What’s actually driving safe healthcare?

By Rachel Biblow and Dr. Tejal Gandhi

In 2001, the Institute of Medicine released Crossing the Quality Chasm, a landmark report that signaled a new era in the healthcare industry’s view of patient care quality. Fast forward 20 years, and healthcare systems are still coming to grips with the report’s conclusion that clinicians must look beyond the one-on-one relationship between caregiver and patient and toward a more holistic healthcare journey.

Our healthcare landscape is evolving day by day. Members, patients, consumers, and caregivers expect more from the healthcare system than ever before.

In the traditional model of quality care before 2001, the clinician was only responsible for tracking and maintaining their own clinical and technical performance. Providing “quality” care simply involved identifying the issue and treating the patient, with less measurement of excellence around the actual experience of how care was delivered.

Crossing the Quality Chasm broadened this view, identifying domains of “next generation” quality care as “safe, effective, patient-centered, timely, efficient, and equitable.” For the healthcare industry to truly close the gap between the old definition of care and how modern patients view quality, the report held, it would need to focus on ways to measure these six domains and improve them.

Over the last 20 years, much more focus has been placed on areas such as safety and efficiency rather than equity, resulting in inconsistent or episodic progress in each area. For example, safety has arguably received most of the attention and focus, but somehow, preventable harm is still frequent across the continuum of care.

Where do we go from here?

The Crossing the Quality Chasm report was a wake-up call for the industry and, in many ways, one that resonates more today than it did 20 years ago. In addition, the lens of quality needs to be extended to cover the entire patient journey across the continuum: from the moment a person decides they want to seek care, through care, and after care. This broader, longitudinal perspective is essential for next-generation care in health systems that are trying to attract and retain patients while optimizing performance.

The COVID-19 pandemic has put unprecedented pressure on our country’s healthcare system. At a time when the system is as strained as we’ve ever seen it, how do organizations ensure they are making the tough decisions and necessary changes that move them toward next-generation care?

They turn to the data.

Valuable feedback from thousands of patients, caregivers, and physicians across the country allow health systems to place unparalleled focus on continuous improvement efforts in both quality and safety and advance the overall patient and employee experience. We’ve found that patient experience, employee engagement and satisfaction, and safety and quality measures are not siloed. Each is critical to improving the others.

Think about the last time you went to see a doctor. Why did you choose to go to one over another? Maybe it was because of the location and convenience, the ease of making an appointment, or the option to connect through telehealth. Or maybe you read multiple reviews that made you confident in your choice. If at any point in your decision-making you had a negative experience or even a few inconvenient ones, would you have changed your mind?

Say you went in for an appointment and had to wait an hour, or you were told to go to a specialist but given no guidance to find one, or the office incorrectly filed your insurance. Would that change your opinion on the quality of the care you received? What if you went to an appointment and there were no hassles at all, but you didn’t feel that the care provided was safe? That would likely affect your perception of quality more than any other factor.

Each of these factors affects individuals differently and contributes to a unique view of care, making it difficult to truly define and track quality. Luckily, the Institute of Medicine’s report continues to serve as a guide. The culmination of all six next-generation factors, when they work together in harmony: big quality.

Big-picture insights drive big quality

When health providers have big-picture insight into their patient and employee data, they can identify key metrics, goals, and pain points. This data must be integrated across organizational siloes, putting safety, employee engagement, and patient experience insights in the context of one another to help prioritize and understand key foundational issues requiring improvement across all domains. Together, they provide the lens of big quality to show where organizations are struggling and how easily trust can be eroded.

For example, data shows that, when a patient has an easy experience booking an appointment, they will rate their care quality in the 99th percentile. If a patient hits a snag before they arrive for their appointment, that rating will drop to the 4th percentile.

For that second patient, if they do not have another issue during their appointment, they will rate the quality in the 81st percentile. But if their access to care is disrupted, either before or during the appointment, their rating will be in the 1st percentile. These challenges, or “cracks,” in the overall care experience quickly accumulate and erode confidence.

Data also shows that the patient’s “likelihood to recommend” (LTR) response is often impacted by the perception of safety within the clinical setting, Based on Press Ganey survey response data, the results from respondents recommending the practice based on experience hovered around the 65th percentile. When patients reported feeling safe, potentially by observing the entire care team engaging in recognized safety behaviors like washing hands, masking, etc., their LTR rose to the 99th percentile, signaling higher overall loyalty and retention. However, if they reported feeling unsafe, LTR dropped to the 1st percentile.

These daily friction points or breakdowns in process present themselves as the manifestations of larger issues affecting overall safety and outcomes. Seeing through this lens of big quality allows individual health providers, and our industry more broadly, to drive improvement. To provide care that is “safe, effective, patient-centered, timely, efficient, and equitable,” providers must view a complete picture of their organizations. They must see across patient experience, employee engagement and safety, and make decisions driven by data.

It’s through these data-driven insights that we will fully realize next-generation quality care.

Rachel Biblow is senior vice president and partner for strategic integration and transformation at Press Ganey. Dr. Tejal Gandhi is Press Ganey’s chief safety and transformation officer.