Abstract
Quality improvement (QI) programs differ from one hospital to another. Hospitals use different QI metrics and indicators to monitor quality improvement in-hospital care. This paper compares the quality improvement programs of three hospitals, namely, St. Michael’s Hospital, Mount Sinai Hospital, and Sunnybrook Health Sciences Center. It outlines the similarities and differences between the three quality improvement programs. A comparison of the elements of the three programs is also given.
Introduction
Many hospitals have developed quality improvement (QI) programs to promote the quality of patient care and safety. The Institute of Medicine (2001) expressed the need to reform the health care system to promote the safety, efficiency, and effectiveness of patient care delivery. In response to this call, many hospitals have developed quality improvement initiatives to deal with inadequacies in care delivery and enhance patient safety. However, the nature, impact, and extent of the quality improvement plans differ from one hospital to another. This paper examines the similarities and differences between the QI plans of three different hospitals, namely, St. Michael’s Hospital, Sunnybrook Health Sciences Center, and Mount Sinai Hospital, based on quality improvement indicators set by the regulator.
Similarities
Continuity of Care
The three hospitals have undertaken to support continuity of care through partnerships with community health centers. To promote continuity of care, St. Michael’s hospital books its patients for a 7-day follow-up care in their communities or homes (St. Michael’s, 2015). In addition, the hospital collaborates with health care institutions, such as the “Post Acute Care Rehabilitation and Mid East Toronto Health Link (METHL)” (St. Michael’s, 2015, para. 11). The aim is to ensure a smooth transition of trauma patients into community care. It has also established a joint liaison committee that facilitates transition care for discharged patients with complex health needs.
Mount Sinai hospital has also undertaken initiatives to enhance the quality of post-discharge care. It has established a ‘Patient Navigator Program’ to prepare patients for transition care in their community (Mount Sinai Hospital, 2014). The hospital’s other initiatives include improved discharge summary, and weekly discharge huddles with community-based clinics to facilitate safe and quality transition care.
Sunnybrook offers post-discharge referrals to community care centers to facilitate continuity of care. In addition, the hospital collaborates with paramedic centers to reduce wait times in the ED department (Sunnybrook Hospital, 2015). Presently, the hospital is part of the NETHL consortium that provides care to patients with complex care needs.
Information Management
The three hospitals use data management tools to measure care quality indicators. Through its TC LHIN project, St. Michael’s hospital can improve the efficiency and security of its patient information collection processes. The data collected are important in patient care planning both within and outside the hospital. The TC LHIN project is also instrumental in the hospital’s efforts to streamline discharge summaries so that they can provide “timely, consistent, and relevant information” to providers (St. Michael’s, 2015, para. 14). Another initiative is the iCARE plan that aims at promoting inter-hospital partnerships, EMR, and healthcare analytics.
Similarly, Mount Sinai has developed EMR tools to promote quality and safety in patient care delivery. It has adopted a computerized provider order entry (CPOE) to support the analysis of clinical information and assess quality indicators such as the rate of patient falls and medication errors (Mount Sinai Hospital, 2014). Sunnybrook uses its iLead data portal, SunnyCare, and a best practice dashboard to track its performance (Sunnybrook Hospital, 2015). The hospital uses these QI tools to measure quality indicators and performance.
Staff and Leadership Involvement
The three hospitals have undertaken to foster a culture of inter-professional consultation and cooperation. St. Michael’s QI process involves representatives from all levels, including the board, its inter-professional teams, and the QI committee, among others. Similarly, the development of Mount Sinai’s QI goals involves inter-professional consultations between the board members and clinical teams (Mount Sinai Hospital, 2014). Sunnybrook engages its leaders and staff in formulating evidence-based strategies for improving quality indicators. It also has an inter-professional quality committee whose main responsibility is to monitor QI activities and standards in the hospital.
Accountability Management
In all three hospitals, accountability is achieved through regular review of the set quality indicators to ensure that their QI programs succeed. St. Michael’s hospital has an executive team that evaluates QI action plans and consults the clinical teams before releasing monthly reports to the physicians and front-line staff. The team is accountable for the realization of the set goals.
