Blog spotlight: The push and pull of quality initiatives

April 11, 2012

Sometimes quality can be a bit like a game of whack-a-mole. As you try to improve in one area, another area falls off the radar, gets worse, and  you winding up shifting resources every quarter, back and forth in a reaction to data. Like whack-a-mole, you keep trying to hit moving targets.

But perhaps there’s more happening behind the scenes than you think. Maybe it’s more like tug-of-war: As you pull at one quality initiative, you inadvertently cause the another one to suffer. This has more of an effect than simply shifting focus and resources away. For example: A hospital tries to reduce falls, and accidentally winds up increasing catheter-associated urinary tract infections because instead of working on mobility, staff are keeping patients in bed with catheters to ensure they don’t fall on their way to the bathrooms.

Now, here’s another one: Longer length of stay may actually reduce readmissions. As hospitals work to reduce length of stay, are they shooting themselves in the foot? An international study of 7,000 patients showed a significant relationship to length of stay and the probability of a readmission in heart failure patients. Although it’s unclear what about the extra time helps, it could be a number of things: better clinical stability, better discharge planning and patient education, etc.

My previous post that discussed how standardized quality measures might actually hurt perception of quality care is yet another example of this tug-of-war.

If one initiative hurts another, you might want to throw your hands up in the air and be done with it. But many of these complex issues have solutions.

Read more.