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Demonstrating Quality is Necessary
Quality
Performance Recognition
JCAHO Accreditation
Process
Monitoring Tools
Advantages of
Quality Monitoring
Demonstrating Quality is Necessary
Every sector of the healthcare profession must
constantly raise the bar to ensure they are providing
the best patient care possible—to eliminate costly
errors, maximize patient and client satisfaction, and
secure competitive advantage. Occupational medicine is
no exception. In fact, because relationships among
employers, payers, and patients are uniquely intimate
in occupational health, quantifying and demonstrating
quality performance is even more imperative to
competitive success and profitability.
Holding providers accountable for quality is a
nationally growing movement in healthcare. One
familiar form of such accountability is the use of
medical guidelines, patterns of treatment, and
discounts by HMOs, PPOs, and other networks as
performance leverage, or as conditions of network
participation and reimbursement. Payers are “kicking
it up a notch.” Blue Cross of California, one of the
nation’s largest health insurers, recently published a
plan to hold doctors accountable for the quality as
well as the cost of care, linking physician bonuses to
patient satisfaction and quality of care.1 Moreover,
WellPoint Health Networks, owner of Blue Cross of
California, says it will extend this program to other
states where it operates.
With or without heavy-handed incentives, the focus on
quality care and patient satisfaction will continue
with increasing intensity. Occupational medicine
providers need to carefully monitor and demonstrate
quality performance, and have a variety of available
methods.
Continued vigilance is known by many names, among
them: Process Improvement, Continuous Quality
Improvement, Quality Assurance, and Risk Management.
Other approaches are tied to formal quality
recognition programs such as the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO) and
ISO-9000. “Regardless of the name or source of quality
standards, the fact remains; the healthcare system
needs a constant assessment of its patient care
delivery systems with a focus on seeking opportunities
to improve performance and customer satisfaction.”2
Payers and consumers are demanding it.
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Quality Performance Recognition
The distinction between quality performance
recognition and process quality monitoring needs
clarification. Quality recognition for a provider
organization is gained through a formal application
process to a recognized entity that measures quality.
The entity conducts a survey, using proprietary
quality standards as indicators of quality, and
provides the healthcare provider with acknowledgment
of successful completion. Certification,
accreditation, or other awards may be granted.
Process quality monitoring, on the other hand, is the
methodology used to monitor, manage, and demonstrate
quality performance, either for the purpose of earning
quality recognition or to improve internal
performance. Several quality-monitoring tools will be
described in coming articles.
One prestigious quality recognition program is the
ISO-9000 Quality Management System described in the
Summer 2002 issue of Occupational Health Tracker.3
Registration by ISO-9000 indicates that an
organization’s quality management system has been
validated and certified as meeting established
ISO-9000 standards during the period for which it was
certified. ISO-9000 registration yields benefits such
as industry recognition, client awareness, and market
advantage. Other organizations have established
quality recognition guidelines as well.
In addition to ISO-9000, other well-known quality
recognition organizations for healthcare include:
• Joint Commission on Accreditation of Healthcare
Organizations (www.jcaho.org). Accreditation by JCAHO
is required for occupational health centers associated
with hospitals that are JCAHO certified, and it is
available to independent occupational health programs
that participate in the process. Accreditation is said
to be different from quality certification because it
establishes minimum standards and applicants can
achieve accreditation while continuing to work toward
full compliance.
• Leapfrog Group (www.leapfroggroup.org) was founded
by the Business Roundtable (www.brt.org) with support
from the National Health Care Purchasing Institute (www.nhcpi.net).
These organizations recognize and rate medical
providers, primarily hospitals. MEDSTAT (www.medstat.com),
a large database management organization, is
participating by collecting and analyzing the data
necessary to benchmark and rate providers. The
Leapfrog Group collaboration supplies quality ratings
of healthcare providers for purchasers of healthcare
services such as HMOs.
• Another alliance, between J.D. Power and Associates
and HealthGrades (www.healthgrades.com), grades
providers for excellence. The resulting information is
promoted and sold to payers and other constituents.
This collaboration evaluates a wide range of
healthcare market segments, such as long-term care and
hospitals.
