” is a formally documented method or technique that has been institutionalized in the hospital and that has consistently shown performance excellence results at least if not yet proven superior to those achieved with other means and which can be or better, is being used as a benchmark by other hospitals.  The presence of a documented comprehensive set of “Best Practices” (as I have defined it) will be the ultimate single criterion to say that a hospital has achieved the highest bar or level of quality and performance excellence.  This presence should be validated and affirmed by a Level 4 PQA and a reputable external hospital standard accrediting body that puts emphasis on documented best practices and benchmarking.  This is essentially the message that I have in the heading: “Aiming for Best Practices in Quality and Performance Excellence in Hospitals / Medical Centers.”

How to Aim for Best Practices in Quality and Performance Excellence in Hospitals / Medical Centers

There are three topics to discuss or three things to know to facilitate aiming for best practices in hospitals. These are the following:

  • Processes of developing a “Best Practice”
  • Comprehensive set of “Best Practices” in a Hospital
  • Strategies to have a documented comprehensive set of “Best Practices” in a hospital

Processes of Developing a “Best Practice”

“Best Practice,” as I defined it, is a formally documented method or technique that has been institutionalized in the hospital and that has consistently shown performance excellence results at least if not yet proven superior to those achieved with other means and which can be or better, is being used as a benchmark by other hospitals.

Thus, the processes in developing a “Best Practice” consist of the following:

Decide on a management system that will be developed into a “Best Practice.” One can choose from the list that I will provide later. For examples, communication management system and strategic planning management system.

Formulate a design and development plan or blueprint that will include a systematic approach in the planning of the management system; deployment and implementation; evaluation, review, and continual improvement; management review and independent audit.  In the management system plan, adopt / adapt with innovations best practices from other institutions if there are. In the planning also, use a systems approach, meaning taking into account the whole hospital system as well as components of the system for purposes of synthesis (i.e., look at and managing the hospital as a whole); alignment (i.e., promoting consistency of all plans, processes, evaluations, actions of the component systems to support the whole hospital’s goals); and integration (i.e, making all components function as an interconnected unit). In the evaluation, always include timelines and measurements with key performance indicators.

Track the implementation of the management system plan.

Evaluate the results of the implementation for at least 3 years in terms of level (i.e., current level of performance based on formulated key performance index), trends (i.e., rates of performance improvements and the sustainability of good performance); and comparison (i.e., performance relative to appropriate comparisons such as other similar hospitals and benchmarks or hospital industry leaders).

 

All the above must be formally and completely and accurately documented.

 

If the management system plan has been implemented for at least 3 years and has consistently shown performance excellence results even if not yet proven superior to those achieved with other means, then it can be considered as a “Best Practice” for the hospital.  Once publicized, it can be used as a benchmark by other hospitals.

Comprehensive set of “Best Practices” in a Hospital

Aside from developing “Journey towards Excellence” as the Parent Best Practice, the hospital should develop other specific “Best Practices.”

Below is a list of “Best Practices” which I consider comprehensive and which I think all hospitals should develop as part of the “Journey towards Excellence.”  I formulated this list using as references the PQA Criteria for Performance Excellence and the international hospital health care standards particularly on patient-care.  I also included what I think are steadfast strategic objectives for hospitals in which hospitals should develop “Best Practices.”

Using PQA Criteria for Performance Excellence as Reference:

At least one “Best Practice” under each category of PQA Criteria for Performance Excellence

  • Leadership
  • Strategic Planning
  • Customer Focus
  • Measurement, Analysis, Knowledge Management
  • Workforce Focus
  • Operations Focus

Using the international hospital standards as reference:

At least one “Best Practice” under each category of hospital health care standards

  • Access to Care and Continuity of Care
  • Patient and Family Rights
  • Assessment of Patients
  • Care of Patients
  • Anesthesia and Surgical Care
  • Medication Management
  • Patient and Family Education
  • Hospital Infection Control

 

Using ROJoson’s Experience in Hospital Administration as References (In addition to above)

At least one “Best Practice” under each steadfast strategic objectives of hospitals:

Systems perspective in governance
Integrated value-based health care service
Physician engagement (patronage and loyalty)
Maximal utilization of services with controlled expenses and losses
Customer delight
Full compliance with the quality and performance standards (local and international)
Integrated IT-enabled operations system
Staff engagement
Learning organization
CSR program with tangible social impact

 

At least one “Best Practice” in the following:

Communication Management System

Strategies to have a documented comprehensive set of “Best Practices” in a hospital

What top management and senior leaders should do?

  • Leadership Strategy

o   Commitment

o   Motivation

o   Support

o   Role model

  • Management Strategy

o   Technical competence in the processes of developing “Best Practice”

  • Communication Strategy

o   Clear communication

o   Close-loop communication

o   Information

o   Alignment and integration

o   Engagement of staff to the project “Best Practices”

  • Education Strategy

o   Education, coaching, mentoring on developing “Best Practices” to all hospital staff

o   Online Collaborative Interactive Learning

Examples of Best Practices in Quality and Performance Excellence in Hospitals / Medical Centers

Strategic Planning – MDH / CMZ (Brief description)

Balanced Scorecard – MDH Experience

Safety Promotion and Disaster Preparedness – MDH Experience

Continual Improvement Program – MDH Experience

Corporate Social Responsibility Program – MDH Experience

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