The workforce is missing a key to unlock quality goals

Healthcare quality professionals need to learn new skills and have a stronger framework to properly address inequalities and worker safety concerns that were revealed during the pandemic, according to a new study.

Most professionals surveyed by the National Association for Healthcare Quality considered patient safety and improving performance and processes key aspects of their work duties. However, less than 30% reported they used quality improvement methods and tools to help manage population health, according to a new study published this week in the Journal of Healthcare Quality.

“Population health is still an emerging area for healthcare organizations, and they are just starting to look at it to help manage their communities,” said Rebecca Miltner, lead author of the study.

Quality professionals don’t have standard core duties to define the scope of their work, said Stephanie Mercado, CEO and executive director for the NAHQ.

That’s led to wide variation in the skills and levels of expertise of these professionals, who range from managers to vice presidents and above. That limits their ability to advance their organization’s quality improvement goals.

“There is not another profession in healthcare that does not have this level of structure around it and expressed competencies,” Mercado said.

NAHQ has worked to develop a framework.

In 2019, NAHQ released a program that covered eight competencies around patient safety, performance improvement, quality review and accountability. Those provided the basis for survey respondents to assess the scope of their job duties and their levels of proficiency.

Nearly 1,700 healthcare quality professionals responded to the survey between July 2019 and February 2021.

Of those who responded, 60% had received Certified Professional in Healthcare Quality accreditation, which is offered by NAHQ, and 31% reported they had worked in healthcare quality for five years or less.

Two-thirds of survey respondents reported they worked in four or more quality competency domains, with 34% of those with CPHQ certification working in six to seven domains compared to 22% of non-CPHQ respondents.

Healthcare quality has greatly evolved since it began more than three decades ago.

“In the 80s and 90s, we tended to think, some people died or got hurt while we were treating them because our treatments were cutting edge and the technology was increasing,” said Miltner, who is an associate professor of nursing at the University of Alabama-Birmingham. “We kind of just assumed that there would be some consequences to that because some people might not tolerate it as much as others.”

The 1999 Institute of Medicine’s “To Err is Human: Building a Safer Health System” changed that thinking. The landmark report revealed the toll of preventable medical errors, which were calculated for the first time; 44,000 to 98,000 deaths annually.

Before then, anyone could call themselves a quality professional without having much training or expertise, said Dr. David Nash, founding dean emeritus for the College of Population Health at Jefferson Health.

Between 2014 and 2017, a focus on patient safety led to declines in hospital-acquired conditions like infections, adverse drug reactions and falls, according to the Agency for Healthcare Research and Quality.

Many of these efforts were led by healthcare quality professionals.

Population health will need to become a greater focus for quality professionals as systems continue to deal with the long-term health effects of the COVID-19 pandemic on their patients.

A quality initiative has prompted Roper St. Francis Healthcare to recruit CPHQ-accredited professionals in recent years. That’s reaped rewards, said Dr. Jeffrey DiLisi, president and CEO for the Charleston, South Carolina-based system.

“I think it helps to not just have people say you’re good quality but to know you’re good quality because you’re following a certain framework,” DiLisi said.