Similarly, hospital leaders in Mount Sinai are accountable for reaching the hospital’s QI goals that involve indicators such as “hand hygiene adherence and medication reconciliation on admission (Mount Sinai Hospital, 2014, para. 19). Sunnybrook compensates its executive management based on their performance. In addition, the hospital has developed an evaluation program for measuring specific performance indicators. A similar performance-based compensation program exists in St. Michael’s hospital.
Health System Funding Reform (HSFR)
Each of the three hospitals has an HSFR strategy for addressing gaps between hospital care and standard care costs. Both Sunnybrook and St. Michael’s hospital use ‘Quality Based Procedures’ (QPBs) while Mount Sinai utilizes the Renew Sinai initiative to reduce variability in care delivery and promote efficiency at the unit level.
Differences
Patient Engagement
Patient-centered care is one of the pillars of quality improvement. The hospitals have undertaken to utilize different methods to engage patients and their families in care delivery. Sunnybrook uses patient and family advisory committees in care planning and improvement initiatives. The input of families and patients is considered when making key decisions. It has also put up an external website where the public can post their views about the hospital’s patient/family engagement approaches.
In contrast, St. Michael’s hospital uses patient satisfaction data to define key improvement areas. Patient engagement in the hospital also involves the PDSA cycle and discharge preparations (St. Michael’s, 2015). The hospital also empowers patients to play a central role in their care planning through initiatives such as the Homeless & Under-Housed program that targets vulnerable populations. On the other hand, Mount Sinai has no elaborate patient/family engagement approach.
Risk Management
The hospitals plan to employ contrasting strategies to mitigate risks in their health care processes. The main challenges anticipated by St. Michael’s hospital include funding pressures, competing demands from staff, high patient expectations, and growth constraints. To overcome these challenges, the hospital plans to prioritize its QI activities to ensure a proper use of resources, launch an education program to teach staff PDSAs, and implement a patient-centeredness strategy.
In contrast, Mount Sinai’s risk management strategy focuses on continuous monitoring of the quality of its services. It plans to put in place a risk management framework for monitoring and reporting of all intervention projects in the hospital (Mount Sinai Hospital, 2014). The hospital will also adopt a redevelopment program called ‘Renew Sinai’ to create a high-performing workforce and promote care quality and patient safety.
On its part, Sunnybrook undertakes to address QI indicators using three strategies. The first strategy is to build the capacity of front-line staff to give quality care through its iLead Quality & Patient Safety initiative (Sunnybrook Hospital, 2015). Sunnybrook also plans to increase leadership involvement in the achievement of its QI indicators. The third approach is empowering project managers to implement interventions in each department to reduce wait times and improve patient flow.
Performance-based Compensation
Under its executive performance management initiative, Sunnybrook hospital gives its management compensation of between 10 and 30 percent annually depending on the extent to which the hospital meets its goals (Sunnybrook Hospital, 2015). In contrast, St. Michael’s hospital gives compensation of between two and five percent of annual salary to its leaders depending on the achievement of its QI indicators. Mount Sinai, on the other hand, has not outlined the metrics for evaluating managerial performance.
Comparison between the Program Elements
The Links to the Programs
- Mount Sinai hospital: www.mountsinai.on.ca
- Sunnybrook hospital: www.sunnybrook.ca
- St. Michael’s hospital: www.stmichaelshospital.com
References
Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press.
Mount Sinai Hospital. (2014). Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario. Web.
Ransom E.R., Joshi M.S., Nash, D.B., & Ransom, S.B. (2008). The Healthcare Quality Book: Vision, Strategy, and Tools (2nd ed.). Chicago: Health Administration Press.
St. Michael’s. (2015). Quality Improvement Plan (QIP) 2015-16. Web.
Sunnybrook Hospital. (2015). Sunnybrook’s 2015/16 Quality Improvement Plan. Web.