“Quality” Programs Focus on Results

Since its inception, HMI’s Quality Management Program has assisted organizations in measuring the provisions and outcomes of patient care and services. The program relies on evidence-based principles and techniques and the extensive experience of HMI consultants.

Now, HMI has developed “Introduction to Clinical Quality Management,” an interactive workshop for organizations that want to utilize HMI’s expertise without committing to a full-scale quality management consultation. The workshop is offered as a “Train-the-Trainer” program. Client trainers are selected by the senior management and trained by HMI faculty, who help trainers tailor the workshop to their organization train fellow staff in the principles of clinical quality management.

Dr. Sharon Kleefield leads HMI’s quality improvement programs; now a workshop will bring these techniques to a wider audience

“The workshop offers a way for an organization to undertake a quality program quite cost-effectively because they are training their own people,” said Dr. Sharon Kleefield, an HMI director in charge of health care quality and evaluation. “Additionally, the training is tailored to the particular culture of an organization, and trainers who know their culture first-hand are usually the most effective educators.”

A path to improvement
The workshop provides an organization with the design and process for achieving a specific objective, such as developing a quality plan or working toward international accreditation. In most cases, the program takes 9–12 months. About nine months into the program, HMI faculty will conduct a review of the organization’s training implementation phase.

At the start of the program, two HMI faculty members spend three days at the client’s site. During that time, they meet with senior management and train 12-15 trainers (who ideally are a mix of doctors, nurses, and administrators) to run interactive quality management workshops and tailor them to reflect the organization’s experience . Each trainer receives a certificate of achievement, PowerPoint slides, handouts, and instructor’s notes.

After successfully completing the Train-the-Trainer program, client trainers complete an organizational self-assessment survey tool that allows HMI faculty and senior management to identify priority departments for the training program implementation. Using the materials they receive during the Train-the-Trainer Program, client trainers then begin training the organization’s staff in interactive, cross-functional team-based workshops, which can be completed in one day. The workshop trains staff to identify barriers to improving quality of care and service; develop solutions to minimize these barriers; work as teams across the organization; and identify priority areas in which to apply the HMI model for clinical quality management.

Workshop participants receive a letter of completion from HMI after passing an online examination. Organizations are responsible for translating the materials and examination, and HMI provides translated materials online for the organization.

“At the end of the program, hospitals develop an evidence-based approach to improving quality, and they can use this evidence to demonstrate why they are now among ‘the best’ institutions of their kind,” said Kleefield. Quality outcomes that hospitals sometimes use for comparative analyses include hospital acquired infection rate; inpatient mortality rate; unscheduled readmission rate; return to emergency departments within 36 hours.

This slide from HMI’s Introduction to Quality Management workshop highlights elements of a process which is the target of most health care improvement strategies. Suppliers, who can be physicians, patients, or vendors of medical surgical supplies, provide the inputs to the process. Inputs can be orders and guidelines (physicians), need for care/treatment (patients), medical equipment and supplies (vendors).

Putting quality into practice
Because the term “quality” can mean different things to different people, said Kleefield, HMI uses a single framework for its quality programs. “We define structure, process, and outcome,” she said. Structural measures include human resource allocation, medical record keeping, physical plant safety, and licensure. Process measures focus on communication, and information and patient flow, as well as systems for providing direct patient care. For example, a process measurement would include medication order, delivery, and administration, operating room scheduling, patient education, and discharge planning. Finally, outcome measures include such data as mortality rates, complication rates for specific procedures, patient feedback on symptom relief, and patient satisfaction with the care they received.

Since Kleefield joined HMI five years ago, she has conducted quality consultations, both large- and small-scale, in India, Thailand, Saudi Arabia, Brazil, Spain and Colombia.

This fall, Kleefield is part of a team at HMI that will begin a three-year program with Hygeia Hospital Corporation, with the goal of educating its staff about quality management, as well as guiding the hospital as it undertakes a major quality initiative focusing on selected areas of clinical service delivery. HMI will be involved in the hospital’s educational component, the assessment, and, later, helping the physicians and others within the institution to implement needed changes.