• Malcolm Baldridge Award (www.quality.nist.gov),
founded and supported by the U.S. government, is
well-known in the industry. Awards are granted
annually to a small number of organizations in
specific categories, including healthcare.
• Blue Cross of California (noted above), the American
Society for Quality (www.asq.org), the Institute for
Healthcare Improvement (www.ihi.org), and scores of
other organizations focus on informing consumers about
quality healthcare providers.
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JCAHO Accreditation
Of most concern to hospital-affiliated occupational
health centers is JCAHO accreditation. JCAHO quality
standards consist of lists of performance guidelines
aimed at achieving quality in specific hospital
specialties, including ambulatory-care centers such as
occupational health clinics. Performance standards are
adjusted for the scope of services provided by the
organization. If a center’s services include only
physical exams, requirements are different than if a
center provides injury treatment with minor surgery.
Of particular concern to JCAHO are patient safety,
avoiding treatment, and medication errors. Also,
consistent physical evaluation and pain assessment
procedures must be demonstrated. If exceptions are
noted, a root-cause analysis is undertaken with
procedural adjustments and documented monitoring of
reconstruction.
JCAHO requires applicants to develop and prioritize
annual plans to comply with their guidelines. Because
JCAHO surveys are conducted every three years, some
applicants are tempted to slide until just before
surveyors arrive. A better approach is to demonstrate
continuous quality performance using a set of quality
process monitoring tools that contribute to JCAHO
accreditation. Indeed, JCAHO wants evidence of past as
well as present compliance.
Process Monitoring Tools
All quality recognition programs measure performance
based on a set of quality criteria or standards. To
demonstrate quality performance for any purpose, an
organization must infuse its operational process with
the means to observe and record performance against
standards, performance exceptions to standards, and
reconstructive processes. The discussion of quality
monitoring tools in the next article on this subject
will step beyond generally recognized healthcare
programs of Quality Assurance (QA), Total Quality
Management (TQM), and Risk Management to more
aggressive methods of leveraging data. Newer methods
that are data-driven consistently monitor performance,
establish trends, and manage quality, all of which are
required to meet today’s challenges. Benchmarking,
balanced score carding, and Six Sigma® quality
monitoring processes are among data analysis methods
widely accepted in industry. Now healthcare providers
are adopting these methodologies.
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Advantages of Quality Monitoring
Regardless of whether a health service entity is
applying for formal quality recognition, complying
with a regulatory agency, or creating an internal
quality monitoring process, benefits will accrue to
the organization. Data-driven quality monitoring
processes expand understanding of internal strengths
and weaknesses, reveal problems and trends early, and
support management in gaining proactive operational
quality control.
Re-engineering operations to infuse quality monitoring
tools is essential. Part of that process is to
optimize data integrity and exception management by
establishing individual staff accountability for data
quality. Staff will be re-energized when results are
shared concurrently. Additionally, quality criteria
and initiatives should be prioritized, beginning with
the most nagging or threatening problems. Don’t
attempt to eat the elephant with one bite.
When selecting and applying to a formal
quality-recognition organization, consider the degree
to which clients will understand and appreciate the
meaning of any recognition that is received. Those
occupational health centers accredited by JCAHO, for
instance, may need to educate customers and clients
because industrial clients may be unaware of
healthcare traditions. Stated more positively, use the
opportunity to inform clients about JCAHO
accreditation scores, thereby differentiating your
occupational health center from others to gain market
advantage.
Organizations that implement continuous quality
monitoring methods will:
• achieve strategic business goals;
• increase efficiency and sustain profitability;
• minimize costly errors, re-work, and loss;
• demonstrate medical practice and business
excellence;
• revitalize customer relationships;
• differentiate themselves from competitors for
marketing advantage;
• comply with mandated quality performance;
• control liability exposure;
• define quality knowledge for payers, clients, and
patients.
Occupational health providers cannot afford to ignore
the growing trend toward accountability for quality as
well as cost. The good news is they will benefit from
it.
Footnotes
1 Lee, D. , “Blue Cross to Rate Doctors,” Los Angeles
Times, October 10, 2002.
2 Ibid.
3 Crago, M., Zaia, A., Ward, D., “Healthcare Process
Management Quality,” Occupational Health Tracker, Vol
5. No. 2. Summer, 2002.
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