QUEST in Action

QUEST’s tight focus, data-sharing and broad participation can result in sustainable change, according to providers

For years, providers have worked to improve qualitycare, reduce mortality rates and limit healthcare costs. Premier healthcare alliance believes the solution lies in QUEST, a voluntary three-year project involving 166 nonprofit hospitals across 31 states. And, participating providers appear to be buying into it, primarily because of its focused approach and emphasis on data-sharing.

Why its working
These are not new lessons: “Don’t bite off more than you can chew,” and “share with others.” Indeed, QUEST is based on a systematic approach (rather than trying to tackle the big picture at once) and the sharing of data among providers – all with positive results.

“Between 1999 and 2002, we tried to fix everything [in hospitals] and clearly weren’t fixing anything,” says Jan Mathews, RN, MPHA, CPHQ, CNAA, BC, director of clinical performance improvement at Gaston Memorial Hospital (Gastonia, N.C.). “QUEST places structure on the process. It allows us to focus on specific elements, achieve success and then move on. All of the hospitals participating in QUEST are sharing data. We are helping each other and looking at patient care across the nation. I think this is a new approach.”

“I feel [hospitals] have made tremendous progress in the last 10 or 15 years in improving patient safety,” says Bruce Van Cleave, MD, senior vice president and chief medical officer for Aurora Health Care (Milwaukee, Wis.). “But with so many pieces [to consider], there has been room for something to go wrong.” Not so with QUEST, which focuses on five performance targets:

  • Save lives by achieving a mortality rate 17 percent less than expected.
  • Safely reduce the cost of care below the midpoint among participating hospitals.
  • Deliver the most reliable and effective care for each patient.
  • Improve patient safety by preventing incidents of harm in 20 categories, such as healthcare-acquired infections and birth injuries.
  • Increase patient satisfaction by improving the patient care experience.

“We understand the steps involved, as well as what other hospitals are doing and how they are succeeding,” says Van Cleave. Aurora Health Care is a 13-hospital IDN, with two additional hospitals under construction, as well as various physician groups/clinics, home-health agencies and retail pharmacies. The IDN was originally involved in Premier’s Hospital Quality Incentive Demonstration project (HQID). “HQID focused on evidence-based care issues,” he explains. “QUEST takes this to another level” by calling on hospitals to define their objectives and report their activity around each of the performance targets.

HQID focused on such parameters as acute myocardial infarction, heart failure, pneumonia, care of open heart patients and care of patients who receive hip and knee implants, according to Mathews. QUEST expands on these parameters to include stroke and other patient populations, she points out. By raising awareness in the community and taking steps to provide immediate care to treat stroke victims, Gaston Memorial has reduced mortality at its facility by 50 percent. “That’s what it’s all about – reducing mortality and providing the highest quality care,” she says.

“Evidence-based care means we must have everything in place,” she continues. “The next step is to see results: fewer patient re-admissions and lower mortality rates.”

Transparency
Premier collects data from the 161 hospitals participating in QUEST and reports on their performance, including how each of them compares with one another on each of the five performance targets, notes Van Cleave. “Hospitals set performance threshold goals and aim to make progress on all five measures. We need to get all five of these into the top performance quartile.”

Fred Manchur, president of Kettering Health Network (Dayton, Ohio), an IDN comprised of six facilities and 50 specialty sites, agrees that a critical piece of QUEST involves sharing data among hospitals. “We have always prided ourselves in doing a good job [on each of the five performance targets], but we have never benchmarked ourselves against the very best hospitals,” he says. Executives from each of the health networks participating in QUEST made a commitment to share their results, he notes. “We’ve never before shared why hospitals are doing a good job. I think it’s this collaboration – the sharing of results and being able to see what does and does not work for other hospitals, and why – that will [make this project] work.”

Another strength of QUEST is its ability to draw in a wide variety of healthcare professionals, not just hospital executives, he adds. “We’ve brought together a quality council from across our facilities, including our chief financial officer, clinical and medical staff and nurses. If a hospital can show the CFO that it doesn’t have to duplicate a procedure and that we have [still managed] to reduce mortality, the CFO can see the cost-savings to all of this.”

Sustainable change
Involving more individuals – from clinicians and physicians to nurses and administrators – is exactly what it takes to facilitate change, says Mathews. “It’s one thing to tell someone to do something or to change, but this type of change is not sustainable,” she says. “But, if you involve people in the project, change is [more likely to be] sustainable.” She points to the case of a couple driving home one night to illustrate her point: “The husband had a stroke and his wife called 911. All of the pieces fell into place. Afterward, we brought together everyone who touched that man’s life and presented this to the clinicians and staff at the hospital,” she continues. “About 30 individuals stood up who touched his life.” It was overwhelming to see, she adds.

“QUEST has been a big undertaking for our hospital,” says Mathews. “But we work as multidisciplinary teams, which has helped. We provide a lot of feedback and celebrate our successes. In the end, it isn’t just about what the hospital is doing to improve patient care, but what we are doing.”

About Laura Thill

Laura Thill is a contributing editor for The Journal of Healthcare Contracting.

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