MedCity Influencers, Hospitals

Healthcare will improve when quality improves – and it begins with workforce competencies

Covid-19 and other challenges of 2020 have carried a sobering mandate: quality can no longer be a “nice-to-have” in healthcare. While there has always been a passion for quality (and with it, safety and value) across the industry, in a post-pandemic era, we will face a dire financial imperative to close the quality gap now. […]

Covid-19 and other challenges of 2020 have carried a sobering mandate: quality can no longer be a “nice-to-have” in healthcare. While there has always been a passion for quality (and with it, safety and value) across the industry, in a post-pandemic era, we will face a dire financial imperative to close the quality gap now. And the key to unlocking better quality in healthcare is found in a renewed emphasis on workforce competencies in quality.

Too often, a crack in quality systems, processes and structures leads to inefficiencies, poor outcomes, safety concerns and higher costs for all. The macro data makes this abundantly clear: Our industry wastes between $760 B and of $930B annually, and medical error, one way of quality failures manifest, is now the third leading cause of death in the U.S. Sadly but not surprisingly, most of us have experienced preventable quality breakdowns in healthcare. And unlike sending a meal back to the kitchen, you cannot send back a surgery, a misdiagnosis, or an underserved community. With so much at stake, we owe it to patients to train the workforce to be ready to deliver on healthcare quality at every step. In short, healthcare will improve when we improve.

But how do healthcare leaders understand, assess, measure and improve the dynamics influencing quality in a healthcare system, when our system was built – and the workforce was trained — piece-meal, at a local level, without the benefit of an industry standard? At the center of any response should be a commitment to understanding workforce competencies and skills needed, and improved training to meet those needs.

While healthcare has robust, well-worn pathways and standards to train clinicians (e.g., you do not become a medical doctor without graduating medical school), we cannot say the same for quality and safety training. With the shortage of relevant training upstream, we are forced to triage quality downstream at the point of care; wasting money, fueling burnout and even costing lives. Today, the U.S. boasts roughly 20 graduate degree programs teaching healthcare quality and safety, yet this is not nearly enough to address the knowledge, skills and competencies required to do quality work well. Training hundreds of people annually is positive, but training hundreds-of-thousands is necessary for meaningful healthcare quality change.

We must also fix the inconsistencies evident in training programs that do exist to streamline our approach across clinical and operational fronts. Variability in quality training (among clinical and non-clinical healthcare disciplines) contributes to variability in care.

Understand the Standard, Then Assess, Optimize and Measure
At the National Association for Healthcare Quality (NAHQ), we believe building a workforce ready for quality is the path forward. We and others have built frameworks for healthcare quality competency and these define the competencies required to achieve quality across the healthcare workforce and stratifies them to appreciate progression and sophistication.

Such frameworks include many actionable insights for clinical and operational leaders to understand and fully leverage the spectrum of healthcare competencies needed to ensure quality is contemplated in every healthcare touchpoint. It provides leaders with a record of when and how those skills are currently deployed, or not. Absent this standard framework, we are sending healthcare heroes to war without a battle plan. With it, we can see the competencies we need and enlist the right people, supported by the right training, measured by the right metrics to achieve healthcare goals and mandates.

Speaking of waging war, when Covid-19 hit, healthcare leaders who had strong quality competencies stood out as trusted leaders to address the crisis. In July 2020, NAHQ asked almost 30,000 individuals how they contributed during the pandemic. Of those responding, 36% said their role was more valuable in a Covid-19 environment. Why? Because these people had the competencies to handle crisis command centers, communicate change across a system, address regulatory mandates quickly, stand-up telemedicine programs in a matter of days vs. months, and deploy rapid-cycle improvement methodology to deal with an environment that was changing hourly.

The bottom-line is simple. A broader swath of the healthcare workforce now needs skills like this, and healthcare executives must consider infusing quality competencies as a Core Necessity. The healthcare workforce is lacking competencies in key areas, including population health and care transitions; connecting payment models to healthcare practice/delivery; quality review and accountability; including provider feedback loops and improvement opportunities coaching; change management; communications skills, and more.

Quality means “the standard” we measure against, but ironically and until recently, we never defined the standard of competencies required for healthcare quality itself. Armed with this knowledge and with a properly prepared, thoughtfully deployed workforce leading the way, we can activate individuals and organizations to improve quality across the continuum of care. The first step was creating the standard. Now, it’s time to assess your workforce to identify opportunities for skill enhancement, allowing you to better leverage individual contributors as a cohesive team to achieve a comprehensive quality vision across your organization.



Stephanie Mercado (CAE, CPHQ) is Executive Director/CEO at The National Association for Healthcare Quality, an organization dedicated to defining the standard of excellence for the profession and equipping professionals and organizations across the continuum of healthcare to meet these standards. The organization has developed the twice validated, industry standard healthcare quality competency framework.

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