Incorporating Joint Commission OPPE into a Hospital-Wide Quality Improvement Program

Richard Bankowitz, MD, for HealthLeaders Media , April 9, 2010

Stage 2: Anger. "How dare you? Who are you to tell me this?" Don't be scared off of by this response. Expect it as a move in the right direction to the next stages. Remember . . . there may be a need to visit this (and other) stages more than once before positive and consistent forward movement is achieved.

Stage 3: Bargaining. The "Yes, but . . ." stage. "If you just had better data . . . if it were more clinical and less administrative…my patients are sicker and this doesn't take that into account . . ."

Here's where executives can engage in a discussion of the validity of the data and the risk-adjustment model to help move the practitioner to the next stage. For example, Premier healthcare alliance member hospitals can point to the fact that they are using the largest clinical comparative database of its kind, used by more than 600 facilities in North America. It includes inpatient and outpatient data, from all payers, representing one in every five discharges in the U.S. Even that kind of evidence supporting the data presented may not be enough. But this is a critical juncture in the road toward acceptance-having a dialogue about the data instead of a total rejection of it.

Frame the discussion in terms of how "we" can use the data to improve patient care quality and safety, while maintaining the effective use of hospital resources and the practitioner's time.

Stage 4: Depression. Practitioners don't typically spend much time at this stage, once they've gone through bargaining. They will either move on into the acceptance phase, realizing that they need to get on with the tasks at hand, or they will circle back immediately to anger and then further bargaining. Framing the exercise as one of quality improvement for the sake of providing exceptional patient care—rather than as an attack on professional competence—will hasten progression to the acceptance phase.

Stage 5: Acceptance. Now's the chance to move this practitioner and the entire medical staff in a more transparent process to not only satisfy the OPPE requirements, but more fully ingrain an organization-wide, ongoing professional performance improvement culture that they will support willingly.

What can be achieved?
The need to have an operational OPPE program has become a given. It's a Joint Commission standard for recertification and thus important to virtually every hospital. Having an effective OPPE program is another matter. Making an OPPE program truly effective requires framing it within the context of using information for improvement rather than judgment, and using "actionable" information to improve the lives of patients and staff alike.

More importantly, having a process and tools to effectively gain practitioner buy-in can and should lead to an organizational culture where physician performance reporting is part of a larger, transparent quality improvement process-where the organization can focus on delivering the highest level of care possible, rather than engaging in non-productive "grief" sessions.

Recognizing the inherent challenges of coping with change, providing "actionable information" and correctly framing the exercise in the context of institutional improvement will allow hospital execs to be prepared to deal with roadblocks that will inevitably occur along the path towards improved performance and outcomes. It will also afford the opportunity to accelerate an organization's overall performance improvement initiatives and results.

Richard Bankowitz is chief medical officer at Premier Inc. in Charlotte, NC. He may be reached at
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