Healthcare Quality Improvement and Patient Safety

The future of healthcare quality involves a delicate dance between digital advancements and quality improvement, with patient safety as a top priority.

If you can't describe what you are doing as a process, you don't know what you're doing.

– W. Edwards Deming

Richard Greenhill, DHA, CPHQ, HACP-CMS, PMP, FACHE,

Richard Greenhill, DHA, CPHQ

Healthcare Quality Improvement and Patient Safety refer to the systematic and continuous efforts to enhance the effectiveness, efficiency, and safety of healthcare services delivered to patients. It involves a range of activities aimed at preventing errors, reducing harm, and improving patient outcomes. The importance of healthcare quality improvement and patient safety cannot be overstated, as it directly impacts patient well-being and overall healthcare outcomes.

We sat down with Richard Greenhill, DHA, CPHQ, HACP-CMS, PMP, FACHE, to discuss the importance of quality improvement, how it can be accomplished, and what the future holds considering the recent coronavirus pandemic and the advancement of artificial intelligence (AI) in care delivery.

Greenhill serves as the Program Director for the Bachelor of Science in Healthcare Management  in the TTUHSC School of Health Professions and a national and international leader and voice in healthcare quality.

Recently, Greenhill received the prestigious honor of being elected to the International Academy of Quality & Safety (IAQS). Membership in the Academy is lifelong and one of the highest honors that someone in healthcare quality can achieve. In addition, he serves as a content expert with the National Association for Healthcare Quality (NAHQ); as well as American College of Healthcare Executives (ACHE) Faculty for healthcare quality and value.

Healthcare Quality Slogans Vs. Process

“Healthcare that cares.” “A passion for putting patients first.” “Better doctors, better care.”

These are a few examples of slogans used by healthcare providers to communicate their intentions to patients. But Greenhill invokes Dr. Deming’s point No. 10 and believes that slogans in healthcare delivery should be eliminated in the quest for reduced process friction to reduce burnout with laser focus on zero harm for caregivers as well as patients.
When it comes to healthcare quality improvement and patient safety, process is more important than slogans, as it involves implementation of concrete actions and strategies over hyperbole.

“Slogans are great and they inspire people, but they have not consistently translated to improved outcomes and operational efficiency at the frontline,” Greenhill explains. “Stable and reliable processes are the key to high-quality, safe and equitable care.”

Process-oriented approaches emphasize the systematic identification and analysis of issues, the development and implementation of evidence-based protocols and guidelines, as well as the continuous monitoring and evaluation of outcomes. By focusing on process improvement, healthcare organizations can effectively address root causes, promote sustainable change, and ensure that patient safety and quality-improvement efforts are integrated into everyday practice.

“In the performance improvement world, I grew up in, we focused on the microprocesses and then methods that ultimately took hold to facilitate cultural transformation,” Greenhill says. “Focusing on process reliability is a key overarching strategy to get to highly reliable processes.”

Coming Back from COVID-19

The state of healthcare quality and patient safety has long been impacted by issues of burnout and worker shortages. Burnout among healthcare professionals, including physicians, nurses and other staff, has reached alarming levels. Additionally, the persistent worker shortages in various healthcare fields further strain the system, leading to increased workloads and fatigue, which can have negative implications for patient outcomes.

While the coronavirus pandemic has shone a new light on healthcare quality, burnout, and staff shortages, Greenhill is quick to remind us that these are not necessarily new concerns.

“These were always issues, even before COVID,” he says. “In the aftermath of COVID, the effects are exacerbated and we're reeling on a host of fronts. There are just not enough people to work, and it's not like the expertise of our professionals can be created overnight.”

Addressing these challenges requires comprehensive strategies, including promoting well-being among healthcare workers, improving work-life balance, and implementing measures to attract and retain a skilled workforce, ultimately safeguarding healthcare quality and patient safety.

“Perhaps it’s time for us to think differently, post-COVID, and let the change originate more organically from the frontline,” Greenhill suggests. “Let the staff and clinicians that do the work drive innovation upwards and then leaders can integrate and align grassroots change with strategy. It’s a different mental model but given the constraints we face on a host of fronts, we must think differently.”

The Role of Interprofessional Education in Quality

The TTUHSC School of Health Professions prioritizes interprofessional education (IPE) by offering collaborative learning experiences that bring together students from different healthcare disciplines. Through interprofessional simulations, case-based discussions and team-based projects, students at TTUHSC School of Health Professions learn to work together, communicate effectively, and understand the importance of interdisciplinary collaboration in providing comprehensive patient care.

