My #1 Secret for Building Effective Quality and Safety Programs

Everyone wants to know the secret to building great quality programs.  I know I did, and I’ve been leading quality and safety programs for more than 20 years.

Over this time, I have tried a lot of things that worked and more that didn’t.  I’ve worked with great teams, and their collective wisdom added to our list of things to try.

But 14 years ago, the answer to all of my implementation problems walked into my office.  She walked in, extended her hand and said, “Hi, I’m Lori.  I’m from finance and I’m here to help.”  That got my attention.  Finance is here to HELP?  But once I got over my initial trepidation, we got to work.

The next day we were brainstorming about how to roll out our new quality reports to over 70 hospitals .

At some point, she immediately stood up.  She stopped and said, “I’ve got it.”  “What do you mean, you got it,” I asked.  She replied, “I know how to solve all of our implementation headaches.”  And did she ever.  

The next thing I know we’re engaged in a game of “20 Questions.”  She asked:

  • Which department has the most influence in the organization?
  • Which department insists that you manage with data?
  • Which department is great at goal setting and manages toward those goals throughout the year?
  • Which department requires that you explain any variances from plan?
  • Which department does the best job of holding managers accountable?
  • Which department has their processes “hardwired” into daily work life?
  • Which department almost always achieves their year end goals?, and
  • Which department’s performance is wedded to executive pay?

At about this point, I thought, “Oh Oh, I’m not going to like the answer.”  But in retrospect it was a simple, straightforward, elegant solution to everything we were bumping up against – the doctors wouldn’t use the data, the organization wouldn’t hold management and leadership responsible for their quality performance, a hospital CEO was being a “holdout,” and quality wasn’t even in the strategic plan.

Lori’s answer was – “The Finance Department!”

Since that day, my #1 secret for building effective quality programs is … yup, you guessed it … to emulate everything that our finance colleagues have done to hardwire the organization.  By replicating every tactic and process they use – we achieved astonishing success.

We subsequently used this approach in three large systems and in each system we had similar results:  Implementation barriers fell, execution improved, and most importantly we started to see improvements in the majority of our quality and safety measures.  Not just incremental improvement, but huge, statistically significant shifts in performance.   When I say “the majority of our measures” I mean this – as we were nearing the five year mark at a large tertiary care hospital, the clinical staff had driven significant improvement in over 600 measures.  Yes, 600 measures!!  And the reason?  We were using “The Playbook from Finance.”

There you have it.  My #1 secret to success and the lady who helped me do it.  To get us started, here are four tips I learned in my first week working with Lori.

Tip Number 1 – Don’t Try to Calculate Cost Savings (“by yourself Mr. Doctor Person,” she said)

Unless you’re trained in finance or accounting, don’t try to do their job.  If you’re a clinician, don’t try to calculate the savings generated by any of your programs – no one will believe you, especially your colleagues in finance.  Instead, partner with finance and ask them for help.  First, ask them to create a model to calculate savings generated your quality programs, let’s say complication reductions.  Then ask them to do the calculations and document the savings in a form that everyone in finance will support, all the way to the CFO.  And ask your CFO to approve the methodology.  With the CFO’s stamp of approval and the analysts in finance doing the calculations, everyone will trust the cost savings attributed to your program!

Tip #2 – Quality Reporting

Your ability to report quality and safety performance should equal the organization’s ability to report on financial performance.  If you can report financial performance for every department in your organization, you should be able to report quality performance for every specialty or service line in your organization.  How to do this will be a topic for a future blog.  But a hint – you already have all of the data you need to drive 10 years of improvement.  You don’t even need an EMR.  It’s in the finance or cost accounting systems.

Tip #3 – Resources for Quality

The majority of quality departments in US hospitals are under resourced, but to be effective, they need adequate human resources and access to technology.    Have you ever seen an under resourced finance department?  Probably not.  So why are America’s quality departments short changed?  By demonstrating a good business case for quality, you can get the resources you need.  I’ll show you how I did it for dozens of hospitals and health systems.

Tip #4 – CFO + CQO = Value

How many organizations do without a CFO?  Who would consider such an outrageous proposition?  If it takes a CFO to lead and manage the financial health for an organization, doesn’t it reason that a it would take a Chief Quality Officer to lead and manage quality (clinical quality, safety, performance improvement, satisfaction, accreditation, and quality reporting).  I certainly think so.  The body of work requires similar levels of expertise and leadership capability.  And to fulfill today’s demand for value, outstanding quality performance is imperative.

In future posts, I’ll provide more information on these four tips.  I’ll also continue to review the processes and tools used by finance and show how they can be used to a create a highly effective quality program.