Author: Clinical Quality

Important Aspects of Clinical Quality Benchmarks

Clinical quality benchmarks are those benchmarks that are set for clinical quality measures. These Clinical quality measures are tools that help measure and track the quality of services provided in the healthcare industry by eligible professionals, eligible hospitals, and other health institutions within the healthcare system and industry. These clinical quality benchmarks enable healthcare providers to deliver high-quality care and achieve long-term quality goals for the overall healthcare organization. clinical quality measures help to ensure that the healthcare system is delivering effective, safe, efficient, patient-centered and timely care. The major aspects of a healthcare organization that clinical quality measure and sets its benchmarks with are:

  • health outcomes
  • clinical processes
  • patient safety
  • efficient use of healthcare resources
  • care coordination
  • patient engagements
  • population and public health
  • adherence to clinical guidelines

Now achieving each and every one of these benchmarks is not an easy task and so the process is usually burdensome for healthcare organizations, doctors, and clinicians alike. There are, however, ways that you can effectively manage quality measures to ensure the smooth flow of process and efficiency in an organization.

Prioritize measures that impact patient care

The number one goal of any healthcare organizations should be to always offer and continuously improve patient care and outcomes. Patient safety measure like surgical site infection and Central Line-Associated Bloodstream Infection (CLABSI) should be part at the top of the priority list and part of the safety measures revisited frequently. Performing poorly on patient safety measures means not doing well by patients and leaving money that could have been earned on the table. So patient safety and patient harm measures should always be included in organizational scorecards, but care must be taken of how your internal goals align with benchmarks and thresholds identified in the pay-for-performance programs.

Have a line-of-sight to reimbursement

Financial considerations need to be monitored in addition to those related to quality and safety. When this is ignored the quality of care could start to decline because of lack of motivation. Doctors and nurses work long hours and work hard continuously when their reimbursements methods or even amount are ignored by the organization’s, there’s bound to be a drop in morale which will affect the quality of care. It’s important to look at the alignment of measures across programs, understand the reimbursement tied to each one, and then make informed decisions about which ones to support the most.

Having tools available to show not only clinical performance on quality measures but also the projected payment impact of that performance, allows an organization’s clinical and finance teams to work together to make informed decisions on prioritization of improvement efforts. Sometimes great clinical improvement work isn’t tied to any reported measures, but it still deserves financial recognition. Having this awareness and connection between quality reporting and reimbursement can help to then continually improve the existing pay-for-performance program.

Involve the right people

Always include financial and clinical leadership. Financial leadership plays the role of creating a budget based on performance in these programs, and clinical leadership plays the role of tracking monitoring performance and delivering the outcomes of improvement in work. This includes the department within an organization that is responsible for paying contractors as well. A strong connection with this team is critical to set measurable goals with commercial payers that align with the efforts required of government programs.

Additionally, involve frontline nursing staff. Nurses play a crucial role and should not be ignored. Their roles are usually underestimated or downplayed but the fact is most hospitals will be unable to run at all without nurses. Work with physicians and nurses to define and align internal measures with publicly reported measures. This has multiple benefits: optimized patient care, and improved forecasting and monitoring of performance in programs like the IQR.

Clinical Quality Benchmarks and Patient Engagement

The natural — and perfectly understandable — inclination is to accept your doctor’s recommendation. Unfortunately, your inclination might be completely wrong. In fact, your doctor’s reliance on personal observation might be harming some of her patients — and could harm you. What your doctor should be doing is basing her decision on evidence or proven medicines and treatments. There should be set clinical benchmarks put in place that doctors can refer to when diagnosing a patient. Why should doctors make decisions based on the results of the care of dozens of patients when there is data on the results of the care of thousands of patients? Evidence-based medicine says they shouldn’t. It’s possible, for example, that large clinical trials show that one treatment on heart disease works better on men than women while another treatment works better on older people than younger people, and other specific treatments work better on people with specific kinds of heart problems.

It’s also possible that doctors making decisions based on their personal and clinical experience are relying on too small a sample size for their conclusions to have any scientific validity. Perhaps, your doctor hasn’t treated any individuals who are the same age, gender, and size as you are and is in the same medical condition. Does that matter? A large clinical trial of thousands of patients might have the answer to that question — and might show what specific treatment works for people who are specifically like you.