“IPE lets our students experiment in a simulated, safe environment where we as educators can give them real-time feedback and create a positive experience,” Greenhill says. “This is a fantastic way to model removal of some of the silos that they will face that threaten patient safety and efficiency. It also allows us to show them how to work with and understand other professionals in the care continuum. I believe IPE goes a long way to create a foundation for psychological safety through dealing with common misconceptions and hierarchy.”

Interprofessional education and collaboration are vital to healthcare training, as they foster teamwork, enhance communication skills and promote a patient-centered approach. By bringing together students and professionals from various disciplines, such as medicine, nursing, pharmacy and allied health, inter-professional education cultivates a holistic understanding of healthcare and encourages a collaborative mindset.

“Interprofessional education is a magic bullet here [at TTUHSC], and it creates an environment that translates over to practice when our students leave the classroom for the hospital or clinical setting,” Greenhill says.

The Effects of AI on Quality Improvement and Patient Safety

AI has the potential to significantly impact healthcare quality and patient safety. Firstly, AI-powered technologies can assist in early detection and diagnosis of diseases, improving patient outcomes by reducing missed diagnoses, and facilitating prompt intervention. Secondly, AI algorithms can analyze vast amounts of medical data to identify patterns and trends, enabling healthcare providers to make more informed decisions and personalize treatment plans.

“Machine learning and AI include methods that will radically transform how care is delivered in the future. We're going to see lots of improvement in diagnostic testing, and a further progression in precision medicine as well as some administrative areas,” Greenhill says.

However, challenges such as data privacy, algorithm bias and transparency must be addressed to ensure the ethical and responsible use of AI in healthcare.

“The challenge and opportunity relate to ensuring that our workforce and our leaders are digitally literate and feel competent with leading the teams who create these methods and truly understand what's going on when an algorithm is used in care delivery processes. The issue of explainability is an important one for our leaders to focus on. I think many issues will arise from this concept and we need to be ready for this,” stresses Greenhill.

AI algorithms devour vast quantities of data with astonishing speed and efficiency. Just as a jet engine ingests massive amounts of air to give the plane lift, AI algorithms consume immense datasets, extracting valuable insights and patterns. Ensuring equity in the data used for AI is crucial to avoid perpetuating biases and disparities that exist in our current data. The quality and representativeness of data influence the fairness and accuracy of AI algorithms, impacting decisions and outcomes in healthcare.

“The data has to be relevant and manipulated carefully to ensure equity,” Greenhill says. “There are a lot of challenges to manage before we are ready to maximize the use of these tools. For example, there are no quality standards around AI algorithms, which relates back to explainability and execution.”

Furthermore, AI can automate routine administrative tasks, allowing healthcare professionals to focus more on direct patient care and reducing the likelihood of human errors. However, according to Greenhill, this could create additional concerns related to liability and risk.

“When you consider clinical licensure and medical, who is liable when there is a mistake? Is it the algorithm, the company, the physician?” Greenhill asks rhetorically. “The technology is advancing quicker than the laws, regulations, and vetting mechanisms.”

Global Health: Expanding Our Learning Network

Greenhill believes that the United States’ medical system can learn from other global systems by examining the models and practices they implement. For example, studying the universal healthcare systems in countries like Canada, the United Kingdom or Germany can provide insights into how to achieve broader access to care and reduce healthcare disparities.

“There’s an opportunity in the United States to learn from other countries, what they’re doing, and their successes and failures. Often when this comes up, the conversation is shut down with the notion that we are different. While we are different in many ways, there are some innovative things happening overseas that we can glean insights from,” Greenhill says. In addition, we can even learn from some of the innovations in developing nations. It boils down to us having the humility to seek knowledge in places where we might not expect to have commonality.

He recounts a recent trip abroad to Brisbane, Australia, where he learned about some of the innovative practices being undertaken in the Australian system of care as well as advances in coproduction put forth by the Dartmouth Institute for Health Policy and Clinical Practice.

“While our cultural norms and lifestyle are different in the U.S., high-quality and safe patient care is a universal goal for most countries.” Greenhill says. “I think there could be a greater emphasis to think about how we can learn from our international partners around the world. Lots to learn, and it's why I am proud to be in this space where I can conduct research, share and learn from my colleagues around the world, bringing those insights back home.” 

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