In particular, lower-performing systems in some cases had made changes recently that were likely to enhance quality—but the changes hadn't taken yet. And in other cases, the processes and policies appeared to be in place on paper, but the passion and commitment from the organization toward them seemed lacking.
Systems with a strong culture related to quality demonstrated the following:
- A shared systemwide commitment to achieving the system's quality and patient safety goals. For example, "system management is as important in achieving quality goals as is physician compliance with evidence-based guidelines."
- A system board that is very engaged in quality and safety, such as being directly involved in setting the system's strategic goals for quality and safety and in frequently monitoring (at least monthly) the progress toward achieving these goals.
- Extensive opportunities and vehicles for hospitals to collaborate and share best practices for improving quality and safety.
- Transparency around reporting performance both internally and externally. Teamwork needs to be emphasized to improve quality and safety, along with shared accountability for good outcomes.
- Having a mind-set of perfect care and dramatic increases or stretch goals as compared to incremental improvement.
With this in mind, the answer to the question posed at the beginning may be "j": recognizing that "joining together at all levels is important to meeting quality goals."
Janice Simmons is senior quality editor for HealthLeaders Media. She may be contacted at firstname.lastname@example.org