International Forum on Quality & Safety in Healthcare, London, 2015
I didn’t want to attempt to summarise a four day conference in around 400-500 words so have decided to pick one key presentation related to “quality measurement and improvement” (which is also linked to my own PhD research interest so was slightly biased in the topic selection!) Conference Overview The international forum is a large conference with around 3000 attendees from over 80 different countries representing a varied mix of policy makers, clinicians, managers, students and others involved or interested in quality improvement and safety in healthcare. The conference is now in its 20th year jointly led by the BMJ and Institute for Healthcare Improvement. Presentation Summary: “How an online reporting tool of whole-system measures helped Kaiser better understand, track and improve quality across the entire healthcare system” delivered by Andy Amster (Senior Director, Kaiser Permanente, USA) Kaiser Permanente is a managed care organisation in the USA providing care for over 10 million members across eight states, operating 37 hospitals and 611 clinics, and employs over 165,000 people. Given the size of the organisation one of the key challenges it faced was in understanding variation across its national portfolio of services and identifying where quality improvement efforts could be best prioritised. The speaker talked through the eight year journey the organisation had in developing a comprehensive list of strategic quality and service measures which it automated through an online dashboard that allowed people at all levels of the organisations to track performance across the key areas of quality; Effectiveness, efficiency, safety, equity, patient-centredness and accessibility. The talk focussed on the importance of understanding variation and using variation constructively to improve quality. The speaker discussed how Kaiser had co-developed quality measures through a quality measure clearinghouse with clinicians, ensuring that measures were valid, reliable and robust, that could then be used to identify variation in care across the organisation to put in place quality improvement interventions. An example of where the organisation had achieved this was in reducing the combined group hospital standardised mortality rate through identifying variation across hospitals and putting in place quality groups to identify areas of improvement from drilling down through mortality data (sepsis management was a key area identified and improved). Some of the key lessons in developing a quality measurement approach were in;
- Prioritising measurement (selecting key areas of focus and high care variation to prioritise quality improvement)
- Identifying and clearly communicating the reason for measurement (for example, where measurement for learning versus accountability and assurance can illicit different behavioural responses in staff)
- Selecting appropriate measures that are well-formed, relevant, consistent and agreed upon
- Using automation and technology to easily monitor measures (the Kaiser system allows graphical representation of key measures complete with composites and sub-scales)
The conference has a wide range of topics related to quality and safety across all care areas and some good speakers so would certainly recommend it as there is usually something for everyone!
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