The Symbiosis of Clinical and Business Mandates for Quality

The Symbiosis of Clinical and Business Mandates for Quality

It has always been the goal of today’s surgicenter to deliver business and clinical solutions for its readers, with an eye toward the symbiotic relationship that they possess. There is a sense of mutualism between the two, forged and refined through the years as a result of evolving healthcare policy and reform. Despite the fact that quality healthcare cannot exist without the keen interplay of clinical and business imperatives, disinterest, and even occasional animosity exists in the business office and the surgical suite. There are administrators who won’t set foot inside an operating room to understand the mandates for quality care, and clinicians who burn through surgical supplies without regard for the fiscal health of the facility, for example. This behavior is detrimental to healthcare providers, administrators, and especially to the patient, because two disparate halves of the whole are not working in concert to achieve fiscally responsible, high-quality care.

In the 2004 report from The Commonwealth Fund, “Beyond Bankable Dollars: Establishing a Business Case for Improving Healthcare,” authors Michael Bailit and Mary Beth Dyer assert that to address widespread deficiencies in the quality of healthcare, organizations must make a business case for improving quality:

1. A positive financial return on investment (ROI), realized as “bankable dollars” (profit), a reduction in losses for a given program or population, or avoided costs.

2. Reduced expenditures or cost avoidance; in other words, do targeted quality interventions reduce expenditures or avoid costs?

3. Organizations document current or projected costs associated with an identified problem; is cost used as an argument for investing in quality improvement if it cannot convincingly use ROI or cost effectiveness?

4. A regulatory or contractual requirement faced by a provider, health plan, or other entity often presents a compelling argument for making an investment of organizational resources; the potential loss of contracts, revenues, or market share related to lack of compliance with mandatory quality measures is just one example of how conditions of participation can create a business case for quality.

5. Organizations may use positive performance incentives for specific investments; employees are rewarded for an investment in quality, or penalized for lacking one.

6. Organizations recognize that image, reputation, and product differentiation on quality measures directly affect market share and the ability to recruit and retain high-quality staff and providers.

7. Organizations develop or strengthen relationships with key stakeholders (providers in its network, large purchasers, and healthcare consumers) critical to a business investment.

8. Organizations predict that the quality initiative will significantly improve its strategic position in the future, in part by changing the environment in which it operates.

9. Organizations consider a quality improvement investment in light of its relevance to its mission to serve its patient population.

10. Organizations may base a business decision on the message that a particular quality improvement investment sends throughout the organization, such as motivating staff to help create an internal culture that promotes quality and excellence.

Just a few things to ponder as you attend AAASC and AORN this month. See you there!

Until next month,

Kelly M. Pyrek
Editor in Chief
kpyrek@vpico.com