How CFOs impact high-reliability patient care
See how hospital and health system CFOs can help ensure patient care is provided with consistently high levels of safety and quality.
The challenges hospitals and health systems face in providing patient care with consistently high levels of safety and quality have never been more complicated, or more important.
Inpatient admission data from hospital and health systems consistently show patient severity levels increasing over the past three years — indicating that hospital inpatients are sicker and that managing their outcomes is more difficult.
At the same time, public awareness of safety failures — together with increased attention to quality metrics by consumers and payers — means that performance shortfalls are under greater scrutiny.
Furthermore, publicly reported metrics such as rates of hospital-acquired conditions (HACs) and readmissions carry the potential for payment penalties imposed by health plans and government payers alike.
The science of high reliability has been embraced by other high-risk industries, such as aviation, to great success.
A similar approach for health systems offers a compelling opportunity to move beyond a reactive posture toward safety and quality to proactively and systematically seeking out and preventing failures.
The Agency for Healthcare Research and Quality (AHRQ) recently updated its Patient Safety Primer to provide an overview of the characteristics of high reliability and their applicability to health care.
AHRQ emphasizes that high reliability is “an ongoing process or an organizational frame of mind, not a specific structure.” It goes on to describe high reliability as a condition of “persistent mindfulness” toward quality and safety."
Developing a high-reliability culture requires strong leadership commitment; a mandate for quality and safety improvement; and rigorous, ongoing and data-driven process improvement.
Finance leaders have an important role to play in each of these areas, because gaining insight into the relationships among cost, quality and safety can provide an important basis for funding these efforts and expanding their impact.
The cost of poor safety, clinical variation and unreliable quality remains high and finance leaders in many organizations are now contributing analytics expertise and leadership to support strategic improvements and drive a culture of high reliability.
The importance of documentation
Finance also has a special role to play in helping clinicians understand the impact of accurate coding and documentation in ensuring that the organization captures all necessary clinical diagnosis and intervention data.
Accurate, complete documentation and coding produces revenue benefits from improvements in multiple areas, including case-mix-index calculations, clean billing claims and accurate quality metrics.
However, many clinicians struggle to reconcile the differences between information captured in a patient chart and information summarized on a patient bill, making it critical to provide clinicians with ongoing support and education.
Finance leaders are in the best position to identify potential coding and documentation gaps, dedicate the appropriate education and training resources to support improvement and track accuracy metrics to ensure sustainability.
Partnering across the aisle
Historically, finance executives and clinical executives have not always collaborated well. The tension between clinical investment and limited financial resources often results in opposing viewpoints regarding priorities and how to address ongoing challenges.
Ultimately, finance leaders have to believe that improving quality and patient safety is a worthy investment of limited resources. Finance leaders have an opportunity to be true champions of high reliability, to reach across the aisle to their clinical counterparts and work together.
High reliability is first and foremost about quality; however, there are clear financial benefits that accrue to the bottom line when quality is improved.
Just as it is important for finance leaders to understand and communicate the benefits of high reliability, it also is essential that they recognize the ways in which they can support and accelerate the impact.
Practically speaking, laying the foundation for a culture of high reliability requires dedicating specific resources for enhancing and sustaining process improvement in key areas of care delivery and the core operations related to it.
This effort can include implementing tools to monitor and manage the process improvement, establishing selective physician incentives and establishing analytic and engineering resources.
This article first appeared in “HFM Blog" as "What do finance leaders have to do with high-reliability patient care?"
