Crash Course in Health System Quality Improvement with Dr. Neha Patel

– Logan Brock, MS2 –

For our most recent HealthX Crash Course, we hosted Dr. Neha Patel, MD, MS, who gave a Crash Course on healthcare quality and patient safety. Dr. Patel earned her medical degree at the University of Pennsylvania School of Medicine and completed her residency in internal medicine at the Hospital of the University of Pennsylvania. She has been a practicing hospitalist in the Section of Hospital Medicine since 2009. During her time as faculty at Penn, she completed a Master of Science in Healthcare Quality and Patient Safety at Northwestern University in 2013. In 2016, she transitioned from Interim Chief of the Hospitalist group to become Associate CMIO at Penn, in a role that was specifically created for her to develop Penn’s mHealth strategy. Additionally, she serves as the Director of the Healthcare Leadership in Quality Residency Track, which prepares physicians for leadership roles in health system by providing hands on experience improving healthcare quality. To top it off, she serves as Director of Mobile Strategy and Applications at Penn Medicine. Here are some key takeaways from her talk:

Work Within a Framework – It Doesn’t Matter Which

The key to successfully implementing quality improvement projects in a hospital system is to use a framework that allows problems to be approach systematically. While this is crucial to ensure effective quality programs, it is less important which specific framework is followed. There are a number of different change management systems that are used in healthcare, including Six Sigma and the Model for Improvement. While these models differ slightly in their approach, each provides a method to rapidly design, test, improve, and implement changes to hospital systems, allowing the hospital to continually improve.

Measuring Healthcare Quality is Extremely Complicated

While it certainly isn’t surprising to hear that measuring quality in healthcare can be a challenge, Dr. Patel illuminated just how challenging it really is. In the current healthcare climate, terms like “bundled payments” and “value-based purchasing” are frequently tossed around – however, it can be rather complicated to understand what they really mean. As an example, Dr. Patel brought the current year’s value-based purchasing “domain weighting” chart – essentially, the metrics to which 2% of all Medicare payments are tied in 2018 (here’s an overview of value-based purchasing). The metrics include four categories that contribute to the overall “value” the hospital provides and multiple subcategories within each category. As an example, one sub-category is “pain management,” as reported by patients. The score used for this metric is compiled from surveys randomly given to patients, in which they rate the quality of their hospital stay. Thus, improving the score would likely require massive overhauls in hospital operations, and this is just one of many metrics to which hospital reimbursement is tied. This crash course conveyed the immense challenge of measuring healthcare quality.

Improvement Requires Openness to Evaluation

Dr. Patel highlighted one of the most significant challenges to implementing quality improvement initiatives in the hospital – in order to make changes to improve a process, it is first necessary to admit that the process might be flawed. In a healthcare system where doctors are working as hard as they possibly can to provide the best care they can, it is a difficult shift to admit that there could be room for improvement. Thus, one of the key challenges in improving healthcare quality is allowing the measurement and reporting of areas where care could be enhanced. This is naturally difficult for a profession in which mistakes can have life-or-death consequences, but it is crucial for continual improvement.

 

It was a pleasure to host Dr. Patel and learn more about quality improvement in healthcare and the significant challenges that physician-leaders grapple with every day in their quest to provide better healthcare.

– Logan is a second-year medical student at the Perelman School of Medicine. He is the co-VP of curriculum for Penn Health-X, an occasional co-host of the Penn HealthX podcast, and a contributor to the Penn HealthX blog. You can contact him at  john.brock@uphs.upenn.edu –

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