The Quality of Care Chasm: 10 Questions Hospital Executives Should Be Asking

[NRSKarenRN, BSN, RN]

the quality of care chasm: 10 questions hospital executives should be asking

preston gee, aug. 31, 2005

10 questions on quality

to prepare, every responsible hospital executive team should be considering (in earnest) these very critical and very relevant questions and their follow-ups:

1. how well are we positioned for pay-for-performance? the inertia-breaking and thought-provoking qualities of this soul-searching question should create a rather animated dialogue around the board table and get the ball rolling.
   
   
   
   
2. how do our clinical outcomes stack up against our competition? do we even know, and if so, how often do we measure the movement in this area?
   
   
   
   
3. what priority have we given to quality improvement and overall patient safety effort? if priority has been given, how are we making our employees and the medical staff aware of the relative prioritization?
   
   
   
   
4. what initiatives do we have in place to improve our clinical outcomes? how effective have these been in moving the needle and improving our performance? is the effort consistent across the entire continuum of care?
   
   
   
   
5. how engaged is our medical staff in the quality improvement effort, and is our quality initiative led by a member of the medical staff? can this be quantified in terms of percentage of staff involved and engaged? can it be qualified in terms of degree of interest and active participation?
   
   
   
   
6. what is the trend in our financial performance as it pertains to quality? can we measure our own correlation between quality outcomes and economic performance? if so, what are the trends over time? how likely are the commercial payors in our market to follow the lead of cms in financially rewarding distinctive clinical performance?
   
   
   
   
7. how does our economic position match that of our market competitors? do we know and consistently monitor this? what impact has this gauge had on market share/position and competitive performance?
   
   
   
   
8. what strategies do we have in place to improve our financial performance and market position? how effective have these been over time? have they been modified to account for the dramatic market shifts and consumer expectations as related to the quality component?
   
   
   
   
9. how aware is our executive team or the board of directors of the potential impact of pay-for-performance? how much time has been devoted to discussion and planning on this subject? how has its impact been incorporated into the long-range plan and strategic direction of the organization?
   
   
   
   
10. how aware are other key stakeholder groups like employers and community and media representatives of our quality improvement initiatives? what plans are in place to make them aware of and keep them updated on our vital priority and unwavering commitment to improving quality?
    

how about adding nursing involvement to the list, seeing we are the largest group of providers in a hospital !!!!